Beri-Beri is a rare form of multiple neuritis.

Malarial fever, which so far has killed more of our troops than yellow fever, is given considerable space. In 1897 malaria killed 7,000 Spanish soldiers. Tropical malaria is divi ied into the benign, calenturas, and the bad, pernicious. The benign are similar to our malarias and yield promptly to quinine. If not quickly checked they are liable to run into the pernicious forms. The liver and spleen are usually enlarged. The chill usually occurs in the daytime, seldom earlier than 8 A. M., and not often after 4 P. M. There are exceptions. Barring acute, infectious diseases, such as yellow fever, dengue, etc., chills at night generally suggest sepsis and not malaria. Cases vigorously treated during the paroxysm as well as after it, and continued so as to anticipate another, give uniformly good results. Studies by Saveran, Golgi, and Mannabag, show that quinine acts most energetically upon the young parasites just as they burst out of the blood-cells. They demonstrated scientifically that quinine exerted but little effect on the intracorpuscular parasites. For the tertian type Dabney uses seven and one-half grains of the sulphate of quinine every hour or two, until cinchonism is produced. Usually three doses are suffiIcient. Five grains of phenacetine or acentanilid seem to enhance the value of the drug, and they certainly add to the patient's comfort. One dose of acetanilid is sufficient. The patient should be kept in bed, the bowels, skin, and kidneys looked after, and moderate cinchonism kept up. On the third day seven and onehalf grains of quinine combined with five gains of Dover's powder or acetanilid should be given four hours before the chill time, and five grains of quinine every hour afterward until twenty-five to thirty grains have been given. Then five grains three times a day for four or five days, and iron or arsenic for from ten days to two weeks. For the pernicious form, Dabney recommends hydrochlorate of quinine in gramme doses in aqueous solution hypoder

mically.

Dysentery killed 12,000 Spaniards in Cuba in 1897. In all fatal cases of tropical dysentery, abscess of the liver occurs in one case in four. No hard and fast lines can be drawn in this disease. There

are dysenteries without bloody discharges, and bloody discharges without dysenteries (intestinal malarias, intestinal hemorrhages, etc.). Nor is tenesmus at all necessary. It usually appears in the form of a most innocent diarrhoea, and without any apparent cause. Suddenly large stools at short intervals intervene. They are odorless, and of a grayish or yellow color. But, after a while, the patient presents himself with every evidence of marked debility. He complains of no particular pains; he sleeps well; there is no elevation of temperature; the tongue is at times clear, but generally covered with a muddy coat, and is quite thick. The most careful examination fails to find a grave symptom, and yet this disease gives the highest death rate of all endemic tropical diseases. The first attack is usually recovered from. A second or third attack is sadly different. The patient may sink into a chronic cachexia, or a fever may be lit up and the end hastened. The author lays stress on the seriousness of this disease. Treat all cases, especially diarrhaas, quickly, actively, and continuously.

For the gangrenous form of dysentery, often accompanied by hepatic abscess, he recommends free evacuation of the latter. For acute and sub-acute hepatic inflammations, Dr. Dabney recommends nitro-hydrochloric baths night and morning. Take one -ounce of the undiluted acid to one or two gallons of warm water. Place both feet in the bath and sponge the legs, insides of the thighs, and the region of the liver for fifteen minutes. If the bath bites too much, diminish the quantity of acid.

In the treatment of acute amoebic dysentery, ipecac has given the best results, and opium the worst. From thirty to sixty grains of powdered ipecac is Dr. Dabney's dose. Thirty drops of laudanum should precede it by a half-hour. The patient should be kept in bed, and but little fluid allowed while the ipecac is being taken. It should be repeated in four to six hours for a day or two. A rigid diet at first, then broiled fish, roast beef, soft eggs, and red wines freely. When the case becomes sub-acute, high enemas of nitrate of silver, thirty grains to the quart of water, two quarts if possible, should be given once a day. When possible, change of climate is the proper treatment. Each patient with dysentery

should be separated from his fellows, and all discharges should be destroyed by fire, and not by some new disinfectant that does not disinfect.

Our readers will note that there is nothing novel in the treatment recommended, but it is the latest and best our friends have to offer.

ADMINISTRATION OF ANESTHETICS.

Dr. Frederic W. Hewitt, anesthetist to the London Hospital, has analyzed in 6,657 administrations of anesthetics at that institution during 1897 (Lancet, February and March, 1898). Of this number, 2,910 were anesthetized with ether, 677 with chloroform; or, more than four administrations of ether to one of chloroform. This is contrary to the accepted belief in this country, that English surgeons prefer chloroform to ether.

