1

extend their baneful influence beyond the bladder into the ureter and the kidney, thereby seriously threatening life, it is necessary to introduce into the cavity of the bladder something that will check their multiplication. If we diminish the quantity of mucus by the treatment already advised, we in a measure limit the multiplication of the micro-organisms, because without the presence of mucus they would not thrive.

We have in the drug known as peroxide of hydrogen a remedy which may be used inside the bladder, providing it is used in a proper manner, and has power to destroy the materials upon which the micro-organisms thrive, and to destroy the micro-organisms themselves. Peroxide of hydrogen should never be used in the bladder unless a large catheter has first been introduced, and unless the catheter has a number of openings which insure the ready escape from the bladder of the detritus resulting from the action of the peroxide upon the pus, mucus, and micro-organisms which the bladder contains. A fifteen-volume solution should be diluted one-half, and, previous to its introduction the bladder should be washed out with a warm solution made by dissolving a teaspoonful of common salt and one-half teaspoonful of bicarbonate of soda in one quart of water.

Injections of strong solution of nitrate of silver, in cases of chronic cystitis, have sometimes given very flattering results. No doubt these results are due to the antiseptic properties of the solution, since weak solutions are of little or no avail. Solutions of less than five grains per ounce have not given good results, while solutions of twenty grains per ounce are generally recommended.

In the use of peroxide of hydrogen for the purpose of thoroughly cleansing the bladder of organisms which, by their multiplicity in it, keep up cystitis, we are employing a drug that causes none of the dangers which a strong solution of nitrate of silver might produce; therefore, I do not think it necessary to recommend the use of strong solutions of nitrate of silver, or any other of the solutions of antiseptics that have been resorted to heretofore in the treatment of this disease.

To summarize, I would state the principles upon which the treatment of cystitis should be based in the following terms: (1) thorough drainage of the bladder; (2) rendering of the urine bland by food, medicine, and the liberal use of sterilized distilled water; (3) the relief of tenesmus by anodyne suppositories in the rectum or vagina; (4) the destruction of micro-organisms in the bladder by washing it out with solutions of peroxide of hydrogen; and (5) the removal of all foreign bodies from the bladder.-Dr. Hal C. Wyman in American Therapist.

STRYCHNINE AND DIGITALIS IN DIARRHEA.

In the London Practitioner for August, 1992, Surgeon-Captain Harold Hendley writes upon this subject:

Fever of a remittent character or with a tendency to a continued type has often necessitated recourse to various drugs and expedients to meet the many complications that arise. A complication occurring frequently, and at a time when the patient, worn out by fever and with rapidly failing digestive powers, is least able to resist it, is persistent diarrhea.

In such a case the temperature at this stage probably ranges from one to two and a half degrees above normal; the pulse is soft and yielding, not very rapid,

and markedly wanting in tone. The motions, at first four or five in the day, increase in number, until each installment of nourishment appears to excite an action of the bowels, which has an even greater tendency to fluidity. The extreme is reached when the motion escapes involuntarily, but is followed by a decided tendency to cardiac failure, if not collapse, which is not unseldom accompanied by a consciousness of approaching dissolution in the patient. It was in such a case as this, occurring in an English lady in India, that the author first tried the effects of a combination of tincture of digitalis and liquor strychnine, the one on account of its well-known general action on the vaso-motor nervous system, and the other for its lesser-known, more direct action on that portion of this system concerned in the control of the blood supply to the intestines. There was the risk that the strychnine might increase peristaltic action, but, having often given it for constipation, it appeared that its marked good effect in this complaint had been due to increased muscular tone, more especially in the lower bowel. Now, however, the need seemed greater than the risk, so astringents were stopped, and a mixture was given containing tincture digitalis, four minims; liquor strychninæ, two minims; and spirits of chloroform, five minims, in water.

One hour afterwards, when the dose was repeated, a change for the better was observable. Of the two motions passed, the last had been accompanied with the very slightest tendency to faint, there was less restlessness, and the pulse had improved. The third dose was given after an interval of two hours, and half an hour afterward the patient fell into a deep sleep, which, with intervals for the taking of the mixture, now given every four hours, and for food lasted twentyfour hours. Recovery from this point was rapid, and no relapse followed.

