HYDROCHINON.-Hydrochinon (Therapeutic Gazette) occurs in grayish-white acicular crystals, having a slightly bitter taste and a neutral reaction. It is moderately soluble in cold water, readily soluble in hot water, alcohol, ether, and in acid solutions. The usual adult dose as an antipyretic is fifteen to twenty grains, best given in alcohol. Forty grains have been taken with

out disagreeable effects. Hydrochinon is at present somewhat dearer than quinine. Thus far only two writers have reported their clinical experience with the drug, but their results have been so encouraging that much benefit may be expecred from its further employment.

It has recently been successfully used as an antipyretic in St. Luke's Hospital, New York.

CHEMISTRY.

C.

adapted to their needs. They do not like to handle bromine, and the druggists, who are usually very willing to supply them with any reagents they want, make excuses when asked to prepare this mixture.

Dr. Squibb has endeavored to remove the difficulty by substituting for the hypobromite solution the U. S. P. liduor sodæ chlorinatæ, and furnishes a simplified form of apparatus in which this may be used. It is quite possible that with some samples of this solution satisfactory results can be obtained, but commonly the quantity of gas evolved has been less than it should be. The gas is evolved much more slowly, also, when the hypochlorite is used, and the reaction does not appear to be complete even when a large excess of the reagent is employed.

This difficulty Dr. Lyons overcomes by changing the hypochlorite into a hypobromite solution, extemporaneously. He adds to the solution of chlorinated soda, of which 25 c. c. should be sufficient to decompose the urea in 4 c. c. of urine, 5 c. c. of a 30 per cent. solution of potassium bromide, a few minutes before the urine is introduced. With some specimens of the solution chlorinated soda it is necessary to add also a little caustic soda-2 to 5 c. c. of a ten-per-cent. solution-to insure absorption of all the carbonic anhydride formed in the reaction. The solution chlorinated soda must answer the U. S. Pharmacopoeia requirement of containing at least two-per-cent. of available chlorine. With this modification of Dr. Squibb's plan, results are obtained identical with those reached by the hypobromite process, and as the reagents are easily procurable, there need be no longer any reason why the estimation of urea should present any especial difficulties to the physician.

-Pharmaceutical Record, Aug., 1885.

NOTE ON THE ESTIMATION OF UREA IN URINE BY LABARRAQUE'S SOLUTION.-Dr. Lyons (Pharmaceutical Record, May, 1885) suggests a capital improvement in the process of estimating urea by what is known as the hypobromite process. The urea, in this process, it will be remembered, is decomposed in an appropriate apparatus, by means of a solution of bromine in excess of caustic soda. The hypobromite solution is unstable, and hence must be freshly prepared when required for use. Physicians find this a very serious drawback to the adoption of a method of ureometry otherwise so well

SURGERY.

NEPHRECTOMY-ITS INDICATIONS AND CONTRAINDICATIONS.—In an interesting paper read before the American Surgical Association, Dr. S. W. Gross has collected 233 cases of extirpation of the kidney. Of these III were removed by the lumbar incision with the result of 70 recoveries and 41 deaths-a mortality of 36.93 per cent.-while of 120 cases where the incision was ventral, there were 59 recoveries and 61 deaths---50.83 per cent. In the two other cases, which were fatal, the nature of the operation is uncertain.

From his study of the subject, Dr. Gross makes the following propositions:

I. That lumbar nephrectomy is a safer operation than abdominal nephrectomy.

until after the failure of other measures, Ist. in subcutaneous laceration of the kidney; 2d. in protrusion of the kidney through a wound in the loin; 3d. in recent wounds of the kidney or of the ureter, inflicted in the performance of ovariotomy, hysterectomy, or other operations; 4th. in suppurative lesions; 5th. in hydronephrosis and cysts; 6th. in calculus of an otherwise healthy kidney; and, finally, in painful floating kidney.

4. That nephrectomy is absolutely contra-indica ted, ist. in sarcoma of children; 2d. in carcinoma at any age, unless, perhaps, the disease can be diagnosticated and removed at an early stage; and, 3d. in the advanced period of tubercular disease.--American Journal of the Medical Sciences, July, 1885

M.

