Nencki showed to have no real anti- | dian ague, twelve hours before in terseptic property. tian, and from eighteen to twenty-four hours beforehand in the quarta variety. To these figures, however, another hour should be added; half an hour on account of the tendency of the onset of successive attacks to be antedated to that extent, and half an hour as allowance for imperfect absorption from impaired gastric action. For the last reason also, and to obviate its rejection, the required quantity should be given in two or three divided doses at halfhour intervals. Two doses, eight to ten hours before the expected onset of shivering, are almost always effectual. If the result be unsatisfactory, an aperient should be given. The part played by bacteria in intestinal digestion is limited probably to the fermentation of sugar and carbohydrates generally, the excess of acid resulting from this fermentation being neutralized by the alkaline intestinal juice. But, much as bacterial life abounds in the intestinal canals, varying according to the kind and quality of the ingesta, it does not appear that the processes initiated by these organisms are of such value or importance in nutrition as the chemical ferments. Certainly the patient who was the subject of these observations gained in flesh, although for six months she was deprived of all the bacterial processes that go on in the large intestine.-Lancet. During the first three days, 0.8 to 1 g. of hydrochlorate of quinine daily. No quinine during the fourth, fifth, sixth and seventh days. On the eighth, ninth and tenth days 0.6 to 0.8 g. None from the eleventh to the fourteenth day. On the fifteenth and sixteenth days, 0.6 to 0.8 g. None from the seventeenth to the twentieth day. On the twenty-first and twenty-second days, 0.6 to 0.8 g. Laveran states that no microbes are found in the blood of malarial patients after sulphate of quinine has been taken for eight days in doses of 0.6 to 0.8 g.; THE INDICATIONS FOR QUININE. but that if after three or four doses it be Manquat (Lyon Méd., October 25, discontinued, the microbes reappear, 1891) gives a summary for the indica- and a relapse occurs. Upon this is tions for quinine. In malaria it is effi-based his scheme of treatment, namely: cacious in all types, besides being a preventive. Laveran showed that malarial microbes disappear from the blood after quinine has been taken for a certain time, and that the addition of a minute quantity of a weak solution to malarial blood destroys them. He considers that the white blood corpuscles are not directly influenced, but enabled more easily to subdue and seize upon the micro-organisms rendered dead or moribund by the drug. If given during or just before the onset of an attack quinine has no power to check it, while this may be prevented if taken at a sufficient interval beforehand. Baccelli made intra-venous injections of 1 g. during the onset, but during the first six hours could recognize no modification in form, number, or movement of the microbes. As the largest part of a given dose of quinine is eliminated during the sixth hour after ingestion, while according to Laveran it is during the onset that the microbes are present in the blood in greatest number, the drug should be given at an interval of about six hours before an expected attack. Quinine should be taken eight hours before shivering appears in quoti In very severe cases recourse should be had to hypodermic or intra-venous injection, or injection into the respiratory tract. A gramme of a salt of quinine may be injected subcutaneously, and repeated after a short interval; as a rule, 1 to 2 g. are sufficient. The injection should be made into the deep subcutaneous tissue to avoid complications. The following formula may be used: B Quin. sulph. I g., acid. tart. 0.5 g., aq. destill. 10 g. The addition of a little antipyrin greatly enhances the solubility; I g. quin. hydrochlor., with 0.5 g. antipyrin will dissolve in 2 g. of water. When with severe depression there is reason to believe no absorption has taken place, the solution may be injected into the trachea through the crico-thyroid membrane. Baccelli rec ommends intra-venous injection as the most prompt and efficacious method in very grave cases (quin hydrochlor. I g., sodii chlor. 0.75 g., aq. destill. 