after a pulsating pain in the right thigh (third day),.-3.30 P.M., while at rest in my office, the right leg elevated and resting on the table, and after a walk in the open air, a crampy lameness in the right leg just above the instep, relieved by walking. Immediately after and while at rest, a drawing, crampy sensation in the hollow of the right foot, passing up to the outer ankle and along the outer border of the gastrocnemius muscle to the knee, relieved by walking, returning while sitting, the feet resting on the floor, passing slowly upwards from the outer ankle to the knee, then in the tibia, where it becomes a numb aching, then in the tarsus, where it occasions a drawing aching, as if the foot would cramp; continued motion relieves (second day),.—While at rest, a numb, drawing sensation in the left instep, which extended to the knee, followed by a sense as of warm air, like an aura, ascending half way to the knee. The numbness and drawing then concentrated at the instep, where it remained a short time, and again the aura ascended slowly to the knee; at the same time both the tibia and fibula ache; there is also a sense of increased temperature and fulness in the leg. The numb drawing then moved over the dorsum of the foot to the toes, where it terminated in a prickling; relieved by motion, but returned when motion ceased (seventh day),.-4.30 P.M., while at rest in a warm room, a transient pain passing upwards over the inner ankle of the left foot (fifteenth day),.-8.30 A.M., while walking in the open air, sudden lameness and loss of strength in the left ankle (second day),.-12.30 A.M., a crampy aching in the right instep, relieved by motion (second day),".-5.44 P.M., while at rest in a warm room, the atmosphere loaded with moisture, south wind, a drawing, crampy sensation at the dorsum of the right foot, in the region of the external cuneiform bone, spreading outward and over the cuboid bone, and forward over the metatarsal bone of the little toe; then moving upwards to the region of the anterior ligament, where the drawing, crampy sensation ceases and becomes a bruised aching, extending to the external malleolus. Sometimes it extends up the tibia and fibula, producing a feeling of fulness in these bones. When walking there is lameness (twenty-first day); 3 P.M., while at rest in the house, a return of the aching in the right ankle (twenty-second day),.-4.36 P.M., a threadlike pain in the right foot below the outer ankle, terminating in aching (twelfth day),.-[310.] Drawing sensation in the right big toe, as if the toe would cramp, at 6 P.M. (second day),.-A sticking pain in the metatarsal joint of the big toe, at the plantar aspect (fourteenth day),8.

Generalities.-Several times during the afternoon a sense of weakness, with heat and perspiration on the face and neck (sixteenth day),.During the forenoon, aching in both sides and upper arms, the right side worse (sixteenth day),.

Skin.--10 A.M., while at rest in my office, itching on the inner side of the left thigh, then above the right eye, then on the scalp; 10.15 A.M., itching at the inner border of the gastrocnemius muscle of the left leg, relieved by rubbing. Immediately after a tingling itching on the right side of the upper lip, then a crawling itching on the right malar region, then an itching moving downwards from the right commissure of the mouth, then an itching on the palmar aspect of the right carpus, moving towards the palm of the hand, then an itching at the angle of the jaw on the right side; 10.55 A.M., itching at the right eyebrow; 11.40 A.M., a biting-corrosive itching on the right forearm, over the belly of the palmaris longus muscle. Immediately after itching on the right side of the face, near the angle of jaw, then itching on the posterior aspect of the right forearm, then an itch

ing on the dorsal aspect of the first phalanx of the index finger of the right hand (first day). During the afternoon itching on different parts of the exterior body (third day),.-Itching on the extremities and face (first day),-Stinging itching on the right scapula, at 2.45 P.M. (tenth day),*.

Sleep.-Last night the sleep was dreamy and refreshing. It seemed more like a clairvoyant state. After midnight I dreamed of birds singing, which awoke me, and caused me to listen with intense interest, but stillness and darkness reigned supreme (third day),.-The sleep last night was light and dreamy. After midnight I dreamed I entered a beautiful garden, from which I passed into a low woodland, in the eastern border of which was a sluggish, broad, shallow stream of water; to cross dry shod required some exercise of mind. This morning arose from bed refreshed, lighthearted, and cheery (second day),.

CONCHIOLINUM.

Langenbeck's Archiv f. Klin. Chirurgie, XVIII, pt. 4. Inflammation of the bones (ostitis) in the mother-of-pearl grinders, by Dr. Carl Gussenbauer. Prof. Billroth has observed in his clinic during the past four years several cases of a peculiar inflammation of the bones in the mother-ofpearl grinders, to which English (Wien. Med. Wochenschrift, 1870) first drew attention. The peculiar characteristics have been defined already, together with a description of the progress of the disease, in his publications on this subject, in such a manner that the classification of this disease as a new and special one is perfectly reliable. English thinks that the occupation of the mother-of-pearl grinders itself is the cause of the disease. We had, therefore, from cases coming under our observation, in two directions, to make use of the clinical experiences, carefully collected, stating the variations in the symptoms, and thus representing the general picture of the disease, with reference to the etiology, course, and results; to verify the previous observations or to add to them. The etiology, with reference to the intimate relation of this disease to the occupation of the mother-of-pearl grinders, was, if possible, to be affirmed or proven. In regard to this, inspection of the factory rooms and close watching of the fabrication of mother-of-pearl buttons, give us most reliable information ; upon this information we base our thesis.