SUCCESSFUL RESECTION OF INTESTINE IN A CASE OF STRANGULATED FEMORAL HERNIA.-Dr. J. Clark Stewart reports in the January number of The American Journal of the Medical Sciences a successful case of resection of the intestine in a male aged sixty-eight suffer

ing from strangulated femoral hernia. The peculiar feature of the operation was the non-excising of the T-shaped piece of mesentery usually recommended. This was to avoid the chance of cutting off any bloodsupply to the remaining gut, which is one of the dangers of the V-incision.

As to the propriety of resecting the gut in this case, instead of opening it and leaving it in situ, as is generally advised, Dr. Stewart's hospital experience of the latter measure had been so discouraging as to make any alternative preferable. He holds that the resection of gangrenous intestine in strangulated hernia is not such a forlorn hope as it is usually represented to be, when an old man, too stupid to understand his danger or his chances, and in bad condition physically and mentally, recovers after such an operation performed with the hospital house-staff as operator, assistants, and advisers.

TREATMENT OF INTESTINAL OBSTRUCTION BY THE FORCE-PUMP. Dr. H. Illoway, of Cincinnati, in a paper in the January number of The American Journal of the Medical Sciences, advocates the employment of enemata administered with sufficient penetrating power to pass beyond the ileo-cæcal valve and into the small intestines, and to produce peristaltic action. He advocates the use of the force-pump, and claims:

I. That enemata thus administered are superior to every other method of treatment in the rapidity with which they either relieve the symptoms or clearly indicate the necessity of surgical interference.

2. That they are entirely free from all danger, and in no way prejudice the case should a surgical operation become necessary.

A NEW HÆMOSTATIC AGENT.-Dr. Spaak employs two parts of chloroform to two hundred parts of water, as a hæmostatic in operations on the mouth and throat, and claims that patients thus treated suffer but slight hæmorrhage.

He also uses the chloroform water as a spray after excision of the tonsils. This chloroform water seems to close the open mouths of small blood-vessels instantly.— Jour. de Med., Brussels; Cin. Lancet and Clinic. C.

HYGIENE,

RCHARDSON'S HYGIENIC RULES FOR THE TREATMENT OF PULMONARY CONSUMPTION.-Dr. B. W. Richardson, in 1856, published the following rules for the hygienic treatment of consumption. They were looked upon with disfavor by the medical profession of that time. But under the new animalcular pathology they are largely approved. He publishes them in his Asclepiad. We give the rules, omitting the explanations of

the same:

I. A supply of pure air for respiration is the first indication in the treatment of the consumptive patient. Especially should the consumptive be the sole occupant of his own bed and bedroom.

2.

Active exercise is an essential element in the treatment of consumption.

3. A uniform climate is an essential element in the treatment of consumption.

4. The dress of the consumptive patient should be adapted to equalize the temperature of the body, and so loose that it interferes in no way with the animal functions.

5. The hours of rest of the consumptive patient should be regulated mainly by the absence of the sun.

6. The occupation of the consumptive patient should be suspended if it is in-door or sedentary; but a certain amount of out-door occupation may be advantageous.

NEW SERIES, VOL. X, No. 6. WHOLE NO. 243

Original Communications.

CAUSATION OF PNEUMONIA.*

BY HENRY B. BAKER, SECRETARY OF MICHIGAN STATE BOARD OF HEALTH.

THIS

HIS PAPER was accompanied by many tablets, and by sets of thirty-one illustrative diagrams which were distributed to those present. These diagrams were drawn accurately to scale, and represented immense nu nbers of cases and deaths from pneumonia and meteorological observations at the same times and places. The magnitude, and hence the probability of their accurately representing average conditions, may be inferred from the fact that the curve for temperature in Michigan was based on 154,500 observations; that the curve for sickness from pneumonia in Michigan, which followed so closely the curve for temperature, was based on 31,014 weekly reports of physicians; 5,473 deaths from pneumonia in Michigan are tabulated and graphically shown; as also 114,119 deaths in London, England; also 11,596 deaths, and 49,487 cases of pneumonia in the U. S. armies during the three years 1862-64; about 10,000 cases of "Respiratory Disease" (not including phthisis) in the European and native troops in India were also shown in diagrams, together with a curve of the temperature at representative stations. The statistics. of the other states and countries serve to reinforce those of Michigan, and Dr. Baker says he has found no statistics which conflict with conclusions drawn from the Michigan statistics, although he considers the statistics of sickness in Michigan the most reliable of all. The following is an abstract of the paper:

