character, this is perhaps more due to the imperfect state of our knowledge than to the turn of the author's mind. There is much food for thought, and if Dr. Fothergill's views are not conclusive they may suggest profitable lines of research.

of great advantage to the practitioner to have general principles to guide him, and that he should not, when confronted with an assemblage of pathological symptoms, be at the mercy of an unreasoned experience of a similar case, or be obliged to swear in verba magistri. He will find in this work reasons for not looking upon drugs as grouped in fixed and unalterable categories, but learn when and why he may give opium to cause purgation and castor-oil to check it. We strongly commend it to our readers.

Clinic of the Month.

Alcohol as Food.-Some recent experiments by Mr. Wanklyn, made conjointly with Mr. W. J. Cooper, promise to throw some light on the much vexed question of the transformations of alcohol when taken into the stomach. A weak solution of alcohol -one part to a thousand of water-was passed many times through a silicated carbon filter, and was then examined. Four-fifths of the alcohol had disappeared, no acetic acid was present; but the solution contained twenty grains per gallon of organic matter which was not volatile at the boiling point of water. It was suggested, that the alcohol may have been oxidised into glycol; and if this be so, the transformation of alcohol by oxidation into a substance of nutritive value has been here accomplished; and this will have to be taken into account by physiologists in subsequent investigations of its value as food. If a quarter of a pint of brandy be taken in the ordinary way, this, when distributed through the fluids of the body, would give an alcoholic solution of about one part in a thousand, such as was used in this experiment. (British Medical Journal, November 4, 1876.)

Treatment of Acute Pneumonia by Turpentine.Mr. R. E. Power, Dartmoor, has adopted the following treatment with great success in pneumonia:

First, a hot terebinthinate stupe is applied until the skin is well reddened; then a little plain oil of turpentine sprinkled over the affected part; finally, a blanket wrung out of boiling water covered with a dry blanket. He has had patients delirious and gasping for breath, with sordes on the lips (patients who should have seen the doctor twelve hours previously), fall asleep as the last blanket was applied and awake out of danger. The internal remedies subsequently used were quinine and tincture of perchloride of iron. Diet: milk and water, beeftea, lemonade ad libitum, occasionally wine. The application of the turpentine to little children must, of course, be modified to suit the age. In all cases, he keeps on the swathe three or four days or more uninterruptedly. He has found that, as a

rule, the active treatment need not be pursued very long, the patient being generally out of danger in twenty-four or fortyeight hours. The sequelae of pneumonia are much modified; frequently altogether escaped. (British Medical Journal, November 11, 1876.)

Liquor Ferri Perchloridi Fortior as a Local Application in Erysipelas.—Having during a course of several years, in hospital and private practice, used a variety of local applications in simple or cutaneous erysipelas, Dr. Leavens White has for the past two years discarded all for the above, which he has never seen to fail. The form in which he uses it is the following: -Equal parts of liquor ferri perchloridi fortior (B.P.) and spiritus vini rectificatus; the whole affected surface, and about an inch beyond the affected parts, to be painted over with the lotion by means of a camel's hair brush. (British Medical Journal, December 9, 1876.)

Remedies for Chronic Diarrhoea.- Dr. Kent Spender remarks that at this time of the year medical men are often troubled with cases in which a painless diarrhoea is the leading symptom. It may come and go with the changes of temperature (being specially influenced by dampness of air and decaying vegetation), or it may be the sequel of an acute form of the malady which was never properly cured during the summer. Assuming that most of the common remedies within reach have been tried and have only partially succeeded, he recommends firstly, a systematic use of the more powerful vegetable astringents somewhat as follows:-(a.) A teaspoonful of tincture of galls in an ounce of distilled water three times a day is extremely effective, and should be continued at least once daily for some weeks. (b.) The liquid extract of bael has many merits, and may be given in the same way. (c.) Salicin should be administered in a dose of five or six grains, perhaps combined with a grain of ipecacuanha. Let them be mixed into a couple of pills, and taken three or four times a day. This plan seldom fails to appease an obstinate diarrhoea. But, secondly, opium is now and then absolutely necessary, and he contends that it should always be prescribed in comparatively small and frequent doses, so as to obtain the least physiological with the most medicinal effect. Let the wine of opium be given to an adult in the quantity of three or four minims (with an ounce of chloroform water) five or six times in the twenty-four hours, and the remedy ought invariably to be left off by degrees. Speedy and permanent results may follow this method. One point in diet is important. Sometimes bread in any form disagrees, and, in the place of it, the patient ought exclusively to eat biscuits. (British Medical Journal, December 9, 1876.)

