of rectal and prostatic troubles due to bicycle riding. The writer feels justified in saying that such troubles rarely occur as a direct result of wheeling. Hemorrhoidal troubles are so nearly universal in men that caution is needed in ascribing their occurrence to the use of the bicycle in every instance in which they happen to a rider. It is easily conceivable that if the saddle or the clothes worn by the rider chafe or irritate the peri-anal region, in an individual whose digestive organs are not in good order, an attack of piles may occur.

As for prostatic troubles, we have been assured that some have been observed as direct results of riding. In our long experience of wheeling we have failed to see any such cases, but there is good reason to believe that caution is necessary in advising male adults to ride, and that the existence of prostatic trouble should be a signal for giving up the wheel.

*

Since then

JACKSONIAN EPILEPSY FROM OLD CEREBRAL ABSCESS.- Dr. Lepine has recorded in the Lancet a curiously interesting case of a woman aged sixty-two who, ten years before her admission to hospital, had had a series of convulsions with loss of consciousness, and these were succeeded by left hemiplegia, which lasted fifteen days. Since then she had had frequent attacks, which had been regarded sometimes as Jacksonian attacks, sometimes as hysterical. In December last she had one day several attacks, and these continued to recur day after day. There was loss of consciousness in the severe ones, but there were also slighter ones in which there were jerkings of the fingers and forearm, but no loss of consciousness. On the day after her admission, following a severe attack, left hemiplegia was noted affecting both arm and leg, but sparing the face. The attacks came on more frequently, and although bromides lessened their severity it did not control them, and the patient gradually sank and died. At the necropsy it was found that in the right frontal lobe, rather nearer to the anterior border of the hemisphere than to the fissure of Ro

lando, there was a cyst two to three centimeters in diameter with caseous contents. It was, in fact, apparently a cold abscess, and there seems every reason for believing that it must have existed for the ten years during which symptoms, only explicable on the hypothesis of such a lesion, had been present.

UTERINE GONORRHEA. Wertheim (British Medical Journal) believes that next to the urethra the uterus is the most common seat of gonorrhea. The germ sets up true acute interstitial endometritis; in chronic disease the glandular tissue of the endometrium is greatly increased. The muscular coat is often involved, and a kind of sclerosis of the vessels occurs, whilst the connective tissue undergoes hyperplasia at the cost of the muscle cells. Gonococci are usually to be found in the inflamed mucosa, yet sometimes they are entirely absent, and they rarely, if ever, can be detected in the exudations in the muscular coat. The os internum offers no protection to the entrance of gonorrheal poison into the uterine cavity. The cervix is less involved, and the disease is always least marked nearest the os externum. The puerperium is the most dangerous condition when gonorrhea exists in the genital tract lower than the uterus. Menstruation, coitus, and the sound are much less liable to expose the uterine cavity to gonorrheal infection.

Dr.

BLOOD SERUM THERAPY.-The use of blood serum as a therapeutic agent is receiving much attention just now. G. Fütterer of Chicago gives in Medicine a history of its development and uses and lays down the following conclusions:

1. The preventive vaccination against smallpox has been practically proven beyond a doubt, and in diphtheria to a certain degree. So the principle represented must be accepted.

2. The antitoxins which cause immunity are products of toxins of bacteria, formed in the blood of the animal body.

3. We do not know the process of the

formation of those antitoxins, and Buchner is of the opinion that we do not know their chemical nature. While they may stand in a certain relation to albuminous bodies of the blood, this relation is not close, as these albuminous bodies may be precipitated, thus proving that they themselves contain only a very small amount of antitoxic substances, certainly much less than the previous solution as a whole. The opinion of Buchner, who believes in the existence of an albumen in a live state, must also be wrong, as the serum containing the antitoxine can be mixed with solutions of carbolic acid or other solutions which destroy animal life, and be kept mixed with them for any length of time, without losing its antitoxic properties.

