brane over the right inferior turbinated bone. Two cauterizations a fortnight apart sufficed. Dr. Hall also found a similar procedure serviceable in hay-fever, and anterior hypertrophies of the Schneiderian membrane in some cases of asthma. Local anesthesia by cocaine was employed

in all cases satisfactorily. We have found, during the summer, good results in two cases of the so-called "rose-cold" from light searing by the electric cautery.

NEW AND IMPROVED APPARATUS.

In our notice of the improvement in gravity cells by the Partz Electric Company in the Times of November 13, 1886, pressure on our columns permitted the introduction of one cut only. The cell illustrated was one with slotted cathodes, and is that intended to substitute the Leclanche, but the reference was to the new acid gravity, which is shown on page 501.

An ingenious method of insuring prompt action of static machines in murky weather is that now a favorite in France, where much more attention is paid to this form of electro-therapeutics than is done with ourselves. The air within the case is not only kept dry, but it is warmed to any desired temperature by maintaining its circulation through a tube in connection with a rotary fan-wheel. The two ends of the tube are within the case, but at a part which is exterior to it an alcohol-lamp heats the air as it passes. The fan, together with the rotating plates of the machine, is driven by an electro-inotor, which is in turn energized by four Bunsen cells. Messrs. J. W. Queen & Co., of Philadelphia, are agents for the apparatus.

A NOTE ON THE IRRADIATION
OF MOTOR IMPULSES.
Read before the College of Physicians of Philadelphia,
March 2, 1887,

BY N. A. RANDOLPH, M.D., Professor of Hygiene in the University of Pennsylvania.

ABOUT two years ago this question arose in my mind: If a man perform work with the muscles of (e.g.) his

right hand exclusively, and to the point of fatigue, can he thereafter perform as much work, of the same nature, with the left hand as he could if the right had not been previously exercised?

It will be seen that this question relates in no wise to a comparison of the work of the two hands, but to an examination of the work which may be accomplished by one hand, as conditioned by the previous exercise or non-exercise of its fellow of the opposite side.

It is evident that the answer to this query is dependent on intracranial processes solely, and that such answer would throw some light upon the functional independence or interdependence of the two halves of the brain.

In order to answer the question just stated, certain conditions are prerequisite. The subject of experiment must have no conception of the object of the investigation, or he will unconsciously become a partisan of one or the other hand. must also have a very strong inducement to exercise his volition to the utmost.

He

These conditions were fulfilled in the persons of some intelligent and vigorous convicts in the Eastern Penitentiary in this city. The stimulus was a money-prize to the man who accomplished the most work in a given time. In the prosecution of these experiments I am under obligation to the courtesy and assistance of Dr. W. D. Robinson, physician to the Penitentiary.

In the first series of experiments rubberbulb syringes, identical in all their measurements, were used, and the amount of water which the men could transfer from one vessel to another in a given time was accurately measured and taken as proportionate to the work performed. Some forty observations were made by this method, with the uniform result that either hand could do more work when its exercise preceded than when it succeeded the similar exercise of its fellow of the opposite side. It was found, however, that the muscular effort could not be entirely restricted to one side of the body in this method, as great fatigue was always accompanied by a grimacing and writhing which implicated the muscles of both sides of the face and trunk.

A Morse telegraph was next used, the muscular movements in this case being restricted to an up-and-down motion of one finger of each hand, the number of such

The

movements made in a given time being recorded on the usual long and narrow strip of paper as dots or dashes in accordance with the celerity of contraction and relaxation of the flexors of the finger. results of this series of experiments were uniformly confirmatory of those before obtained, but the method had to be abandoned as productive of great eye-strain in counting.

I then had made the instrument which is here shown. It consists simply of the clockwork and dial of an ordinary gasmeter, to which a lever is adapted in such wise that each flexion of the finger is recorded by an appropriate motion of the index on the unit-dial. The apparatus is fixed in a box, upon which the hand and forearm may conveniently rest. The lever projects through an aperture in the lid, and a glass plate in the side permits the records on the dial to be easily read off and noted. Six healthy prisoners, supplied with the incentives of cash and competition, were repeatedly examined by this means. To each fifteen minutes were given to make the best record he could with (e.g.) the right forefinger, and thereafter the left forefinger was similarly exercised for the same time. On the following day the same process was repeated, always commencing, however, with the finger of the hand which had been used second on the previous occasion. No hand was ever thus employed twice on the same day.

