AMOEBA INFESTING SHEEP.-Sheep in New South Wales are affected by a disease which appears to be very similar to epithelial cancer, and is met with on the feet behind the hoofs, and also on the lips and nostrils and the gums of lambs. The epithelium in these places grows with pathological rapidity, the horny layer produced soon attaining a thickness of 3-5 mm., the wool drops out in the diseased parts, and below the thick outer layer a festering process sets in. After some time a new epithelium makes its appearance below the festering layer. Then, provided the lamb does not die, the thick horny layer is thrown off like scurf, and the epithelium below attains new wool and replaces the old skin.

In studying the circumstances in which these sheep live, Dr. R. V. Lendenfeld found that they were invariably exposed to being wounded in those places which eventually developed the disease, blistered by standing on rocks heated by the sun after they had been standing in water for several hours, or pricked by the spines of the variegated thistle, and it was found by a process of artificial breeding in an aquarium that the disease is produced by an amœba (A. parasitica), which enters the wound and multiplies rapidly in the epithelium, causing

very strong irritation. The organism is found between the layers of horny substance.

Dr. Lendenfeld adds: "It is well known that several fungi in certain stages of their life appear very similar to amoeba, and so it is not impossible that my amoeba is in some connection with them. I do not consider this probable, however, as I made no observation which might lead one to suppose that the amoeba ever divided into a multitude of swarming spores." (Jr. of Royal Microscopical Society, Dec. 1885.)

HYDROPHOBIA:

M.

THE PRINCIPLES OF PASTEUR'S PREVENTIVE TREATMENT.-Dr. Biggs (N. Y. Med. Journal, March 27th) states the principles of Pasteur's preventive treatment of hydrophobia thus:

The period of incubation of rabies as transmitted from the dog to other animals is very variable, but in man, as a rule, is exceedingly long, being rarely less than thirty days. By the passage of rabies from dogs through a series of rabbits, the period of incubation of the disease may be finally reduced to about seven days, as it occurs in these animals. The virulence of the spinal cords from rabbits dead of a seven day rabies may be diminished in a constant degree by suspension in an absolutely dry air at a given temperature. Man or animals that have been subjected to a series of inoculations with a very weak virus, and gradually going on to a stronger and finally to the most virulent form, gradually become The period of insusceptible to the most virulent virus. incubation of this virus is very short, and the time required to confer insusceptibility to the disease is much less than the ordinary period of incubation of hydrophobia as produced in man by the bite of a rabid animal. Hence, if too long a time has not elapsed after the bite of the rabid dog before treatment is commenced, the person or animal may be rendered insusceptible to the disease before the period of incubation has elapsed. The time that may elapse in the human being bitten by a rabid animal before successful treatment may be commenced is probably as a rule not less than twenty days, and in some cases may be considerably more than this, but is perhaps as variable as the period of incubation of the disease in different cases in the human subject resulting from the bites of rabid dogs, and is dependent upon the same idiosyncrasies of the individuals.

sidered to be gonorrhoeal rheumatism were merely cases of toxæmia, produced by a toxic substance absorbed from an inflamed genito-urinary mucous membrane. The cases I refer to are met with especially among the examples of chronic mono- or oligo-articular inflammation.

2. That in other cases the disease is a rheumatism modified by toxic infection from a venereal or nonvenereal inflammation of the genito-urinary mucous membrane. The rheumatic or toxæmic phenomena may in these cases be present in very different degrees of relative prominence, sometimes the rheumatic, and, at other times, the toxæmic phenomena being the more prominent. This, the true form of gonorrhoeal rheumatism, presents itself chiefly as an acute or sub-acute disease.

3. That in no variety of gonorrhæal rheumatism is the progress of the disease materially influenced by the administration of salicyl compounds; and as the distinction in acute, and even in sub-acute cases between gonorrhoeal and ordinary rheumatism is always at the commencement, and sometimes during a great part of their progress, a matter of much difficulty, the failure of the salicyl compounds in the former disease is a valuable assistance in diagnosis.

The doctor recommends no special form of treatment, but speaks well of iodide of potassium, colchicum, guaiac, and alkalies; while blisters, moderate pressure, the uninterrupted induced electrical current, and passive movements, are of service in the more chronic stages of the joint affection.

TREATMENT OF GONORRHOEA WITH DECOCTION OF Lemons, and CITRIC ACID.-Cut three fresh ripe lemons into pieces, and place them in an earthen vessel, add ten ounces of water, reduce by gentle heat to one-third. Press and separate the solid matter. The liquid is injected three or four times a day. It should be made freshly every two days. The decoction is said to destroy the gonococcus in two or three days. It may be used in the acute stage.

The following is the formula suggested by M. Rebatel, and found by M. Jullien to be especially useful in cases of obstinate gleet: citric acid 1.50, salicylic acid 0.05, water 250 grammes; to be injected twice a day. The salicylic acid is added merely to preserve the liquid.