4. Metschnikoff's phagocyte theory we consider also unsatisfactory, for reasons mentioned above, and because if we expose a mixture of serum and phagocytes to the freezing process and thaw again, our mixture will not have a stronger antoxic effect than before.

5. Favorable results have been obtained by using antitoxines for curative purposes in diphtheria, tuberculosis, syphilis, tetanus, cholera, typhoid and other diseases.

6. There is no absolute natural or artificial immunity. If immunity is not always conferred by an attack of smallpox, we certainly cannot expect such a result in diseases like diphtheria by artificial immunization. There is no absolute artificial healing, but the lower death rate which we have had reported so far may yet be decreased by using mixed antitoxins to also influence the streptococcus and staphylococcus, and in rarer cases the pneumococcus, and by a more correct dosage.

7. The antitoxin in diphtheria alters the local diphtheritic process and the general condition in a favorable way. Intubation and tracheotomy are less frequently needed, on account of the favorable influence of the antitoxin on laryngeal stenosis. The prognosis of The prognosis of these operations, especially the former, has improved under the use of antitoxin.

8. Although we have after-effects by

the use of antitoxins, it may be said that exanthemata are not dangerous; albuminuria as observed in our cases has been generally transitory, except in one case, and it is hard to tell whether albumen had not been present in a great number of cases before the antitoxine was used, and even if it came after whether it was caused by it or not; the cases of paralysis of the soft palate are also a little doubtful in their explanation -as this diagnosis is often made in diphtheria where only a firm exudate stiffens the palate, and in the cases reported who can tell whether diphtheria itself caused paralysis? Graver symptoms were observed in one of our cases in the form of a gastro-enteritis and nephritis, but even if we lay it to the use of the antitoxin it is only one case out of nearly four thousand, and of no account if we remember the comparatively low death rate achieved by the use of antitoxin.

9. The birthplace of the antitoxins and their mode of forming are, so far, unknown; but I believe, with Roux, that they are produced by cells, but certainly not by the white blood-corpuscles.

I firmly believe that in antitoxin we have a therapeutic agent of no transitory importance and value. It will find friends and enemies like vaccination. But what do the latter amount to? There are enough physicians whose logical thought and never-tiring, able work will bring truth to light, and enough physicians whose intelligence will show them the good as soon as it comes and who by the strength of their conviction will become strong apostles of the truth.

UREMIC PERICARDITIS.— Dissy (British Medical Journal) reports the case of a man, aged 48, who died of uremia. At the necropsy there was found slight increase in the pericardial fluid, which was opaque from contained cells and small fibrinous floccules. Both layers of the pericardium had lost their smooth glistening appearance, and presented small reddish points covered here and

there with a layer of fibrinous material. The heart was hypertrophied, especially the left ventricle. No valvular lesion but the aorta and coronary arteries were atheromatous. Small white granular kidney with signs of extensive arteriosclerosis. Bacteriological examination of the pericardial fluid was negative. No micro-organism was found by any of the various methods employed. Banti calls these non-bacterial cases of pericarditis uremic; he has collected five other similar cases, and supposes that they arise from the effect of some one of the poisons circulating in the blood in the uremic condition.

THE INFANT POOR IN SUMMER.With the advent of the hot weather, says the American Medico-Surgical Bul letin, comes the ever-recurring question of the protection of infant life during the heated term. The adult poor suffer severely in our large cities, but it is a question whether the sum of infant suffering does not far exceed that of their elders. Ignorance and superstition, neglect and mistaken kindness, combine to make their lot a very unhappy one. Older children following their instincts may adapt themselves to their surroundings and can make known their wants, but fortunate indeed is the waif toddling about in scanty rags, whose very rents serve for ventilation, beside the unfortunate infant whose band and pinning blanket are tightly adjusted in a refinement of precision and torture for the child, but to the eminent satisfaction of the elderly midwife or ignorant mother. If under these tight and unyielding layers the perspiration starts freely and heat-rash develops, or the folds of the groin, buttocks, or axilla become erythematous, they will probably be powdered with plain starch, which soon makes a sour decomposing paste, or with fuller's earth, whose dry lumps intensify the irritations. If the infant fails to appreciate its blessings and ventures to express its disapprobation it is rocked or jolted in the hot arms of the attendant until the perspiration starts afresh with the unwonted exercise. If the hot

weather cause gastric uneasiness, the child's cry is invariably interpreted as a sign of hunger and more food is given at short intervals and in larger quantities, only to increase the existing trouble.