The results were practically uniform. The man who for fifteen minutes flexed and relaxed his right forefinger with the greatest speed possible to him would, on the following day, accomplish on an average nearly ten per cent. less work with that finger when its exercise was consecutive to a similar exercise of the forefinger of the opposite side than when its work was initial.

Usually, more work could be accomplished by the simultaneous exercise of the two forefingers than by their exercise one after the other. In such exercise of both hands at once, and apparently from some unconscious effort at rhythm on the part of the subject, it was noted that the movements of the left forefinger were generally more active and rapid than when used alone, although in both instances the greatest effort at speed was evidently made. I am told that some pianists have a similar experience, inasmuch as they find it pos

The relation of these facts to the observations of Dr. S. Weir Mitchell and Dr. Morris Lewis is largely supplemental in its nature. These observers, as is well known, showed that the knee-jerk is reinforced by any voluntary movement in any part of the body, and that this reinforcement was apparently due to such an irradiation of motor impulse from the active centres to other similar centres as placed them and their related muscles in a condition of heightened responsiveness to external stimuli. My studies not only tend to confirm these observations, but to show that the fatigue of one centre may induce a sympathetic fatigue in other centres.

These observations are of interest, inasmuch as they suggest that the centres for volition, attention, and co-ordination (or one or more of these) are not, in their functional activity, bilaterally symmetrical and independent, that is, that these functions have not attained complete differentiation into right and left will, attention, or co-ordination; that probably the first effect of the voluntary activity of a portion of one cortical motor area is a stimulation of the corresponding portion of the other hemisphere, a stimulation that may result in its slightly premature fatigue; that apparently more work can be effected through the voluntary simultaneous exercise of two such portions of the motor apparatus than by their independent exercise, one after the other.

irritating cough, with no expectoration; râles were heard over both lungs; pulse full and bounding; eyes injected, and lids somewhat swollen; bowels sluggish, and tongue slightly coated. Prescribed cathartic and nauseant expectorant. Next morning his temperature was 101°; the other symptoms were unchanged, except that the bowels had been pretty freely opened. So he ran on for several days, but without improvement. On examining his tongue more closely, I thought I noticed a condition which I have learned to associate with malarial fevers. The tongue was pretty well covered with a tough, white coating, except near the end, where it had very little if any coating. Through this the papillæ stood out prominently. Having failed signally in treating the "cold," I concluded to try the effect of quinine, and accordingly gave him twelve grains in solution; next day, ten; third day, five; continued at this daily dose for a week. After the first day his temperature remained normal, and he was up and about on the second day.

Case II-Mrs. W., mother of Case I., æt.

35, of phthisical tendency. In the spring of 1884 she had a severe attack of catarrhal pneumonia, which left a slight impairment of left apex. The day her son first got up she went to bed, with pain in left mammary region and a temperature of 101°. Her cough was severe, with some mucous expectoration. I thought that I detected crepitant râles and beginning dulness over lower lobe of left lung, and instituted appropriate treatment. Saw her tion: temperature still 101°. On the next day, in the evening in very much the same condias I could not find any adequate chest-symptoms, in lieu of something better I gave her twenty grains of quinine, with the result of clearing up the case. Under the regular use of quinine she made a perfect recovery, and has been in better health ever since than she had been at any time after February, 1884, though she was under great mental excitement while convalescing.

