But perhaps no physician will fail to see the significance in promoting onr present economic condition of the event celebrated by the tablet on the north wall:

JENNER

DISCOVERED THE PRINCIPLES OF

ful intent; and if, while too far gone to have any further eight events that most contributed to make our present intent, he does a wrongful act, the intent to drink civilization possible. One bears the name Newton, one Coalesces with the act done while drunk, and for this Copernicus, names connected with the establishment of combination of act and intent he is liable criminally. the principle of inflexible law and order in inorganic It is, therefore, a legal doctrine, applicable in ordinary nature. One tablet celebrates the introduction of guncases, that voluntary intoxication furnishes no excuse powder, one the discovery of printing; one bears the for crime committed under its influence. It is so even name Watt and the date of the invention of she steamwhen the intoxication is so extreme as to make the engine, one the name Morse-to whom is due our person unconscious of what he is doing, or to create a present system of rapid transportation and communitemporary insanity." "Again, the law holds men re- cation. sponsible for the immediate consequences of their acts, but not ordinarily for those more remote. If, therefore, one drinks so deeply, or is so affected by the liquor that for the occasion he is oblivious or insane, he is still punishable for what of evil he does under the influence of the voluntary drunkenness. But, if the habit of drinking has created a fixed frenzy or insanity, whether permanent or intermittent-as, for instance, delirium tremens-it is the same as if produced by any other cause excusing the act; for whenever a man loses his understanding, as a settled condition, he is entitled to legal protection, equally whether the loss is occasioned by his own misconduct or by the dispensation of Provi. dence." If drunkenness produces insanity through delirium tremens or mania a potu or other disease, and the accused at the time of the homicide has no sufficient capacity or reason to enable him to determine between right and wrong as to the particular act he is doing, or has no power to know that the act is wrong and criminal he would not be responsible. In cases of delirium tremens or mania a potu, the insanity excuses the act, the frenzy being, not the immediate effect of indulgence in strong drink, but a remote consequence superinduced by antecedent drunkenness.

Formanilid: A New Analgesic in Laryngeal Diseases. J. Preisach found (Wien. Med. Presse) that, after insufflation, pain in swallowing subsided in a few minutes, and that the effects continued from two to sixteen hours, usually ten to twelve. Palpitation of the heart and depression occurred in one in stance, but lasted only a few seconds. With the anesthesia of the mucous membrane its reflex irritability is likewise subdued. He finds it as active as cocaine, and much more enduring in its effects A. Bokiai (Ibid.) recommends it in painful inflammations, as tonsillitis, pharyngitis, etc. M. Neuman first found biting and then numbness of the tongue from a twenty per cent solution, with pallor and analgesia of the mucous membrane, the effects lasting an hour or an hour and a half. -Record.

VACCINATION IN 1796.

Europe might have thrown aside fatalism and superstition and become imbued with the idea of the stability and inviolability of Nature's laws; she might have printed books and papers; she might have obliterated feudalism with gunpowder and travelled by steam controlled by the electric telegraph; nevertheless, without that security that vaccination has furnished from a pestilence we know now only by name, the industry and the wealth of to-day would be impossible. perhaps, worthy reflection that nothing so much threatens the usefulness of this great exhibition as the possibility of an epidemic of Asiatic cholera, and to prevent such an epidemic we have only the uncertainty of quarantine.

It is,

Every physician who visits the Exposition and notices the fact that there is no combined medical exhibit will regret the lack of organization or lack of spirit that has allowed this great opportunity of advancing our professional interests to slip by unimproved. In the World's Congresses that are held in the Art Institute, a a place was assigned to medicine, but it was not filled. It cannot be argued that the meeting of the American Medical Association and Pan-American Congress, or the World's Congress at Rome, fills the place that the management of the Exposition proposed.

The hospital service for such emergency cases as the erection of the buildings for the Exposition naturally required has been improved and extended for the emergency work that now comes with the throngs of visitors. The emergency hospital is under the supervision of a medical director and a staff of thoroughly equipped physicians, every one of whom has had hospital service, most of them in the Cook County hospital The hospital itself, though not an exhibition, is well worth the attention of medical visitors, and medical men will be received without formality. The equipment On the interior of the great dome of the Adminis- and furnishings are good, and the nursing is a fair reptration Building of the Columbian Exposition, at Chi- resentation of the nursing of the best hospitals in the cago, hang eight bronze tablets commemorative of the country. The ambulance department is well manned,