10 g.). The solution should be injected very slowly into one of the small venous branches at the bend of the arm. In continued malarial fevers quinine must be given in larger doses. Laveran advises 1.5 to 2 g. daily (0.6 morning, 0.8 evening), till fever disappears. This nearly always happens by the second or third day. If fever persists with four days' treatment, it may be assumed to be non-malarial. When the temperature falls, 0.6 to 0.8 g. should be given daily for a short time. In malarial cachexia quinine wine may be taken with meals, but not fasting, or long before food, otherwise gastralgia and dyspepsia ensue. As a preventive, quinine is not effective in smaller doses than 0.25 to 0.30 g. It should be given also in all malarial complications and incidental affections (for example, neuralgia, hemorrhage, pneumonia). In typhoid fever Jaccoud and others restrict its use to certain conditions, namely, non remission of fever, or very slight morning remission; an uninterrupted series of evening temperatures over 104°; cardiac failure. In pyæmia quinine in large doses (1 to 2 g.) is the only remedy which has been in some measure successful; but as it has often failed when given alone, a definite conclusion as to its value cannot yet be drawn. In acute articular rheumatism it has been frequently given with success, but is of much less efficacy than the salicylates or antipyrin. In Ménière's disease quinine has been given with some success in daily doses of 0.6 to 0.8 g. for one or two weeks, followed by discontinuance for an equal period, and then by renewal of similar treatment. The first doses appear to cause exacerbation of the symptoms, and must be continued for some time before improvement occurs. In blennorrhagia, tepid 1 per cent. injections of sulphate of quinine have proved of marked service. Rapid improvement began from the first, and continued till the fifth day, when, as a rule, only a drop of cloudy discharg appeared. Complete recovery did not however, ensue for some little tim (quin. sulph. 1 g., bism. subnit., 5 g mucilag. 10 g., glycer. 30 g., aq. destill cal. 120 g.—Jullien). Regarding the mode of administra tion of quinine generally, the sulphate though most often used, is less suitabl than the hydrochlorate, which is mor soluble, contains more quinia, and less subject to mould. A solution of in 20 is very useful, but very bitter. O account of this, and its concentration, is well to prescribe half a tumbler o some drink afterwards; coffee is a goo menstruum. For rectal injection, th desired quantity of quinine should b dissolved in 100 to 120 g. of tepid water If opium is not contra-indicated, th addition of 10 g. of laudanum is usefu The injection should be preceded by simple enema.—British Med. Journa PNEUMONIA, THE PRODUCTION O IMMUNITY AGAINST, AND ITS CURE. In 1890 was published the importan discovery by Behring and Kitasato tha blood-serum taken from animals that ha been rendered immune to tetanus an diphtheria was capable of curing othe animals suffering from those disease Drs. G. and F. Klemperer (Berline Klinische Wochenschrift, August 2 and 31, 1891) published a researc carried out in regard to pneumonia with the object of discovering hov immunity against the pneumococcu could be best produced, whether re covery from the disease rendered a animal immune, and whether it wa possible to cure pneumonia by th blood-serum of animals that had re covered from the disease. Their experi ments, which were confined to rabbits revealed. that every nutrient mediur in which the pneumococcus has bee cultivated will, if inoculated, render a animal immune against pneumoni septicemia, even after the cocci hav been removed by filtration. The powe of producing immunity is more speedil acquired, and is increased if the infecte nutrient medium (before or after re moval of the cocci) is exposed to a temperature of between 41° and 42° Centigrade for two or three days, or of 60° for an hour or two. In every case, however, it was found necessary that some interval (varying from three to fourteen days) should elapse between the inoculation and the production of immunity. Hence it was too late to cure a diseased animal, or even to prevent the onset of an attack, if the injection was given simultaneously with the outbreak of the disease. On the other hand, serum taken from animals enjoying immunity was found able, especially when introduced directly into the circulation, to cure pneumonic septicæmia. The serum was injected twenty-four hours after infection, while the animals had a febrile temperature between 105° and 106.5° Fahrenheit. Eight cubic centimetres were injected, with the result that the temperature gradually sank during the next twenty-four hours. In twelve successive cases a successful result was obtained. This research, therefore, confirms, in regard to pneumonia in rabbits, what Behring and Kitasato did for tetanus and diphtheria. Drs. Klemperer next studied the question how the bloodserum of an immune animal cures an attack of pneumonic septicæmia, and discovered that when the pneumococcus is introduced into the body of an animal it generates a poisonous substance which can be isolated, and to which the name of "pneumotoxin " has been given. This pneumotoxin sets up a febrile condition which lasts several days, after which another substance is found to have been produced, called "antipneumotoxin," which is able to neutralize the pneumotoxin. The serum taken from an immune animal contains this antipneumotoxin, and it is by means of this substance that it cures an attack of pneumonic septicemia in