Case 111.-E. W., youngest son of Mrs. W., ææt. 4, was a bright, robust lad, who spent most of his waking hours out of doors, the type of a healthy country child. Went to bed the day his mother began to convalesce; saw him at 9 A.M. Except slight nervousness, he did not seem to be at all sick, and it was remarked by his parents and the nurse that it was his wish to be in bed with his mamma more than laxative. At 4 P.M. he was taken with a conillness which kept him in. Ordered a mild vulsion, the most terrible it has ever been my lot to witness. Consciousness did not return until 10 P.M. He passed a moderately good night. Next morning the temperature was 102°, an uncontrollable diarrhoea set in, and he died in the evening, less than forty-eight hours after his first complaining. No post

mortem.

Case IV.-H. G., male, æt. 3, for several

weeks had been affected in an anomalous manner, now better, now worse; at no time much fever, and at no time any periodicity. This latter fact was noted in all this series of cases. There was not as much variation of temperature as in an ordinary case of typhoid fever. After having exhausted my resources and the patience of the family, I gave him quinine as an antimalarial, and the result was all that could have been wished.

Case V-Male, æt. 12; was ill for several days. Evening temperature never above 103.5°; morning, never below 103°. In the light of the preceding cases, put him on quinine. As his stomach was irritable, mixed it up with an equal weight of chocolate. The case also promptly recovered.

These cases all occurred within a period of ten days, and all within a radius of oneeighth of a mile. Aside from the peculiar aspect of the tongue I have mentioned, there was nothing to indicate a malarial element, to say nothing of a malarial cause. Above all, there was no element of periodicity, which is regarded as so essential a feature of the continued malarial fevers. The next series of cases was also peculiar.

*

Case I.-J. W., male, æt. 4. When two years old, several lymphatic glands in the neck suppurated and were discharged. Was well up to August, 1886; then had enlargement of the cervical and submaxillary lymphatics. Put on treatment, with negative results. Seemed to be some periodicity in his malaise, but no distinct febrile exacerbation

or remission. He was cured at once by qui

nine. Never had malarial fever.

Case II. and Case III-Were sisters, who had long been subjects of malarial paroxysms, though they had had no attack for nearly a year. About the same time both were affected as Case I.,-decided glandular enlargement without any tendency to suppuration. It yielded at once (within thirty-six hours) to quinine. Both ladies were of stru

mous type.

Case IV.-M. T., female, æt. 20. About four years before, a horse had fallen on her and injured her left tibia; afterwards she had considerable trouble with it. In December, 1884, I had incised it, evacuating a small amount of pus, with the result of putting the leg in better condition than it had been since

the accident.

In December, 1885, she began to have severe pain in the limb. Counter-irritation relieved it for a time. Pain would recur in spite of all treatment. As the attacks of pain seemed

to recur at regular intervals, I put her on large

*Sternberg's "Malaria and Malarial Diseases," p. 209. (William Wood & Co.)

but gradually diminishing doses of quinine. Recovery perfect. About six months afterwards had slight recurrence, but did not see her; she sent for some of the solution of quinine and was relieved. At no time was the temperature above 99.5°. Had never had malarial fever.

The only explanation of these cases I am prepared to offer is that the dose of the malarial poison was too small to cause a distinct outbreak. As a chain is no stronger than its weakest link, so the weakest local point in all four of these cases was the first to suffer. This is the only way in which I can conceive of these cases being malarial, but that they were so I am fully convinced. Cases II. and III. expressed a belief that they had malaria, knowing the sensation from prolonged experience in former years. None of the last series had a temperature above 100° during their

treatment.

FAIR PLAY, MARYLAND.

TRANSLATIONS.

IODOFORM IN THE TREATMENT OF GONORRHOEA.-In an interesting communication to Le Progrès Médical of March 5, 1887, M. Thiéry extols in high terms the use of iodoform in the abortive treatment of gonorrhoea. He states that he feels a certain timidity in presenting a new therapeutical agent for this most troublesome disease after so many others have been tried, accepted, and rejected; and yet, impressed with the fact-based upon the researches of Neisser and others of the microbian origin of the disease, he was surprised that among all the antiseptics employed, such as corrosive sublimate, carbolic acid, boracic acid, resorcin, etc., iodoform should not have been included, -an antiseptic used daily in the practice of surgery.

