In addition to its popularity as an infant food, Malted Milk is now acknowledged to be one of the best diets for typhoid, fever and many other wasting diseases that has yet been produced. It is the ideal milk diet, very palatable and easily assimilated, more nutritious than beef extracts, and superior to raw milk, as it will not form into hard curds in the stomach. This important feature is obtained by partial digestion of the milk albumen by plant pepsin. Physicians appreciating the vital importance of diet in typhoid fever and other cases, should give it a trial. Samples supplied by the manufacturers, Malted Milk Co., Racine, Wis.

THERAPY OF PHENACETINE.-"Phenacetine was originally introduced into medical practice as an antipyretic, and subsequently was found to possess analgesic powers. In diseases attended by hyperexia, such as rheumatism, pneumonia, typhoid fever, and phthisis pulmonalis, Phenacetine exerts a very happy effect in about half the dose of antipyrine, the ordinary dose being from 3 to 8 grains. The mortality of the typhoid fever of children has been very materially reduced by the employment of Phenacetine. The fall of temperature does not occur until half an hour after the drug has been taken, and the effect continues from four to eight hours. As an antipyretic, Phenacetine is considered by many good authorities as the safest and most efficient member of the aniline group. In epidemic influenza, Phenacetine rapidly relieves the muscular pains and favors diaphoresis; the catarrhal symptoms subsequently require other remedies."-John V. Shoemaker, A. M., M. D.

SOME NEW FEATURES IN PARKE, DAVIS & Co.'s LIST.-Among recent additions to the list of Parke, Davis & Co., whose constant endeavor is to add to and improve their manufactures, are the following: Fluid extract of Cocillana, the Bolivian remedy for respiratory inflammations. Compressed tablets of Calomel and Sodium Bicarbonate, 2% grains each. Tablet triturates of ext. Cascara Sagrada, 1 grain. Antiseptic tablets, Ṛ “C." Gelatin-coated pills -Terpine Hydrate, 5 grains, and several other convenient preparations.

LOOK out for cold weather, but ride inside of the Electric Lighted and Steam Heated Vestibule Department Trains of the Chicago, Milwaukee & St. Paul Railway, and you will be as warm, comfortable, and cheerful as in your own library or boudoir. To travel between Chicago, St. Paul, and Minneapolis, or between Chicago, Omaha, and Sioux City in these luxuriously appointed trains, is a supreme satisfaction; and as the somewhat ancient advertisement used to read, "For further particulars, see small bills." Small bills (and large ones too) will be accepted for passage and sleeping car tickets. For detailed information, address Harry Mercer, Michigan Passenger Agent, Detroit, Mich.

DURING the cold weather, physicians, and especially country physicians, will find it very convenient to have a package of Horlick's Malted Milk at home, so that they can make them

selves a warm and nourishing drink at a moment's notice, when called out for a long drive, or to use as a lunch at other times when there is no opportunity of enjoying a full meal. It is not a stimulant, but supplies warm and concentrated nutrition in an easily assimilable form. The Malted Milk Company offer trial packages for this purpose, on application.

ELECTRICITY IN GENERAL NEURASTHENIA.Dr. Joseph Adolphus, of 48 S. Butler St., Atlanta, Ga., writes to the Jerome Kidder M'fg. Co., 820 Broadway, New York: "I have your machine, bought in 1874. It is a 10-current, and is to-day as good as ever. I have used it almost continuously, and have had to replace platinum element several times. I have used other machines, but yours is decidedly the best. The A. B. & C. D. currents I use very frequently, and find them real nerve soothers and tonics. They afford the best currents for general faradic tonic effect on the system in the treatment of nervous women and general neurasthenia."

