very difficult for physicians to furnish the medicine themselves, as is done so largely abroad. We do not advocate this, for there are many objections to it, but there are also many objections to the mixture of one half quack, one-half patent medicine vendor and the rest apothecary.

THE INFLUENCE OF MALARIA AND QUININE UPON PREGNANCY AND PARTURITION.-The questions relating to this subject, of great and practical import to all practitioners in malarial districts, are set forth in a study of the matter by G. T. M'Keough, of Chatham, Ontario, published in the Canadian Practitioner for August and in The Epitome. The author writes:

In the first place, are pregnant women liable to suffer from intermittent fever, or other manifestations of malarial toxemia, or does the state of pregnancy confer upon them a condition of immunity from the action of this poison. Credé (Monatsch. fuer Geburtsh., Band. xv, S. 1, 1886) states that in Leipsic during the year 1856 to 1859 there was almost absolutely no case of ague in a pregnant woman. Griesinger (Virchow's Handb. der Spec. Path. und Ther. Infect. Krank., 1856) found that during the prevalence of a quartan fever in Prague, only two out of 8639 pregnant and parturient women were attacked. On the other hand, Loov states that it is very common for pregnant women to have intermittent fever. Playfair says that the occurrence of hypertrophied spleens in infants has been often observed in malarious districts, and consequently believes that the disease must frequently occur in intra-uterine life. Goth, of Klausenburg, (Zeitsch fuer Geb. und Gyn., Band vi, S. 17, 1881), asserts that in a severe outbreak of yellow fever, forty-six out of 881 pregnant women were affected. My own notes agree more nearly with the later observers referred to. Of two hundred and twenty-eight (228) cases of pregnancy investigated by me, thirty-six or 158 per cent, exhibited some form of malarial poisoning. Secondly. When malaria attacks a pregnant woman, does it exert any remarkable effect

upon the course of pregnancy? To this query my observations give a very decided affirmative answer. Of the thirty-six women who contracted malaria during their period of gestation, all of whom received treatment, some, however, in a later stage than others, seventeen either aborted or were delivered prema turely. Malaria may not have been the sole cause of the miscarriage in each case, but as they all suffered from this toxic condition at the time of the accident, I believe it to have been a prominent factor in the etiology.

While authorities differ so widely on the last two questions, these discordant opinions extend equally to the action of the remedy upon which all depend in the treatment of malaria of pregnancy. Schroeder and others maintain that it is extremely problematical whether quinine has an oxytocic action or not. Cazeaux considers it a certain preventive against premature labor, whilst many others. assert that it has a decided ecbolic action. Hausman (Berliner klin. Wochenschrift, Sept. 11, 1882) records a case of well-marked uterine contractions following the administratration of quinine in a case two months advanced in pregnancy.

I have given quinine both in large and small doses in many cases for the purpose of quickening or rendering more efficient labor pains in cases of inertia of the uterus, or for stimulating the uterus to contraction when the escape of the amniotic fluid has not been followed by pains. I have also frequently administered it for intermittent fever, neuralgia, and other malarial phenomena during the course of pregnancy, and in only two cases have I ever seen any perceptible ecbolic action follow its use.

From the action of quinine in these two cases, which I think is sufficiently definite, I infer that in certain rare instances quinine overlaps its ordinary physiological area, so to speak, and, exceptionally produces uterine contractions.

The fourth and last controversial point upon this subject which I desire to refer to is the effect of labor upon a malarious attack. Ritter believes that the tendency of parturition

a committee of the British Medical Association, that was directed to investigate the several accepted tests for albumen in the urine, as to their reliability, it was decided that the nitric acid test is by far the most trustworthy,

Dr. James Tyson, in the Polyclinic discusses the heat and nitric acid test. The several precautions and all the minutia to be observed in the simple process are clearly pointed out. In speaking of the defects of the ordinary methed of testing, he says: This urine is alkaline in reaction, and although it may contain considerable albumen, there will be no precipitate on the application of heat for albumen is not precipitated from an alkaline solution unless there be a large amount present. I apply heat to this specimen of alkaline urine, and, as you see, there is no change in its transparency. I add a few drops of acid, and still there is no precipitate.

