time been absorbed. This treatment must be renewed every night, and usually the improvement is marked by the third morning or sooner, blood, mucus, pain all three have disappeared. A disease which formerly made us despair has now lost its terror to us.

The opium may be substituted by a hypodermic injection of morphia. Bismuth subnitrate may be given during the day. Small doses of ipecac are more than useless; they have been tried in India for more than two centuries without lessening the mortality in dysentery. Since more than twenty years the above has been adopted as almost the only treatment in British India and has given the best results.

TREATMENT OF PSOAS ABSCESS.

This much disputed question was brought up recently at the meeting of the American Orthopedic Association, and elicited views differing most widely from one another. Dr. H. Hodgen of St. Louis, inclined to the belief that the proper method of dealing with them was by early aspiration.

The treatment, although not new, had not, he thought,received the attention it merited. The three methods of treating such abscesses

were:

The expectant, the operative with drainage, and aspiration as soon as the diagnosis of vertebral disease could be made and the presence of pus detected. The objections to allowing the abscess to take care of itself were that there was destruction of tissue, that there was interference with function, and that there was inconvenience if not pain to the patient. The uncertainty as to where the abscess would burrow was also an objection to the expectant plan; it might burrow under Poupart's ligament, or point in the gluteal region and do no harm, yet it might enter the bladder or the intestine. In one of his cases he believed it had opened into the hip joint of the same side with the abscess. In each of his five cases the result after from two to five aspirations had been good. No evidence was left of their ever having been psoas abscess.

He would not aspirate more than four, five or seven times; after that he would put on the plaster-of Paris jacket and let the abscess alone.

OPERATION FOR HEPATIC ABSCESS.

Hepatic abscess, comparatively rare in our country, is of such frequency in tropical coun tries, that nearly all our knowledge of that affliction and a great part of its literature, come from men practicing in that part of the world.

Its severity and high mortality render any procedure for its relief interesting to the physician. Dr. Geo. Zancarol, who has had an immense experience with this affection in warm climates, says he has pursued the following plan of treatment for the last two years with the best results. In his communication to the Brit. Med. Jour., he speaks of it as follows:

The operation consists in making a large opening sufficient to expose the whole cavity of the abscess and in throughly cleansing it of all the pus and debris of sloughing hepatic tissue. It may be divided into three stages: 1. Exploration of the liver; 2. Opening of the abscess. 3. Cleansing of the abscesscavity.

1. Exploration of the liver.-After having well washed the skin with a brush and soap and water and a two per cent solution of car bolic acid, an exploring trocar is plunged into the liver to find the abscess; this exploratory puncture may have to be repeated several times, so that a good idea may be formed of the size and direction of the abscess.

2. Opening of the abscess.-An opening is made with the thermocautery into the lower third of the abscess, five to seven centimèters (two to nearly three inches) long, accord. ing to the size of the abscess, and as much as possible in the direction of its greatest diameter. This opening must be sufficiently large to enable the surgeon to see the whole cavity with ease when the edges of the opening are held well apart by retractors. To obtain this result in abscesses of the left lobe, an opening

in the soft parts will suffice; but if the abscess is in the right lobe resection of one or two ribs will be necessary. This resection is also performed with the thermo-cautery, using an elevator to detach the periosteum, and Liston's bone forceps, care being taken not to wound the intercostal artery; should this, however happen the hemorrhage will cease as soon as the abscess is opened. After resection of the bone, the abscess is opened with a thermocautery, keeping always in the direction of the resected rib, and with the aid of two strong retractors held by an assistant, while the margins of the incision are kept open, they are pressed against the liver and kept in close contact with the abdominal and thoracic walls, so as to prevent either pus or the liquids used for washing out the abscess, from finding their way into the abdominal or pleural cavities. If this precaution be observed, no harm will result even should there be no adhesion between the wall of the abscess and the parietal peritoneum; for when once the abscess has been thoroughly washed and cleansed adhesions will be established before fresh pus can accumulate. In fifty such operations performed by me during the last two years, no purulent matter has. ever escaped into the pleural or peritoneal cavities, although cases were operated upon in which no adhesions existed.

