examination the lungs were found to contain particles of carbon widely disseminated, and specially numerous in the lymphatics, but without any sign of tubercle. The writer further argued that the amount of carbonaceous infiltration of the lungs bears no relation to the probability of finding tubercle. The latter may be found in miners with little or much carbon in their lungs, and in those who have spent few or many years in occupations involving the constant respiration of carbonaceous particles. Cases such as those brought forward by Dr. Tripier are of course inconclusive, but they must be allowed reasonable weight. They certainly tend to corroborate the view that pneumokoniosis or pulmonary anthracosis is not an independent affection with a definite cause and definite natural history, but simply one of the many varieties of pulmonary phthisis.-Lancet.

ACUTE NON-SUPPURATIVE ENCEPHALITIS.-Oppenheim, discussing this affection before the Berlin Verein f. inn. Med. (Centralbl. f. inn. Med.), said the separation of the non-suppurative from the suppurative disease was most important. The etiology of the hemorrhagic form of the disease is not always the same. By some it has been attributed to alcohol, by others to influenza, and there are a number of cases of no known etiology. It begins with severe symptoms, but usually runs a favorable course. The author gives short details of five cases observed by him, all of which recovered. Three cases were acute, occurring respectively in girls aged sixteen and ten, and in a young woman. In two subacute cases in a girl aged twelve and a man aged twenty-one, the lesion lay in the floor of the fourth ventricle (Wernicke's type), and a complete ophthalmoplegia developed itself. In none of these cases was there any evidence of syphilis. In the literature of this disease the prognosis has not always been looked upon as very favorable, but in recent writings recoveries have been noted. The author's experience has been most favorable. Polio-encephalitis must be distinguished from disseminated sclerosis, which not very rarely takes an acute form, and which, according to the author, may end in complete recovery. Acute course, rapid development, high temperature, etc., are unfavorable signs, whereas low temperature and a protracted course make the outlook favorable.-British Medical Journal.

THE MURPHY BUTTON.-Murphy's button has now been largely tried by a great number of surgeons, especially in America and Great Britain, and also on the Continent of Europe. The consensus of opinion seems to be that it admirably fulfills the two primary requirements: it greatly shortens the operation, and by its use intestinal anastomosis can be made with great precision, and as a result the mortality of these operations has been greatly reduced. Against this most satisfactory result two facts may be mentioned as a set-off. In the first place the button is a rather complicated and very delicate piece of mechanism; it requires to be made very well, and to be used with gentleness and care. Again, the button, when

set free by the separation of the rings of bowel compressed between the two portions of it, may linger for a very long time in the alimentary canal; but, so far, experience has shown that this retention of the button is not attended with danger. Too much weight must not be given to these objections to the use of the button. Simplicity of construction is to be diligently sought in all our appliances, and we doubt not that Professor Murphy himself, or some other surgeon with a mechanical genius, will be able to devise some simple method of attaining the same mechanical result. Delicacy of mechanism is not a fatal objection, at most it is a remediable defect; and Professor Murphy's tables show that it is compatible with brilliant operative results. He has certainly succeeded in lifting this whole department of operative surgery-not one isolated operation merely-on to a different and better plane, and has given intestinal anastomosis a position in surgical therapeutics it has never held before.

The paper, by Mr. Ernest Lane, published in our columns last week, in which he recorded three cases in which he had used the Murphy button, fully supports our good opinion of this device, and he is able to add still more cases to those recorded by Professor Murphy himself. No doubt the lists are by no means complete, and probably, as in most similar instances of a new operation or procedure, an undue proportion of successful cases have found their way into print. But this applies equally to all other methods of intestinal anastomosis, and in no way invalidates the comparison of the results of using the Murphy button with other modes of performing the operation.-Lancet.