Ni

Corrosive sublimate coagulates the albuminoids, forms non-antiseptic bases with them, and thus exerts but a passing and superficial influence upon the germs. trate of silver acts upon the microbes, but at the same time seriously affects the mucous membrane. Iodo form, besides its antiseptic value, is readily absorbed wherever the mucous membrane is denuded, and is also decidedly analgesic,-two important qualities which adapt it specially to the treat

ment of gonorrhoea. Its odor can easily be disguised by a little oil of eucalyptus, vanilline, etc.

The purpose of the abortive treatment of gonorrhoea at the present time is to destroy the gonococcus. This accomplished, the inflammation will readily subside with appropriate measures. In an examination of thirty-eight cases it was found that in the pus passed during the period from the first to the fifth day the gonococci were comparatively few in number. They increased from the fifth to the fifteenth day. The maximum was attained from the eighth to the tenth day, while after the fifteenth day they began rapidly to decline, sometimes remaining, however, as late as the end of the third week. These figures are important as showing the most favorable time for the use of the antiseptic injection. Antisepsis will be best accomplished during the first four days.

M. Thiéry reports six cases treated with the iodoform injection with the most gratifying results. In his résumé he states that as to iodoform-intoxication it seems impossible. In the employment of iodoform alone, its elimination can easily be verified by an examination of the urine. In one case only did the patient complain of the taste of iodine in the mouth. Its presence in the saliva could never be detected by means of the test. In its use there were no other uncomfortable sensations, and yet as many as twenty-nine injections had been given in a period of twentyeight days. On the other hand, its action is safe, rapid, and positive, the microbes quickly disappearing, sometimes being entirely absent by the eighth day.

com

As failure in the treatment of gonorrhoea occurs usually on account of the patient's ignorance in managing the injection, M. Thiéry recommends that the physician always attend to this part of the treatment himself. He uses as the injected material iodoform porphyrized as pletely as possible, and simply suspended in the oil of sweet almonds. Before making the injection, the urethra should be gently washed out, to remove as much of the pus as possible. Micturition just before the injection is the best means of accomplishing this result and avoiding any backward flow of the pus into the bladder. The olive-shaped nozzle of the syringe should be introduced just within the meatus. About two grammes of the

liquid is then thrown into the urethra, and retained there by the patient holding his finger over the meatus for about twenty minutes. A strict and temperate diet should be used during the period of the injections.

SOME RECENT STUDIES UPON THE BACILLUS TYPHOSUS.-At a recent meeting of the Société Médicale des Hôpitaux, M. Chantemesse presented some interesting statements of the result of his studies, in company with M. Widal, upon the bacillus typhosus-the bacillus of Eberth and Gaffky. It is enlarged at the extremities, extremely mobile, and offers strong resist ance to the usual modes of staining. It can be developed in meat-broths, better in gelatin, but best of all upon the potato, upon which it shows itself as a moistened thread after three days, sometimes not until after fifteen days. Slowness of development is specially characteristic of this bacillus. Reproduction takes place readily in pure water, especially if the water be sterilized. It resists cold, and will endure a temperature of 45° C. without perishing. It is destroyed by a temperature of 80° C., as well as by boiling for several minutes. It increases more rapidly in a moist than in a dry soil. As to the action of antiseptics upon its vitality, a 2000 solution of corrosive sublimate will prevent its culture; a sulphate of quinine will produce the same effect; while the of carbolic acid will have no effect at all upon its multiplication in a culture-fluid. By adding a twoper-cent. solution of hydrochloric acid to the culture the growth of the bacillus is retarded, but it does not die, for, on dropping a little of the fluid containing it into an alkaline broth, it will begin again. to multiply with all its original vitality.

of

A propos to this subject, it is to be noted that M. Dujardin-Beaumetz read a report before a recent meeting of the French Academy of Medicine, in which, after stating the methods of M. Pecholier to jugulate the course of typhoid fever simply by means of quinine and tepid baths, he expressed the hope that the day would soon come when, after a better knowledge of the bacillus typhosus, we shall be able to possess an attenuated virus, permitting us to realize all the expectations now founded upon the proceedings of Pas❘teur.