PHTHISIS. Professor Bouchard prescribes: B Beech-wood creasote, Balsam of Tolu, . Terebinthine, Benzoic acid, 3j. 3134. gr. xv. q. s. twice daily. When the pain had disappeared the use of guaiacol was suspended, as it did not seem to possess a resolvent action upon the inflammatory infiltration of the epididymis. Guaiacol often determines a slight erythema of the scrotum, followed by scaling of the epi M. Make into 80 pills, and let 10 pills be derm. The drug seems to be effective by a reflex action, starting from the cutaneous nerve-endings. Absorption by the skin and lungs plays, no doubt, a certain part, but the rapid relief produced by the painting seems to point especially to a local action.—La Médecine Moderne. NEURALGIA. For stubborn neuralgia try the following: 0.12 grm. 10.0 gtt. Sig. One pill thrice daily.-Med. World. : NEW USES FOR GUAIACOL. Diabetes. Dr. Clemens, of Frankfurt-onthe-Main, reports favorable results in this disease from the administration of pure guaiacol, in the daily dose of from 18 to 30 drops, given in three doses, suspended in milk or cod liveroil. The patients were allowed to drink beer, and were upon a nitrogenous or mixed diet. At the end of eight days there was a notable diminution of sugar. After four weeks of treatment the patients were able to partake of some saccharine foods without increased glycosuria being produced. The salutary effect upon the polyuria was still more pronounced. At the end of several days of treatment the amount of urine passed in twenty-four hours had often diminished by one half. The general condition was improved. The drug was well borne.-La Méd. Moderne. Orchitis.-MM. Balzer and R. Lacour report that paintings of guaiacol give very favorable results, relieving the pain, reducing the fever, improving the general condition, and permitting sleep. Upon the skin of the inguinal region pure guaiacol may be applied. Upon the scrotum a pomade containing from 30 to 75 grains to the ounce of vaselin can be used. At the moment of application it causes a burning sensation, which is followed by cessation of pain for three or four hours. Amelioration sometimes is decided from the first application. As a rule, it was employed Ext. aconite, Hyoscyami hydrobromat., M. et ft. caps. no. xxx. : Sig. One every two or three hours, -Prescription. PERIODICAL NEURALGIA. Dr. William H. Thomson, of New York, has had good results in severe, long-standing, and rebellious cases from the use of ergot. The fluid extract of the drug was employed, combined with an equal quantity of elixir of cinchona, to obviate its tendency to cause nausea. Two drachms of this mixture were to be taken in water as soon as the premonitory symptoms of headache were noticed, and the patient was advised to lie down and keep very quiet. If after an hour the headache continued, a second similar dose was taken, and then a third in another hour, if necessary. As nausea was such a general accompaniment of this affection, it was provided that if either of the doses be vomited it should then be taken in an enema of 2 ounces of water.— American Practitioner and News. THE Medical Bulletin. JOHN V. SHOEMAKER, A.M., M.D., Editor. Philadelphia, July, 1894. THE INFLUENCE OF THE NERVOUS SYSTEM IN THE PRODUCTION OF FEVER. IN Na general way, all will admit that the nervous system plays an important part in giving rise to pathological increase of temperature. Every observant practitioner knows that fatigue reduces the resistant power of the organism and permits it to fall a prey to the attack of any febrile disease to which it may be exposed. We know the depressant effects of grief, anxiety, and alarm. We have witnessed rapid extension of epidemic disease among those prostrated with fear. We have had occasion to deplore the effect of vivid emotion in producing a relapse or, at least, an exacerbation. To this interesting and important subject Professor Bouchard devoted his address at the general session of the late International Congress at Rome.* The deliverances of Professor Bouchard always attract the attention of the profession, for the reason that he is possessed of a wide clinical experience, which he constantly seeks to interpret by means of the purely scientific studies which lie at the basis of rational medicine. The aberration of heat-production exemplified by fever is a subject which has always engaged the thoughts of the philosophic physician. In inquiring how fever originates, we have been led to ask how animal heat is generated. To the solution of this problem the physiologist has addressed himself, and from his labors we have learned much concerning the production of heat in health and the means by which the temperature of the body is maintained at a normal standard, notwith * La Tribune Médicale, April 19, 1894. standing the fluctuations of atmospheric heat. In disease, physiologico-pathological elements enter into action, complicating and obscuring the problem. If the state of the nervous system has much to do with the production