ary duties. But about four hours later she was attacked with an intensely painful rachialgia, and Dr. Prouff was summoned immediately; he found her deathly pale, with dreadful pains and a pulse that could not be counted. The next day she was dead.

M. Nelaton has recently observed some very severe cardio-pulmonary cases of great severity, and the analysis of the cocaine used showed that it had undergone changes which might possibly have been the cause.

M. Rochard confirmed the opinion of M. Nelaton. The cocaine is often changed in quality; among other things is found a product of decomposition, ecgonine, which possesses properties analogous to atropine.

THE ANODYNE TREATMENT OF ACUTE PERITONITIS.-McCaffrey (The Etiology, Pathology and Treatment of Acute Peritonitis, "Medical News") observes that the most pronounced indication for treatment in peritonitis is that for the relief of pain. Blisters and counter-irritation, the older resorts, are practically useless. Hot water bags and poultices are far superior, but the relief they afford is only temporary. In some cases the içe bag is more grateful than hot applications. But whether hot or cold is employed, it should be relied upon only until other lines of treatment can be instituted. Papine should be given in teaspoonful doses every hour, and the doses repeated frequently enough to afford the desired results. Relief from pain, short of narcosis, should be sought, and this is generally easily obtained by proper dosage. Papine does not produce nausea, but rather prevents this symptom. In the event. of the development of more or less prostration, a proper stimulant, such as strychnine or nitro-glycerine, should be judiciously employed.

QUINIC ACID AND GOUT.-Dr. de la Camp, assistant at the Medical Clinic of Berlin University, invites attention ("Münchener Medicinische Wochenschrift," July 23d, 1901) to the result of Weiss' experiments, that quinic acid lessened the excretion of uric acid and increased that of hippuric acid in the human subject; and he recommended it as a therapeutic and prophylactic remedy in the uric acid diathesis, and more especially in gout. Combinations of quinic acid with other remedies for gout, such as citrate of lithium, piperazin, etc., have been recommended by various observers; and Nicolaier has recently experimented with one with Urotropin, called Chinotropin.

De la Camp has employed Chinotropin for his experiments. Two preparations were experimented with: a Chinotropin II., composed of two molecules of quinic acid and one molecule of Urotropin, and Chinotropin III., containing four molecules of quinic acid and one of Urotropin.

He concludes that quinic acid, even in large doses, is harmless. He advocates the employment of the quinate of Urotropin (Chinotropin) because the Urotropin itself is decomposed in the human body, and gives formaldehyde, which forms readily soluble combinations with the uric acid. And in urinary concretions more especially, Chinotropin is deserving of further experimentation.

A NEW COUGH SEDATIVE.-"Antikamnia and Heroin Tablets," each tablet containing 1-12 grain Heroin Hydrochloride (muriate) and 5 grains Antikamnia, is particularly recommended by Dr. Uriel S. Boone, Professor of Pharmacology and Surgery, College of Physicians and Surgeons, St. Louis, as an efficient cough sedative, alike useful in acute bronchial cough and in tuberculosis.

DIRECT INFECTION of a nurse from a consumptive patient is reported by Stewart ("American Journal of the Medical Sciences," September, 1901), in the description of a case of acute splenic miliary tuberculosis. The patient was a young woman who had no evidence of tubercular infection prior to her attendance upon a phthisical patient. The patient was in poor circumstances and had apartments which were badly heated and damp, and the nurse's nourishment while attending him was of very poor quality. In the middle of her second week of attendance upon the case she became acutely ill, and died 68 days later, the autopsy revealing a universal tubercular infection.

KOCH'S MODIFIED STATEMENT.

In answer to criticisms of his address at the Tuberculosis Congress in London for his omission to recognize the priority of the discovery of the non-identity of the human and bovine tubercle bacillus, by Theobald Smith, he now says that he laid no claim. either to priority or monopoly to any ideas propounded in the address, but "I sought only to tell of my own private experiments, and was, in fact, glad of the opportunity given to mention my contemporaries in some of their experiments, among whom was one

of America's greatest medical authorities, Dr. Theobald Smith.” Regarding the danger of infection from tuberculous cattle, he said, in the address: "I should estimate the extent of infection by the milk and flesh of tuberculous cattle and the butter made of their milk as hardly greater than that of hereditary transmission, and I therefore do not deem it advisable to take any measures against it." As modifying this uncompromising statement, he now says: "I did not mean to recommend the abandonment of comprehensive and expensive systems of regulation, prevention and inspection that are now in operation. I simply said that it was injurious and unnecessary to go further with such systems when we were justified in expecting that our long-sought remedy was found and almost within our reach. Why, then, should we rear higher structures which must inevitably fall to the ground?" He very justly adds that experiment and not argument must now be the watchword of medical and scientific men who would conquer tuberculosis.