Medicine at the Columbian Exposition. -The following interesting descrsption of Medical Ex hibits at the Worlds Fair by the Medical News we take the liberty to reproduce in its full text:

under the direction of a physician who has been thor- have an opportunity of studying it only by giving his oughly trained in the theory and practice of rendering card to one of the German Imperial Guards, who patrol first aid to the injured. Unfortunately the ambulances the exhibit, and requesting him to take it to the comare of an antique, delivery-wagon pattern, similar to missioner in charge. In this way an escort can be those that are being worn out none too fast in all of our secured and every opportunity to study the marvellous large cities. Their inadequacy has lately been tested in exhibit that these universities have made. This exhibit an accident that threw upon the ambulance service the is particularly rich in the department of medicine. It transportation to the hospital of fifteen or twenty in- includes not only a careful study of the educational jured painters and decorators. methods and curricula of the medical schools, but also a Perhaps the most illustrative medical exhibit, and one full account and fair exhibition of the material equip. that is well worth a protracted study, is that of the ment of some of these universities. The equipment and United States Army in the model hospital just south of material for anatomic study, including histology, is elathe United States Government Building. The first borately laid out in one section showing all of the in floor of this hospital is fitted out with a drug-room, a struments, manikins, preparations, microtomes, and misupply-room, and an office, and the ward itself contains croscopes used in this department, not only at the a single model bed. The remainder of the room is present time, but in past years. In the department of filled with an exhibit from the United States Army bacteriology, living and growing specimens are to be Museum at Washington. It will require a considerable observed from day to day, mounted with special referamount of time to properly study this exhibit, and, as ence for exhibition and demonstration to classes. All there is usually a very great crowd in the rooms, physi- of the necessary equipment for this department is also cians are advised to visit them early in the day. On in working order, manufactured in various styles and the second floor of this hospital is a clinical laboratory arranged in the best manner for exhibition. The operat in working order. A modest notice upon the stairway ing surgeon and gynecologist will also see the identical excludes all visitors except members of the medical furniture and equipment of the best operating rooms in profession; but anybody who chooses can go into the Germany, with photographs and plans of hospitals. laboratory without a pass or without formality. A The pathologic department is, as we should expect very polite attendant will answer all questions that are asked in relation to the working of the laboratory, and a care ful study may be made of this laboratory by making ap plication for the opportunity from the officer in charge. In the south end of the gallery of the Liberal Arts Building, the colleges and universities have their exhibit. The medical man will find much to admire in the exhibit of the Johns Hopkins University. The alcove in which this exhibit is placed is a good resting place after a long tramp. All of the publications of the University are on tables and can be consulted. There are a few interesting exhibits from the medical departments of Harvard Uuiversity, the University of Michigan, the University of Pennsylvania, and Columbia College; but we regret that the same spirit has not been manifested in the exhibits of the medical depart ments of these Universities as is to be seen in the exhibits of other departments of the same institutions. The veterinary department of the University of Pennsylvania has a very much more instructive and attract ive exhibit than the medical department itself. In none of these exhibits is to be found a display of the work of medical students, and in fact nothing that shows the character or quality of medical education. From the standpoint of a medical teacher, there is no exhibit from these schools worthy the names and reputations Liberal Arts building. The exhibition of the Swiss these institutions carry.

rich. The specimens are well describee in a catalogue, which will be furnished the student on application. Although other exhibits are much more brilliant and, upon the first view, more attractive, the bibliographic exhibit is perhaps the richest of all of the exhibits of the German universities. In medicine this exhibit is naturally very large and choice, and will well repay a careful and critical study, in spite of the fact that the three or four great libraries of the United States possess much of it on their shelves. Such universities and colleges as are entitled to this consideration may, during the progress of the Exposition or soon afterward, receive a handsomely printed account of the exhibition of the German universities prepared especially for this occasion. This series of handsome quarto volumes, of which but one volume has appeared, will be a lasting monument of this splendid educational work that Germany has so well accomplished.

In the gallery of the Liberal Arts Building the campfollowers of medicine have made grand exhibitions, which will attract much attention. Everyone will be interested in the exhibition of the manufactures of optical, chemical, and physical instruments. These exhibitions will be found in the departments of the vari ous foreign countries and in the north gallery of the

instrument-makers is, however, on the first floor in the Swiss section. Pills, powder, surgical instruments, and office appliances are elaborately exhibited in this gallery.

The most instructive exhibit of the science of medicine is that of the twenty-one German universities. This display is to be found in the second and third galleries of the German section of the Liberal Arts All appliances relative to public and domestic hyBuilding. The German educational exhibit is shut off giene, to charities, correction, and reformatory institufrom the general public, and the medical visitor can tions, are exhibited in the south end of the Ethnological

Building. Here are to be found the exhibits of the principal hospitals. Special attention should be given to the exhibits of the Johns Hopkins Hospital and the Boston City Hospital. Much valuable information for the hospital man will be obtained from these exhibits, and hospital wardens and managers will here find a great many valuable hints in hospital management and equipment.

Dr. H. M. Hurd in an article "On Post Febrile Insanity" in the Journal of Insanity studies the delerium of fevers and the psychoses developing from specific infections, and Dr. G. T. Tuttle, of Somerville, Mass., reports the results of the examination of the urine in two hundred consecutive cases in the McLean Asylum (Journal of Insanity). Albumen and casts were found in 55 cases, albumen alone in 64 cases. He collects statistics from various pathological reports of hospitals and finds that in about 40 per cent of autopsies in the insane, kidney disease was found, and concludes that chronic nephritis [uremic poisoning] is sometimes the cause of mental aberration which may be called insanity.

