swollen, and the attacks occur as a reflex from this. The time required for this is from three to six hours, bringing the attacks on early after midnight.

Dr. Black reported from his service at the City Hospital a traumatic aneurism of the temporal artery in a negro girl. Into the sac was a small opening, from which a constant stream of blood flowed. It was treated by pressure with a compress and bandage. In three days there was decided improvement. The bandage was replaced, and when removed a few days later the cure was complete.

Dr. H. Jones tried pressure on an aneurism caused by a blow on the temporal artery for four days, and then for three days, without result. He then ligated the artery, and cured the aneurism.

Dr. Krauss recalled a most graphic description he had given the Society a few meetings before of distressing results from cocaine in a patient to whom he gave it. Recently, to complete an operation he at that time abandoned, he tried on the same patient chloroform as an anesthetic, given by a most experienced anesthetist, and the patient again became so unmanageably insane that he had again to abandon the operation. So he attributes these manifestations more to peculiarities of the patient than to the anesthetic.

Dr. Williams was glad to hear this addition to the report on the effect of cocaine, as he finds it a most useful agent.

The doctor reported briefly a most unusual case of unilat eral facial atrophy, the bones, and all overlying tissue, one side of palate and tongue being involved; no sensory disturbance. There are only sixty or seventy such cases on record. The atrophy of the bone differentiates this disease from progressive muscular atrophy. The only history the patient brings is of having suffered from a burn on the affected side in childhood. A. B. HOLDER, M.D., Sec'y.

Paraldehyd possesses many of the good without the evil qualities of chloral. Used in insomnia resulting from various causes. The objectionable taste of the chemical is to a great extent disguised in Robinson's Elixir Paraldehyd (see adv.), which is an elegant preparation.

Translations.

BRAIN SURGERY.*

A successful case of brain surgery is reported in the City of Mexico by Dr. Lavista. The skull was trepanned directly over an intracerebral abscess. Upon removal of the button of bone, a pachymeningitis, complicated with suppurating cerebritis, was found. The abscess contained a considerable amount of pus, which escaped from a tunnel 11 centimeters in depth. At the bottom of the tunnel was found a small glio-sarcoma, attached by a wide pedicle; this was removed.

Before the operation the patient suffered hemianesthesia, hemiplegia of movement, and paralysis of the right muscle motor oculi. After the operation he immediately recovered his reason, power of speech and all sensibilities, and the pupil returned to its normal state, and there was no impairment of any other function. The wound was dressed antiseptically and a Nebauer drainage tube inserted, which became clogged with brain detritus, and was removed and replaced with a sterilized hard rubber one. The patient fully recovered.

Itching in Scarlet Fevers

Is not always agreeable, but it has never been supposed to be a favorable sign, yet St. Phillippe (Rev. Mens. des Mal. de Lienf., February, 1890), according to A. F. C., in Archiv. Ped., in a paper presents the following conclusions:

1. Scarlatina is a disease which is often accompanied by itching.

2. This variety usually has a favorable prognosis.

3. The itching is due to the fact that the eruption is not intense, and the cutaneous lesions not very profound.

The best application for the relief of this itching, or almost any other, for that matter, is the following: R Camphophenique, 3 ss; albolene unguent, 3jss. M. Sig.: Apply night and morning. Another advantage is, that it is in the direction of personal disinfection.

* Translated from the Spanish, Gaceta Medica, City of Mexico, by Geo. Mott, M.D., Spurger, Tex.

Miscellaneous Selections.

Piperazine-Uric Acid Solvent.

A recent communication on piperazine, by Dr. Biesenthal in the Berlin Klinische Wochenscrift, contains a very favorable report on this remedy, from which the following information is gleaned. The non-corrosive and non-poisonous action of the strong base is remarked, and confirmatory evidence given not only of the extraordinary solvent action of piperazine on uric acid, but also of its capability of dissolving the organic cementing substances that bind the uric acid concrements together. On internal administration, piperazine, which is not decomposed in the human system, first saturates the uric acid still dissolved in the organism, and the remainder, dissolved in the alkaline blood, attacks any deposits of uric acid, dissolving both acid and cement, and carrying the former out of the system in the form of the easily soluble neutral urate of piperazine.