TREATMENT OF HÆMORRHOIDS.-Dr. G. F. Center, of Jacksonville, Fla. (St. Louis Courier of Med.), in an article on the treatment of hæmorrhoids, sums up as follows:

To sum up all that is worth knowing about piles, we would say: Dilate the sphincter ani internus with a dilator for external venous and internal arterial piles, and do nothing more, unless, in the case of external venous piles, you remove the tumors, for cleanliness after defecation, and this is only necessary in old cases. In internal

venous piles, do not excise, ligature nor inject the tumors, nor dilate the sphincter ani internus, but give your patient hunyadi janos water to free cartharsis, removing thus the liver engorgement. Replace the uterus, if misplaced, or give astringent injections or suppositories, and nature will complete your work.

HYGIENE.

HOW TO DISINFECT INFECTED DWELLINGS.—The following method of thoroughly disinfecting a room in which an infectious disease has existed is reported in the Centralb. f. Chirurgie, No. 12, 1885, by Prof. König, who has successfully employed it for 20 years:

The windows of the infected room having been closed tightly, 50 to 60 grammes (11⁄2 to 2 oz.) corrosive sublimate are placed on a small shovel of burning coals; after that the person leaves the room immediately and closes the door. The sublimate evaporates rapidly and exposes the room to its vapors for three or four hours. Then the door is to be opened, and, covering the nose and mouth with a piece of cloth, the person re-enters, opens the windows and closes the door again. The room having been thus ventilated for several hours, the possibly remaining vapors are to be rendered harmless by the burning of sulphur in the closed room. After repeated ventilation the room may again be occupied.Therapeutic Gazette.

TOXICOLOGY.

MUSCLE POISONING.-The Medical Press gives the following instance of muscle poisoning. At Wilhelmshaven two vessels were taken into dry-dock on October 18th, 1885. The sides of these vessels were covered with the common muscle. The ships were not copperbottomed. The dock work people collected large quantities, took them home, prepared and ate them. Nineteen people were attacked with symptoms of poisoning. Nine of the cases were serious. One death occurred about two hours after the eating, and four others followed in about four and one-half hours. The post mortem examination showed conditions of irritant poisoning. There was redness, swelling, and in many places complete detachment of the mucous membrane from the small intestine. The spleen was swollen and thickened. Examined carefully by experts, it was found that both flesh and decoction contained the poison. Neither heat nor alcohol weakened this poison. Small animals were killed by it in half an hour. The poison acted like curare by paralyzing the motor centres. Virchow places the poison in the series of poisons which develop in fish both living and dead. All active extracts of the poison were rendered inactive by being moistened by sodium bicarbonate. Thus it would seem as if the poison was an alkaloid which has not as yet been isolated.

NEW SERIES, VOL. X, No. 7. WHOLE NO. 244)

WHEN

Original Communications.

CEREBRO-SPINAL-MENINGITIS.*

BY GEORGE DUFFIELD, M. D.

HEN we have had a case of severe illness, one in which the patient has been at death's door for several weeks and such a one recover, we are apt to feel. very happy and we are anxious to let others know of our good fortune in the saving of our patient.

cians in the place.

{Single copies, 30 cents. $2.00 a year.

However, she recovered and was the first of many other cases to get well.

The patient has been married twice. By the first husband, she had a dead child, born at full time; during this confinement her menstruation was regular throughout. By her present husband, she has had one child, which lived to be 9 years old. During her second confinement she had no menstrual flow.

In September, 1876, her child died. She went one afternoon to his grave, and while there lost consciousness and lay for a long time upon the wet ground. It was

A few remarks on the history of the patient and her family will give a clearer view of the case and show how poor the prognosis was from the start.

Mrs. C., aged 39, was seen first by me March 9th, 1885.

When she was a child of five years, in an epidemic of scarlet fever, she contracted the disease, which was followed successively by severe attacks of whoopingcough and measles. The eruption in the latter was nearly or quite suppressed.

During this attack of measles there was a violent attack of enteritis, which lasted for several weeks. At the close of this attack, a cataract in the right eye was discovered. It had a white and glistening appearance, and has retained its whiteness ever since.

During her early childhood she had always been troubled with constipation. When but 16 years of age she began teaching a district school. She would at times go four or six days without having an evacuation of the bowels.

When 17 years of age she got her feet wet during her menstrual period and caught cold. An epidemic of cerebro-spinal-meningitis was then prevailing at La Porte, Ind., where she then lived, and was very fatal in its progress. She contracted the disease. The attack began with a chill and cramp of the lower extremities, which was followed by convulsions and active delirium and high fever.

