action, which, in my judgment, is the origin of the impulse we feel when we take the cord between our fingers. I have a better proof, if possible, than the one I have just given. It is the case of a full grown fetus born without a heart. The case to which I refer was the one recorded by Sir Benjamin Brodie. The fetus was one of twins, and received the blood from the placenta. It was tolerably well developed, brain and all, except the heart, thymus gland and pleura, all of which were absent. The lungs were very imperfectly developed. The aorta was well developed, but it started from the left umbilical artery in the left groin, and extended upward along the front of the spine, into the upper part of the thorax, where it gave off the two sub-clavian, and afterward divided into the carotid artery without forming an arch. The external and internal iliac arteries of the left side came from this artery from the left groin, immediately after it left the umbilical; and the common iliac of the right side was given off from it after it had gained the normal situation of the aorta. This is not the only case of the kind that has been reported, but one is as good as a thousand. The question arises, how was the circulation maintained, not in part, but altogether? I would explain it just as I would the circulation of the lymph or the portal circulation. I can explain it in no way but by peristaltic movement. Other proofs of this kind of action I think may be found in the erectile tissues of animals. And also examples are found in the human species. Take for instance the erection of the penis. I know in this case you have a dilatation of the vessels of the organ, and an active congestion of it, but I hold you have the peristaltic contractions of the vessels playing an important part also. If not, why does it become so much more rigid and harder than other tissues exposed to a similar vascular action? Take for instance a part plugged by a thrombosis, or a varicose condition of a part, and they are not nearly so rigid as the first-mentioned organ. Another condition in which I think peristaltic contraction plays a prominent part, is in the secretory organs. We will take, for instance, the stomach in the act of act of digestion. Here you have more blood passing through the organ in a given time than is done normally; and why is this? Is the heart action at all increased? I think not. Then how is more blood carried to the part in a given time than there is normally? I know that it is held by some that the "vessels of the stomach become dilated,"and in this way receive a greater supply of blood. But how is this extra supply of blood produced? In the following manner. The food in the stomach presses the peripheral ends of the sensory nerves in the mucous coat of the stomach and a sensory impression is carried over this sensory nerve fiber to the vasomotor center and is reflected as a motor impression to the muscular coat of the bloodvessels and produces a peristaltic contraction of the blood vessels leading to the stomach, and in this way increases the amount of blood sent to the stomach in a given time and not by a mere dilatative action as is generally supposed, or by a paralysis of the vaso-constrictor nerves of that organ. We will see how a mere paralysis of the vaso-motor nerves would affect a part, a thing that has often been done by simply dividing the nerves of the part, and in this way paralyzing the vaso-constrictor nerve fibres, of course, producing a dilatation of the muscular blood vessels. Now, the point I wish to get at is, will this dilatation of the vessels cause more blood to flow through a part in a given time or less? I must say that I think less, from the simple reason that the rapidity of the blood current is greatly diminished, and there is less tone possessed by the vessel, and a consequent stasis of the blood in the vessel. This has been proven more times than one, by dividing the cervical sympathetic in the neck which causes a congestion and a statis of the blood in one half of the head. Consequently if the increase of blood supply to the stomach during digestion, cannot be accounted for by a simple dilatation of the vessels, how are we to account for it? I can see no more rational way of accounting for it than by giv ing to these vessels a peristaltic action. I will also call attention to another condition of WEEKLY MEDICAL REVIEW, the circulation, in which I think beyond a doubt this peristaltic contraction must be present, viz., in the establishing of collateral circulation, and in a part that has recently become congested. In these conditions you often see the current of blood reversing or turning back in its course, and flowing directly against the arterial current. I would ask how could this action be produced, except by peristaltic action, with the heart and elastic arteries sending the current of blood directly against this reversed current? I have other EDITED BY THE MEDICAL PRESS AND LIBRARY ASSOCIATION Contributions for publication should be sent to Dr. I. N. Love, Secretary