For this purpose I visited several such factories, and came to the conviction that in all these factories, only one and the same injurious agency affects the workmen, and produces the peculiar inflammation of the bones. This injurious matter is the dust of the mother-of-pearl, which was so densely suspended in the air in all the factories inspected, that in a few minutes the clothing was gray.

These so-called "mother-of-pearl" button factories are not at all what we imagine, or like other factories, with large rooms and sufficient ventilation, corresponding to the number of workmen employed, but, on the contrary, are small low rooms, in which four to six or more turning-lathes are placed, so that the workmen have scarcely room enough for free motion. There is nothing in the utensils that can give rise to this peculiar inflammation of the bones. The necessary manipulations are not different from those used generally by turners. The only existing difference is the

crude material.

Metal and wood-turners furnish, no doubt, a large percentage of the dis

eases of the respiratory organs, produced by dust-inhalation, but they are never afflicted by the same diseases as the mother-of-pearl grinders.

English brought up the question as to which one of the constituents of mother-of-pearl the injurious effects are due, and stated that horn-turners also are affected with diseases, and more frequently than mother-of-pearl grinders; he thinks that the organic ingredients of these materials may be the injurious agents. English does not say positively whether the former are afflicted by similar diseases, and it seems as if such cases had never come under his own observation.

Hirt and Merkel in their able work on the diseases from dust inhalation do not mention a case of an analogous disease among the horn-turners. Now, if the idea were correct, that inhaling mother-of-pearl dust produces such a disease, the mode of its action is a mystery. In what manner do these injurious effects occur? Through the production of a general disturbance of nutrition, a dyscrasia, as English supposes, or in what other way?

To answer this question will be the theme of our present paper, in which the discussion on the etiology and pathogenesis of this disease will be the principal part.

The first question, whether inhaling the dust of the mother-of-pearl causes the disease, demands a close examination of the constituents chemically. It is almost exclusively the inner layers which are worked. After the mother-of-pearl is divided into small parts adapted to the purpose, the two layers are separated by splitting, and the inner layer of the shell is used for the grinders' work. The dust produced therefore by the grinding consists exclusively of atoms of this inner layer. The minimal quantity of dust produced by the steel instruments used at this work, and the wood splinters from the turning-lathes settle by their gravity to the floor, and consequently need not be taken into account.

The grinding of the shell pieces produces only a slight amount of dust, or none at all, as the grinding is generally done on a wet grindstone. It is, therefore, clear enough that the dust suspended in the workroom consists mainly of particles from the inner layer of the mother-of-pearl. According to chemical analysis of bivalve shells in general, the mother-ofpearl consists of 90-95 per cent. CO,CaO, 2-3 per cent. of organic matter, and about the same per cent. of other salts. A reliable and correct analysis of mother-of-pearl could not be found. A knowledge of its constituents was necessary for understanding the effects of the dust. Dr. Klausen, assistant at the Pathological Institute of Chemistry, made, at my special request, a very reliable and satisfactory quantitative and qualitative analysis of the mother-of-pearl, for which I am very much indebted.

The shell of the Avicula margaritifera, which gives us the precious mother-of-pearl, consists, like other bivalve shells, of threefold anatomical and chemical constituents or layers. First, the external or scale layers, consisting of manifold brown, superimposed scales. Second, the calcareous layer (Schlossberger's terminology for the oyster-shells), consisting of a lustreless, chalk-white triturable mass, which is accumulated especially between the external and inner layers, though also between the single sheets of the former, and minimal quantities also in the latter. Third, the motherof-pearl layer, the innermost of all the layers, possessing besides the known brilliancy of mother-of-pearl, the greatest firmness, and it is like the external layer, stratified. A calcareous substance is found between the single

lamine in minute quantities. These different layers consist, according to Dr. Klausen's analysis, of the following compositions:

I. The external scale layer: 10.22 organic substance; 0.55 HO; 89.23 CO,CaO, traces of MgO and alkaline salts.

II. The calcareous layer: 10.15 organic substance; 0.32 HO; 89.49 CO,CaO, traces of MgO and alkaline salts.

III. The mother-of-pearl layer: 5.57 HO, insoluble organic substance; 0.11 HO, soluble organic substance; 0.47 HO; 93.555 CO,CaO; 0.295 alkaline salts (chlorides and sulphates).

PO, could not be detected in this.

The organic substance consists of 16.7 per cent. (results of two analyses) nitrogen. The organic substance insoluble in HO is also insoluble in diluted alkalies and acids. Concentrated boiling alkalies and acids dissolve the same, but decompose it. Phosphorus and sulphur could not be detected in the organic substance.