of an abnormal temperature, the existence of fever, on the other hand, reacts most powerfully on the nervous centres. In beginning his address, Professor Bouchard remarked that it is a frequently observed fact, though it is one of which little mention has been made and for which but little explanation has been offered, that, in fever patients brought to the hospital, the temperature is, four times out of five, higher on admission than it will be on the following day. It has also been observed that visits received by fever patients cause an immediate ascent of temperature. Even when convalescence has been established, the visits of friends will often cause a return of fever. Another fact in reference to this class of patients is that food taken too eagerly during the course of a continued fever causes a rise of temperature. The first food ingested after convalescence will frequently be followed by the same effect. It is likewise known that muscular fatigue increases the fever, and that the typhoid convalescent, on first rising from bed, often experiences an elevation of temperature. Even a moderate walk may raise the temperature of a consumptive two or more degrees centigrade. The speaker alluded, furthermore, to the fact that in the weak, sick, or convalescent, intellectual exertion or emotional excitement sufficed to recall or provoke fever. These causes, however, do not excite fever in healthy persons. While the facts are of every-day occurrence, they are differently interpreted. Many have taught that the nervous, muscular, or digestive troubles are only an indirect cause of the aggravation of fever. Professor Bouchard, on the contrary, states his belief that they act directly in producing a recurrence of abnormal heat, and that they find a weakened system less able than the healthy organism to resist their influence upon the production and dissipation of animal heat. After a brief consideration of the modes by which a balance is preserved between the pro duction and loss of heat and the relation between the temperature of the body and that of the air, the speaker pointed out that the reflex agencies protect the body better against external cold than external heat. Per contra, the variations in the temperature of the nervous centres constitute a more rapid defense against internal heat than internal cold. The rapidity is variable, moreover, being eleven minutes, upon an average, according to Professor Bouchard's experiments, when perspiration is excited by heat due to muscular effort, while protection against the effect of chilling by external cold results with the rapidity of a reflex. The mechanism by which heat is dissipated, however, is perturbed in the pathological condition. Here, a morbid product often intervenes, and, notwithstanding that the temperature is elevated both in the centre and in the periphery, renders perspiration impossible. The same individual who, in the normal condition, perspires upon a certain region of the skin when its temperature is 35.9°C. (96.6° F.) and the interior is 36.8° C. (98.2° F.) was seen, during an attack of influenza, to have a dry skin when the thermometer stood at 37.5° to 38.2° C. (99.5° to 100.7° F.) upon the surface, and at 38.1° to 38.8° C. (100.5° to 101.8° F.) in the rectum. Nevertheless, an antagonistic poison, antipyrin, in the dose of 1.50 grammes (about 24 grains), overcame the resistance to transpiration, and the evaporation of the sweat caused the temperature of the skin to fall to 37.5° to 37° C. (99.5° to 98.6° F.), and the internal temperature to 38.1° or 38° C. (100.5° or 100.4°F.). All that we know, continued the speaker, concerning the conditions of the automatic regulation of the temperature teaches us that man is much better prepared to resist deviation from the norm than to effect a return to the temperature of health. Consequently, it long resists the constant action of disturbing causes without the vigilance and energy of the nervous system being impaired. This resistance is continued to the moment when the nervous system is exhausted by the strife. The period during which the struggle against abnormal elevation of temperature continues is more or less prolonged in proportion as the energy is more or less considerable. It results, therefore, that among weak or weakened individuals, among those who are radically debilitated, among the exhausted, those who suffer from chronic diseases or prolonged acute affections, and convalescents we observe attacks of fever or recrudescences of fever from causes which, in the healthy person, may, indeed, augment calorification, but are not able to elevate the temperature. In this manner, also, is explained the singular fact that during recovery from typhoid fever the same cause may produce indifferently syncope or a febrile access. The same reason explains why, among convalescents, the ascent of temperature which follows rising diminishes gradually in proportion as increasing alimentation recruits their force. Very slight physical