each dose of the acid might obviate this result to some extent. The third case, reported by Dr. Ogle, was remarkable, inasmuch as the patient, a girl of eighteen, after taking one hundred and eighty grains in eighteen hours, appeared to be suffering from all the effects of severe cinchonism, and he has observed a similar result in another case. This would decidedly seem to point to a similarity of its action with that of quinine. In all the cases the acid was given in solution with bicarbonate of soda, just sufficient to dissolve it. It was found to be preferable to giving a large dose of an insoluble powder; while with the soda it forms an agreeable mixture, almost without taste, quite in contrast to the solution of the acid in borate of soda, which is decidedly the reverse of pleasant. (British Medical Journal, March 17, 1877.)

Erythroxylon Cuca in the Treatment of Febrile Diseases. Dr. McBean, of Newcastle, refers to the observations of Dr. Ringer, showing that in all febrile diseases, with the exception of yellow fever, the amount of urea formed is abnormally increased, and that as urea represents the wear and tear of the frame (tissue metamorphosis) it may be regarded as affording, in fever, not only an index of the severity of the disease, but also a direct clue to an exceedingly important line of treatment. Dr. McBean submits that as throughout the duration of a case, say of typhus fever, there is present a specific morbific agent which so influences the sympathetic nervous system as to produce or permit an amount of tissue metamorphosis (indicated by the increased quantity of urea excreted) not only incompatible with health, but most probably productive of the various febrile phenomena, the sum of which constitutes this disease; therefore to restrain such metamorphosis until the morbific agency has ceased to exist is clearly indicated as the most desirable end to accomplish in treatment. To accomplish this end he believes we possess a very efficient remedy in cuca, the dried leaves of the erythroxylon cuca. Dr. McBean gives several cases in which good recovery took place after the use of cuca. He states that he has also found cuca of great service in both acute and chronic pneumonic phthisis. Where there is much febrile excitement, it lowers the temperature and restrains, or materially alleviates, the distressing perspiration. (British Medical Journal, March 10, 1877.)

Treatment of Typhoid Fever.-In notes made by Dr. Edebohls on the mode of treating typhoid fever in St. Francis Hospital, New York, it is stated that iodine has usurped the place of the mineral acids, and is given internally in all cases. It is believed to lessen the troublesome gastric irritation so often present, and to diminish the number of evacuations from the

bowels. The formula usually employed is, B Iodinii 3j., Potassii iodidi 3ij., Aq. Dist. 3x. Misci. Three drops to be taken in a wineglassful of water every three hours. Lugol's solution, the Liq. Iodinii Comp. of the Pharmacopoeia, may be used in doses of six drops every three hours. In patients possessing the average physical strength, and sick with typhoid fever, the cold bath is employed promptly whenever the temperature of the body rises above 103° F. The patient is immersed to the neck in water having a temperature of 85°-90° F., and cold water is then steadily added, until a bath having a temperature of from 38° to 60° F. is obtained. After remaining in the bath from ten to twenty minutes the patient is removed, rubbed dry, enveloped in a blanket and put in bed, and an ounce of brandy administered to aid in establishing reaction. The thermometer is used fifteen minutes after the patient has been placed in bed, and the temperature in the rectum of a male and in the vagina in the female, has, as a rule, been found to have been reduced from 2°-4° F. If at any time during the employment of the bath symptoms of marked prostration supervene-as evidenced by decided chilliness, lividity of the surface, most readily detected on the prolabia and nails, chattering of teeth, &c.-the patient is immediately taken out of the water, rubbed dry, and warmly covered in bed. In conjunction with the cold bath, quinine might or might not be administered. When, for any reason, cold water is contraindicated, chief reliance has been placed upon the antipyretic influence of quinine. The drug has been used in the following manner:-1st. It has been given in small doses, frequently repeated (five grains every two or three hours). 2nd. Twenty or thirty grains have been administered in one or two doses at the time when the temperature was highest, generally late in the afternoon. 3rd. The same quantity has been administered in one or two doses when the temperature had about reached its lowest point. Of these three methods the first had exercised but little influence in controlling the temperature; the second had generally yielded tangible results in so far as the temperature, taken from one to two hours after the administration of the drug, had generally been found to have been more or less reduced; but the improvement was only transient, and another large dose was soon required. The third method was considered the most judicious, and was the one generally employed. (The Medical Record, No. 314.)

Extracts from British and Foreign Journals.

Necessity of Caution in the Use of the Aspirator.— E. Pingaud adduces two cases which show that under certain circumstances the application of the aspirator may cause rupture of blood-vessels and dangerous symptoms. In one of the cases a man met with a railway accident, causing a compound fracture of the skull and strong depression, which was not removed after the trepan had been twice applied. Ten days subsequently symptoms of intracranial suppuration made their appearance. M. Pingaud passed the needle of Dieulafoy's apparatus through the dura mater and the brain, and, after several unsuccessful penetrations, some brownish-coloured pus escaped by the tube. The canula was not immediately removed, and a sudden flow of blood took place, which instantly produced the most severe cerebral symptoms, complete paralysis, deep coma, stertorous breathing, and dilatation and immobility of the pupil. In order to diminish the pressure which had been occasioned by the hæmorrhage into the cavity of the abscess, M. Pingaud divided the dura mater freely, and made the point of the bistoury enter the cavity. A few grammes of blood escaped, and the grave symptoms immediately disappeared. Death, however, took place on the following morning. Post-mortem examination showed a fracture of the base of the skull. The cavity of the abscess was filled with fresh coagulum of blood, which had burst through the walls of the lateral ventricle, and had filled all the ventricles. In the second case a puncture was made into an abscess resulting from caries of the vertebræ. Very little pus escaped, mingled with a few drops of blood. The canula was immediately removed, but the whole cavity became tense with blood; distinct fluctuation was perceptible; recovery took place by absorption. (Gazette Hebdomadaire and Centralblatt. f. Chirurgie, No. 30, 1876.)

