THE Lexow investigation has brought out the fact that there are 10,000 opium-smokers in New York City.

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THE Louisville physicians tamely submit to a license tax of $10 despite the notorious conflicting legal fact that they are exempt from jury duty on the ground that their occupation is affected with a public use.

THE "Medical Rec." is much disturbed over its discovery of "paternal impressions' in a lucubration by Dr. Cullen, a "surgeon-accoucher" who revamps certain old notions discussed under the title of the "heredity of influence" by Ribot. In consequence it views with alarm the prospects of sex war.

DR. ROMBERG concludes ("Med. Fortnightly") that the highest grades of parenchymatous degeneration of the heart muscle are present by the end of the second week in typhoid fever, then slowly disappear in the later weeks; interstitial myocarditis begins mostly at the end of the second week, while in scarlet fever it begins mostly on the fourth day, becoming excessive in middle of second week; in diphtheria, degeneration begins at the seventh or ninth day, and reaches its highest development at the end of second or beginning of third week, except the characteristic fatty degeneration of diphtheria which begins often very late. During fever, irregularity and smallness of the pulse and dilatation are marked; the best sign of the latter is the gallop rhythm. This is an important physical sign. Amount of urine is usually diminished, slight albuminuria with or without hyaline casts. A bad prognostic sign in diphtheria is a very slow pulse.

DR. PAUL GARNIER of Paris, France, who has made a special study of slum children, says ("Med. Rec."): "There is a flaw in the very nature of these young wretches that the psychologist sees clearly and notes with apprehension-the absence of affective emotions," and where they do not become lunatics they show "insensibility and pitilessness."

DIRT-EATING, according to Dr. Louise R. Smith of Van, Asiatic Turkey,is ("Woman's Medical Journal") frequent in that vicinity. This frequency is hard to explain, unless it be due to the dirt that pervades all food there. Victims among the children may be told at a glance by the yellow, waxy skin, the anæmia being intense. Cases also occur of people who adopt the habit in middle life. Once acquired, dirt-eating has the tenacity of the opium curse. A similar habit exists in the Southern United States.

THERAPEUTICS AND PHARMACOLOGY. INOCULATION AGAINST SNAKE-BITES.From time to time travelers in Central and South America ("Med. Bull.") have brought back stories of a process of vaccination in common use among the Indios bravos, or uncivilized Indians, against the bite of venomous serpents, but not until recently has any European or American undergone or even witnessed the operation. In a recent number of the Archives d'Anthropologie Criminelle, a writer describes the vaccination as practiced upon himself, and gives strong testimong as to its protective value. Says he: "Cocoyango removed one from a bottle containing many fangs of the grago (an extremely venomous serpent), and with it made three incisions near my ankle, each of them about an inch and a quarter in length. The wounds were allowed to bleed for a minute, during which time I became faint, and the perspiration stood in great beads upon my forehead or rolled down my face. He then dusted the wounds with a black powder, and the blood at once ceased to flow. This powder, I have since learned, is composed of the liver and spleen, dried in the sun, and powdered along with the poison-glands of the snake. Cocoyango put some of the powder in his mouth, along with the green leaves of forest trees, and chewed them vigorously together, then applying his lips to the wounds on my ankle forced into them as much as possible of the saliva, just about as one would 'blow up' a bladder, and the operation was finished. I have since been bitten seven times by exceedingly dangerous serpents, gragoes, coral snakes, etc., and I never experienced the slightest effects." The Galibis, Bonis, Emerillons, and other Indians, as well as the Bosso negroes and other indigines of Guiana, proceed in the same manner. They go so far as to claim that the children of a person thus vaccinated are proof against the venom, sometimes for several generations.

CALOTROTSIS IN ECZEMA.-Dr. J. Morton (Indian Med. Rec.") reports the case of a woman who had suffered for nine years from eczema extending from the axilla to the tips of her fingers. After many remedies, both internal and external, had been tried in vain, a poultice of mudar-leaves was applied to the fingers. On

the second day the weeping had stopped and the parts looked healthy. It was continued for another two days, and the fingers were healed. Encouraged with this result, it was applied to the whole arm, which, to the surprise of both doctor and patient, was well within a week.