We have, therefore, again a urine which is albuminous, but in which the application of heat and acid fails to show the pres ence of albumen. Let us not, however, conclude too hastily against the delicacy of the test. The quantity of albumen in a given specimen may be so small as to give no immediate response to heat and acid, when by waiting a little while the evidence will be plain. The quantity may be so small, and the little flakes which are precipitated, so fine, that they do not appreciably affect the transparency of the urine, and eannot, therefore, be at once recognized by the naked eye, but if

time be allowed for the flakes to aggregate and fall to the bottom, they can be recognized in mass. In testing for such small quantities of albumen, it is essential that the urine should be perfectly clear. Under orninary circumstances, it will filter clear through one paper, or, if not then clear, the process may be repeated. But sometimes you find a urine which will not filter clear when thus treated. Under such circumstances, liquor potassæ or liquor sodæ may be added, the urine warmed and then filtered. The phosphates are thus precipitated in such shape that they can now be filtered out, and bacteria, which also contribute to the diminished transparency, are removed at the same time. If a perfectly clear urine, treated with heat and acid and set aside for six hours, is still perfectly clear, we may conclude that there is no albumen in it. But if a precipitate is found, does it necessarily follow that it is albumen? Not necessarily. It may be one of three things: nitrate of urea, which may be precipitated from a highly concentrated urine, acid urates, or albumen. But if the precipitate consists of nitrate of urea or acid urates, it will be redissolved on the application of heat. If it is albumen, on the other hand, the little flakes will again be diffused throughout the liquid, but they will not be dissolved. Used in this way, the test with heat and acid is much more delicate than is ordinarily supposed.

REUNION OF CUT OFF FINGERS.-The cases of severed extremities, which by a certain amount of good management have reunited, are becoming more numerous, and, if conservative surgery continues its efforts in that direction, will not be so much of a rarity in a comparatively short time. In Vratch for 1881 and 1884 as also in Tchernigov Zemsky Sbornik 1884, we find such cases recorded.

The Medical Record gives an interesting case reported by Dr. Perkins in 1885. Dr. S. D. Ivanoff records two cases in the Russkaia Meditzina. Both cases occurred in healthy soldiers, one of whom had accidentally cut away, by a stroke of an axe, the second

phalanx of the forefinger of the right hand. The second phalanx of the thumb of the left hand was cut off in the other case. In the first case, there was a bridge of skin about two centimeters in width which united the severed portion to the hand. The cut was clean and a portion of the base of the second phalanx was chipped off. Two hours after the accident, the wound was washed with an antiseptic solution, the parts accurately fixed by means of sutures and an iodoform dressing applied. In the other case the cut-off portion was brought away in a glass and was seen three hours after the accident. The same method of treatment was adopted as the first. In both there was union by first intention and limited mobility with a return of sensibility.

ARGYRIA. Although the question of administering salts of silver, more especially in the treatment of epilepsy, does not possess the importance it held some years ago. Experiments have been made to find the results of such salts in the organism. Dr S. Kysinski has examined the organs from three cases of argyria in man (Vratch in London Medical Record), and made a series of experiments on rabbits and rats, and he gives the following as the results in a preliminary note on the subject. The black granules which are met in the organs in cases of argyria in man or in animals, are constituted of an organic salt of silver, the precise composition of which is not determined. These granules are deposited in the walls of the blood-vessels first, and in the connective tissue subsequently. This deposition leads to an alteration and degeneration of the vessels. However, the granules may be deposited in the epithelial cells as well as in the endothelium, then in the afferent and efferent vessels of the malpighian tufts of the kidneys, and in the leucocytes of the blood. The granules deposited in the liver are found mainly in the ramuli of the portal vein and central acinar veins, as also in the capillaries which exist between the former and latter vessels, as was first pointed out Huyet. K. contends that this deposition of

silver in the organs not only takes place in chronic but also in acute poisoning by the metal, even if the toxic action has lasted only forty-eight hours. These deposits do not turn black, however, until after treating them with sulphuretted hydrogen. The most intense deposit seems to be in the cellular elements of the bone marrow. The general conclusion which the author draws, is the rather sweeping one, that even a short treatment by silver is highly dangerous, and this form of remedy should be absolutely dis carded.