This case occurred in 1889. Since then Hendley has used strychnine alone, or combined with tincture of digitalis or salicylate of sodium, in a very considerable number of cases in which diarrhœa has been accompanied with symptoms denoting a general want in tone, and with much success. The last very important case occurred in a native woman, who had four days previously been confined of twins. She had been attended by partly-qualified women-doctors, and everything that could be done had been done. She had lost much blood, she had fever ranging from 102° to 103° Fahrenheit, and her condition when the author saw her was much the same as that already described in the other case,-plus an ill-contracted uterus. No success had attended efforts to stop the diarrhœa by means of astringents, and when the writer saw her she appeared to be beyond hope of recovery. Astringents were at once stopped, and a mixture containing liquor strychninæ, five minims; tincture of digitalis, five minims; and liquor bismuthi and ammonii citratis, eight minims in dose, was given in peppermintwater, for the first three doses, every two, and then three, and later, four hours. Here the immediate effect was not very evident; but later on there was very marked improvement, the extreme feeling of cardiac distress during the passing of a motion soon passed off, and stools became less watery, but in the first fortyeight hours decreased frequency was not apparent. The patient made a slow but complete recovery.

Mr. Hendley is not inclined to consider strychnine and digitalis of value in diarrhœa other than such as described. There can, however, be no doubt but that astringents often do more harm than good, and that opium, especially in cases of diarrhœa with hepatic congestion, tends eventually to a fatal issue.

Strychnine appears to him to have a much quicker action on both the muscular system and the blood-supply of the intestines than it is generally credited with, though it is doubtful if in medicinal doses it has an effect in creating or increasing peristaltic action.

Regarding the use of digitalis with strychnine, he has long looked upon the two drugs as very efficient companions in other morbid affections under allied conditions, and there is little doubt but that the combination is one of much value, and capable of yielding marked and very satisfactory results.-Therapeutic Gazette.

THERAPEUTIC EFFECT OF TESTICLE JUICE.

BROWN-SEQUARD (Soc. de Biol., October 29) sums up the experience so far accumulated as to the therapeutic effects of testicle juice as follows: In more than one hundred thousand injections the procedure has only on two occasions been followed by rise of temperature; hardly any pain has been complained of, and no symptoms of septic infection have been observed. In one hundred and twenty cases of ataxy in which the method has been used there have been only two instances of failure. In four cases of cancer improvement has taken place, discharge being diminished, pain ceasing, bleeding being checked, œdema disappearing, and the tumor seeming to shrink. In cases of uterine fibromata the tumor has always been reduced in size. Of seven cases of paralysis agitans two have been improved, one of them being almost cured. In all the cases of lateral sclerosis in which it has been tried, the method has given good results In tuberculosis it has been very successful; diabetes has also been favorably influenced, and one case has been cured. The preparation, as prepared by d'Arsonval, is now of the strength of one in two and five-tenths instead of one in five, as it used to be. An equal weight of water should be added to it before use; this prevents the injections causing pain.-British Medical Journal.

THE APPLICATION OF ICE TO THE SPINE AS A THERAPEUTIC MEASURE.

JUST at present the employment of heat and cold in therapeutics is interesting the profession so largely that an article by Dr. Kinnear, of New York, upon the application of ice to the spine in various functional and chronic diseases is of interest.

After quoting the work of Dr. John Chapman, of Paris, upon neuralgia and kindred nervous diseases, in which Dr. Chapman urges the employment of the spinal ice-bag as an important remedial measure, Dr. Kinnear details his own experience with it. He points out that Chapman showed that by this means it was possible to overcome the coldness of the extremities frequently seen in nervous or hysterical persons, and that frequently hyperesthesia of various portions of the body could be overcome in this way. As a rule, the application was found to be soothing and to exercise a pleasant effect upon the patient, although most of them before it was applied were firmly convinced that the results of the application would be unfortunate. Dr. Kinnear states that a patient of his reported to him that since using the ice-bag her legs and feet had become warmer, that her head was much clearer, that her temper was less irritable, and that the

application "quiets and soothes the constant restlessness to which I am generally subject."

In addition to this, it revealed reflex excitability, so that she was startled by loud noises. These results were obtained after a treatment lasting about three weeks.

Dr. Kinnear also states that in cases of eczema and pruritus, the ice-bag will sometimes give relief when all others fail, and that it will also relieve mental worry. The ice-bag should be applied to such portions of the spine as seem tender upon pressure.-Therapeutic Gazette.

INJECTIONS OF EXTRACT OF SHEEP'S THYROID IN MYXEDEMA.