TIN PLATE TREATMENT OF ULCERS.In the Vanderbilt Clinic of N. Y. College of Physicians and Surgeons, the staff ("Med. Bull.") has been very successful in the treatment of ulcers by means of a tin plate. A piece of tin is cut slightly larger than the ulcer and the edges bent upward so they will not injure the patient. The plate is then bent so that it will fit the leg quite snugly and evenly. A piece of thin rubber tissue is wrapped around the plate, which is now ready to be placed on the ulcer. It is held down by strips of adhesive plaster, and over this is placed a compress wrung out of a bichloride solution 1 to 5000. The leg is then bandaged, pressure being made on the plate. At the end of every four or five days the bandage and plate are removed, and the ulcer sponged gently with peroxide of hydrogen, care being taken not to rub off the new layer of epithelium which has been formed. The ulcer must be in a fairly healthy condition for this treatment to be effective; if sloughing, apply a wet dressing for a week or two, and at the end of that time the ulcer will probably be in condition for the plate. This treatment has been tried in about thirty ulcers so far, and in every case the ulcer has healed rapidly. Ulcers of two or three years' standing have in this way been cured in a month.

STRONG CARBOLIC ACID SAFEST.-Dr. O. H. Allis states (Philadelphia "Polyclinic'') that the use of carbolic acid in full strength upon the fresh tissues, raw surfaces, etc., causes the formation of a protection albuminate, a condition which renders further absorption impossible. The same takes place when the strong acid is applied to a raw burned surface. It is not claimed that an aqueous dilution is safe when applied extensively to raw surfaces; on the contrary, the more dilute the more dangerous. In a case of washing out the thorax in the treatment of purulent pleurisy, the late Roger Keys. a most careful, judicious physician, came near losing a patient from absorption of the dilute

acid. It will strike many with astonishment when it is stated that it would be safer to pour a gallon of pure carbolic acid into a purulent thoracic cavity than to pour in a gallon of water into which a single ounce of carbolic acid had been placed. Excess of the strong acid in a cavity such as an abscess cavity, or upon exposed tissues as a burn or a fresh wound, does no harm, while excess of a dilute solution, if left in a cavity or used over an extensive raw surface, will be promptly followed by dangerous if not fatal toxic effects.

UNTOWARD EFFECTS OF IODO FORM.Lewin remarks ("Med. Age") that acne and purpura have been noticed after its internal use. Cutaneous symptoms are frequent, and are chiefly more or less limited to local dermatitis, though it may also be general and not due to local contact; this may be either eczematous, vesicular, pustular, impetiginous or erysipelatous, and often accompanied by high fever. In other cases there may be extensive erythematous eruptions with formation of bullæ or purpural patches, as well as urticaria and papulesintense itching may last for several weeks. Conjunctivitis, changes in the pupils, strabismus, and transient amblyopia, are sometimes reported. Among the nervous symptoms are psychic changes, which either exist alone or are the forerunners of more severe mental affections; in the majority these assume the form of melancholias, with anxiety, uneasiness of mind, inclination to tearfulness, suicidal tendencies, and restlessness, very often alternated with periods of excitation; or they may be associated with vertigo, headache, elevation of temperature, sleeplessness, and small and rapid pulse-the pulse may, without disturbance of the general health, run up so as to be uncountable, while the temperature remains normal, yet the latter is liable to rise several degrees over the normal and remain there for several days without the patient feeling ill. The increase of pulse without accompanying fever is a dangerous symptom in elderly people. Acute confusional insanity, which is the chief symptom of the cerebral action of the antiseptic, when it has once appeared persists, and is accompanied by hallucinations, persecution delusions and attempts at suicide-such patients, as a rule, at night, and even during the day, suddenly jump from their beds, try to spring from the windows, to run away or throw themselves into the water; attempt to tear off bandages, destroy the bed clothes; talk con

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fusedly, stamp the feet, rage, and do not recognize surroundings; this condition may last from a few hours to a few days, and pass over into a morose and tearful state, which soon ends in recovery. They remember nothing of the attack. In some cases the depression increases in intensity, and stupor develops, with refusal to take food, and rapid death. Seizures of anxious excitement and confusion, choreiform attacks, loss of appetite, and vomiting have also been remarked. In men and animals poisoned with iodoform no alterations are found in the brain and its membranes, but fatty or parenchymatous degeneration of the heart muscle, liver, and kidneys.

To

SPARTEINE AND CHLOROFORM ANÆSTHESIA. Dr. Langlois stated at a recent session of the Paris Biologic Society that ("N. Y. Med. Jour.") the accidents to be avoided in anæsthetization with chloroform were primary, or laryngo-reflex, cardiac syncope and secondary, or bulbar, cardiac syncope. Atropine and morphine had been employed to prevent the first, and by so doing the inhibitory action of the pneumogastric nerve upon the heart was diminished. gether with M. Maurange, he had conceived the idea of giving sparteine sulphate hypodermically along with morphine before administering chloroform. This drug, he said, was a regulator of the heart and diminished the excitability of the pneumogastric. After previously injecting about half a grain of sparteine, in rabbits, he had produced rapid and profound anæsthesia; in an animal under the influence of sparteine arrest of respiration caused by the contact of chloroform with the nasal mucous membrane took place, it was true, but the heart rapidly regained its normal rhythm. Diminished excitability of the pneum gastric was to be observed experimentally. In the dog the arterial pressure was kept up in the midst of the most profound narcosis. The remedy had been employed a hundred and twenty times in the human subject. Half a grain or more of sparteine, together with an eighth of a grain of morphine, was injected fifteen minutes before giving the chloroform. Langlois had often had to deal with persons affected with heart disease or subjected to a prolonged operation, but the heart had always continued perfectly steady. Gley asked if sparteine would prevent the accidents that occurred at the outset of the inhalation of chloroform by diminishing the excitability of the pneumogastric nerve. Langlois replied that