Executive Committee, Cor. Grand and Lindell Aves. All remittances and communications pertaining to Advertisements or Subscriptions should be addressed to J. H. CHAMBERS, 914 LOCUST STREET, ST. LOUIS, MO. SATURDAY, DECEMBER 11, 1886. proofs of this kind of action, and of the direct NASAL INSUFFLATIONS IN WHOOPING COUGH. kind. I will call attention first of all to certain facts chiefly to be observed among the lower animals. I believe in the first place it is a fact that in proportion as the action of the heart becomes insufficient as we descend the animal scale, just in that proportion do the blood vessels become more muscular. Why is this so? Is it to regulate the supply of blood to a part to which the arteries lead? I think not, and I cannot imagine besides this any other purpose this muscular tissue should fulfill, if not to supplement by peristaltic action, a deficiency in cardiac action. The kind of action I am now speaking about may be seen in the embryo of birds, and more particularly of chickens when the first blood vessels appear in the egg. An action that appears to be peristaltic may be seen in the young of frogs, and has been seen in the arteries or veins by thousands of observers in the various lower animals. Thinking the numerous instances cited for the proof of peristaltic action of muscular blood vessels sufficient, I leave the subject for your consid eration. -At the recent annual meeting of the St. Louis Obstetrical and Gynecological Society, the following officers were elected: President, Dr. Walter Coles; Vice President, Dr. G. J. Engelmann; Recording Secretary, Dr. W. M. McPheeters; Treasurer, Dr. G. A Moses; Corresponding Secretary, Dr. E. C. Geerung. Additional testimony to the efficacy of a local treatment directed to the nasal cavities in cases of whooping cough comes from all sides. A late report is by Guerder in L'Union Médicale. He blows a powder consisting of equal parts of boric acid and finely triturated roast coffee into the nostrils. Radical relief was generally obtained in eight to fourteen days. Three cases were aborted and none of the complications incidental to the disease occurred. It will be remembered that Michael and Lublinski had equally favorable results from the use of quinine-insufflations. Apropos of this subject of local treatment we find a report by R. Pick, of Coblentz, in the Deutsche Medicinische Wochenschrift, on inhalation of pure carbolic acid. The use of dilutions of carbolic acid never resulted in much benefit. He therefore devised a sort of a mask, or muzzle, within which a ball of cotton is fastened, upon which fifteen to twenty drops of pure carbolic acid are sprinkled. This device is worn for an hour or two at a time, the cotton and carbolic acid being renewed two or three times a day. The mask can be so constructed that it does not interfere with speech and play. The urine should be watched for signs of intoxication. Pick reports five cases that were certainly favor ably modified. Pearse, M. D., discussed the duration of infectiousness in scarlatina, small-pox, measles, mumps, and diphtheria in the following terms: We must distinguish infection from the person and that from clothes. We must know for how long infection is exhaled from the patient as well as the potency and duration of infection attaching to the cast-off débris of pathological processes induced by the disease. A case may be said to be first infectious and later contagious. Infection is exhaled for a much shorter time probably than we have generally imagined. The question to determine is, for how long the pathological processes induced by the different diseases-for example, the desquamation of scarlet fever and the catarrh of measles-continue the carriers of the contagion. How long will the discharge from skin and mucous membrane bear infective properties? I have reason to believe that personal infection, or exhaled infection, in contradistinction to infection by contact or inoculation of the disease products, has a definite duration, and that a special period of duration of this exhaled infection characterises each disease. On the other hand, many things are explained to hasten or hinder the elimination of infection with the characteristic discharges of the disease. The rules given, that scarlet fever is infectious as long as desquamation lasts, small-pox as long as every scab or scale remains on the skin, diphtheria while sore-throat or albuminuria, or discharges from mucous surface continues, are all open to question. Upon this hypothesis, we could never say when a person ceases to be infectious. I would suggest that infection only attaches to those cast-off products of the disease when they were formed during its strictly infectious period; that, forjexample, the early desquamation of scarlet fever, and not the second or third peeling, is infectious; the primary albuminuria of diphtheria as well as scarlet fever, but not that which may remain for weeks or months or years afterwards. I hold that these pathological conditions and their products, induced in a