during convalescence from low fevers, muscular debility, and the neuropathic predisposition; while among the latter may be mentioned errors of refraction, the use of a magnifying lens for one eye, and long-continued work, especially in a bad light. If the insufficiency is under 10°, Dr. Hansell usually finds the symptoms relieved by the use of prisms of one-half the strength of the defect, and divided between each eye; but if above 10°, tenotomy of the external rectus is usually found necessary; and he has never had to operate on both eyes. Unilateral Tonic Spasm of the Ciliary Muscle inducted by pressure of the carotids.-Dr. Ball, Arch. Ophth., Vol. xvii.— The patient had suffered from metritis for many years, which was treated by massage over the perinæum and pressure on the neck over the carotids. Some days previously to Dr. Ball seeing the patient, as the physician forcibly massaged the neck the patient noticed a feeling of tension in her right eye, after that everything appeared larger than before, and of a reddish colour. These symptoms were succeeded by blurred distant vision, pain in the eye, and headache on the same side. On examination four days after there was congestion of the eye, pupils were of equal size, and reaction to light and accommodation unimpaired. The anterior chamber of right eye was considerably narrowed, pressure over the inner half of the cornea produced pain, and there was marked hyperemia of the optic disc and vessels. R. c. 4'50 D. Light perception and visual fields normal. A thermometer introduced into the right auditory meatus showing o'5° Fahr. higher than on the left side. The eye symptoms gradually yielded to the instillation of atropine, and in a few weeks had quite disappeared. The first impulse of cramp was certainly due to pressure on the carotid plexus, though it is strange why a tonic cramp of the muscle should have been produced, and also that the iris should not have been equally involved. The hyperemia of disc and eye and increased temperature were induced by direct vasomotor disturbance on the corresponding side of the head, but the author is not prepared to say what this disturbance may have been. = THERAPEUTICS. BY ARTHUR FOXWELL, B.A., M.B. Arsenic in Leucocythaemia. — A gardener, admitted into University College Hospital, under Dr. Ringer, with spleen reaching to within an inch of Poupart's ligament. He had had his first attack of ague at Charlton when he was twelve. He noticed his belly to be swelling ten months before admission. He suffered from piles and epistaxis. He was thin and pale; there were mitral and pulmonary systolic murmurs; the arteries were fibroid. On admission, blood showed 38 per cent. red corpuscles with 1 white to 25 red. He was then put on liq. arsenicalis m. 5 t.d.s., and this was pushed to m. 25 q.d.s. in eighteen days. This dose (nearly gr. j. arsenious acid daily) was continued for five days, when diarrhoea compelled its cessation. The blood now showed 55 per cent. red corpuscles, with 1 white to 20 red. The spleen was reduced to two-thirds its size on admission, was harder, and had lost all tenderness. The temperature, which had previously had a daily maximum of 100°, became normal. The hæmoglobin was 40 per cent. (Its estimation had hitherto been impossible owing to the turbidity caused by the white corpuscles.) Twenty-seven days later the white corpuscles had increased to 1 to 9 red; his red corpuscles were 50 per cent., and the hæmoglobin was unchanged; but the spleen had returned to its size on admission, and was very tender. But an intervening attack of carbuncles and erysipelas, with temperature reaching 102-104° for a few days, and for which he was treated with iron, vitiates any conclusion drawn from these results. He was now once more placed on liq. arsenicalis m. 15 q.d.s., quickly pushed to m. 23 q.d.s. In 21 days his white corpuscles were only 1 to 300-400 red, these latter remaining stationary till ferri sulph. gr. 2 q.d.s. was added, when they were temporarily increased. The hæmoglobin was unchanged; the spleen was much smaller, hard, and not tender; the skin became quite bronzed, especially over the belly and bony prominences, the bronzing consisting of minute points, chiefly confined to the prominences of the hair follicles. Vomiting, anorexia, and diarrhoea again necessitated omission of the arsenic; and soon after, the patient left the hospital very little improved in health and of the same weight. The following observations made on this patient, showing the effect of food on the corpuscles, are interesting. He was allowed nothing to eat from 5 p.m. to 9 a.m. the next day, when he had a good breakfast. At 8-0 a.m., 50 per cent. red; I white to 4'0 red. 8-30 9-30 " 10-0 red. 11-0 52 per cent. red; 1 white to 3'7 red. The movements of the white corpuscles on the warm stage (90° F.) in this patient were just as active as in a healthy person.-Therapeutic Gazette. The Untoward Effects of Saccharin.