The patient was given up to die by the best physi

*Read before the Detroit Medical and Library Association,

she reached her home. About 1100 o'clock of the same night she again lost consciousness; a physician was summoned and she was found to be paralyzed upon the whole left side. Sensibility and the use of this side were completely lost for two whole months. The limb remained numb, sensation not returning to the normal for more than two years.

When she was able to get about the house on crutches, she would often fall and remain unconscious for from ten minutes to an hour, the length of time depending on whether anyone was in the room or not, since artificial respiration and restoratives would shorten the attacks.

The only premonitory symptoms that had ever been noticed by the friends were, that she would always call for water, and in going for it would fall by the way.

In these attacks she never bit her tongue or frothed at the mouth.

In 1879, during an epidemic of diphtheria, she was attacked the second time with cerebro-spinal meningitis.

The attack began with severe vomiting, which lasted eighteen hours, and which could not be relieved. This was followed by delirium with the characteristic spots of purpura hæmorrhagica, which appeared all over the body. Another consultation was held as in the former attack, with the same result; however, she rallied and pulled through, showing that her staying powers were still good.

No paralysis followed this attack. In a few weeks. she was about again. The attacks of loss of consciousness came on every two or three weeks, but were never

very severe-lasted but a few moments at a time. She complained that after these attacks it was hard to think straight.

This history is, indeed, one full of varied symptoms, and carries much interest with it when we consider her sickness, which I am about to describe.

Yet, if you will allow me to say a word about her parents, brothers and sisters, you will be surprised that the constitution of the patient was as strong as it proved to be.

Her father was a strong robust man, predisposed to apoplexy, from which he died. When enraged or frightened he would lose consciousness, and often had to be bled in order to bring him to life.

The mother is living. She has had several attacks of inflammatory rheumatism. She has a systolic

murmur.

One sister died of congestion of the brain, her child dying of cerebro-spinal meningitis.

Another sister has phthisis. Three brothers have died of paralysis. One, now living, has had two strokes of apoplexy. I can discover no history of syphilis in either the parents or grandparents.

On the morning of the 9th of March, 1885, while in attendance upon her husband, who was recovering from an attack of pneumonia, Mrs. C. consulted me, first, for constipation and headache, which she said had troubled her for several years, dating from an abscess of the rectum, she thought, which had left a stricture, and which caused much pain and tenesmus. Thinking that, her headache was due alone to constipation, I prescribed a pill of the extracts of belladonna, nux vomica, and physostigma, of each grain, to be taken upon retiring. Her tongue was coated, and she had indefinite pains through her abdomen. She told me the next day that she had had an evacuation of the bowels, but only with the aid of an injection. She had habituated herself to these irrigations for some years, and never had a passage from the bowels without their use.

March 10. Her head still ached through the temples, her skin was dark and bronzed-not jaundiced, but rough and dry-her temperature was 99.5°, and her pulse about 80 per minute. She told me, at 3 p. m., that she had not passed her water since she got up in the morning, and had no desire to do so. Percussion over the hypogastric region was negative. Introduction of a catheter evacuated but about an ounce of concentrated

urine, sp. gr., 1.035. Urates and chlorides present in large amounts. Acid. She had never had any misplacements or weaknesses of the uterine organs; had had no miscarriages, and had always been regular. To increase the flow of urine I gave her two drachms of the infusion of digitalis every two hours, and was soon gratified to find my patient's kidneys acting freely.

March 13. For the past two days she refused to take any medicine, saying she was not ill enough. I

noticed, upon my examination of the spine, that she complained of considerable pain when pressure was made over the second lumbar vertebra, and as she said, it ran up and down her spine and made her dizzy, and that when she passed water this pain was more intense than at other times.

While I was talking to her she was seated on an ordinary chair; presently a cry escaped her lips, her facial muscles became set, her eyes rolled back, her head was drawn back upon her shoulders in opisthotonos, and her face denoted severe pain. The convulsion lasted about twenty seconds. She did not seem to lose her whole consciousness. As it passed away she placed her hands to the back of her neck and screamed for some one to relieve the pain in her neck and head.

She was placed in bed with ice to her spine, neck and forehead. As the ice was applied the pain seemed to shift to other portions of the sensorium, and became. more severe, but again subsided.

I ordered 20 grains of bromide of potassium with 6 grains of chloral, to be repeated every two hours if necessary. Ice was kept to the head and spine until the next day, the 14th, when it was removed for a short time, but as the pain returned it was again applied, with relief. There was considerable pain in the back, especially so over the tenth dorsal vertebra; pressure over the hypogastric, umbilical or epigastric region caused severe pain, which was felt in the spine, and not on the surface irritated.

During this time the patient was conscious, the temperature and pulse were normal. Strange to say, the appetite kept up and the patient took food with considerable relish.

March 16.-The third day since the onslaught, a change had occurred; the eye-lids drooped and could not be raised by the patient, the pulse was weak and intermitted slightly. I added some carbonate of ammonia to the medicine and gave some brandy, to add strength to the enfeebled heart.