other animals. The relation of pneumonia as seen in rabbits with that met with in man was next investigated, and the conclusion arrived at that the disease in both cases is produced by the pneumococcus, but that the human body is much less susceptible to the latter than that of the rabbit. Thus it was found that serum taken from pneumonic patients after the crisis could cure pneumonia in rabbits; moreover, pneumotoxin and antipneumotoxin were found to be present in human serum as that taken from rabbits. The crisis of pneumonia, according to Drs. Klemperer, takes place as soon as antipneumotoxin is produced in sufficient quantity to neutralize the pneumotoxin. Why immunity against further attacks lasts so short a time in man is still uncertain, but possibly less antipneumotoxin is formed in man than in rabbits in proportion to the pneumotoxin. Some attempts have already been made to cure patients suffering from pneumonia with the help of antipneumotoxin, but further observations are necessary before results can published.-British Med. Journal. RAT-TAIL SUTURES. be About five years ago, while resident physician in the Presbyterian Eye and Ear Hospital of Baltimore, I saw Dr. Chisolm uses fibers from the tail of an opossum for sutures in some of his eyework. I thought such fibers a good substitute for silk, and spoke to my brother, Dr. A. M. Belt, about it. Shortly afterward a rat was caught at his residence; he had the tail skinned and soaked for several days in water, after which, upon slight manipulation, it separated into perhaps a hundred fibers, each about eight inches in length. These were placed in alcohol and presented to me, upon request, for use in eye surgery. I found the fibers strong and much finer than those from the opossum tail, or any other animal suture, and have been using them quite extensively in suturing the conjunctiva in pterygium operations, and in advancing the recti muscles in correcting strabismus. These sutures have been most satisfactory. As soon as moist they become agreeably soft to the eye, and have never to be removed, while silk sutures are rough and irritating as long as they remain in the eye, and their removal is somewhat painful. Patients from a distance are often detained five or six days to have the silk stiches removed, when | one of the condyles is readily produced rat-tail sutures might be used and the by pressure on the under surface of the patient allowed to depart immediately. olecranon when the posterior rectThese sutures will no doubt be found angular splint is used with a sling that useful to the general surgeon and gyne- supports near the elbow instead of at cologist when they need strong and fine the wrist. The indications are to reanimal sutures. About once a month, duce the deformity and fix the parts in for two or three days, I soak the fibers the correct position. in a corrosive sublimate solution (1:5000), and as I have never had any trouble whatever from their use, I think it probable that this suffices to render them aseptic.-BELT, Med. News. THE TREATMENT OF FRACTURES OF THE HUMERUS INVOLV. ING THE ELBOW-JOINT. Stimson discusses these injuries in the Medical News of October, 1891. He ascribes the causes of limitation of motion as being either a change in the relation of the articular surfaces or an overgrowth of bone, or more or less ossification of the ligaments and capsule. He describes three specimens in which motion was prevented by masses of new bone, the articular surfaces in one being injured. The cause of these new formations is either the persistent displacement of a fragment or the separation of the periosteum. To prevent their occurrence, perfect reduction with avoidance of any subsequent irritation to the periosteum is advised. Motion may also be limited by the formation of a cicatrix in the capsule and periarticular tissues. In regard to the effect of passive motion, it may change the locality of the newly-produced bone, but will not obviate stiffness arising from it. The amount of limitation of motion being proportioned to the amount of inflammation in the surrounding parts, he claims that perfect rest is the best means to obviate it. The cicatricial tissue formed is only that which has come directly from the extent of the primary traumatism. The use of passive motion is deprecated during the stage of reaction when its use is followed by persistent pain and soreness. At a later period, as supplementary to the natural use of the limb, it has its value. Gunstock deformity from displacement of In treating joint fractures, in cases of doubt, use an anesthetic. In supracondylar fractures the lower fragment is usually displaced upward and backward, and permanent traction is usually necessary in their treatment. This can be done by vertical suspension of the limb, or by the weight suspended from the upper part of the flexed forearm when the patient is erect. The weight should not exceed five pounds. In intercondyloid