are any symptoms of cerebral congestion, a stream of water the temperature of the room is poured on the head. A little champagne, or brandy and water, may be given while the child is in the bath. When taken out, he is quickly dried with warm towels and put back to bed. Frequently after the third or fourth bath, the fever falls, the râles diminish, and the affection loses its threatening character.

CHOLERA INFANTUM.

The following brief outline of treatment in this disease appears in the July number of Pediatrics. Cholera infantum is the result of a profound and rapid poisoning from absorption of toxines produced in the intestinal tract, usually from the fermentation of food. Therefore the indications for treatment are not opiates, but the rapid elimination of these poisons by saline cathartics, abundance of pure water, washing the stomach, and high and frequent irrigations of the bowels with such stimulants as will enable the patient to overcome the poison already absorbed. The best stimulants are whisky, camphor, and musk. Whisky should always be diluted; camphor (one-fourth to two grains every hour) may be taken with glycerine and suspended in mucilage; and musk (one grain every half hour) can be suspended in mucilage. Jacobi recommends in threatening cases of heart failure strong coffee, hot or iced, according to circumstances; or the injection into the bowel through a long flexible tube of hot water with some alcohol, and one or more drops of tincture of opium.

SIMPLE DIARRHEA.

The indications are to first remove by purgatives the irritating and decomposing contents of the intestines. This is best done by giving calomel in small doses, say one-tenth of a grain, frequently repeated, or by a full dose of castor oil.

The second indication is to withhold all food which would be likely to undergo fermentation and add to the existing toxæmia. Milk and other foods should be absolutely prohibited. The child should be allowed to take pure water quite freely. Barley water, to which a little white of egg. or sugar has been added, may be given, and, later, whey may also be given. Third. If ptomaines are thought to be present in the lower bowel it would be well to irrigate after each movement of the bowels, using a warm normal salt solution (I dram. to one quart), about one pint at a time.

Finally, such drugs as retard fermentation, e.g., bismuth subnit., grs. x., every two or three hours; or soda benzoate in four grain doses in water every two hours.-J. Lewis Smith in Pediatrics, July, 1896.

POLYARTHRITIS IN SCARLET FEVER.

In a paper read before the New York Academy of Medicine Henry N. Berg drew attention to the frequency with which inflammation of joints occurs as a complication of scarlet fever. It seemed, too, to occur more frequently in cases treated in hospitals than in those met with in general practice. Its development was not usually marked by any special rise of temperature, and it most often made its appearance during the stage of desquamation. For clinical purposes this polyarthritis might be divided into four varieties: (1) Cases in which the inflammation of the joints is not accompanied by serous effusion; (2) cases appearing as a simple synovitis; (3) cases in which the arthritis is at first simple, but subsequently becomes purulent; and (4) cases of suppurative arthritis with rapid destruction of the structures of the joint. The late development of this joint complication would seem to point to its being a secondary mixed infection, and from its much greater frequency in hospital practice he was disposed to think that there was a contagious element. While many clinicians looked upon this arthritis as rheumatic, and it had some points of resemblance to rheumatism, it differed from this disease in being more severe, and in not being commonly associated with endocarditisat least there had been no endocarditis in the cases forming the foundation of this paper. Another reason for believing that this was not rheumatic in its nature was that the salicylates and other anti-rheumatic remedies appeared to exert no beneficial action upon it. Very frequently this scarlatinal arthritis was followed by more or less ankylosis, which, however, in most instances, yielded to proper passive motion and massage.

THE EFFECT OF PHOSPHORUS ON GROWING BONE.

In Virchow's Archiv (Bd. cxliv., 1896) Kissel records a series of experiments with phosphorus carried out on growing dogs. The phosphorus was given in the way usually adopted with children, in oil. He found that the toxic properties are much more pronounced than usually supposed, and that disturbance of digestion during its use, though apparently trivial, may have a fatal termination. Ten centigrammes per kilogramme of body weight caused symptoms of chronic poisoning, with marked atrophic changes where bone had been deposited. Six centigrammes per kilogramme hinders the normal development of bone; 3.3 centigrammes per kilogramme is the largest dose that can be given with perfect safety. In chronic poisoning with small doses there is marked fibrosis of the liver. No dose of phosphorus had any favorable influence on the growing bone.

PATHOLOGY AND BACTERIOLOGY

IN CHARGE OF

JOHN CAVEN, BA., M.D., L. R.C.P. Lond., Professor of Pathology, University of Toronto and Ontario Veterinary College; Pathologist to Toronto General Hospital and Home for Incurables;

EXPERIMENTAL AMYLOID DEGENERATION.

N. P. Krawkow, of the Laboratory of General and Experimental Pathology of the Imperial Military Academy of Medicine in St. Petersburg (Arch. de Méd. Expér. et d'Anat. Pathol., tome viii., 1896, p. 106), says that up to the present time the study of amyloid degeneration has been confined to post-mortem specimens in which the different degrees of the degeneration, together with the presence of other lesions, have rendered the stages of the process very indistinct. Experimental work on this subject has never been attempted, which perhaps explains our very limited knowledge of it. A few accidental cases occurring in laboratory animals have been reported, but the degeneration occurred in animals experimented upon with some entirely different object in view.

