after complete cessation of breathing. The same chloroform had been taken without any bad symptoms by another patient just before this patient took it. The truthful narration given can not but prove sadly interesting. That school of thought which maintains that shock is peculiarly prone to make itself felt, in cases in which the narcotism is not rendered profound before a skin incision is made, will find in the mode of death described above a likeness to cases recorded as instances of cardiac inhibition during imperfect anesthesia. Upon the other hand, it would appear that the respiratory center was paralyzed before the cardiac center, at least this was the view of the chloroformist. Such paralysis is, as a rule, the result of an overdose of the anesthetic, and according to the valuable statistics of the Hyderabad Chloroform Commission in most cases was overcome in the Hyderabad experiments by prompt resort to artificial respiration. In the present instance primâ facie no overdose was given, and the promptest action was taken to restore breathing. We have, however, in speaking of an "overdose" to carefully discriminate between too large a dose being given at one time and the equally perilous and far more insidious overdosage which occurs if through impediment of the breathing by any means. interference takes place with expiration. Such an accumulation of chloroform in the blood as happens under such circumstances probably permanently injures the protoplasm of the medulla before any very marked phenomena, save slight and easily overlooked alteration in the breathing, occur. We must be understood to in no way state any of these solutions of the difficult problem, Why does a patient die under chloroform? as applying to this particular case; we believe it is useful to apply pro and con reasonings in all instances of chloroform deaths when the phenomena are sufficiently clearly stated, as in the particular case upon which we are commenting. London Lancet.

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TREATMENT OF FAVUS.-F. Zinsser (Archiv. für Derm. u. Syph.) reports the results of some experiments made by him in Lesser's Clinic at Berne, on the treatment of favus by heat. Experiments with the favus fungus proved that exposure to a temperature of 50° C. (122° F.) killed it in from four to eighteen hours. His clinical experiments were made on four cases. first applied the heat by means of Leiter's coils placed over compresses wrung out of carbolic acid or sublimate solution. Finding the Leiter's coils inconvenient, however, he devised a special apparatus, consisting of a double system of tin tubes, so arranged as to lie close to the head from the vertex to the edge of the hairy scalp, whereby a uniform degree of heat could be applied to the whole surface. This helmet was applied to the head over compresses wrung out of sublimate gauze; over the coils was placed a thick layer of cotton wool so as to retain the heat. The water in the kettle was at a temperature of 65° to 69° C. (about 150° to 157° F.), and in its passage through the tubes cooled down to 50° to 51° C. (122° to 124° F.). The heat apparatus is kept on uninterruptedly for twelve hours out of the

twenty-four for a week or ten days. In three cases the result of the treatment was perfect and permanent cure. The fourth was an exceptionally severe case, and was an unfavorable one for treatment, as the hair was abnormally thick, bristly, and deep set in the skin. The author points out that patients speedily become accustomed to the treatment; if the delivery and return pipes are of sufficient length they can readily move about, and the children so treated are able to play in bed. When a sufficiently high temperature can be applied to the head to kill the fungi in the hair and in the follicles, it is possible to effect a radical cure in from eight to fourteen days. The author suggests that by the use of salicylic acid or potash in the compresses the epithelium may be thinned so that the heat shall more readily reach the seat of the fungus; the greatest obstacle to the treatment is, he believes, the slight heat-conducting power of the hair.-British Medical Journal.

SERUM THERAPEUTICS.-Now that there is every prospect of a general trial in diphtheria in this country of the remedial agent which has been obtained according to the fullest knowledge of the nature of the disease gained by the researches of recent years, it is above all things necessary that the conditions of performance of this gigantic therapeutical test should be well weighed and formulated and the results carefully and dispassionately sifted. It will not do to be content with the fragmentary results of isolated observers with no guarantee that the cases were really diphtheritic or the treatment carefully applied. It is said to involve no risk, and this may be so, but nevertheless the practitioner must not employ the remedy without close observation of its effects and a faithful record of them. Doubtless much will be learnt this (Friday) evening from the report to be made to the Clinical Society by two able observers, who have had the opportunity of treating a considerable number of consecutive cases. But for the future we trust that isolated instances of its application will be carefully withheld from publication, and that patience will be exercised until a vast body of well-authenticated facts has been collected and analyzed. In this respect we imagine all who have the interest of medicine at heart will cordially concur. There are few acute diseases for which so many "specifics" have at one time or another been vaunted. As medical journalists we have been the recipients, more often than we care to think, of communications from enthusiastic advocates of unfailing remedies for the cure of diphtheria. Yet we know that our correspondents can not all be right, that one or other of them must have jumped at a conclusion from insufficient data. It passes the bounds of credulity to believe that a practitioner can pass through life without losing a single case of this dread disease, as some gravely assert— a fact which they attribute to the efficacy of their prescriptions, but which the outsider is forced to assign to mistaken diagnosis on the part of the reporters. Hence we would venture to repeat the recommendation made in these columns a fortnight since in view of a thorough investigation of a