External Application of Mercury.-C. Balogh, in a communication to the Medical Society of Buda-Pest, states that rabbits died after the inunction of fifteen grains of Unguentum Hydrargyri in from nine to ten days (33 milligrammes of finely

divided mercury to 100 grammes of body weight are thus fatal). The skin of the dead animal was submitted to microscopical examination, and fine globules of the metal were found in the hair follicles and sweat glands, as well as in the connective tissue-cells and the interstices of the tissue, the particles which were most deeply situated being the smallest. Balogh believes that the mercury is volatilised in this mode of administration at the ordinary temperature of the body, and is then absorbed by the fluids of the body and by the blood. Black oxide of mercury, which is always contained in mercurial ointment that has long been made, proves fatal in somewhat smaller doses than pure mercury. It also penetrates into the cutaneous glands if rubbed in with fat, and breaks up in passing into valerianic and capronic acids in combination with mercury, and finally into the pure metal. The yellow oxide of mercury in solution in oil is far more energetic than either of the above preparations; it proves fatal to rabbits when applied externally, even in doses of 4 milligrammes to the 100 grammes of body weight. In a ten per cent. solution it causes violent dermatitis, and very rapidly produces its general poisonous effects. The easily-oxidisable oleic acid quickly burns in the body, and the mercury is distributed through the body in statu nascendi as a gas. M. Balogh believes that in mercury—albuminate solutions-the mercury is in the regulinic state. The rabbit experimented on lost appetite and weight, the temperature fell, and diarrhoea, dyspnoea, and albuminuria supervened. After death the brain was found to be anæmic, the lungs hyperæmic, the villi of the small intestine were detached, the Lieberkulmian follicles were swollen, and fatty degeneration was observed in the liver, kidneys, brain, and other organs. The preparations of mercury cause the disappearance of syphilitic neoplastic formations by causing them to undergo fatty degeneration. (Centralblatt f. Chirurgie, No. 32, 1876.)

Treatment of Carbuncle.-Raimbert, supported by the views of Davaine, that the origin of carbuncle and of the socalled malignant oedema is connected with the migration of poisonous bacteria, which can be rendered innocuous by antiseptic means, treated the following cases by the subcutaneous injection of carbolic acid:-1. An artisan, forty-six years of age; the vesicles appearing behind the ear, followed rapidly by infiltration of the whole face, and great prostration. Treatment by means of the actual cautery, then with sublimates, proved unsuccessful; but repeated injections of a two per cent. solution of carbolic acid effected a cure in twenty days. The infection apparently took place from a diseased sheep. 2. A labourer, aged forty-eight; carbuncular pustule in the hand from injection

NO. CVI.

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of the blood of a diseased cow. Three days after the infection the wound was cauterised with caustic potash, but the swelling extended up the whole arm. Repeated incisions and cauterisations proved totally ineffective, but injections of carbolic acid (diluted), after producing momentary syncope, caused rapid improvement and ultimate recovery, though the skin became gangrenous on the ring finger. 3. A woman, twenty-three years of age, in the seventh month of pregnancy, in whom the disease probably arose through the skins of animals. A car buncle appeared on the cheek with extended infiltration and gangrene of the skin. On the evening of the third day subcutaneous injections were made with diluted tincture of iodine, improvement occurring in the local symptoms, but the child died, abortion taking place on the eighth day, followed by considerable hæmorrhage, with steadily increasing debility and attacks of swooning, and death on the tenth day from the commencement of disease. Microscopical examination of a blood coagulum taken from the patient whilst living contained no bacteria. Raimbert arrives at the following conclusions:-Cauterisation of a fresh carbuncle is rational because it destroys the bacteria, which may be supposed to be in the skin and especially in the circumscribed scab; as long as the poison is limited to the skin and subcutaneous connective tissue, we may hope to neutralize it by the subcutaneous injection of antiseptic solutions, which must be made in sufficient numbers in appropriate positions. If the poison has been absorbed into the blood, subcutaneous injections are no longer capable of destroying it; and M. Raimbert considers intravenous injections as too dangerous a proceeding to be adopted. (Gazette Hebdomadaire, 1876, No. 25.)

M.

Selection of Anæsthetics for Dental Surgery.-M. Moreau-Marmont gives the preference to nitrous oxide gas to other anæsthetics on account of its relative freedom from danger. According to statistics collected by Darin, 53 deaths occurred in 152,260 administrations of chloroform, or 1: 2,872; 4 in 92,815 of ether, or 1:23,203, and 3 in 300,000 of gas, or 1:100,000, one of which was due to an accident, namely, the falling of a cork into the air-passages. He attempts to give an explanation of the less danger of nitrous oxide gas, and thinks it deserving of general introduction into minor surgery. (Gazette des Hôpitaux, 1876, Nos. 88, 89.)

Carbolised Jute Dressing.-R Köhler describes the mode of using this kind of dressing practised in Bardeleben's clinic. In amputation and similar operations it has been found exceedingly serviceable, and it is extremely cheap. It appears to be in common use for open wounds. If bleeding has ceased, the wound is thoroughly washed out with a three per cent. solution