fractures with marked separation, there is no practical means sure to maintain reduction, and considerable limitation of motion is to be expected. The author prefers for these a broad, heavy posterior plastersplint extending from the axilla to the hand, the elbow being flexed at a right angle. Traction by a weight can also be used. In fractures of either condyle, he advises a posterior rectangular splint of either metal or plaster with encasement in plaster at the second week, and support by a sling at the wrist. When dislocation is associated with fracture, immobilization, with the elbow flexed well within a right angle, is advised, also gentle massage and change of the angle of flexion from time to time. Splints should be worn for six weeks in the supra- and intracondylar fractures, and about four weeks for either condyle. After the removal of the splints, passive motion or special exercises should be used.-University Medical Magazine, December, 1891. THE ANTISEPTIC FUNCTIONS OF THE LIVER. Dujardin-Beaumetz (Gazette Hebbomadaire de Medicine et de Chirurgie, August 15, 1891), writing concerning the antiseptic functions of the liver, says that while, at the present day, it is proved beyond doubt that the liver creasote possesses antiseptic powers, there are | fit derived. Sommerbrodt administers creasote in the form of capsules, each containing about my ijss of with a little cod-liver oil or olive oil. There are very few persons with whom the drug disagrees, and in no case has he seen any harm done by its administration.-British Med. Journal. IDE ON THE COURSE OF EX- CULOSIS. no signs which show definitely when this function is being properly fulfilled. The problem has been approached in various ways. Haymen and Tissier claim that the presence of urobilin in the urine is a sign of a morbid condition of the hepatic cells. The presence of urobilin is easily detected by the spectroscope. It is certain that its presence INFLUENCE OF POTASSIUM BROMindicates some derangement of the liver cells, but such derangement often exists without any urobilin in the urine. Roger claimed that a correlation exists between the glycogenic and antiseptic functions of the liver, and is only necessary to determine the condition of the former to judge of the latter. But this is not to be relied upon. A third method of determining the condition of the antiseptic function of the liver is by determining the toxicity of the urine. But this is not reliable, as jaundice is frequently present, and bile is much more toxic than the urine. To maintain the integrity of the antiseptic function, we must attempt to increase the glycogenic power and to shut off the supply of poison. The first object is attained by a nourishing diet and by keeping down the temperature; the second, by intestinal antisepsis, favoring-Supp. British Med. Journal. elimination and diminishing cellular activity. The best antiseptics are salol and bismuth salicylate. Purgatives are of use only when there is constipation. Favor diuresis by copious draughts and by mild alkalines, and keep the skin active by baths and friction. Forbid meat and hard work, either bodily or mental.-University Med. Magazine. CREASOTE IN TUBERCULOSIS. Sommerbrodt (Berlin klin. Woch., October 19, 1891) reaffirms his faith in creasote both for incipient and for advanced cases of tuberculosis, pulmonary as well as laryngeal. Complete and permanent recovery is by no means uncommon even in persons in whom a tuberculous predisposition existed. Large doses (mxv-3j per diem) are most beneficial. Indeed, the more the patient can tolerate the greater bene Starting from the fact that patients. who have long taken bromide of potassium rarely develop tuberlosis, Féré has investigated the action of this drug on the development of experimental tuberculosis (Sem. Méd., October 21, 1891). He tested it on guinea-pigs and rabbits by feeding them for some time with potassium bromide, and then inoculating them with tuberculous material. Far from there being a prolongation of life in these animals, they died much more rapidly than the controls inoculated at the same time. It seems, then, that this salt not only does not render animals refractory to tuberculosis, but even hastens the course of the disease. TRANSFORMATION OF VIRUS. Dr. Chauveau concludes a work on this subject, read at the Paris Academy of Medicine (Gazette des Hôpitaux) as follows: I. Vaccinal virus never gives variola to man. 2. Variola virus never gives vaccinia to the cow or horse. 3. Vaccinia is hence not attenuated variola and cannot be compared to benign anthrax infection communicated to animals by the inoculation of attenuated anthrax virus. 4. If vaccinia is derived from variola it is by means of a radical transformation of the variola virus, up to the present time beyond the knowledge of experimenters. 5. The attenuation of virus is not an operation that can be identified with transformation.—N, Y. Med. Journal. |