line of treatment upon which so much turns, not only at present in respect to diphtheria, but for the future of the methods of cure of infective diseases, namely, that a committee should be formed to supervise and report upon all cases coming under the treatment in public institutions. It seems to us that in regard to the undertaking entered into with the Laboratories' Committee by the Metropolitan Asylums' Board that such a committee might well be nominated by the two Royal Colleges. Unless some such step is taken we fear that there will be much waste of energy and very little real attainment of practical value. There is another point in this connection which requires to be determined, and it is of no mean importance. It will be observed that Dr. Hansemann, whose objections to the rationale of the method are fundamental, laid much stress on the fact that many cases which would otherwise be regarded as diphtheria do not yield the Löffler bacillus. As the alleged efficacy of antitoxin is confined to the cases which are due to this microbe, it would be important to know more accurately than we do at present what is the course and what the issue of the "pseudo-diphtheritic" cases. If such cases are invariably benign, or if they are never followed by “diphtherial paralysis," then one chief objection raised by Dr. Hansemann to the grounds of the method would be met. A committee such as we contemplate would soon be able to collect sufficient material to determine this point.-London Lancet.

INTRAVENOUS SUBLIMATE INJECTIONS IN SYPHILIS.-Blaschko (Berl. klin. Woch.) has treated a number of patients by this method introduced by Baccelli. He uses rather a stronger solution than Baccelli, namely, sublimat. 0.3, sodii chlor. o.6, aq. destil. 100 The first injection consists of a quarter, the second of half a syringe (containing two cubic centimeters); later I or even 2 syringefuls are given daily. In a course of thirty to thirty-six injections only 1 to 2 cgr. of sublimate are thus given. Lately the author has used even stronger solutions than the above. The treatment is usually only available for in-patients. It may not be possible in fat people whose veins are not visible. Clotting takes place if the needle pierces through the vein. or passes by it, and then a hard, painful aseptic periphlebitis ensues. The needle should be very fine and sharp, and must be washed out with alcohol and kept in vaseline. The strictest cleanliness must be practiced. The author has never seen hemoglobinuria after this treatment, and only once a temporary albuminuria. Urine passed one hour afterward was always found to contain mercury. No mercurial depot is formed in the body, as occurs in some other methods of mercurial treatment. The author's cases were mostly of early syphilis. A therapeutic effect was always obtained if the treatment was continued long enough. The author has already observed four relapses. The advantages of the method are its painlessness (if the vein is entered), the small amount of mercury given, the exact dosage of the drug, all of which is utilized, and the absence of unpleasant results. It appears to be inferior to inunction and subcutaneous injection in its per

manent effects. This mild treatment is suited to cases where it is desirable to avoid large quantities of mercury. Baccelli's method shows how little mercury suffices to cause the disappearance of syphilitic manifestations, and it also inaugurates the intravenous method of treatment.-British Medical Journal.