INFLUENZA.-Mossé (Rev. de Méd.) contributes a study upon the pathogeny and treatment of influenza. The experiments were arranged in three groups: (1) Animals were inoculated with the blood of individuals suffering from influenza. In four out of seven experiments it was found that rabbits previously injected with quinine were protected in varying degrees against the disease as compared with control animals. Healthy human blood had no such action as that from influenza patients. (2) Animals were inoculated with Pfeiffer's bacillus. In three out of four rabbits the animal previously treated with quinine escaped, whereas the control animals became ill and two died. In one of these cases tuberculosis was found. This had been latent before the inoculation, and the author instances it as an example of a disease becoming active as a consequence of the diminished resistance produced by influenza. Another rabbit developed no symptoms, although it had only received half the usual dose of quinine. (3) Cultivations were made from patients' blood and also from that of rabbits infected with influenza. The first-named experiments were negative. The latter experiments revealed Pfeiffer's bacillus in one out of three rabbits previously treated with quinine, and in two of three rabbits not so treated. From clinical observations the author concludes that quinine is useful as a prophylactic, and also to some extent as a means of aborting the

the attack. As regards the dose, 1 g. to 1.25 g. should be given on the first two days, then 0.8 on the third; this may be gradually diminished to 0.4 g. The author then deals with the possible objections to quinine. Cardiac symptoms can not be attributed to it. Hypodermic injections have the advantage of sparing the stomach and getting the quinine into the circulation rapidly. The author gives details of three very severe cases of influenzal pneumonia so treated, with two recoveries. The largest total amount of quinine injected by him in the twenty-four hours was 1.6 g.-British Medical Journal.

TREPHINING IN EPILEPSY.-Hallager (Arch. de Neurol.) records the following case: A woman, aged twenty-two, with a phthisical and neurotic family history, chlorotic since the age of thirteen, suddenly became aphasic in January, 1893. The next day she had her first convulsive attack, and the right upper limb became paretic. Fits recurred frequently for some days, during which paresis developed in the right lower limb. In the course of a few weeks the aphasia and paresis disappeared, leaving alexia that had not previously been noticed. Subsequently fits became more frequent and severe. Each fit commenced with a sensation of trembling in the right upper limb; the arm then was raised and the wrist flexed; the right facial muscles twitched, and an indefinable pain was felt in all parts of the body; immediately after this consciousness was lost and general convulsions ensued. Occasionally a fit did not proceed beyond the aura and and slight twitching in the upper limb. Bromide treatment continued for a year reduced the frequency of the fits, but had to be abandoned owing to toxic symptoms induced. In February, 1894, memory was impaired, intellect dulled, pain was frequent and intense on both sides of the head; the ocular fundi were normal; increasing weakness of the right upper limb was observed. In April, 1894, a trephine hole was made over the center for this limb, and a cyst the size of a hazel-nut was found just beneath the exposed cortex. This was emptied of its brownish débris. For some days after the operation the right limbs were paretic and felt numbed and heavy. From time to time sensations of muscular contraction in the forearm were felt, but there was no visible contraction. On May 19th the patient had two fits of the same type as before; 4 g. of bromide daily were then prescribed. No more fits occurred up to the time of being seen in August, 1894.-Ibid.

NEURODIN.-Ugo Lippi (Il Policlinico) gives an account of some experiments made by him with neurodin, an analgesic introduced by Von Mering (Therap. Monats.). The cases in which the drug was tried were fourteen in number, and are classified as follows: (1) Experiments on persons not suf fering from pain, made in order to determine the limits of tolerance of the drug, and the possible toxic effects which might be caused by it. (2) Experiments on persons suffering from pain of various kinds, either in the form