3. Cleansing the abscess cavity. The retractors being still held in the position already described by an assistant, a strong current of warm distilled water is allowed to play within the abscess cavity by means of a syphon; every particle of adherent pus and necrosed tissue is removed with the fingers, or with sponges fitted to proper holders, and the washing-out is continued until the walls of the cavity look perfectly clean, often granulating and the water returns clear. The retractors are then withdrawn, two drainage-tubes of large caliber are inserted in the cavity and the dressings applied which are left undisturbed for twenty-four hours; the cavity is then washed out again with warm distilled water as above described, and the current kept on until the water returns perfectly clear.

As a rule the temperature becomes normal immediately after the first washing, but if fever should reappear, or if the pus is abundant the washing-out should be repeated every twelve hours; if in spite of all this the fever persists or diarrhea sets in, this would indicate that other abscesses exist in the liver, and such cases are invariably fatal.

NEURECTASY FOR THE RELIEF OF PAIN.

In the Brit. Med Jour. is found a review of the Bradshaw Lecture of 1883, one of the chief features of which was the portion devoted to neuralgic pains and their relief by section of the nerve, excision of a portion of it or simply by stretching it. The lecturer argued that there probably would be found on the trunks of the nerves and on the larger branches sensory nerves, which he would call "nervi nervorum," the stretching of which would in many instances account for the relief given by nerve stretching in many forms of neuralgia. In the appendix now added are some carefully executed drawings by Mr. Horsley, showing the existence of what Mr. Marshall had predicted. Sensory nervi nervorum of the medullated variety are found in the epineurium, and terminating in the tactile corpuscles or end-bulbs of Krause, or in small but perfect Pacinian bodies. Other fine non-medullated nerve-fibers are found, but these are apparently vaso-motor, for they fol low the course of the smaller blood-vessels. It is claimed by the author, and the acceptance of the proof is beyond question, that the conjecture he offered as to the existence of such sensory nervi nervorum, and their relation to certain neuralgic pains may be regarded as having been completely verified.

In the course of the lecture various methods for relief are presented by the lecturer, and the conclusion arrived at is that nervestretching is an operatioon of positive benefit. in certain classes of cases.

vantage and applicability of these must be contrasted with nerve-stretching. Neurot omy seems to have but a temporary effect, and the parts too rapidly unite to make the operation of much use when the condition of the nerve is seriously impaired. Moreover, it is not applicable to the nerves of the limbs, owing to the extensive paresis or par alysis involved. Neurectomy promises to be of greater value in the painful affections of the head and face, but is equally inapplicable to the nerves of the limbs. It is curious, however, that sometimes the simple operation of nerve-stretching succeeds after neurotomy and even neurectomy has failed.

In conclusion, the sum of opinion as to the special applications of nerve-stretching may be thus stated. It is useless and dan gerous in all cases of cerebral disease, such as confirmed ataxy, myelitis, fully established tetanus, pure epilepsy, and paralysis agitans. In reflex forms of epilepsy, in an ascending neuritis bringing about epileptiform seizures, in the early stages of a distinctly traumatic tetanus, provided that in any of these cases the peripheral cause of irritation can be clearly localized, and the nerves accurately defined, nerve stretching may be serviceable if employed soon enough. As to the hope or suggestion that the excitation which a slight amount of stretching produces by vaso-motor or trophic changes upon a nerve might be the cause of improvement as regards pain, hyperesthesia, anesthesia, or paresis on the one hand, or as regared clonic spasms or paralyses on the other, it seems to rest on but little favourable clinical experience. Such states, when remediable, are cured more readily by lapse of time, or medicines, or electricity, or massage.