exertion of a patient suffering or just recovering from typhoid fever will suffice to cause an ascent of temperature. Professor Bouchard discusses the generation of heat in the healthy subject by physical exercise. He refers to his observations upon a healthy man, of moderate strength, habituated to exercise, but not carrying it to an extreme. The man was directed to perform every day, at the same time and with the same rapidity, the same exercise. The exercise began immediately after rising, at a time when the rectal temperature, reduced by the night's rest, had risen to 37° or 37.1° C. (98.6° or 98.7° F.). The mean rise which occurred in half an hour was 1° C. (1.8° F.). The ascent was at first quite rapid, but became gradually more slow after the appearance of perspiration, and at last the mercury became stationary, notwithstanding continuation of exercise. When the experiment was varied, it was ascertained that the elevation of temperature was in relationship to the intensity of effort, rather than to its duration. An energetic but short exercise gave rise to an elevation which lasted for ten or fifteen minutes after the physical effort was discontinued. Reduction of the temperature generally began from sixteen to twenty-two minutes after the end of the work. From the invariable regularity of the results Professor Bouchard feels himself warranted in declaring that, in the normal state, moderate work produces in man an increase of body-heat, which, however, is soon limited by the loss through perspiration. The reduction of cutaneous temperature during muscular work begins while the rectal temperature still continues to ascend. The mean of many observations has shown that in healthy men in repose the temperature of the groin is 0.6° C. (1.08° F.) lower than that of the rectum. Perspiration, as a result of physical exertion, increases the difference to 1.2° C. (2.1° F.). A similar difference is observed when the rise of temperature is due to a fever. In as far as the disease checks perspiration the skin and the rectum exhibit a parallel increase, the mean of the differences being 0.6° C. (1.8° F.). When perspiration occurs, the difference amounts to 1.1° C. (nearly 2° F.). It is more difficult to demonstrate in healthy men the calorific effect of a meal. The effect is not denied; if oxygen intervenes in the production of heat, there is no doubt that the element is furnished directly or indirectly at the expense of the aliments. We also know that the functional activity of the digestive and salivary glands and the liver is a source of heat. When the diet is too abundant, or when the digestive function is impaired, ingestion is followed by a thermic rise, due either to excessive energy of the glands or an action exercised upon the nervous system by the imperfect products of digestion. This is the fever which should not be regarded as a relapse or recrudescence of the original malady. Intellectual activity does not, in itself, give rise to much increase of temperature, but its influence may pass beyond the intellectual zones and extend to the thermogenic areas. Fever may thus be occasioned by an action of the whole body upon nutrition. This increase of temperature from mental labor, little manifested in health, is decided in illness. Practitioners are aware that speaking, reading, or attending to business will provoke a return of fever in one just recovering from a pyrexia. The same result is determined by emotional excitement. The antipyretic effect of the cold bath may even be counteracted by these causes, and, in an excited woman who has resisted balneation, a rise of temperature may occur even while she is immersed. These facts may throw a light also upon what has been called hysterical fever, and have no relation to auto-suggestion. The effect is due to struggle and nervous fatigue. In health a nervous mechanism regulates the thermogenic result of muscular exertion, but nervous debility renders this protection less vigilant or less efficacious. Such debility renders the organism particularly susceptible to the influence of the causes of fever. EMPYEMA OF THE SPHENOIDAL led to the recognition of pathological conditions which were formerly only vaguely inferred, or, it may be, not even suspected. By means of such studies, it is almost needless to say, our data for exact diagnosis have been greatly enlarged. It follows that our therapeutical methods have been correspondingly enriched. "Dyspeptic fever is," says Professor Bouchard, "a reality." The flushing of the face, dyspnoa, marked acceleration of the pulse, are not the simple result of a reflex influence produced by the contact of a too great quantity of food with the normal gastric mucous membrane, or by a normal mass with an irritable mucosa. It represents a true fever, with elevation of central temperature. The speaker had seen the An interesting monograph from the pen of thermometer rise to 39 4° C. (109.2° F.). that, excellent teacher, Professor Moure, of Such fever is not