of essential neuralgia or as an epiphenomenon in other morbid conditions. These included (a) four cases of sciatica; (b) one case of slight attacks of angina pectoris in a patient with atheroma of the aorta; (c) one case of intestinal pain caused by malignant growth of the retroperitoneal glands; (d) one case of neuralgia in a person suffering from polyneuritis; (e) one case of brachial neuralgia in a neurotic subject; (f) one case of gastric pain caused by epithelioma of the gall-bladder; (g) one case of headache in a nervous person the subject of a multiple neuralgia simulating polyneuritis; (1⁄2) one case of neuralgia of the bladder and stomach in a patient suffering from cancer of the liver and stomach; (i) one case of muscular pains, probably of rheumatic origin, in a tuberculous subject; (k) one case of pains in the arms symptomatic of spinal irritation. As the result of these experiments Lippi draws the following conclusions: (1) Neurodin may be given in doses from 0.5 to 3 grams; these are effective and well borne, and may be repeated several times a day. (2) These doses are perfectly harmless, and produce no other ill-effect than occasional diarrhea, with or without intestinal pain. (3) Hardly any physiological effects were noticed; in rare cases there was a very slight diminution in the heart-beats; no marked effect on the kidneys was observed. (4) As regards the analgesic action of the drug it was found to have the property of soothing and even of abolishing pain, whether neuralgic in character or symptomatic of an organic affection; its action, however, is uncertain, and notably inferior to that of other similar remedies, such as phenacetin and antipyrin. The remedy moreover has the great disadvantage of not being readily soluble in the vehicles in common use. Ibid.

DIRECT LARYNGOSCOPY.-Dr. Kirstein, of Professor Senator's policlinic in Berlin, has devised a new method of examining the larynx and trachea, in which the interior of these organs is seen directly and not by the intervention of a mirror or prism. He does not say, however, that his plan is applicable generally, but only that in "many persons" it can be carried out. The patient is placed on his back in the horizontal position with the head hanging down, and an esophagoscope is introduced. A metal speculum in the form of a tube about ten inches in length can then be passed behind the epiglottis and illuminated by a "Caspar's electroscope," and through it the larynx viewed with the naked eye. It does not do for the observer to wear spectacles, as these rapidly become dimmed with moisture. The tube itself acts as a tongue depressor, being a lever whose fulcrum is the edge of the upper incisors. Dr. Kirstein does not, of course, suggest that this method should ordinarily be employed instead of the common method of laryngoscopy, but he thinks that in some cases it will be found capable of extending usefully our methods of laryngeal and tracheal examination, and he asserts that it is by no means so severe a procedure as may be imagined, and that, especially if cocaine be employed, it causes the patient no distress either at the time or subsequently.-Lancet.

THE AMERICAN PRACTITIONER AND NEWS.

Vol. 19.

NEC TENUI PENNÂ."

SATURDAY, JUNE 29, 1895.

No. 13.

D. W. YANDELL, M. D., LL.D., and H. A. COTTELL, M. D., Editors.
JOHN L. HOWARD, M. D., Assistant Editor.

A Journal of Medicine and Surgery, published every other Saturday. Price, $3 per year, postage paid.

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THE GOLD CURE" AGAIN.

It begins to look as if the only demonstrable virtue of the so-called gold cure for inebriety is that it lines the pockets of its inventor and assistants with gold.

Last issue we quoted from the New York Medical Record some statistics, with the New York Medical Record's editorial comments, secured through collective investigation by the Rev. Dr. Buckley, of the Christian Advocate.

As this investigation was pursued chiefly among clergymen, many of whom were believers in and of course promotors of the treatment, the Record concluded that the percentage of cases (51%), as reported, is probably too high. An investigation, however, by certain physicians, as quoted by the Boston Medical and Surgical Journal of May 30th, does not materially change the percentage of so-called cures; but it fixes the figure at such a proportion as to show that the Keeley cure, measured by results, is no more efficacious than any approved rational form of treatment now practiced by any well-informed physician:

Dr. B. D. Evans, Medical Director of the Asylum at Morris Plains, N. J., in an article published in the Medical News, May 18, 1893, presented a table of 88 cases of insanity, all of which had been treated in Keeley institutes and graduated as cured.