A. NAPIER (Glasgow Medical Journal, September) reports the following case: A woman, aged fifty-four, suffering from myxedema, was treated with subcutaneous injections of extract of sheep's thyroid. Treatment was begun on May 12, when one gramme of a watery extract of fresh thyroid was injected into the subcutaneous tissues between the shoulder blades with a carefully disinfected Koch's syringe. The treatment was continued till June 25, when the patient was discharged much improved, sixteen injections in all having been given. A variable degree of rise of temperature was noticed after each injection, and a small abscess formed near the site of injection. As early as May 16 the patient herself noticed that her skin was looser and softer than it had been, and the author states that there can be no reasonable doubt that most marked and manifest improvement followed immediately on the adoption of treatment.-British Medical Journal.

BACTERIOLOGY.

THE DISINFECTION OF THE INTESTINAL TRACT.

(Ueber Disinfection des Darmkanales. From the Med. Klin., at Breslau; Zeit. f. Hygiene, Bond XIII, page 88.) By Stern.

The indications of the therapeutics of infectious intestinal diseases present themselves under the following heads:

(1) One endeavors by mechanical means to rid the intestines of its bacterial contents either by purgatives or enemata.

(2) One endeavors to destroy the vitality of the bacteria in either by means of disinfecting agents.

(3) One endeavors either to neutralize the poisonous products of bacterial growth in the intestines before they are absorbed, or to favor their elimination after absorption has taken place. In the experiments of Stern especial attention was given to the study of those agents more especially employed for the disinfection of the intestines. These he divided into three groups:

The easily soluble, those that are dissolved with difficulty, and those that are broken up in the intestinal tract, and the actual disinfecting properties thus developed.

In the first group belong inorganic and organic acids, corrosive sublimate and other metallic salts, phenol, resorcin, chloroform, water, etc.

thol.

In the second group are placed calomel, iodoform, naphthalin, a- and -naph

The third group comprises bismuth salicylate, salol, betrol, tribrom-phenol, etc. From the disinfection experiments of these substances performed outside of the body it was impossible to draw any definite conclusion as to the probable behavior within the intestinal tract, for the antiseptic or disinfectant activity of a substance outside of the body is not always an indication of a similar property when in the body.

By careful bacteriological study of the evacuations of an individual upon whom his experiments were performed, Stern is led to conclude that, after the employment of ẞ-naphthol for twelve days, the whole amount administered being over forty grains, there was no appreciable diminution in the number of bacteria present in the fæces.

In a second series of experiments, in which a number of individuals received with their meals suspensions of of easily-recognizable, innocent, saprophytic bacteria, to some of these the disinfectant was administered immediately before the meal, while to others it was given immediately after. In none of these cases was disinfection complete, for in the intestinal evacuations of all of them the organisms that had been administered by the mouth could easily be detected. In these experiments the disinfectants that were employed were calomel, salol, naphthalin, ẞ-naphthol, and camphor.

The persons upon whom the experiments were performed were in some instances those in the possession of normal health, while the balance were suffering from intestinal catarrh, intestinal tuberculosis, or typhoid fever.-International Medical Magazine.

MEDICAL MELANGE.

FOR CHRONIC SUPPURATION of the middle ear bichloride of mercury, one to eight thousand, solution is a very efficient antiseptic, used once daily.

FOR COLD IN THE HEAD while in the acute congestive stage there is no better remedy than gelsemium. One good large dose, about ten minims of the fluid extract, taken upon going to bed, will effectually dispose of this troublesome and uncomfortable affection. One dose is usually sufficient.

MATICO IN EPISTAXIS.-Dr. T. K. Hamilton, in a paper read before the South American branch of the British medical association, calls attention to matico as the most efficient drug for controlling nose-bleed. He has found that the powdered leaves used alone or combined with powdered starch are most valuable in controlling persistent oozing, where other remedies had failed to control the bleeding.

CINERARIA MARITIMA IN CATARACT.-Dr. R. P. Banerjee, of Calcutta, reports several cases of cataract cured by the use of the juice of cineraria maritima, which strengthens the testimony of previously reported cures with this remedy. In all cases in which the doctor used the remedy the opacity cleared away in a very short time. Two drops of the juice should be dropped into the pupil three times daily, continuing the treatment for several months. The application causes no inflammation, and only a temporary burning sensation, which is but of short duration.