A short time ago a Birmingham manufacturer died from taking strychnine supplied to him by a retail chemist for phenacetine. It was shown at the time that the retail chemist supplied only that which had been furnished to him by the wholesale chemist. At the present Birmingham Assizes an action was entered by the widow of the deceased to recover damages, both the wholesale firm and the retailer being sued. The plaintiff's case was concluded on the second day of the trial, when counsel stated that terms had been arranged. The record was withdrawn, the wholesale chemists paying plaintiff 2,800 and taxed costs, the retailer paying his own costs. The representative of the wholesale chemists explained that how the mistake arose was a mystery, and the defendants desired to act honorably. The judge expressed his satisfaction with the terms stated.

The Duke of Devonshire has opened the Farm Colony for the Employment of Epileptics; it is founded upon similar lines to a colony in Germany, where now 1,100 epileptics are engaged in the cultivation of a farm of 400 It is hoped that the work so successfully begun may be extended

from time to time.

Mr. Victor Horsley was recently summoned to Cardiff to operate on a tumor from which the Turkish Consul was suffering; before, however, any thing could be done, the Sultan's permission for its removal had to be obtained. As the Sultan did not appear to mind, Mr. Horsley proceeded to operate.

The children in the London hospitals are eagerly looking forward to the annual Christmas distribution of the toys got together for the purpose by the editors of Truth.

LONDON, December, 1895.

THE OPERATIVE TREATMENT of Wry Neck.—Mikulicz (Centralblatt für Chirurgie, 1895-The University Medical Magazine), being dissatisfied with the results both of subcutaneous and open division of the sternomastoid in cases of wry neck, advocates almost the total removal of the contracted muscle, the posterior part of the upper extremity, where it is traversed by the spinal accessory nerve, being left. He has operated upon seventeen cases with success, the only bad results being the disfigurement of the neck caused by the absence of the muscle. Examination of the extirpated muscle in these cases has convinced him that wry neck is the result of a chronic inflammatory condition (myositis fibrosa) involving the whole of the sterno-mastoid muscle. This condition he attributed in congenital cases more to compression of the muscle during a long, difficult labor than to laceration. The so-called hematomata of the sterno-mastoid sometimes observed in infants is not due to effusion of blood, but to thickening and induration of the inflamed muscle.-The College and Clinical Record.

Abstracts and Selections.

SORE THROATS IN INFLUENZA; THE TONGUE AS AN AID TO DIAGNOSIS ; The Difficulties of Differential DIAGNOSIS.-Some months ago a letter of mine on "Sore Throats in Influenza" was published in the Lancet. The epidemic was then at its height, and I made a few remarks on the condition of the tonsils, uvula, pharynx, larynx, and tongue. Since then I have studied carefully a great many cases, both in the acute febrile stage and in a sort of subacute and chronic stage. I should now like to say a few words on the condition of the tongue in each of these stages, as I feel certain that if any of the conditions to be described are present in any case we may safely diagnose influenza, whatever else there may be in addition. Every one must have known how difficult it is sometimes to diagnose for certain an ordinary case of influenza even during a recognized epidemic; it is more especially difficult to do so when the case occurs previously to or at the end of a general outbreak. True it is that the blood or sputum may be examined for the influenza bacillus; but it is not absolutely certain that the specific bacillus has been found. If the condition of the tongue immediately to be described is fairly constant, and I believe it is, I think we have an important aid to the diagnosis of influenza. In the early acute stage of the disease the tongue is covered as a rule with whitish or grayish fur; this layer may be so thin that the pink substance of the tongue shows through it; or it may be absent, the tongue being clean, but often fissured. The characteristic feature, however, is the presence of dark purplish-red spots or elevations scattered all over the tongue, being most numerous on the anterior half of the dorsum and on the tip and edges; they are rather larger than an ordinary pin's head and are probably enlarged fungiform papillæ. At the back of the tongue, in the region of the circumvallate papillæ, there are several elevations varying in size from that of a pin's head to a split pea or even larger; they are fleshy in color and somewhat resemble mucous condylomata. When the tongue is coated with white fur the red elevated papillæ produce an appearance most characteristic, a white strawberry tongue; when there is no fur the appearance is more like a red strawberry. At a rather later stage the red spots or elevations have turned into pinkish-white jelly-like vesicles; on pricking them, however, no fluid escapes. In the chronic cases, that is, in those cases in which the patients have got over the acute febrile stage, but are still weak and ill, or those where there has been a relapse (which often occurs if the patient resumes his work too soon), the tongue still shows quite characteristic signs; it is generally of a deep-red or purplish color, is fairly clean, or is sometimes slightly covered with a grayish or brownish fur; the purple spots or pinkish-white jelly-like vesicles are no longer to be seen, their place being occu