Employing the data collected in the office of the Michigan State Board of Health, relative to the sickness from pneumonia and the coincident meteorological conditions in Michigan, more especially during the eight years 1877-84, I find that certain meteorological conditions are so uniformly associated with sickness from pueumonia as to make it appear that they bear a causal relation to that disease. The atmospheric condition which

*Abstract of a paper read before the American Climatological Association.

$2.00 a year. Single copies, 30 cents.

is most closely associated with pneumonia is the night ozone; but, although it is, perhaps, one factor, the manner in which it is associated does not indicate that it is always the controlling factor in the causation of pneumonia. Besides, the amount of ozone is, to a great extent, controlled by the temperature, therefore I think ozone is not a primary cause. The velocity of the wind. has rather close relations to the disease. Variations in atmospheric pressure appear to have influence in the causation of pneumonia. Relative humidity of the atmosphere has apparent relations to the disease in some months; but it also depends largely upon the atmospheric temperature. Absolute humidity of the air has very close relations to pneumonia, and in such manner as to indicate a causal relation. That condition of the air, however, is, so far as relates to out-door air, almost wholly controlled by the temperature.

Finally, the curves representing the average temperature uniformly bear a very close relation to sickness from pneumonia; and the curves representing sickness follow uniformly at such a period after the temperature curves as to make it seem certain that the sickness is, directly or indirectly, caused by a comparatively low temperature.

So far, the result is only to prove in a scientific manner the truth of more or less wide-spread beliefs since the time of Hippocrates. But what follows may render this contribution more acceptable. The difficulty in the way of accepting the hypothesis has been to understand how it is possible for cold to cause pneumonia. Thus, Prof. Rindfleisch has said: "Even when, based upon some unequivocal observations, we have proclaimed the taking cold as a common cause (of croupous pneu. monia), there has yet by this no insight been obtained into the process of taking cold. For, what has the partial refrigeration of the outer skin to do with the inflammation of an interior organ?" The key to this "insight" which Prof. Rindfleisch has said is wanted, has seemed to me to be the fact that the "refrigeration" is not so much of the "outer skin" (which is usually covered with clothing) as it is of that inner skin-the mucous lining of the lungs and air-passages, and which we are so liable to forget is so extensive amounting as it does, according to Prof. Dalton, to about 1,400 square feet of surface, in