Dr. Hewitt reports that one death resulted either directly or indirectly from the ether and two deaths from the chloroform. According to Wyeth, the estimated death-rate from ether is one in 20,000; from chloroform, one in 3,000 administrations. This would make Dr. Hewitt's figures show that he was particularly unfortunate, as his death-rate was about seven times as great. The relative proportion of deaths in Dr. Hewitt's cases, however, is not much different from the rate as indicated in Wyeth's figures.

It may be of interest to consider these three deaths more in detail, and to note what Dr. Hewitt has to say concerning them.

Case 1. This subject was a boy of fourteen. Three months before he had had a severe attack of typhoid fever, from which he had apparently recovered. January 5, 1897, he entered the London Hospital to be operated on for appendicitis. On the day of operation, January 15, the boy appeared to be in very fair health, the heart sounds were good, and there was no cough nor difficulty in breathing. The administration of ether lasted for forty minutes. Induction of anesthesia was smooth and without incident to the ordinary observer. As Dr. Hewitt had been making a special study

of the respiration under anesthesia, however, he was somewhat surprised to observe that the breathing was thoracic instead of abdominal as he usually found. There was also a very slight cyanosis. The respiration was quiet and regular, the pulse was good, and there was not an abnormal amount of mucus. The operation was a success.

Some hours later the respiration was thirty-two, pulse one hundred and twelve, and amount of mucus increased. The next morning the patient was a little worse, râles had developed throughout the chest, respiration and pulse more rapid. The untoward symptoms increased until at ten P. M. the respiration was eighty-one, pulse one hundred and fifty. The patient died thirty-four hours after the operation from pulmonary edema.

Dr. Hewitt believes that there was a peripheral paralysis of the diaphragm due to the recent typhoid fever. This was exhibited under anesthesia by the thoracic breathing. This paralysis Dr. Hewitt believes to have been the primary cause of death. The secondary cause was the ether which from its irritating effect caused the edema.

Had chloroform or the A. C. E. mixture been substituted for the ether, Dr. Hewitt thinks perhaps this patient could have been. saved.

Case 2.-A laborer aged twenty-six. This patient entered the London Hospital to be operated for tubercular epididymitis. This patient had had occasional attacks of bronchitis, and although he had taken ether for minor operations without trouble, it was considered best on account of the bronchial trouble to administer chloroform. The patient was all right until the stage of intoxication, when there was considerable struggling with rigidity of the muscular system, lasting from thirty to forty seconds. After that the patient took two breaths, and the chloroform was resumed. On the way to the operating room, the patient suddenly became cyanosed and breathing ceased. The pulse was palpable for several minutes. Brandy and strychnine were administered without avail. The patient subsequently respired twenty times at quarter minute intervals, and artificial respiration was induced for a long time, but

the patient was never resuscitated. Death was directly due to the chloroform.

Dr. Hewitt believes that in this case respiration was first suspended on account of the struggles; this left the right side of the heart engorged. Added to this, when respiration ceased, the chloroform was absorbed, and acting as a direct heart poison, paralyzed it, thus causing death.

Case 3. This patient was a man with empyema. It was proposed to resect two ribs. A very small quantity of chloroform had been given, when, as the pus was escaping he patient died.

Details of this case are lacking in Dr. Hewitt's paper, further than that the patient was in a very serious condition. Dr. Hewitt states that he thinks the chloroform had little or nothing to do with this death. To substantiate this it would have been wise to add more details.

In his experience, it is extremely dangerous to use anesthetics in acute empyema. In chronic empyema-the above was a chronic case-chloroform is usually safe.

In speaking of the after effects of anesthesia, Dr. Hewitt recommends that no food be given for at least four hours before administration. Digestion of the last food taken should have been completed. He advises clear soup or beef tea without solids, as the final food, and states that milk or eggs should be avoided. The bowels should be empty. The giving of the anesthetic should be as brief as possible. Afterwards no food should be given until the patient asks for it.

Notes and Comments.

State Society Meeting.-The Syracuse meeting of the New York State Homœopathic Medical Society was one of the most successful in the history of the organization. The local physicians had made elaborate preparations, and left nothing undone to ensure the success of the meeting. The Yates Hotel was an excellent house for the purposes of the society, and the arrangements and care of guests were more than satisfactory. The attendance was very large