VARIX OF LABIUM.-RUPTURE DURING LABOR.-The question as to whether anything could have been done to prevent the rupture of the varix, had its existence prior to delivery been known, leads Mr. Ambrose Atkinson to relate the following case in the British Medical Journal: Mrs. F., aged 39, was in her eighth confinement. On examination, a breech was made out, and, in a short time, it came well down in the pelvis. When near the outlet, the right labium began to swell. Delivery was easily effected, and, whilst the child was being separated, the patient was seized with another strong pain. On examination, a second bag of membranes could be felt. The tumor, however, steadily increased to an alarming size, and, another pain coming on, it suddenly burst on its side, deluging the bed. A napkin, folded so as to make a firm pad, was held to the parts, so as to effectually stop the bleeding. Forceps were applied and the second child suddenly expelled, the injured part being freely compressed at the same time. On examination, it was found that the inner side of the labium was so torn that four fingers could be passed into the opening, which led to a cavity sufficiently large to admit the whole hand. Iodoform was applied together with plugs and pressure. About the fifth day, a piece of vein, about three-fourths of an inch long, which lay across the wound, sloughed off, a little bleeding taking place. On questioning the patient about the veins, it was ascertained that she had observed a lump there

for some time. She also noticed that it became larger towards night, but did not think it worth while mentioning. Iodoform dress ings and subilmate injections (1 in 3,000) twice daily for a week, secured a good recovery.

NAPHTHALINE IN URINARY TROUBLES.-At the late meeting of the French Society for the Advancement of Science, M. de Pezzer stated that naphthaline possessed the property of retarding the putrefaction of urine. He has administered it to patients affected with disturbances of the urinary organs accompanied by fetid urine. In pyelonephritis, in cystitis, in chronic prostatic troubles with stagnation of urine, in old strictures with numerous fistula, naphthaline in daily quantities of twenty-two grains caused this fetid condition of the urine to disappear rapidly in a period of time varying from two to five days. The urine which was turbid, pus laden and alkaline becomes limpid, neutral or acid, and the pus diminished in quantity or even entirely gone. No untoward symptoms developed with respect to the digestive organs. Naphthaline in these cases is given preferably by the mouth and

does not increase the number of micturitions, as has been contended by some. On the contrary it has a sedative effect upon an irritable bladder, and diminished a great deal the number of times that there is a desire to urinate, ber of times that there is a desire to urinate, and, consequently, of catheterization. It is probable that it acts favorably upon the kidneys and bladder in cases of pyelonephritis and cystitis; but, granting that it only possesses the property of preventing fermentation and fetidity of the urine, it becomes of great value in the treatment of genito urinary

diseases.

NON-CATAMENIAL HEMATEMESIS IN HYSTERIA.-M. Aug. Ollivier has lately shown in l'Union Medicale that there exists at times, in individuals subject to hysteria, no matter what the sex may be, more or less gastrorrhagia, which appears to be exclusively due to a special state of the nervous system. This variety of hematemesis, which there is too great

a tendency to regard as a symptom of ulcer of the stomach, is in reality, a form of local hysteria with a gastric form and hemorrhagic manifestation. The absence of profound disturbances of nutrition, the sudden debut, the existence of nervous commotion and the comparative prompt return to health are generally sufficient to acquaint us with the true nature of the disease. It has been suggested by some that this form of hematemesis is much the same as the hemorrhages which can be produced in the hysterical by suggestion. The similarity of these two conditions has been well shown by Bernheim.

ANTISEPTICS IN GONORRHEA.-In quite a lengthy article on medical antiseptics, Dr. P. Le Gendre gives the following which is very suggestive. Since the parasitic nature of gonorrhea has been demonstrated, it may be said that its treatment has been definitely entered into the ranks of antisepsis, which, however, had been previously employed in an empirical manner. Urethral injection of corrosive sublimate of various strengths, and also of quinine and of salicylate of bismuth have given better results than the old methods. Unfortunately, the arrangement of the muous membrane of the urethra, rich in crypts where the micro-organisms quarter themselves in epithelial cells, permits the gonococcus to escape the antiseptic sometimes. The value of antiseptics and more particularly of the bi

chloride has been well established in the treatment of gonorrhea. The presence of gonococci in the crypts of the urethral mu cous membrane easily explains the occurrence of cases where a return of the gonorrhea takes place spontaneously, as it were, after an ap parent cure.

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