ANNOUNCEMENT.-E. B. Treat, Pub., N. Y., has in press for early publication the 1893 "International Medical Annual," being the eleventh yearly issue of this extremely useful work. A glance at the prospectus gives promise that the 1893 issue will be better than any of its predecessors. There are thirty-eight distinguished specialists on its corps of editors, carefully selected from among the most eminent physicians and surgeons of America, England, and the continent. It arranges in a practical way for ready reference what is worth preserving of the year's medical literature, together with a number of important papers specially written; and will contain over 6000 references to diseases and their remedies, many illustrations in black and colors being used where helpful in explaining the text. The service rendered by this work, giving the year's progress in medicine and surgery so conveniently and at so low a price ($2.75), cannot be overestimated. Altogether it makes a most desirable, if not an absolutely necessary, investment for the practitioner.

CONTENTS OF LIPPINCOTT'S MAGAZINE FOR FEBRUARY.-The First Flight (illustrated), Julien Gordon: Men Who Reigned: Bennett, Greeley, Raymond, Prentice, Forney (journalist series) (portraits), Hon. John Russell Young; Palinode (a poem), Charles Washington Coleman; Josiah's Alarm, Josiah Allen's Wife; A Remorse (a poem), E. W. Latimer, from the French of Hippolyte Lucas; Wrestling (athletic series) (illustrated), Herman F. Wolff; Trust (a poem), Floy Campbell; The Russian approach to India. Karl Blind; Change (a poem), C. L. Whitney; New Philadelphia (illustrated), Charles Morris: Bobolink (a poem), Daniel L. Dawson; The First-Born of the Orchard, Francis Wilson; Love's Season (a poem), Ella Wheeler Wilcox; Recollections of Seward and Lincoln (portrait), James Matlack Scovel; With a Match-Box (a poem), Charlotte Fiske Bates; Seventh-Commandment Novels, Miriam Coles Harris: An Organ and a Reform, Frederic M. Bird; Men of the Day. M. Crofton; With the Wits (illustrated by leading artists).

VOL. II.

ORIGINAL ARTICLES.

CONCERNING CHOLERA.

BY PAUL PAQUIN, M. D.

(Illustrations in Frontispiece.)

So much is being said and printed now about cholera, that physicians, in view, of the possibility of its appearance in this country next spring, are all very anxious to inform themselves as much as possible on the most recent discoveries concerning it. It may not be amiss, therefore, to publish at this time, some notes on the most important points concerning its cause, development, and

treatment.

At the outset, it is well to bear in mind that Asiatic cholera is, as the medical profession well knows, endemic in India, and reaches Europe usually by way of Egypt. It never arises spontaneously in Europe or America.

As far back as 1848, the parasitic nature of cholera was suspected. In that year Virchow, and in the next year Pouchet and Swayne, found vibrios in abundance in the dejections of choleric patients, without attributing to them any specific action. From that time until the discovery of the comma bacillus by Koch, numerous investigations were made without definite results. In 1884 Koch became positive that cholera was due to this parasite, which he termed the comma bacillus because of its peculiar curved appearance, something the shape of a comma.

The definition of Asiatic cholera may be given as follows: An essentially infectious disease, apparently contagious under certain circumstances, and epiIt may or may not be attended

NO. 2.

by premonitory diarrhoea; its invasion is sudden, accompanied by copious evacuations, vomiting, diarrhoea, cramps, and algidity, which frequently end in death, or in a reaction in which various symp.tomatic manifestations occur, followed by recovery or death. It must not be confounded with cholera nostras or cholera morbus, which sometimes present many of the foregoing characteristics, but which are produced without the comma bacillus, by different micro-organisms. These other organisms appear and do mischief in certain seasons, contrary to the Asiatic cholera, which may appear with more or less violence at any time of the year. It is modified but not destroyed by low temperature.

The Germ of Cholera.- As we have mentioned, the comma bacillus of Koch is the parasite which produces cholera. It is found in the inodorous aqueous liquid dejections in which float whitish riziform grains. The comma bacillus is almost always present in these particles.

The bacteria can be demonstrated by spreading on a cover-glass a fragment of riziform particle, allowing it to dry, and then coloring it a few seconds with methyl-violet or methyl-blue. The prep

aration is washed and examined with an immersion objective and an Abbe condensor. This method, however, shows numerous other bacteria, among which it may be difficult to discover the comma bacilli. To find these bacilli in large quantities, it is necessary to study a case very rapidly in the earliest stage, when they may be as plentiful as in a new, pure culture.