It is one of the things inexplicable, that the infant organism and its needs are judged as things apart by the ignorant classes and that the simplest deductions from their own adult experience are not only not applied, but directly contradicted in the care of their children. In hot weather the mother hastens to assume her thinnest garments, but continues often to dress the infants in a manner she herself would find intolerable. She may know the relief to be gained from spongings with cool water, but it never occurs to her to apply it to the baby at any other time than that of its daily bath. She is conscious that many things disturb and irritate her physically but the cry of the child can have but one cause hunger. Although suffering from anorexia and eating very little herself, she continues to stuff food into the child. Despite her own thirst she needs to be told by the physician that the infant may often. be thirsty and not hungry, requiring water instead of food.

Pain

Children are often brought to us in the hot months by alarmed parents because there is temporary anuria, and inquiry almost invariably elicits a history of excessive perspiration and insufficient ingestion of fluids, very probably no water having been given at all. ful micturition from increased acidity, temperature, irritability, and even somnolence, often accompany this condition and disappear like magic when water, the simplest of nature's remedies, is given. Century after century has rolled by and civilization has brought much enlightenment, but it is doubtful whether the intuitive knowledge of how to care for their children is any greater among the lower classes than it was a thousand years ago. It can only be through the patient and reiterated instructions of the physician that these simple principles can be inculcated and the unnecessary suffering of infant humanity alleviated.

MARYLAND

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BALTIMORE, AUGUST 24, 1895.

IN a report presented to Governor John Lee Carroll in July, 1877, by Dr. C. W. Chancellor, Secretary of the State The New Board of Health, upon the Insane Asylum. public charities, reformatories, prisons and almshouses of the State of Maryland, is contained some very interesting and suggestive statements. The facts as shown by Dr. Chancellor at the time might well have been received with surprise and indignation by the citizens, and should have awakened in the official minds to whom addressed a degree of activity sufficient to in part at least ameliorate the condition of the insane as reported by Dr. Chancellor. Dr. Chancellor says, "It is painful to report the shocking condition in which many of the public institutions are found, and it is difficult to conceive that anything worse ever existed in a civilized country." Here truly was an indictment which should have aroused instant attention on the part of the State, but sad to say little

or nothing was done and the condition of affairs today may be safely presumed to be little if anything better than that found by the Secretary of the Board of Health.

At the date of Dr. Chancellor's report there were in the State Asylum 229 patients, in private asylums (Mt. Hope) 302, in almshouses and jails 520; total 1051. It will be seen that the insane under care in the State were almost equally divided between Spring Grove and Mt. Hope on the one hand and the almshouses and jails on the other; we have said under care, and the "care" the half in almshouses received may be judged from the following quotations from the report in question. Page 107: "One insane woman was found on a mattress and chained to the floor." Page 120: "Several of them (the insane), however, were violent, noisy and dirty in their habits; three of this class were women, all of whom were chained by the ankle to the floor. The use of chains as a means of restraint has heretofore been commented upon as unnecessary in any and every case; besides being positively injurious, both mentally and physically. Such treatment is humiliating, and however insane the patient may be, he is yet conscious of the degradation."