As a result of the solvent action of piperazine upon the organic cementing material of concrements, it has occurred many times in the experience of Dr. Biesenthal that concrements composed almost entirely of calcium phosphate and uric acid were disintegrated by this remedy. The piperazine dissolved the combining material that held together the particles of calcium salt, and consequently loosened the whole mass so that the concrement became friable and readily broken up. On account of this property of piperazine attacking and disintegrating concrements composed largely of phos phate of lime, it is further a special advantage that the base does not communicate an alkaline character to the urine, as by its use there is no danger of the formation of deposits of phosphates. For the same reason the combined treatment of sufferers from uric acid diathesis with such large doses of alkaline carbonates, as for instance administered in Vichy, Eau de Vals or Wiesbaden gout water, is extremely questionable, and may produce more harm than good. The formation of vesical stones from urine containing much phosphate of lime in solution at the temperature of the body, must be enormously

increased by the regular administration of large quantities of strongly alkaline mineral water, since the phosphoric acid will be neutralized and the phosphate of lime precipitated, giving rise to fresh deposits of vesical calculi. The continuance of the mineral water treatment frequently accounts, it is thought, for the difference in chemical composition between the renal and vesical calculi, the former generally consisting principally of urates, the latter of phosphates and oxalates. This theory finds confirmation in the examination of many urine concrements, a very instructive specimen of which was recently described, by Dr. Israel, as consisting of a small uric acid nucleus, around which phosphate of lime had accumulated to form a mass of considerable proportions. The patient from whom it was removed had partaken of the Obersalz spring for a considerable time, which contains considerable quantities of alkaline carbonates. Thus the physician should consider the danger of the alkaline treatment, and at least limit the use of alkaline waters and combine the piperazine treatment. Besides 47 recent cases in his own practice, Dr. Biesenthal has collected 220 cases from colleagues, in which piperazine has been employed with great success. All observers agree that piperazine is a very safe remedy in fresh cases of gout, and that even in chronic gout its action very seldom fails, since, especially by regular continued use of the preparation, even in small doses (two to three grams weekly) it exercises a certain prophylactic action. Piperazine has also proved valuable in all cases of renal colic, and also in numerous hemorrhages of the urine passages. The scope of action for piperazine appears to be capable of great extension, especially in the direction of diseases in which increased uric acid secretion is observed, as for instance in leucemia, in which an absolute increase in uric acid has been determined by Fleischer and Petzoldt, and favorable results obtained with piperazine by Professor Mosler. Also its use in chlorosis is indicated by the investigations of Bartel, and it seems worthy of a trial in croupous pneumonia, emphysema of the lungs, degeneration of the heart, and edema. The results obtained up to the present are at any rate sufficient to show that the treatment with piperazine is not confined to its solvent action on uric acid in the urine, but also

on deposits of uric acid in different parts of the body, and the neutralization of free acid in the joints and tissues.-Notes on New Remedies.

Gall-Bladder Surgery.

Richardson (Boston Medical and Surgical Journal, 1892, No. 17) reports the following cases:

A woman, aged thirty, had attacks of colic for seven years. When examined, there was seen a considerable degree of jaundice, and the liver was somewhat enlarged. There was some tenderness over the gall-bladder, but no distention could be made out. Although the diagnosis of obstruction of the common duct, due to gall-stone, was made, the symptoms did not seem severe enough to demand operation. Suddenly, five months later, the patient developed symptoms of a violent peritonitis, and died. At the autopsy, a large stone was found in the common duct, which had become perforated, causing peritonitis. The lesson taught by this unfortunate case added to a considerable experience in gall-bladder surgery since, has led Dr. Richardson to strongly urge exploration in similar cases.

A man, thirty-nine years of age, had a tumor of the gallbladder, with loss of flesh and persistent jaundice. There was a history of having passed a gall-stone. At the margin of the ribs on the right side there was felt a round, fluctuating tumor, with two or three hard nodules at the upper part. In spite of the probability that this case was of a malignant nature, exploration was advised. The gall-bladder was emptied by an aspirating needle of a quart of fluid as clear as water. Further examination revealed malignant disease in the neighborhood of the common duct, and nothing more was done. Death occurred ten days later. Post-mortem showed cancer of the liver, with primary disease of the head of the pancreas.

Another case was that of a male, aged fifty-eight years, with symptoms much like those of the last patient. The gall-bladder was stitched to the abdominal wall, and opened. A pint and a half of pure bile escaped. The cause of the obstruction could not be ascertained. The patient died nine days after the operation. Autopsy revealed cancer of the head of the pancreas. In neither of these cases was the operation the cause of the fatal termination.