One of the first cases of this kind was reported by Hirschfeld, who found a diffuse amyloid degeneration occurring in a rabbit dead from the effects of a suppuration lasting six weeks, and caused by the inoculation of pus microbes. The microbes in this case were obtained from a man suffering from caries of the bones, and after whose death the kidneys were found to have undergone an amyloid degeneration. Bouchard and Charrin have described two cases of amyloid degeneration in rabbits subjected to repeated inoculation of the bacillus pyocyanus.

Czerny has produced amyloid degeneration in two dogs by subjecting them to a long-continued aseptic suppuration, produced by repeated inoc

ulation of turpentine, thereby proving that the amyloid change is altogether independent of bacterial action. He also found in the pus corpuscles and leucocytes of these animals, a substance apparently not glycogen, and giving the characteristic reaction for amyloid material with iodine and sulphuric acid, although failing to give the equally characteristic reactions with anilin stains. Since the presence of the substance accompanied amyloid degeneration, the possibility of its being an early stage of amyloid: material which is carried to and stored up in the various organs is strongly suggested. This idea would imply that the amyloid change is an infiltration and not a degeneration.

This form of degeneration is very common in our larger domestic animals, in fowls and pheasants, and especially in the horse, where it occurs frequently in the liver, rendering this organ so soft and friable that the fatal rupture often occurs. In all these animals the degeneration is usually secondary to some chronic infectious or wasting disease.

With this series of cases of amyloid degeneration as a foundation the author has carried on a number of experiments with the object of studying the changes as they occur when their production is under the control of the observer. The animals were subjected to prolonged suppuration produced by repeated inoculations of micrococcus pyogenes aureus, this method being chosen as bearing the most direct relation to the common occurrence of amyloid degeneration in man after tuberculosis and syphilis. when a mixed infection with the pus microbes has occurred.

Rabbits in good health were chosen and inoculated with constantly increasing quantities of a bouillon culture, beginning at first with 1⁄2 c.c. Soon the animals would reach such a degree of immunity that they would. scarcely react to 30 c.c. of a culture, 1 to 2 c.c. of which would have at first killed them. This gradual acquirement of immunity seemed to be the most favorable condition for the appearance of amyloid degeneration, animals succumbing to a few large doses rarely showing the change. The history of a single rabbit, as follows, will be a fair sample of the results obtained in the whole series :

Rabbit No. 1; weight, 1556 grammes. Subjected to four inoculations-1 c.c. for the first three times, 5 c.c. for the last. Died in six weeks, much exhausted; weight of body, 779 grammes. The last week the urine was acid and contained albumin; stools watery. Spleen shrunken, anæmic, soft, tearing readily, cut surface not showing the characteristic amyloid brilliancy; microscopic examination showed amyloid degeneration marked in the pulp and in the periphery of the follicles; giant cells containing amyloid presented marked accumulation of pigment; lymphoid elements contained no amyloid. Liver atrophied and anæmic; slight amyloid degeneration of intralobular capillaries; marked albuminoid degener

ation of the liver cells.

Small intestine: Walls thin, mucous membrane pale; marked amyloid degeneration of the villi and glands of Lieberkühn, Kidneys Traces of principally in the capillaries and connective tissue. amyloid in memorana propria of the convoluted tubules. Suprarenal capsule: Traces of amyloid in medullary substance. No traces of amyloid in the abscess, nor in the muscles of the heart and trunk.

The amyloid material of the rabbits gives all the characteristics of the human amyloid, and when isolated seems to be the same chemically. The microscopic appearance of the organs, however, differs from that of man in the advanced stages. The spleen is generally soft and shrunken, the cut surface does not give the characteristic amyloid brilliancy; the liver resembles more an albuminoid degeneration.

In the animals experimented upon the degeneration seemed to begin in the spleen, often being very advanced here when not found in any other organ. This is apparently true in man as well. In rabbits the degeneration is more marked in the gastro-intestinal canal than in the kidney or liver, the salivary glands seeming to stand next in order to the spleen. The idea that the blood-forming organs are most invaded is not supported by these experiments, for the marrow of the bone, probably the most important of all, was never found amyloid They, however, showed that it was possible to have an amyloid degeneration localized in a single organ or in a part of that organ, as the follicles of the spleen.

The degeneration was especially observed in the capillaries, arteriolewalls, and connective-tissue elements. The cells of the organs seemed never to be invaded, except those of the spleen. The presence of giant The author cells in the amyloid spleen is accounted for in different ways. is inclined to think that they absorb the amyloid substance as a body foreign and injurious to the organism. This function would imply that the resolution of amyloid material is possible, and although contrary to the general idea as obtained from clinical information, yet there is much to favor the supposition. Amyloid degeneration in various neoplasms has been observed in parts removed by operation, and later it has been found that the remaining material has disappeared. Litter has also found that fragments of amyloid kidneys placed in the abdominal cavity of animals are absorbed, and here giant cells containing amyloid are numerous.

IMMUNITY FROM SMALLPOX.

"Scientific Researches Relating to the Specific Infectious Agent of Smallpox and the Production of Artificial Immunity from this Disease " was the title of an address by George M. Sternberg, Surgeon-General of the United States Army.