pied by translucent white vesicles, which are larger than those of the earlier stages. The elevations on the posterior third of the tongue are now white or grayish-white in color. I must point out that the order of the changes in the tongue as here described is not constant; the purplish spots may remain spots all through, or the jelly-like vesicles may persist throughout, and so on, but in a majority of cases the description holds good. In every case of influenza, however, one or other of the conditions of the tongue is present. Besides these changes in the tongue, small whitish vesicles may be seen on the mucous membrane of the lips, cheeks, hard and soft palate, and on the pharynx; on the palate and pharynx they are sometimes much elongated, and then look like small slugs; this latter condition, however, is not common. The throat is usually found to be dry and red, the pharynx is much congested and sometimes slightly ulcerated, and the veins on it stand out prominently, often presenting little varicosities. In the late stages the tonsils may still be enlarged and red, but tonsillitis, which is often markedly follicular in the earlier stages, is now much less frequent; often, indeed, the tonsils and uvula have shriveled up to very small dimensions. As the patient gets better the spots or vesicles become less and less pronounced, and finally, when he is well, completely disappear. The spots may, as before said, last some weeks, although the patient expresses himself as feeling quite well, but I do not consider that the influenza has departed until the tongue is quite clear.

I shall not here describe any of the sequelae or usual complications of influenza, as they are so fully gone into in the various excellent books and pamphlets which have of late been written on this subject. But I must draw attention to one complication which I believe is not at all infrequent, and yet, as far as I can ascertain, has not been heretofore described, at least in connection with influenza. I refer to the development of a “membrane" on various mucous surfaces of the mouth and throat; any part may become affected, but the chief sites are on one or both tonsils, the uvula, the hard or soft palate, and on the pharynx or even the larynx. This "membrane " may be either diphtheritic or non-diphtheritic. Whichever it is, the microorganism finds the congested or ulcerated mucous membrane caused by influenza a suitable soil for its further growth and development. "membrane" formed in either case is physically almost the same; and the importance of recognizing that the diphtheria bacillus is not the only one that can lodge in the mouth or throat and form a "membrane" there is enormous. Within the last fifteen months I have had under my care some forty-five cases with a "membrane" on some part of the throat or mouth; to look at, they resembled exactly cases of diphtheria, but beyond the "membrane" there was no other sign or symptom of it. In nearly all the cases the symptoms resembled a sharp attack of influenza with complications, but there was no rapid exhaustion, with quick, feeble pulse, no albuminuria, and no post-paralysis, and with proper treatment the patients got quite well in from about one to three or four weeks. The "membrane,"