SUBSTITUTION IN MEDICINES.

In a recent case of death from poisoning ("Medical Record.” August 24, 1901), the druggist who gave the wrong medicine offered as an excuse that he had merely substituted one article for another on the supposition that it was of equal strength and much cheaper. The prescriber, in testifying on the trial, stated that the practice was a very dangerous and very frequent one, and was apparently past remedy. While the latter may, or may not, be the case, it is quite certain that with many who claim to be reputable and competent pharmacists the practice of substitution is very

common.

From the business point of view it is a fraud on the producer, and, from the ethical view, a danger to the consumer. Both parties in the compact have thus a common cause against the middleman who surreptitiously plays the part of thimble-rigger and

steerer.

The temptation to substitution is always strongest with the most expensive medicaments, and in the case of such as have a known quality of efficacy. An inferior and oftentimes inert article is almost invariably used when substitution is practised. Thus, the manufacturer and the prescriber are always placed in a false light with the patient, who expects certain promised results.

Generally speaking the physician is the one to suffer the most, as his disappointed client is apt to leave him for another. How many lost patients can be accounted for in this way it would be difficult to imagine. The too trustful physician is in a very bad way between the prescribing druggist on the one hand and the ever-ready substituter on the other. Must he be compelled to turn dispenser himself in sheer defence? Certainly, in some cases, the crime has, in this way, met its penalty. But when we look about for a remedy against the evil, we butt against the bulwark of general depravity and the impossibility of applying ordinary missionary efforts. The only thing is to discover and then to punish. The man who substitutes once will do so again. He has no conscience to begin with, and nothing, in fact, to which an appeal can be made. The whole question, then, narrows itself down to that of mutual trust and the dispensing of original unbroken packages.

COLLECTIVE INVESTIGATION OF THE INFLUENCE OF THE SILVER NITRATE INJECTIONS ON PHTHISIS.

TO THE MEMBERS OF THE MEDICAL PROFESSION:

In 1892 the undersigned began a collective investigation of the action of cold in the treatment of acute pneumonia, and there is , reason for believing that this procedure, which resulted in gathering four hundred cases of this disease thus treated, with a death rate of not quite five per cent., was an important factor in calling attention to the utility of that treatment and in introducing it to the profession of this country. That research was based on the conviction that no remedy can be called truly successful until it has passed the exacting crucible of clinical experience, and it is now proposed to apply the same ordeal to the silver-injection treatment of phthisis, which, in a large hospital, dispensary and private practice, reaching over a period of three years, and during which many thousand injections were administered, has given me greater satisfaction than any other method that I have ever employed. In keep ing with the above expressed feeling, a cordial invitation is herewith extended to those members of the profession who have the inclination and opportunity to investigate this method of treating phthisis, and to whom a reprint on the subject, with full information and blanks to report cases, will be cheerfully sent on application. THOMAS J. MAYS, M. D. 1829 Spruce Street, Philadelphia, Pa., Aug. 15, 1901.

EDITOR'S TABLE.

SANITARIAN, OCTOBER, 1901.

All correspondence and exchanges, and all publications for review, should be addressed to the Editor, Dr. A. N. Bell, 337 Clinton St., Brooklyn, N. Y.

GODLINESS AND UNCLEANLINESS, AND DISEASE.

The apothegm that "Cleanliness is next to Godliness," approvingly quoted by John Wesley and frequently by other religious people since his day, is misleading in so far as it is understood to imply a Christian origin.

By whom the phrase was originally composed is unknown, but the spirit of it was understood and practised by some ancient nations centuries before the Christian Era. Among the Egyptians in particular, Plutarch tells us, health was no less respected than devotion. A similar sentiment is expressed in the Talmud, where it is said the Rabbis cultivated health many centuries ago as a religious principle and sanitary law wisely observed by Moses. Hence, as regards even an approximate date when health was first discovered to depend upon cleanliness, there are so few facts upon which one might venture to base a statement, it seems probable that the time antedates written history.

In Hebrew and Greek history, Egypt always appears as the relatively advanced centre of civilization from which the Hebrews and Greeks, as other nations, derived light. Moses, for instance, is described as learned in all the wisdom of the Egyptians. And of medicine in particular, the basis of sanitary knowledge, Homer says the Egyptian doctors "were truly of the stock of Pæëon, and each of them knowing more than all other men together." Herodotus also, in his account of the specialism of medical practice in Egypt, justifies the inference that the rudiments of hygiene, at least, were practised there from time immemorial.

Roman cleanliness as an obligatory civic measure was definitely instituted by the establishment of the Ediles, 494 B. C., and was maintained for about eight centuries. It was doubtless preceded by, or pursued conjointly with, domestic hygiene, as shown among the discovered remains in the ruins of Pompeii.

The Roman system comprehended the division of the city into four police districts, with special provision and officers for the