as regarded primary syncope, the part of sparteine was of small consequence; it was a tonic and regulator of the heart, acting rather against secondary syncope. Morphine, on the contrary, diminished the danger of primary syncope. OBSTETRICS, GYNIATRICS AND PÆDIATRICS.

PIGMENTATION IN AMENORRHOEA.-Dr. A. E. A. Lawrence reports the case ("Bristol Medico-Chir. Jour.") of an 18-year-old who after menstruating suddenly ceased to menstruate, July, 1888. Skin discoloration began in 1889,

and was as marked as a case of Addison's disease in 1890. The discoloration increased until January, 1893; then the health improved, and in June, 1893, the catamenia became once more established. During her ill-health she was weak and despondent. The treatment consisted of vinum ferri, 3 j., and liquor arsenicalis, v., three times a day, burgundy, plenty of milk, and fresh air. She is now perfectly well. As a rule, this form of pigmentation occurs about the face, neck or hands but it very much resembles the pigmentation of pregnancy. The cause is probably due to the absence of catamenia in either case. Dr. Lawrence thinks it is due to the deposition of coloring matter caused by the nonelimination of something that ought to be got rid of at the menstrual period. Dr. OhmannDumesnil is ("St. Louis Med. and Surg. Jour.") inclined to look for the cause in some sympathetic nerve disturbance, which would also explain the pigmentation of Addison's disease. The relationship of so-called "liver-spots" to menstruation should not be forgotten in this connection.

FEEDING OF INTUBATED CHILDREN.-Intubationists have constantly to contend with cases, in which food persists in "going the wrong way." In such cases resort is had to feeding while the patient is lying on the side, or is resting on his hands and knees, or lying on a board or the mother's lap with the head considerably lower than the trunk. While resort to these methods is most frequently successful, cases will occasionally occur in which they all fail. To meet such cases, Dr. Howard S. Paine of Albany ("Albany Med. Ann.") has used a soft rubber catheter passed through the nostril. Feeding through the nose has been resorted to many times, especially in the treatment of the insane, but the suggestion thus to feed intubation cases is a valuable one which will doubtless save lives otherwise lost.

FALLOPIAN TUBE HISTOLOGY.-Dr. M. A. Dixon-Jones claims ("Amer. Jour. Obstet.") that in the tube wall are six layers of smooth muscles. The two main layers are the circular and the longitudinal. These interlace; the circular has the broader area and is nearer the caliber, the longitudinal is nearer the peritoneum. The inner surface of the tube wall is made up of myxomatous or myxofibrous connective tissue, which in turn is supplied with two muscle layers, a broader longitudinal and a narrow circular, both interlacing. The mucosa has folds with many ramifications, serving for the occlusion of the caliber during life. These folds are the result of alternate contractions and extensions of the two muscle layers of the mucosa, the transverse and longitudinal, which are visible throughout all the folds and all the ramifications, arranged in bundles close beneath the epithelial layer. Outside of the longitudinal layer of the tube wall is the layer of blood vessels, mainly arteries and veins, in an arrangement similar to that known to exist in the wall of the uterus. Beyond the vascular layers are the two narrow layers of smooth muscle fibers, both being oblique, both traceable from the uterine ostium up to the fimbriated extremity of the tube, and they correspond to the two oblique layers of the wall of the uterus. The two oblique layers are bordered outwardly by the peritoneum, and seem to serve mainly for the regulation of the afflux of blood in the subjacent arteries and veins. The circular and longitudinal muscle layers are antagonistic in their action. If one layer is contracted the other is relaxed. Again, the two muscle layers of the tube wall proper are antagonistic in their action to the muscles of the mucosa. The contraction of the muscles of the tube wall is accompanied by a corresponding relaxation of the muscles of the mucosa. Within the folds the primary, secondary, and tertiary ramifications are produced by alternate contractions of smaller portions of the muscle layers of the mucosa.