characteristic way for each disease, are not any guides as to the continued infectiousness of a patient, and on this basis I would urge that a mild case is as long infectious as a severe one. My observations make the duration of infection in the several diseases as follows: Measles, from the second day, for exactly three weeks. Small-pox, from the first day,under one month, probably three weeks. Scarlet fever, at about the fourth day, for six or seven weeks. Mumps, under three weeks. Diph. theria, under three weeks. OPERATIVE TREATMENT OF ABSCESSES OF THE LIVER. In the London Medical Record, John Elliott abstracts a paper by Kartulis as follows: According to the handbooks of surgery and other well known works, the results of operative treatment of abscesses of the liver would appear to be extremely unfavorable. Before the discovery of antiseptics it was impossible that larger abscesses in the right hepatic lobe, where they are most common, could be successfully treated by operation. New hopes dawned when Lister, in December, 1878, successfully opened such an abscess under antiseptic precautions (Taylor's Tropical Diseases), and the operation was then frequently performed. Yet in England the method has again recently been condemned" on account of bad results," and the operation by the trocar reinstated. If the results have been bad, Dr. Kartulis, of Alexandria, ascribes the fact to this, that the pus can not be easily discharged, even with drainage, on account of the contraction of the ribs, and thus stagnates in the cavity of the abscess, easily causing pyemia, hectic fever, etc. He therefore determined in a case that seemed to demand it, on resection of a rib. The abscess was in the right lobe; it had been twice punctured, and later on opened with a knife through the seventh intercostal space, but yet without healing. To save the patient, Dr. Kartulis found it necessary to saw away about three centimeters of the seventh rib. Hereupon a great quantity of foul pus was dis charged, and healing proceeded normally. During the first days the bandages were often changed, until the secretion of pus gradually ceased. In less than three weeks the abscess was completely healed; and the general health of the patient was very good. In another severe case, Dr. Kartulis resected about five centimeters of the ninth rib. The thin wall of the abscess was seen to be very tense. Slight pressure caused it to burst, discharging a stream of pus. The first finger could reach the top of the abscess, but not the bottom of it. Strict antiseptic precautions were taken. Five hours after the operation the patient was lively and free from fever. In nine days the abscess cavity was filled up, and two days afterwards the bandaging was discontinued. The patient served afterwards in the same year in the Soudan campaign for half a year, remaining perfectly well. The disadvantage of resection in hepatic abscess, as compared with that in thoracic empyema, is that in the former the diaphargm frequently has to be cut through; and if there be no adhesions, there is the danger of the pus finding its way into the thoracic cavity. In such cases, Dr.Kartulis recommends that two or more ribs should be resected, and the pleural cavity drained. But he thinks there will generally be adhesions, owing to the enlargement of the liver, and that there will be no complications in connection with the operation. Abscesses of the left lobe, which are less frequent and generally smaller, may sometimes heal after one puncture. If these abscesses be large and deep, without adhesions, the cannula should be allowed to remain with antiseptic precautions, or several punctures be made, the abscess being ultimately opened with the knife. It is different if the abscess be in the right lobe. In this case the trocar must first determine the position of the abscess, and then resection be done with a view to opening it at once. It is not well to wait for adhesions, since the delay may prove fatal to the patient. GUNSHOT WOUNDS OF THE INTESTINES was the chief matter of scientific interest before the New York State Medical Association at its late meeting. The subject is a new one and replete with practical interest. We therefore reproduce the report contained in our esteemed contemporary, The Medical News, and direct especial attention to the same. The discussion embraces all that is known and is still being learned regarding a surgical procedure, without which death is an inevitable result. COCAINE INTOXICATION.