The organic substance of the mother-of-pearl is according to the results of analysis composed of the same constituents as all the other shells, and shows like them a great percentage of nitrogen.

It seems probable, on the simple observation of the circumstances under which the mother-of-pearl grinders work, that they constantly respire the dust, which enters freely with the act of inspiration into the bronchi, and eventually into the lungs, and that the dust enters the blood. I had nevertheless to prove by all means the truth of my hypothesis, the more as I base my conclusions upon this fact, such a doctrine must therefore be proved by the most reliable and simplest experiment.

To accomplish this I put a dog into a hermetically-closed tin box, into which by means of a ventilator the dust of the mother-of-pearl was blown ; in this way the air was constantly more or less saturated with the dust. This dust I obtained from a mother-of-pearl button factory, in quantity about 60 pounds, and after being purified from the wood and steel splinters by means of a sieve, I used it for said purpose. With this quantity I continued the experiment for four months and a half, so that the animal had to inhale the concentrated dust in this apparatus four to five hours every day; the rest of the day he was kept in the dog-kennel. I thought of producing ostitis in young dogs, but could not see any results, but in regard to the entrance and accumulation of the mother-of-pearl dust into the respiratory organs, I had the best and most striking results. The dogs were entirely covered with the dust, and the openings of their nostrils densely overlaid by the dust, after a stay of only half an hour in the apparatus, when full at work.

After two weeks the dogs began slightly to cough. At first I had a female dog with two pups, six weeks old, in the apparatus for the experiment; but as the pups on the 5th and 12th of August died, in cousequence of a lobular pneumonia, I had to take another young dog to continue my experiments until the end of September. On these dead animals I could detect the mother-of-pearl dust in the mucous membrane of the respiratory organs, and in the parenchyma of the lungs, in the nasal, laryngeal, tracheal, and bronchial mucous membrane. I could only detect the calcareous dust on the epithelia of the mucus, and here and there in the uppermost layer of the epithelia of the mucous membrane by the microscope, and by treatment with HCl. In the lungs of all four dogs (two of them were killed) the mother-of-pearl dust could be found, not only in the epithelia of the smallest bronchia and alveoli, but also, and more promi

nently imbedded in the parenchyma, disseminated in particles of the size of a pin's head, and as large, too, as hemp-seed. These accumulations were discernible even to the touch as calcareous matter; they effervesced on addition of HCl. These accumulations of calcareous dust were, as the microscopical examination of specimens preserved in alcohol proves, present in the parenchyma of the lung-tissue. On the contrary, in specimens which were kept for a longer time in "Müller's fluid," and which have lost the CO,CaO, I could by considerable magnifying, detect most minute particles of a homogeneous light-refracting substance, partly free in the tissue, partly in round cells, which was not at all changed in form or condition by adding a solution of potash dilute, HCl or HNO,, and therefore can be taken as the organic substance of the decalcified mother-of-pearl dust, "Conchiolin." The mother-of-pearl dust must have therefore entered in the smallest bronchi and alveoli through the epithelium, or after the destruction of this into the parenchyma.

Accumulations of mother-of-pearl dust in the bronchial glands of the dogs could not be detected. These experiments have doubtless proved that the mother-of pearl dust inhaled by the mother-of-pearl grinders penetrates the lung parenchyma under perfectly analogous conditions as those under which the dogs were placed, only that the men breathe the same saturated injurious atmosphere for a longer time each day. This conclusion is borne out by the character of the diseases prevalent among the mother-of-pearl grinders.

In the beginning of their employment in these factories the men are frequently attacked by catarrhal bronchitis. The owners of these factories will not admit that these diseases are consequent upon their work in the factory.

It seems that the men after awhile get accustomed to the irritation which the dust exerts upon the respiratory organs, and consequently cough less frequently.

Observations and experience prove that when the inhalation of any dust is constant the respiratory organs become less sensitive to its irritating action, and if we remember that the quality of the mother of pearl dust is such that it irritates the tissues scarcely more than in a mechanical way, this will not seem strange.

Hirt and Merkel do not agree in their writings upon the diseases of the mother-of-pearl grinders. Merkel classes the mother-of-pearl grinding among employments injurious to health. Hirt does not pay much attention to it. Merkel mentions a discovery by Greenhow; in the lungs of a mother-of pearl grinder, accumulations of the dust from the size of a millet-seed to that of a hazelnut were found, which corroborates the truth of our experiments. It would be of great interest to collect morbility and mortality statistics from this profession. Vienna would be the best place for this purpose; there are the most flourishing factories of this kind. There are about two hundred to three hundred men employed in the factories known to me.

It struck me as a remarkable fact that in each factory which I visited the employed were from the ages of twelve to twenty. On inquiry upon this subject I could get only evasive and unsatisfactory answers.

Let us now consider the etiology and pathogenesis of these diseases. We find first, that the disease has been observed in young people, who were not yet matured, before and after puberty. There is no case known to us where an individual fully grown has been attacked by it. After