March 17. Ptosis was complete when the patient. was visited; pupils responded to light. When the eyelid was held open the vision was very dim. The will power, a strong factor in the disease, still kept up. The patient could grasp my hand, but to exert any pressure she was wholly unable, for the fingers failed to respond to the nerve force sent to them.

The intermitting pulse of the previous day had again assumed its normal regularity.

March 18.-Ptosis still complete; total inability to raise the lids, the pupil contracted when light fell upon the retina, to about 1% of an inch and then relaxed again to about 4 of an inch, and remained in this position.

The patient was totally blind, not able to tell faces or to differentiate between light and darkness. The temperature as taken under the tongue was 99.5° F.; pulse 64.

The family thought it necessary and so called in consultation Dr. David Inglis. The doctor agreed with me in considering the prognosis bad indeed, and suggested that to the bromide of potassium, the iodide be added, keeping up the stimulants as before.

March 19.-The first signs of delirium manifested themselves to-day. The patient, becoming uneasy, would spring from her bed seeking light.

Her skin became very sensitive, so that the bedclothes had to be held up by means of hoops; irritation of the skin, no matter how slight, would cause intense pain in the region of the medulla. To the iodide of potassium (10 grs.) one-half drachm of the fluid extract of ergot was added.

March 21. Ptosis disappeared, eyelids could be easily raised and objects near by could be seen, though they appeared irregular and enlarged. She slept for eight hours consecutively.

For some reason her temperature rose to 102°, and her pulse went up to 100 beats per minute. No complications could be discovered.

March 22.-The pulse and temperature were again at the normal. The vision was clear; the faces looked only streaked, she said, and were of normal size. The grasp of the hand, so long enfeebled, was again fairly strong, and I hoped that the worst had passed. When I made my evening call, I found things changed. The temperature was 100. She was weak and restless, rolling

from one side of the bed to the other, as if in great pain, turning on her back her head would draw backward and her whole body arched would rest upon her head and her heels; her face was distorted, eyes wide open and staring; her arms were placed under the neck and at times the woman would scream dreadfully, a spasm would then appear and would exert its force upon the muscles of the body, after which the patient would sink down and moan piteously. On questioning the nurse and husband, I learned that the patient, desiring to have a movement of the bowels, instead of using the bed-pan, was given an injection and then arose and strained at stool, with the effect that I have above described.

The patient, too, became delirious; the eyesight became very dim; sounds, especially that of music, was heard in the ears, the sounds were discordant and at times would be loud and violent, and so disturbing the patient.

The pupils were dilated and did not respond to light.

red and angry. The pharynx was also congested and pain was experienced upon swallowing.

March 23. Under anodynes she was kept quiet during the whole day.

March 24.-I was called early in the morning. About 6:00 o'clock the patient had grown rapidly worse. She complained of great roaring in the ears, and dimness of vision. When I reached the house, about 6:30 o'clock, she was totally blind. She had no paralysis of the lids, face or tongue. She was totally deaf, being unable to hear even the loudest noises. She spoke at times incoherently and without meaning to her sentences. Her temperature was 100° F.; pulse 90; respiration 22. Very little pain in the back and none at the occiput. I prescribed again iodide of potassium, grs. xv, with two drops of tincture iodine every two hours, and continued the stimulants as before.

By evening she was somewhat better. Her speech was freer.

By the 26th instant, the eyesight began to come back; her hearing improved and her speech was much more connected, showing that the exudate was being absorbed.

March 27.-The night previously had been passed quietly, the patient sleeping considerably. At 11:00 a. m. she complained of severe pain in the back of her neck. Ice was applied and the bromides increased with marked relief. About 1:00 p. m. another severe paroxysm of pain in the neck, lasting nearly two hours, left the patient totally blind for the second time. During this attack her temperature was normal, though her respirations were increased to 40 per minute. Her skin was moist, though pressure upon the muscles caused pain in the back of the neck, while the muscles felt sore after pressure was removed.

March 28. The patient is able to speak, though still blind. She remembers the attack of yesterday, and seems to remember all the happenings of the day. This morning her temperature is normal; pulse 76. The spine is tender in spots over dorsal and cervical regions.

In the evening her sight began to improve, things appearing misty and enlarged. The field of vision was very small; she was unable to measure distances.

March 30.-The improvement has progressed so far uninteruptedly. The appetite is improving. The sight is improving slowly.

March 31.-For most of the night there was considerable pain over the lumbar region and the sphincters recti and vesici were relaxed, and the fæces and urine There was also considerable pain The temperature was normal, and

in the pelvic organs. the pulse at 80.

April 2. The temperature was normal; pulse 90 and weak; skin relaxed and moist; and, strange as it may seem, the patient was muttering in delirium. The right side of the face was relaxed as though a few filaments