an ordinary adult person. We are also liable to forget the quantity of vapor of water constantly being taken out of the body by way of the lungs; and my tables show that the quantity of vapor exhaled in excess of that inhaled is much greater in January than it is in July, in Michigan; because the quantity which enters the lungs with the air inhaled differs greatly according as the air is or is not saturated with vapor, and especially according to the temperature at which the air is inhaled. The higher the temperature (at ordinary temperatures), the greater the amount of vapor of water it will contain; thus according to Prof. Guyot's tables, based upon experiments by Regnault, a cubic foot of air at the temperature of zero Fahr., if saturated with vapor of water, contains .5 Troy grains; at the freezing point it contains two grains; at 70° F. it containg eight grains; at 98° F. it contains 18.69 grains. Thus the absolute humidity of the air is controlled as to its maximum, by the temperature of the air. The air exhaled from the lungs has been in constant contact with moist surfaces throughout its passage into and out from the lungs; it is therefore probably nearly saturated with vapor of water, and at a temperature not far from 98° F. Assuming this, each cubic foot of air exhaled contains 18.69 grains of water; assuming 18 respirations per minute, of 20 cubic inches of air each, there will be exhaled daily 11.68 Troy ounces of water. This is not as much by four or five ounces as is stated by some physiologists, but it is convenient to have a standard arrived at by means the same as those with which we must deal in studying the influence of meteorological conditions, so I continue to employ this method and standard. The absolute grains of vapor in each cubic foot of the atmosphere at any given place and time are ascertained by means of the wet-bulb and dry-bulb thermometers, and the use of tables. Knowing the "absolute humidity" of the atmosphere for every day in each year, as we now do in Michigan, it is easy to compute the quantity of vapor inhaled daily at each season of the year, assuming, as above, 18 respirations per minute, of 20 cubic inches of air each. This, subtracted from the 11.68 ounces exhaled, gives the excess of moisture exhaled over that inhaled. Cold air is, as we have seen, always dry air, and whenever air is warmed as it is in the lungs its capacity to retain vapor of water is increased, and its demand for water is great. Thus, when warm air saturated with water is inhaled, one effect is to lessen the passage of fluids from the blood into the air-cells and air-passages; when the air inhaled is cold and dry, an increased quantity of fluids must pass from the blood into the air-cells in order to keep them in the normal moist condition. The fluid which constantly passes from the blood-vessels into the air-cells contains some of the salts of the blood; and such as are volatile will pass out with the vapor exhaled at every breath; but such salts as the chloride of sodium will not readily pass off with the vapor, the usual mode of preparing salt from brine

being by the evaporation of the water therefrom. For many years it has been known that chloride of sodium, which is found in the urine of healthy persons, is absent during the onward progress of pneumonia, and reappears in the urine when the patient is convalescing. For several years I tried to obtain such analyses of sputa and lungs of patients dead from undoubted pneumonia, and comparisons with sputa and with lungs of persons who did not have pneumonia, as would show whether it was as I supposed-that during the onward progress of pneumonia the chloride of sodium passed from the blood into the air-cells, and accumulated there because it did not so readily pass off as did the vapor of water. However, we are not left to conjecture or hypothesis as to the course which chloride of sodium takes when during the onward progress of pneumonia it disappears from the urine. In Vol. XXXV. of the Trans. of the Royal Medical and Chirurgical Society of London, published in 1852, is a paper by Lionel Smith Beale, wherein he shows by such analyses as those I have outlined, showing the chemical composition of the sputa and of the lungs, that the chlorides, which during pneumonia disappear from the urine, do appear in the sputa and in the air-cells of the lungs, at such times. The meteorological and other statistics which I have colleeted show that at such times as pneumonia is most caused there is an unusual demand upon the air-cells for fluids, their function in this respect is unusually taxed. Passing into the air-cells with the fluids are certain salts which do not pass out with the vapor; this is shown by à priori evidence and also by the analyses by Dr. Beale. The salt which accumulates is an irritant. It has been held that an extraordinary stimulation of an ordinary function of an organ or part of the body leads to the congestion and even to inflammation of that part. If this be accepted the causation of pneumonia is now sufficiently shown.

There are, however, certain facts concerning pneumonia which to my mind can now be more fully explained than is done by the foregoing. Prominent facts in the pathology of pneumonia are those which relate to the fibrinous exudate in the air-cells. Changes in the blood-pressure do not seem to fully account for all of them. The curve for atmospheric pressure does not seem to have uniformly quantitative relations to pneumonia. One of my diagrams shows that the average daily range of the barometer has such relations as to indicate a possible causal relation. It may be noted, in passing, that in albuminuria there is, as in pneumonia an exudation of unformed material which is not subsequently organized. Speaking of the diseases most associated with pneumonia, Dr. Sturges says: "Thus it will be seen from the appendix that renal disease figures largely among the preexisting morbid conditions of the individuals enumerated." He also says: "It appears upon calculation that pneumonia in kidney disease is most frequent in the