rare in the adult, and is fre- Bordeaux, presents us with the results of the quent in children. In the weakness caused by study of localized inflammation of the sphea prolonged illness, or when, during conva- noidal sinus. Although this cavity is apparlescence, the digestive tract has lost its func-ently far removed from observation, yet, says tional power, the first meal or meals dispropor- the author, its methodical exploration is, pertionately large may produce an access of fever, haps, the most simple and easy of any of the accessory nasal sinuses. The first writer to call attention to disease of the sphenoidal sinus was Berger, of Gratz, but his papers seem to have been neglected for several years, until, in 1892, his views received confirmation by Max Schaeffer, of Bremen, and other authors. The sphenoidal sinus, as is well known, communicates with the nasal fossæ by means of two orifices situated at the posterior part of the superior meatus. The cavity is subdivided by a more or less complete and more or less vertical septum. Sometimes a number of septa are present, and Professor Moure, in examining the cadaver, has found horizontal partitions subdividing one or both sinuses into unequal parts. The situation and the dimensions of the orifices are also subject to considerable varia tion. At times placed very high, near the base of the skull, the openings are, in other cases, found at a lower point and adjacent to the nasal septum. From their posterior position their contents discharge rather into the naso-pharynx than into the nasal fossæ. day. Warm foot baths and sinapisms, gentle and moist heat are likewise conditions which favor cure. If the trouble resist these methods, M. Schaeffer advises anæsthetization of the mucosa of the middle turbinated bone and the septum by means of cocaine, followed by catheterization of the sinus. This operation is performed by carrying a sound gently upward and from before backward, passing it along the anterior face of the sphenoid bone. During this procedure a depression or orifice is encountered and may be easily penetrated. At this moment the extremity of the sound is at a distance which varies from nine to eleven centimetres (about three and one-half to four and one half inches) from the entrance to the nose. After the opening has been rendered patulous, the sound is withdrawn, the patient is directed to blow his nose, and the contents of the sinus are expelled in a more or less compact mass, formed by sanious pus. The discharge of this matter relieves the pain. In some cases it is impossible to find the orifice. In this event, if the sufferings are severe, it is recommended to break through the wall of the sinus, an operation of no great difficulty, as the bony shell is usually distended and weakened. The contents of the sinus having been evacuated, a sufflation of air by means of a sound is also recommended for accomplishing the same purpose. With the object of liquefying or thinning the secretion the patient, for some ensuing days, is placed upon iodine. As Schaeffer demonstrated, it is not rare, in consequence of an acute coryza, for the inflammation to attack with particular intensity a certain area of the mucous membrane. We may, therefore, understand that the disease may limit itself to the lining membrane of the sphe-warm solution of boric acid is injected. Innoidal sinus. In acute sphenoiditis the patients generally complain of severe pain in the occiput or toward the base of the skull. The back of the neck is more or less stiff. There is a disagreeable sensation of tension at the bottom of the eyes, and ocular difficulty affects one or both eyes, according as one or both sinuses are involved. Sometimes there is a sense of faint ness, or even of vertigo, and, in all cases, the general symptoms are more marked than in ordinary coryza. Upon direct examination it is recognized that the pituita, situated in front of the sinus, is swollen and reddened. The middle turbinated bone appears as if projected forward and continuous with the mucous membrane of the septum, on account of the effacement of the groove which separates these parts. Very often the remainder of the mucous membrane is healthy or but slightly swollen. The treatment of acute inflammation consists in emollient nasal fumigations several times a The affection is often cured with the coryza from which it originated, and the treatment above outlined is reserved for those cases which prove stubborn or are accompanied by so much pain that there is reason to fear the development of complications. Chronic suppuration of the sphenoidal sinus may, unless sought for, often escape recognition. It is a frequent accompaniment of atrophic coryza. Its subjective symptoms are much less pronounced than those of the acute form. Some patients are troubled by an abundant secretion, which falls into the nasopharynx and occasions hawking efforts. All the manifestations of classical naso pharyngeal catarrh are observed. In some cases the secre |