TREATMENT OF DYSMENORRHOEA-Noll ("Brit. Med. Jour.") does not hesitate to divide the os internum in obstinate cases. He relates five instances of the common form of dysmenorrhoea where there was distinct and severe pain when the sound passed the os internum. Hegar's dilators, zinc chloride, tincture iodoform, and other treatment had proved unavailing. Noll, therefore, in each case thoroughly disinfected the uterine cavity and vagina. Then he

afterwards wiped with sterilized gauze, and then touched with a Paquelin's knife corresponding in size to the No. 9 dilator. The dilated canal dilated the obstruction with Hegar's instrument up to No. 9. Radiating incisions were then made around the seat of stenosis, which was and the uterine cavity were stuffed with iodoform gauze for twenty-four hours. All five cases did well; the patients were kept six days in bed. Noll believes that the good results (for the cases here described were operated upon over a year ago) were due to destruction by the cautery knife of exposed nerve filaments subject to chronic inflammation. The procedure is an old one advocated by Marion-Sims. Later the cervical laceration furor swept it into abeyance and the surgeon of the Emmett era sewed up the cervix he had incised during the Sims era. Noll and Sims both ignore the "systemic effects of operations per se" so potent in many states.

VAGITUS UTERINUS.-Dr. Jas. A. Simpson reports ("Occident. Med. Times") a case in which a woman had been in labor for some hours, the cervix was well dilated and the breech presenting. The natural forces seemed insufficient to effect delivery, and it was decided to perform extraction. Accordingly, the mother was anæsthetized, the hand introduced and one foot brought down. As soon as the foot appeared at the vulva, the cry of a child was distinctly heard by all present. The sound was somewhat muffled, and seemed as though it came from under the bed. The cry was repeated a number of times, but ceased as soon as the head engaged in the superior strait. Delivery was effected as rapidly as was consistent with safety to mother and child. The latter was born asphyxiated, but soon revived, breathed and cried again. There was no evidence of liquor amnii or mucus having been drawn into the air passages. The child is now alive and well.

EYE, EAR, AND THROAT DISEASE. CHOREA OF THE IRIS.-Dr. B. Zieminski discusses ("Univ. Med. Jour.") this disease, which consists of spontaneous contraction and dilatation of the pupil, the spasms being rapid, unexpected, and extended. Hippus is met with in the first period of sympathetic inflammation of the eye, in spasmodic tremor of the eyelids, in disorders of the exterior muscles of the eye, in pathological changes in the place of crossing of the ophthalmic nerves, and in tumors of the cerebellum. Chorea iridis is also observed dur

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ing paretic dementia paralysis, in the first period of meningitis, in hæmorrhage of the brain or dura mater, in multiple cerebral sclerosis, hysterical epilepsy, hypochondria, neurasthenia, and in the course of many mental disorders. Until lately hippus was not observed in chorea. Zieminski admits that very slight variation in the diameter of the pupil, only to be observed by means of suitable optical instruments, occurs physiologically, and that in certain pathological cases there is an increase of such physiological functions, while in other cases this symptom must be regarded as a peculiar form of tremor of cortical origin.

HYSTERICAL LIMITATION OF AUDITION.Contraction of the visual field is an excellent diagnostic symptom. It is almost always found in hysteria, and may often aid in clearing up a doubtful diagnosis. Ledantec ("Med. Bull.") has also indicated another sign which may be pathognomonic, viz., limitation of the field of audition. He regards this symptom as pointing to the existence of hysteria. He has remarked, moreover, that when it is present the patient is likewise subject to colored audition, each variety of sound exciting a perception of color varying according to the sound.

PROTRACTED PREGNANCY.-Dr.W. S. James of Cleveland, Ohio, reports a case in which (“N. Y. Med. Jour.") pregnancy was protracted for twenty-one days, after the appearance of seeming labor, making a total duration of pregnancy of 308 days.

ANDROLOGY AND DERMATOLOGY. GONORRHOEA IN LITTLE GIRLS.-Dr. Cassel of Berlin ("Gaillard's Med. Jour.") has, in thirty cases of purulent discharge from the genitalia of little girls, sought to determine the presence of the gonococcus. The cases stood in no relation to each other, but were all observed during the course of eighteen months. Of this number, twenty-four undoubtedly suffered from gonorrhoea. In the six remaining cases no gonccocci could be detected. The children were from 7 months to 11 years old. Efforts to discover the source of infection were fruitless in ten cases. One was due to an enforced coitus with an 18-year-old brother, suffering from gonorrhoea. In four cases members of the gonorrhoeal families were examined, father and mother as well as the children, and in the discharge from all gonococci were found. Two patients were sisters. In four other cases infection was not derived from the parents, but from other chil