-The general impression seems to be that saccharin is innocuous; and this impression has doubtless been materially supported by a report made to the Medical Society of Berlin, in April, 1886, by Professor Leyden, and by a sort of a certificate of his, widely distributed by the manufacturers of saccharin, Fahlberg, List & Co., to the effect that even the prolonged use of the substance gives rise to no inconvenience. In general terms, this has been the experience of most observers, but many of them add that occasionally a case is met with in which saccharin disagrees. Dr. Stadelmann, of Heidelberg, has experimented with the product, at the request of the manufacturers, and has reported that out of eleven persons, from 15 to 35 years old, to whom he gave saccharin in daily quantities of from 45 to 75 grains for two or three weeks at a time, nine experienced no unpleasant effects, while two suffered with nausea, an excessive sensation of weight in the stomach, and loss of appetite. Dr. Worms has made a communication on the subject to the French Academy of Medicine, an extract from which is given in the Revue Générale de Clinique et de Thérapeutique. After citing the above-mentioned facts, he gives brief notes of the cases of four diabetics who used saccharin by his advice, all but one of whom were soon compelled to discontinue its use, on account of the occurrence of dyspeptic symptoms-nausea, and sense of weight in the epigastrium, loss of appetite, amounting to absolute loathing for food, and in one instance a constant sugary taste in the mouth. Admitting that his observations are not numerous enough to justify much in the way of generalization, he nevertheless thinks it must be admitted that a certain proportion of diabetics can not bear the use of saccharin for sweetening their tea and coffee longer than eight or ten days at a time. Obscure as the problem of diabetes is, the disease comprising innumerable varieties, as regards both the symptoms and the pathogeny, there is, he remarks, one therapeutical rule that must be observed in all cases-that of maintaining the integrity of the digestive functions. It is better for a diabetic that he should excrete a little more sugar and assimilate his food than that he should pass less sugar and still lose ground. Moreover, many diabetics suffer but moderately from foregoing the use of sugar, and it may be said provisionally that they should not be permitted to use saccharin in larger amounts than from three quarters of a grain to a grain and a half daily, and then only so long as it does not give rise to any digestive disturbance. It is usually not until after the substance has been used for from ten to fifteen days that it manifests its evil influence, appearing to accumulate in the system until then.-New York Medical Journal. Phenacetin.-The latest synthetical candidate for professional favour is para-acet-phenetidine, or phenacetin for short. It is a member of the aromatic series of the carbon compounds, remotely akin to antipyrin (dimethyloxyquinizine), and the twin sister of antifebrin (acetanilide). Like these two overpraised drugs, it seems to be endowed with great antithermic and analgesic powers, and is doubtless destined to play an important rôle in the practice and writings of such physicians as have a taste for "seeking and searching out some new thing." This body was first prepared by Dr. O. Hinsberg, of Elberfield, who, with Professor Kast, has subjected it to careful physiological and chemical study. "Phenacetin is an inodorous and tasteless powder, hardly soluble in water, a little more soluble in glycerine, but easily soluble in hot alcohol; it is insoluble in acids or alkaline liquids. Experiments made as to its solubility in acid chyle (gastric juice) or in pancreatic extract, under conditions of normal bodily temperature, yielded negative results." Dr. G. Kobler, of Vienna, has submitted the drug to searching study in practice in the wards of the Second Medical Hospital of Vienna, and in an elaborate paper lays before the profession a clear and forcible demonstration of the power of phenacetin to reduce fever promptly, and seemingly without danger to the patient. The author says: "In healthy persons phenacetin did not produce any ill effects in doses of from 0.5 to o'7 grammes (8 to 12 grains), neither could I observe any influence on the tem perature of the body; but in all cases of pyrexia even relatively small doses of o'3 to 0'4 grammes (4 to 7 grains) were never without perceptible antipyretic effects." The drug, in the author's opinion, is harmless in doses not greater than 26 grains pro die in fevers, sthenic and asthenic, and Hoppe has ventured to administer it in doses of from 16 to 32 grains, several times a day in cases of neuralgia, wherein he claims for it a slow (one or two hours) but sure relief of pain without ill effect of any kind. Dr. Kobler has tested the antipyretic virtues of phenacetin in 50 cases. Of these tuberculosis, pneumonia, typhoid fever, morbilli, puerperal fever, pruritus, and pyæmia were the principal diseases, and in two cases Bright's disease was an important |