Bicarbonate of Potash as a Nerve-Sedative.-Mr. Erskine Stuart considers that the bicarbonate of potash can easily be demonstrated to be a nerve-sedative by any one taking a large dose of it, such as a drachm, in water. A peculiar tingling, numbing sensation is soon felt in the lips and cheeks, and afterwards in various parts of the body, extending gradually downwards to the lower limbs. He has used this drug, combined with the bromide of potassium in epilepsy, with decided effect and has not the slightest doubt that this sedative action on the nerves has a great deal to do with the successful treatment of rheumatism by the bicarbonate. As this is a fact, it is desirable, in treating rheumatic fever with this drug, to give it in sufficiently large doses, such as a drachm dissolved in water, every few hours. That some cases are best treated by means of alkalies there can be no doubt. Others, however, and especially those where there is great hyperpyrexia, are better under the salicine or salicylic acid treatment. (British Medical Journal, December 9, 1876.)

Croton Chloral in Neuralgia.-This substance, according to Dr. Markham Skerritt, is in reality butyl chloral, containing, as Liebreich's researches show, two more equivalents of hydrogen than was formerly supposed. It is essentially an anesthetic, and, in large doses, an hypnotic. The anesthetic influence always commences at the head, and only after this region is fully under the influence of the croton chloral, and sleep has been induced, does the anesthetic effect gradually extend over the rest of the body. With large doses the respiration and pulse become slower, and a fatal result is due to arrest of the respiratory movements, not to paralysis of the heart. In this respect croton chloral differs from chloral, as with the latter death occurs directly from cessation of the heart's action. Dr. Skerritt prescribed the drug for 120 hospital patients at Bristol. In his hands—and he gives the details of many cases-croton chloral was of the greatest use in neuralgias of the fifth nerve, appearing in many cases to act as a specific. Its effect is, however, not always to be relied upon, and he has found that certain conditions are more favourable to its success than others; thus the most marked benefit attended its use in the neuralgias of young or comparatively young patients, especially in the headaches of anæmic women and girls. In these cases either cure or relief resulted in 86 per cent. of the cases treated. About the climacteric period the success fell to about 50 per cent., while, in later life, there was again a rise to about 60 per cent. At the climacteric period bromide of potassium seemed to be more reliable in its action. Again, when the headache occurred in patients with marked hysterical symptoms, the results were not nearly so favourable; in fact, he has arrived at

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the conviction that the presence of hysteria renders the success of the drug very doubtful. It is, he remarks, of course necessary to remember that in giving croton chloral for the neuralgic headache of anæmia we are treating only one symptom of the anæmic condition, and that we must also direct our attention to the removal of that state. Although he is not aware that this substance can be regarded as a direct tonic, yet it is certain that many patients do improve in their general health whilst taking it; it is an indirect tonic, and acts by the removal of what, perhaps, more than anything else conduces to anæmia, and malnutrition-that is, frequent or constant pain. Doubtless, when the general health has been improved by tonics, the neuralgia will in many cases disappear. But the special advantage of croton chloral is that it will often quickly remove that which chiefly distresses and wearies the patient; in not a few instances, where tonics have improved the general condition, but have left the headache untouched, croton chloral has quickly cured this, and a too speedy substitution of tonics for croton chloral has been followed by a return of the pain. The two kinds of remedies may be advantageously given at the same time, so that the croton chloral may keep the neuralgia in check, while the tonic attacks the original cause of the trouble. (Lancet, Dec. 9, 1876.)

Arteries of the Retina in Bright's Disease. From observations of five cases Dr. Gowers confirms the usual observation that the arteries of the retina are contracted in this disease, but while this condition is usually regarded as a consequence of the retinal change, he insists that it may also occur quite independently of retinal change and stands commonly in direct relation to another condition, viz., the blood tension, which, in the cases examined, increased in proportion to the contraction of the arteries. He considers that this fact affords a direct proof of the correctness of Dr. George Johnson's theory, that the increased tension of the blood in Bright's disease is due, in part, at least, to contraction of the arteries. Examination of the retinal vessels may be useful in the diagnosis of Bright's disease in cases where the arterial tension, as shown by the incompressibility of the pulse, cannot be easily tested, on account of its smallness and the amount of subcutaneous fat or oedema. may also help ultimately to distinguish between different morbid states, at present included under the term Bright's disease, and imperfectly distinguished from each other. (Brit. Med. Journ. Dec. 9.)

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