after being pulled off or coughed up, in no case returned, a superficial ulcer being left, which, although painful on swallowing or gargling, healed up rapidly. I may add that nearly every one of these cases presented what I have called "the influenza tongue." It may be urged that a bateriological examination will settle the question; this, as matters are now, I very much doubt. On several occasions I have sent specimens of "membrane" and discharges from the throat to London to be examined. One case only of these was undoubted diphtheria, for there were rapid exhaustion, a quick, feeble pulse, albuminuria, and post-paralysis; but no diphtheria bacilli were found, although the membrane sent up to be examined was a large fresh piece untouched by medicines, gargles, or paints. Other cases-some apparently of ordinary follicular tonsillitis, and some of ulcerated tonsils without membrane, and others with, but with no other sign of diphtheriawere said to be "swarming with the diphtheria bacillus." I believe the fallacy of examination is due to the fact that inoculation on animals is seldom done because of its expense, the time required, or the difficulty in obtaining a vivisection license; hence one has to rely upon the appearance of the colonies and upon the microscopical examination of the bacilli found therein; surely this must be almost useless. One report says: "There is a good deal of irregular growth present, but not characteristic of diphtheria; and the microscope showed "the presence of numbers of a short, thick bacillus closely resembling the 'short variety' of the bacillus diphtheriæ.' Another states: "It is quite possible that the bacilli may be the 'pseudodiphtheritic bacilli.'" In a third case (that of a man aged thirty years, whose hard and soft palate, both tonsils, uvula, and pharynx were covered with patches of thick, white membrane, and which was diagnosed by several medical men as diphtheria) the report was: "Unable to detect any bacillus diphtheriæ either in the membrane, on the cotton-wool, or in the culturetube." In another case, in which the patient got perfectly well in a week, the report was: "The culture shows numerous whitish-gray colonies of growth very characteristic of diphtheria; the culture shows also certain other colonies;" and by the microscope were seen "first the bacillus diphtheriæ of 'medium length;' secondly, groups of staphylococci." I quote these reports, not in any way doubting that the true diphtheria bacillus has been found, but to show that examination by culture and by the microscope, without other confirmatory tests, for instance, inoculation, is almost if not quite useless, or at any rate very misleading.

In conclusion I wish to lay stress on the following points:

1. That the condition of tongue as described is an almost infallible sign of influenza, and that there must be very few cases in which, in one form or other, it does not occur. Although in the last fifteen months I have seen over fifteen hundred cases, I have not met one which did not show some of the appearances described.

2. That however simple a case of influenza may appear to be, it must be treated with great care, especially with regard to the purity of the air; for,

in crowded hospitals or in badly ventilated houses or in houses connected with or near bad drains or cesspools, the congested or ulcerated mucous membrane of the mouth or throat may easily take up one or more of the numerous micro-organisms, causing follicular or simple tonsillitis, simple membranous inflammation, or diphtheria, as the case may be.

3. That the simple (non-diphtheritic) membranous inflammation, though having nothing in common with diphtheria, is highly infectious; and, though as a rule admitting of easy cure, in weakly adults or in children the disease may be extremely serious or even fatal.-John Terry, M. R. C. S., Eng., L. R. C. P., Lond., in Lancet, No. 3763.

KING SAUL'S DISEASE.-The Province médicale for September 21st contains an account of M. Dieulafoy's recent communication to the Académie des inscriptions et belles-lettres. It is, says the writer, of an eminently medicopsychological nature and very interesting.

Saul, says M. Dieulafoy, the King Saul of the Bible, was celebrated for his contentions with David for his visits to the witch of Endor, and for his death at the battle of Gilboa, where he fell on his sword in order not to fall into the hands of his enemies. Was he not neuropathic and hysterical? M. Dieulafoy is of the opinion that he was.

During the course of studies pursued by the author in regard to David and to the Israelites he was led to search for the original cause of prophecy and its influence upon the people. According to M. Dieulafoy, Saul, who was a prophet in the true sense of the word, was not a man of much intellect, but the beginning of his career and the manner of his death showed that he was a proud and high-spirited man. His existence was one of alternate fits of rage and of depression, and he very nearly compromised the destiny of a rising monarchy. Saul and the prophets were, in fact, neuropathics in whom a neurosis was vested with the characteristics of the epidemics of violent hysteria of which history offers such striking examples.

M. Dieulafoy borrows from the Bible the descriptions of the mystic manifestations which were produced by the clairvoyants, and he alludes to the epidemics of violent hysteria from the time of the chorea, or dance of Saint Guy, and the tarantism which prevailed during the fourteenth century in Germany and in Italy, up to the time of the possession of Jaca, which takes place every year in the north of Spain on the occasion of the feast of Santa Orosia, the patron saint of that town.

M. Dieulafoy shows that from the time of Samuel violent hysteria of a contagious form existed among the Hebrews. It was, moreover, consecutive to a religious outbreak and to an interval of physical and moral depression, which was occasioned by the scourge and by long privations. The verses especially devoted to Saul confirm these conclusions. Saul's singular attitude after Goliath's death, his obstinate desire to kill David and his son Jonathan, and finally the condemnation and the massacre of the Levites, all correspond with the delirium and with the homicidal mania of demoniacs.