-In the Chicago Medical Journal and Examiner for December, Lester Curtis abstracts the following notes: Dr. Commanus, Berlin, Berliner Klinische Wochenschrift, describes a case of cocaine intoxication. The patient had contracted the morphine habit in seeking relief from hemor rhoids, and used cocaine as a substitute for morphine. He began with 0.05 grm. of muriate of cocaine three or four times daily. The remedy at first gave him real comfort without producing after effects worth mentioning. According to his account he enjoyed an alleviation of his hemorrhoidal difficulty, and had a stool every day, which was not the case when using the morphine. He finally reached doses of 0.5 to 0.8 grm. daily, when he began to suffer with “a poor appetite, ringing in the ears, occasional shortness of breath, and hallucinations in respect to the senses of sight and hearing." These symptoms he learned how to remove by small doses of morphine. During an attack of herpes zoster he used doses of from a gramme to a gramme and a half daily for two or three days. Then fol lowed "trembling of the limbs, relaxation of the muscles of the body, peculiar and rapidly extending changes of the fin ger and toe nails, loss of appetite and sleep, very great agitation, strong hallucinations in the departments of the nerves of sight, smell and hearing; intensely injected conjunctivæ;a staring look. The patient fired several revolver shots at the objects of his hallucinations. He attacked his servant in order to force out of his mouth a lantern which was concealed there." These symptoms are seen to resemble those of delirium tremens. They were relieved in two or three days by small doses of morphine. Dr. Maerkel, Berliner Klinische Wochenschrift, March 8, 1886, also gives some warnings as to the danger of using cocaine. Among these is the "significant sleeplessness lasting up to six hours after the cocaine injection." oil, quinine, mercury and a few such standard drugs, the physician is usually equipped to meet all emergencies. Almost weekly some new drug is brought to our notice, but in many instances, after trial, it is found either inferior to, or no better than, those which we already have, and its use is dispensed with. But it does sometimes happen that we are offered an article of such undoubted merit that it is warranted in taking rank with the standard articles of our materia medica. Such an article is ingluvin. (Ingluvin is a refined substance, prepared from the ventriculus callosus gallinaceus, the gizzard of the domestic fowl, gallus domesticus.) It is the essential principle of the gizzard, and bears the same relation to poultry that pepsin does to the higher animals. He doubts, however, the danger of forming a cocaine habit, like the morphine habit, because he does not believe that cocaine is a pure nervine as morphine is. It produces its effect first through the nutrient glandular system, which it stimulates, causing an excess of nutrition to flow to the nerve centers. His reasons for this opinion are that after the use of cocaine, a certain amount of salivation is always produced. There always follows a swelling of the lymphatic glands in spite of the most careful antiseptic precautions; even the mammary gland is sometimes affected in the male. This result is more marked on the side which has received the injection. The appetite is always increased as after a tient has entirely recovered. From China drain upon the nutrition. The drug produces not so much a stimula. tion as a feeling of well-being and elasticity, a disposition to play as in growing young animals. After the effect has passed off there is no "katzenjammer," as after a debauch, only a return to the usual condition. At the most there is only a feeling of pleasant weakness. It is in this disturbance of nutrition that he thinks the danger in its use lies. As a partial proof of this view, he states that the cocaine users of Central America always die of phthisis. A favorite prescription of Chinese physi. cians for chronic indigestion, is to cut up and digest chicken gizzards in hot water until they are reduced to a pulp, and then add some spices. A tablespoonful or two of the resulting paste is taken at each meal until the pa the practice passed to other parts of Asia, and was adopted here and there among the Mediterranean peoples. Strange to say, it was never learned by the great nations of Europe until the latter part of the present century. The diseases in which the use of ingluvin is indicated, are indigestion in its various forms, known as dyspepsia, and for sick stomach or nausea, caused by debility of that organ. It was originally discovered to be a remedy, indeed a specific for vomiting in pregnancy; in this respect it stands above all other medicinal agents. In all that is here set forth, the manufacturers claim no more than is sus INGLUVIN—The Med. and Surg. Reporter tained by medical authority of the highest contains the following: It has been a favorite saying among the more distinguished of our profession, that there are a few essential drugs without which the practice of medicine would be impossible, and that when we have selected these few, the great multitude of articles in our materia medica are comparatively useless. This is a very true idea. With calomel, opium, castor standard. In ingluvin, the physician has what might be called a specific for a sickness which in many cases has hitherto been uncontrollable. Ingluvin is a powder of a yellowish-gray color, and may be prescribed in the same manner, dose and combinations as pepsin, three to ten grains. The pulverulent form is con |