But nerve-stretching is certainly beneficial in peripheral disturbances of sensibility and motility, though it is more successful in purely neuralgic peripheral disorders than in those which are spasmodic. It is only admissible in aggravated and obstinate cases after other remedies have failed, and after any discoverable or reasonably conjecturable local cause has been removed. Medicinal and

other remedies are constantly being discovered, but these failing, an adequately carried out nerve stretching will certainly give temporary ease, and in proportion to its thoroughness, to prolonged relie for cure. In the case of the sciatic nerve, it may be preceded by that form of stretching which is called the bloodless method-bending up knee to the chin, extending the leg, and flexing the foot forcibly, and this must be continued for at least five minutes. In the case of any other nerve, the cutting operation should be at once employed, and the nerve stretched as close to the nerve-centre as possible. And the amount of force to be used must be left to the judgment or experience of the surgeon, rather than trusting to any dynamometer or hard and fast rule of the number of pounds weight to be lifted by theforce. Should the operation fail, the only further measure is to perform neurectomy, and than stretch efficiently or even avulse the proximal nerve stump, which will probably effectually relieve the patient from suffering, though at the cost of some local paresis or paralysis.

GLYCOSURIA OCCURRING IN CASES OF STRANGULATED HERNIA.

Mr. Vincent, interne of l'hopital de la Pitie, Paris, had occasion to examine the urine of six cases of strangulated hernia, and in each case he found sugar in the urine. This sugar was found before any surgical interference had taken place, except in one case, where repeated fruitless attempts at reduction had been made. Mr. Vincent finds that it would, perhaps, be a little premature to draw definite conclusions from these observations; he advises research into the matter, however, and, as sugar has been found in every case that has been investigated so far, he hopes to be able to deduce the following: I. That strangulated hernia is or can be accompanied by glycosuria. II. That this glycosuria disappears rapidly in about two to four hours after the strangulation has been relieved, be it by taxis or by some other operation. Certainly every complication which might arise, such as

MICROBE OF PULMONARY GANGRENE.

In the circumscribed forms of pulmonary gangrene Bonome has constantly found as a pathogenic agent, the staphylococcus aureus or the staphylococcus albus, that is to say, the same organism that determines the osteomyelitis, furuncle, phlegmon and ulcerative endocarditis. Its action upon the tissues seems to manifest itself constantly by a central necrosis with a peripheric suppuration. This organism enters the lung either by way of the air passages or through the circulatory apparatus, by means of an infectious embolus. Each time that he has injected this staphylococcus into the lungs of rabbits, Bonome has always produced a typical pulmonary gangrene. It first forms a real gangrenous process, which soon disappears under the influence of the ordinary microbes of putrefaction, which enter by way of the bronchi. jected into the veins, the staphylococcus does not produce a gangrene until after the forma tion of a pulmonary embolus.

PHATE OF LIME.

Doctor Rebory has added his observations to those made some time ago by Prof. Potain and Guyot, and comes to the conclusion that the phosphate of lime is the most efficacious remedy against the night-sweats of tubercu lous patients, not only because it allows of an almost indefinite continuance of administration without bad results, but because in the largest number of cases it has given the most favorable results. Prof. Potain finds that when doses of from four to six grams remain without effect, increased doses up to 15 grams attain the desired results. Sometimes also the absorption of the medicament does not take place, and hence its inactivity. One must always administer it in a soluble form, either as acid phosphate or lacto-phosphate of lime or even adding to its administration it in form of powder, some acid mixture.

Dr. Köbel has investigated the efficacy of arsenical preparations, especially in forms

LIVERY.

Not long ago a St. Louisan, at the time in Vienna, reported a case of hypnotism during delivery. Prof. Braun now reports a case in the Wiener Med. Woch., where he succeeded in hypnotizing during labor. The contractions had been unusually painful; they preserved all their energy, however, during the hypnotic state. The pauses between pain became a little longer, but the delivery pro gressed very nicely, and terminated rapidly and successfully. Upon awaking, the mother found herself quite comfortable, and again fell naturally asleep and slept several hours. A curious feature was the fact that the uterine contractions provoked reflex contractions of the abdominal walls of the mother without awakening, or in the least disturbing her. The hemorrhage was insignificant.

malignant tumors. He has obtained absolutely negative results with epithelial carcinoma whereas in the case of sarcoma, he has had results not to be despired. The author summed up 59 cases of malignant lymphoma, of from one to ten years duration. In seventeen cases he obtained positive cures, in from one to six months, in fourteen cases, only partial amelioration. One must continue the treatment two months to obtain satisfactory results. In almost one-half the cases the treatment gave no result. The arsenic was administered in the following formula: R Fowler's solution,

SOCIETY PROCEEDINGS.