The best means of seeing these parasites in liquid fecal matters containing many, is to spread a bit of a small mucous particle on a glass slide, allow it to half dry, and then cover it with a few drops of weak solution of methyl-violet

(6 B) in distilled water. A cover-glass. is applied, and pressed down with bibulous paper. The preparation is then examined with a high power objective, dry or in immersion. The bacilli are found still alive, though stained; they are very active, and retain their movements for some time.

This mode of preparation, say Cornil and Babes, is better for a delicate examination than a complete desiccation with coloration and mounting in Canada balsam. It is well established that during and by manipulation and dehydration, the bacteria of cholera contract, as do most other bacteria under the same influences. The result is that they decrease in size, while their movements are of course completely destroyed.

The average comma bacillus is about 1μ,5 to 2μ,5 in length by oμ, 5 to oμ,6 in thickness. The germs are well named, "like a comma; "their sides are smooth and their extremities either blunt or a little pointed and thickened. They are. not so long, but broader than the bacilli of tuberculosis. Occasionally two rods are observed end to end, in such a shape that the two united form the letter S. They are perhaps the most characteristic of the comma bacilli. (See Figs. 2 and 3, frontispiece.)

After the second or third day of cholera, when the period of reaction begins, the comma bacilli are scarce, and stained by bile; it is then difficult to see them, and it is sometimes necessary to make cultures if we wish to ascertain their presence. After a long period it would be difficult, if not impossible, even by cultures, to ascertain if they were present, because at the beginning of the period of recovery they disappear, and soon they are entirely absent. In rapid cases, however, in which death occurs, the germs may be cultivated from the fæces immediately after death. The secondary lesions which are found on the mucous membrane of the intestines, etc., such as ulceration and gangrene, are attended by a development of numerous bacteria of decomposition, which eventually destroy the bacilli of cholera. This point should not be forgotten in making investigations.

Numerous methods of growing cultures have been recommended for this germ, as for other microbes; but for practical use the two following seem to have given the most satisfaction:

.

The first consists in inoculating one tube of liquefied gelatine with a platinum wire. This tube is shaken, and from it a second inoculation is made in a second tube with a curved platinum wire, using three drops for inoculating material; the second tube is shaken and mixed as the first. Five drops are then taken from this tube and mixed with the liquid gelatine of a third one. The contents of each tube are then poured on three plates superposed, the first of which should be the inferior one.

The second method consists of taking a few riziform particles of the fæces, mixing them well with liquid gelatine, and making from this some gelatine solutions by Koch's method, i. e., successive solutions with 1, 3, 5, and 10 drops. These different culture solutions are poured on plates. The development is allowed to progress for two or three days, during which colonies of microbes may appear on the first plate as slight liquefied spots. They may be plain enough on some or all after two or three days. The colonies may be scarce or numerous; of course they are more numerous in the more concentrated of the culture solutions.

Another series of similar dilutions is then made, by using a little taken from the liquefied spots. The substance may also be cultivated in beef broth at the temperature of the body. If it contains any cholera bacilli, they will develop on the surface in the form of a white scum.

In examining with a magnifying glass or microscope at 55 diameters, 24 hours after sowing a plate of gelatine, the colony of bacilli may be recognized by the following characteristics, which we quote word for word from Cornil and Babes's writings : —

"In the center of the colony there exists a spot as if formed by a mass of dust surrounded by a granulous circle, and a second circle clear and nongranulous. (See Fig. 1.) Between the center and the first circle the gelatine is liquefied. These cultures have a yellowish appearance: they are more transparent than most of the cultures of the germs of the fæces. The other bacteria of the fæces usually form larger colonies, round, dark, and brown, which do not liquefy gelatine. We have found twice, among the bacilli of cholera, some other curved microbes, which are described in our clas