These are some of the least damnable of the items in Dr. Chancellor's indictment of the almshouse care of the insane of Maryland. Some of his statements will hardly bear repetition, but the following shows one of the causes and one of the most easily preventable causes of the increase of mental disease in the State. Page 110: "There are two instances in this almshouse in which the mother and children were born in bastardy under its roof. One an idiotic white woman, forty years of age, herself born in the almshouse, has given birth to six children in this institution; another, a white woman aged thirty-five years, insane, whose mother still resides in the house, has borne two children here; and still another insane white woman is the mother of a half negro child, begotten and born in the institution. These are not the only examples of a similar kind which could be cited. And the same almshouse care is in vogue today, and in all probability the same conditions exist."

What do the figures of the Lunacy Commission show today? Its last report, December I, 1894, shows as nearly as can be ascertained from its somewhat contradictory and unsatis.

factory tables that there are in the institutions and almshouses of the State, 2287 insane and idiotic; of these the proportion in almshouses still comprises nearly one-half, viz., 1054.

The general condition of the insane of the State is, according to the report of the Commission, "in the main satisfactory," though it is admitted that "much, however, yet remains to be done."

It is impossible to learn from the last report of the Commission how many new cases have been admitted to the asylums and almshouses of the State during the fiscal year which it covers, nor can a correct estimate be made of the increase, if any, of the number of insane under care from 1877 to 1894; as will be observed, the number has, however, more than doubled.

What has the State done in this matter? What have those charged with the supervision of this most unfortunate class urged? Practically nothing. As the JOURNAL has before pointed out it remained for the members of the State Society to urge upon the legislature that some action be taken to relieve these unfortunates and remove the stigma of inhumanity which must rest upon our citizens as long as their present treatment continues.

Reluctantly and with unseemly exhibition of much public and private wire pulling and bargaining for the location of the new institution when established and the possible control of its patronage, the legislature made a meager appropriation and appointed a Commission to select a place and build a new institution. Nearly two years have passed and nothing has been done. Is it possible that in all this fair State no position can be found within the limitations placed upon the Commission? What influence has led to this inexplicable and unnecessary delay ?

Do the Governor and the gentlemen associated with him appreciate the condition to which this delay is condemning hundreds of their fellow citizens? Does he know from actual inspection the condition of the insane in the almshouses of the State? What medical care do they receive, what nursing, what night supervision? How much of restraint, with straight jackets and camisoles, aye, even with chains, is to be found among the unfortunate insane in these receptacles for misery and misfortune? If he wants a picture of what no doubt exists today, as it did in 1877,

let him read Dr. Chancellor's report. Action! gentlemen of the Commission, action! If not, the citizens of the State will hold you accountable for every hour that this disgrace contin

ues.

**

THE study of the body temperature in health and in disease has resulted in certain data, which are used

The Body Temperature. in every day practice. One point is that the

normal temperature for this part of the country is about 98.2°F., while in fever the thermometer may register up to the absurd figures recorded by gullible observers on clever and hysterical patients.

The temperature of the inner part of the body is rarely found, because it is seldom possible to take it beyond a few inches in the mucous entrances to the body. In the mouth it does not register quite as high as in the rectum, and in the latter place the record is more accurate, because there is no breath to affect it at that place. Some have tried to make patients pass water on a thermometer in order to obtain the temperature of the interior of the body. That, however, plausible as it may sound, is very unreliable.

There is recorded in the New Yorker Medicinische Monatschrift, a case by a Dr. Toubin of a prisoner who in his cell swallowed one day an iron teaspoon and the thermometer which had been used that day to take his temperature. It was a clinical thermometer with registering index and was about four and a half inches long and three-quarters of an inch thick. Nine days later he passed both the spoon and the thermometer by the rectum. During the whole time the thermometer was in the body the temperature was taken in the axilla and the highest point reached there was 98.9°, while the thermometer passed showed a register of 101.6°, as the highest somewhere in the body.

In the present day it would be and is an easy matter to measure the temperature in the stomach and it would be done often if it had any practical advantage over that taken in the axilla or elsewhere, but this record taken from the interior of the body, while of no especial practical importance, is worthy of record as showing the varieties of temperature within and outside of the body. The case is looked on as authentic and the facts are vouched for.