CHICAGO MEDICAL SOCIETY.

Stated meeting, Monday, June 6, 1887, the President, W. T. Belfield, M. D., in the

chair.

DR. FRANK BILLINGS spoke on Pasteur's Inoculations against Rabies, as follows: In the short time allotted to me, five minutes, it will be difficult to tell you much of what M. Pasteur has done. There is a mass of literature on the subject; Pasteur himself reports regu larly at intervals of six months, and all the medical journals, when he makes his reports have been filled with affirmative and contradictory evidence.

Early in January, 1881, M. Pasteur first presented to the Académie de Médicin, of Paris his idea that hydrophobia was due to a micro-organism which he called the bacillus lyssæ, and to which he ascribed the phenomena of the disease. Further he said he could inoculate it, and could give immunity to the disease; but he soon had to give up the idea that it was due to that one micro-organism, as it was not long until Koch disproved it, and showed the bacteriological world that the organism really gave rise to general septic in fection. During the next two years M. Pas teur worked on in his laboratory, and finally gave out that the chief amount of virus, that gives rise to hydrophobia, is to be found in the cerebro-spinal system, and if a small amount of cerebro-spinal matter taken from an infected rabbit was injected into other animals by trephining it, produced a like disease, and if that taken from a human was injected into an animals being it would produce a similar disease. He found that where the injection was made subcutaneously it gave rise to the same sort of symptoms, but required a longer incubation; and that the amount of virus injected was in inverse ratio to the stage of incubation; that is, if a small amount of virus was injected the incubation was longer, and if a large amount the incubation was shorter. He urged the point of what he called a "fixed virus" with an incubation of usually seven days; some times it was six, sometimes eight, and sometimes as high as twelve days. The next thing he promulgated was that if he injected this fixed virus into a dog or rabbit, the animal invariably died of the disease he called hydrophobia; and finally, that if he injected the sero-spinal substance which had undergone certain changes by dessication,by which it lost its virulence, that he could protect the

As a

animal, making it refractory to the disease he called hydrophobia. He claimed that he had cured fifty dogs by carrying them through certain series of injections to the number of ten, beginning with the weakest cord, and had made them refractory to rabies. In July, 1885, there was presented to him a boy by the name of Josef Meister who had been bitten in fourteen places by a dog said to be rabid. Drs. Vulpian and Grancher, of Paris, advised that be inoculate the boy, and the boy was put through a series of thirteen in oculations and has never had rabies. In October of the same year, after being successful in this case, M. Pasteur gave out to the Académie de Médecin that he could prevent all cases of rabies, it did not make any differ ence at what time the had been bitten. consequence patients flocked to him from all parts of the world. Not long after that,in 1886, he lost his first patient. He then said that the patients,to be made refractory to rabies, must come to him in thirty-five days after be ing bitten; and not long after that, again losing patients, he placed the period at fifteen days. At the end of 1886, the Royal House of Vienna gave a certain amount of money to erect a Pasteur Institute at Vienna, and Prof. Von Frisch of Vienna was sent to Paris to study Pasteur's methods. He remained there and a month then returned to Vienna,and went through a certain set of expererlments such as Pasteur had followed, but with no satis factory result. He agreed essentially with M. Pasteur in most of his conclusions; but he disagreed with him in one essential point; he found that dogs could be made refractory to the rabies of Pasteur, but that they died promptly when the rabies of the street was injected into them. When Pasteur heard of this he said at once that M. Frisch had used the "slow inoculation;" he had just propogated the "rapid inoculation," and he recommended M. Frisch to try a more rapid procedure. M. Frisch carried out his experiments according to M. Pasteur's instructions, and found that Pasteur was again mistaken; that dogs made refractory by weaker injections sometimes died of the rabies of Pasteur, and invariably died when street rabies was injected into them. M. Pasteur has from the beginning been opposed by a number of medical men. Dr. Peter has opposed him strongly; at every opportunity he has arisen in the Académie and opposed him. When he started out on this rapid inoculation, M. Peter accused him of killing his patients, maintaining that they died of rabies engendered by Pasteur. M. Pasteur was supported by Velpeau and