THE PATHOLOGY OF OPTIC NEURITIS.-In the recently issued volume of the Transactions of the Ophthalmological Society there is an interesting and valuable contribution by Dr. James Taylor bearing on this unsolved problem. It was pointed out some time ago by Mr. Victor Horsley that, as a rule, optic neuritis associated with intra-cranial tumor subsides after pressure has been relieved by trephining and opening the dura mater, even when the tumor could not be reached. Dr. Taylor succinctly quotes a number of cases of optic neuritis due to intra-cranial tumor which had been trephined at the National Hospital for the Paralyzed and Epileptic. There were six cases in which tumors of the cerebral cortex were removed, and in all the neuritis subsided. Later the growth recurred in three cases and caused the death of the patients, but in none of these was there any return of the optic neuritis discernible with the ophthalmoscope up to the time of death. In three other cases pressure was relieved by trephining, but the tumor was not removed, and in these also the neuritis began to subside at once and had completely disappeared in two of them before they passed out of observation. We have here a clear demonstration of the paramount importance of pressure in keeping up optic neuritis when present. Taken by itself, it might also be held to be conclusive that optic neuritis was caused by pressure; but, as Dr. Taylor is careful to point out, there are many facts which can not be reconciled with this theory. He quotes, for instance, the absence of optic neuritis in some cases of a large, slowly-growing tumor within the skull; and we may add that in cases of fairly rapidly-growing tumors it may occur only as a final symptom. Enormous intra-cranial pressure is often met with in the non-tuberculous basic meningitis of young children, in which optic neuritis is decidedly rare. Besides, there are many cases of optic neuritis indistinguishable by the ophthalmoscope from that produced by intra-cranial tumor, in which increased intra-cranial pressure is out of the question. We fear that a solution of this complex problem is yet to be discovered, but all the evidence is contrary to the belief that there is any one efficient cause, and suggests that several factors are required; but the ultimate explanation can only be reached by careful clinical and pathological observation and by the collation of the facts in a clear and unprejudiced form, as in the paper to which we refer.-London Lancet.

HEREDITARY OCULAR SYPHILIS.-Galezowski (Sem. Méd.) remarks that the number of congenital ocular affections due to syphilis is great, and arranges them under four distinct groups: (1) Malformations of the protective organs of the eye, of the orbit, and of the lachrymal ducts. These

affections are very rare, and their syphilitic origin can be shown by the simultaneous existence of lesions in the choroid and iris. Caries of bone and dental alterations denote the same origin. (2) Paralysis of the motor nerves of the eye, ptosis, nystagmus, etc. These are frequent in very young children, and depend on cerebral causes or are produced in the train of the infectious fevers, of traumatisms, etc. Here, in the absence of very clear symptoms, the cerebro-spinal system must be carefully examined for indications of syphilis. Brissaud teaches that in cerebro-spinal syphilisa late affection of early infancy-one meets, among other lesions, a monocular ptosis or nystagmus, with diminution of central visual acuity, convergent or divergent strabismus, etc. (3) Arrest of development, micro-ophthalmia, astigmatism, etc. The arrest of development frequently met with in the infant's eye must be attributed largely to hereditary syphilis. In several such cases Galezowski has met with the choroido-retinal changes characteristic of syphilis. He is especially struck with the fact that astigmatism is frequently caused by syphilis. (4) Inflammatory alterations of the external and internal tunics of the eye. That interstitial keratitis is due to syphilis no one now doubts. It is often complicated with pigmentary retinitis; and, with reference to congenital pigmentary retinitis, it is not due, as maintained by some, to consanguinity of parents, but is the result of congenital or acquired syphilis. It should always be treated by energetic mercurial inunctions.-British Medical Journal.

PRIMARY CARCINOMA OF THE BODY OF THE UTERUS.-The last meeting of the Obstetrical Society was a specially interesting one. After Mr. Targett's demonstration of hydatid disease of the pelvic bones, consisting of numerous photographs thrown on the screen showing the peculiar eroding effect of the disease on the cancellous tissue and a point of morphological importance-the external budding of the secondary cysts from the walls of the parent one, Dr. Lewers related a case of primary carcinoma of the body of the uterus in which vaginal hysterectomy had been performed more than two years ago without any recurrence of the disease. Five other cases were also tabulated. In cases of doubtful diagnosis Dr. Lewers justified the complete investigation of the uterine cavity by dilatation of the cervix, rather than the usual method given in text-books of waiting for the development of symptoms, so that the disease might be dealt with at the earliest possible period. The difficulty of extracting the uterus in nulliparous women, in whom carcinoma of the body is most frequently met with, was specially noticed. In the case described, it was necessary to widen the caliber of the vagina by incision of the recto-vaginal septum, and bring away the excised uterus by means of a pair of forceps devised by Dr. Heywood Smith, resembling small midwifery ones. Dr. Lewers now adopts pressure forceps instead of ligatures for securing the broad ligaments. This formed a subject of discussion among the subsequent speakers, some expressing a decided preference for ligatures.-London Lancet.