I have shown how, through the inhalation of cold dry air, the exudation of fluids into the air-cells is increased; and how, by the unusual evaporation of that fluid, an unusual quantity of the chloride of sodium accumulates in the air-cells. It remains to point out how, through the influence of that chloride of sodium in the air-cells, the exudation into them of the albuminous constituents of the blood serum is probably favored. Prof. Dalton, in his Physiology, says: "But a substance like albumin, which will not pass out by exosmosis toward pure water, may traverse a membrane which is in contact with a solution of salt. This has been shown to be the case with the shell-membrane of the fowl's egg, which if immersed in a watery solution containing from three to four per cent of sodium chloride, will allow the escape of a small proportion of albumin. Furthermore, if a mixed solution of albumin and salt be placed in a dialyzing apparatus, the salt alone will at first pass outward, leaving the albumin; but after the exterior liquid has become perceptibly saline, the albumin also begins to pass in appreciable quantity."

It seems significant that two organs in which an albuminous exudation occurs so markedly as in the kidneys and in the lungs should both be so constituted as that these facts relative to the exosmosis of albuminous substances should be applicable; because chloride of sodium is normally excreted by the kidneys, and as it passes by osmosis with extreme facility, the first beginnings of the urine would naturally contain it, so that when the blood is unusually saline the urine in the uriniferous tubules may be sufficiently saline to induce the exosmosis of albumen from the blood-vessels. But while this may occur in the kidney, one condition seems to make it more probable in the lungs, because in the lungs, through the constant evaporation of the fluids exuded, the salinity of the remaining portion may be constantly increased.

Whether the ultimate fibrinous character of the exudate in the lungs is due to the blood placques, or is a result of the oxidation of the albumin otherwise induced, before or after the exudation, it may be well to notice that the diagrams I present show close relations between the curves for atmospheric ozone and pneumonia. An albuminous or a fibrinous exudate is a favorable situation for the reproduction of micro-organisms; whether in pneumonia there are or not such low organisms as the "pneumo-coccus" of Friedländer, the statistics which I present show that the causation of the disease is absolutely controlled by the meterological conditions. The facts that one attack does not protect from another, and that persons who have had it are more likely to have it

again, are against its being a specific disease, but not against the mode of causation which I have pointed out. In statistics the variety of pneumonia is not usually stated. The data which I present seem to prove that in Michigan it is all or nearly all of one kind, causally, otherwise it would not have absolutely quantitative relations to the temperature as it is shown to have in diagram No. 9. The reason why that diagram shows smoother curves than the others, is, I think, because the details of the observations and reports were more accurately attended to. The meteorological observers were supplied with standard thermometers, the statistics were representative of the area in which the sickness was, the reports of sickness were made weekly, by leading physicians in active practice, and the compilation has been done with great care to learn the exact truth.

Whenever the views here presented shall have been accepted, numerous questions will arise-as to the diet favorable to keeping the blood in the condition to best resist the tendency to pneumonia, as to methods of treatment-whether by warm moist air, and especially as to how best to control the condition of the air breathed by persons generally so as to lessen the danger of their contracting the disease. One lesson seems obvious, namely, the importance of moistening all air which requires to be warmed, in houses, offices, public buildings, and whereever such conditions of the air inhaled can be controlled.

THIS

CLINICAL Lecture.

BY DR. J. M. DA COSTA, OF PHILADELPHIA.

CEREBRAL EMBOLISM.

HIS case possesses very great interest. We have a man who came into the hospital on the 13th of January. He is a sailor; always well until this attack, and has no history of syphilis. Four days before his admission, as he arose from his bunk, he suddenly lost all power in his right leg and arm and fell to the ground; he did not lose consciousness and after being paralyzed for several hours he recovered the ability to walk, and after some little time the use of the arm was regained; but the limb remained weak. He, however, continued

to improve, save for the weakness and shooting pains in the abdomen, until the morning of his admission, when he had a second attack, in all respects, a counterpart of the first. Upon admission he was stupid and drowsy, (which he claims to be his natural state,) the tongue was coated; bowels costive; pupils normal; pulse feeble and temperature and respiration normal. There was complete paralysis of the right leg, as also of the deltoid, triceps and extensors of the right arm; the grasp of the right hand was feeble, but there was no implication of the facial muscles. He could move his arm slightly in the bed, but could not walk. Cutaneous sensibility and