The State Board of Health of Massachusetts has made one of the most attractive and instructive exhibits, and here the physician will receive vrluable help in his study from the courteous attendants, all of them officers of the Board. This valuable exhibit is one of the most suggestive in the line of life saving. A study of the work of the various charitable and reformatory institu- The subject was discussed at the Fourth Congress of tions, whose attractive exhibits fill much of this build- Mental Medicine held at Rochelle in August, 1893. ing, is urged upon all physicians, whether their interest Regis, of Bordeaux, and Chevalier-Lavaure, referees, has been already aroused by practical study of these stated that they had been working on the line of the subjects or not. Attention is called to the exhibit of autogenous poisons, and had made many chemical and the Philadelphia Children's Aid Society, which has clinical researches to elucidate the relation of autodone such marvellous work in providing country homes intoxications to mental diseases. The toxicity of the for destitute children, and thus not only added much to life and happiness, but aroused alarm and consternation in the ranks of professional charity mongers.

It is not unlikely that at the next session, the Legislature will see its way clear to a complete abolition of all maritime quarantine laws, and the relegation of the State and city health authorities to their more appropriate functions of supervising local sanitary conditions. The National Government is abundantly able to take care of a maritime inspection.

Auto-Intoxications in Mental Diseases.There has been of late considerable speculation respecting auto-intoxications in the psychoses. Such speculations have been stimulated by Professor Bouchard's researches on the pathogenic role of the auto intoxications in general.

urine was found to be diminished in maniacal states and augmented in melancholia. The urine of maniacal patients when injected in animals produces excitation and convulsions; that of melancholic patients, restlessness, dejection and stupor. There is often in insanity as in eclampsia an inverse relation between the toxicity of the urine and that of the blood, the latter being hypotoxic when the urine is hypertoxic, and vice versa.

Under the head of "Facts of Clinical Order," these authors consider the psychoses of acute infectious diseases, of visceral diseases, and of diathetic diseases:

1. In respect to the psychoses of infectious diseases. (typhoid fever, eruptive fevers, influenza, erysipelas, cholera, puerperal fever) the sum of researches thus far made goes to show: First, that from a pathogenic point of view, these mental disorders are the result either of direct action of microbes or of their indirect and mediate action by the toxines which they secrete; second, that from a clinical point of view, they may present two aspects. In the febrile stage, the psychosis is an acute delirium, resembling the alcoholic; in the post-febrile stage, it is of an asthenic character, a state of mental

Dr. Kellogg, of Flushing, N. Y., in the New York Medical Journal "considers it probable that a considerable proportion of mental disorders have a toxic origin." In alcoholic, saturnine, and some other forms of pois oning the dependence of the mental disturbance upon the poison is recognized, and he contends that certain obnubilation and confusion (Verwirrtheit). The refeauto-intoxications with ptomaines are probable causes of insanity. The toxic albumoses have been found in the urine in cases of insanity. Why, he asks, may not the autogenous poisons enter the circulation and act directly upon the central nervous centres with sufficient toxic force to produce mental disturbance?

Dr. Rohe, of Catonsville, Md., in inquiring into the relations existing between pelvic disease and psychical disturbances in women, (Journal of the American Medical Association) points out the frequency with which bodily conditions influence mental states, and shows that "a torpid condition of the intestines, Bright's dis ease, putrefactive processes in the intestinal canal, etc., might give rise to melancholia and other disorders of the mental functions,"

rees think that a third form of infectious psychosis must be admitted, a form intermediate between those above mentioned, with the symptomatology of paralytic dementia, and which they call pseudo-general paralysis or infectious general paralysis; and they ask in this connection, if most cases of typical paralytic dementia may not be the consequence more or less remote of an infectious disease? However this may be, the characteristic symptom of infectious psychosis, in all its forms, seems to be intellectual disorder, mental confusion, without doubt the result of the impregnation of the temporary inhibition of the cerebral cells by toxic agents. Generally the psychosis thus produced is susceptible of cure.

2. The visceral psychoses are also believed to be in

The patient, twenty-two years old, healthy, had always menstruated regularly every four weeks. The birth of her first child took place July 4, 1892: the child was suckled by the mother for ten days, and throve. On the eighth of July, four days post partum, coitus took place, followed by sexual abstinence for three months: the menstrual periods did not appear. Fetal motion was first felt in November, 1892, and the child was born March 10,1893, 243 days from the date of coitus, and 247 days from the birth of the last preceding child. The infant bore every appearance of maturity, although, of course, it was premature by 27 days: it was 20 8 inches long, and weighed over 7.5 pounds.

great measure the consequence of auto-intoxication. the Obstetrical Society of Leipzig, March 20, 1893, reNevertheless, experimental researches have not been ported the following case: pushed far in this direction, and in what concerns particularly the psychoses resulting from digestive distur bances, we yet know very little, having only certain imperfect data as to the concomitant alterations of the gastric chemism and the toxicity of the intestinal con tents. We have more satisfactory data regarding he patic and nephritic insanities, and it is clearly established to-day by the researches of French authors that these psychoses are at their highest mark the result of an autochthonous poisoning of the organism, of an auto intoxication. As for the clinical character of these visceral psychoses, it may be affirmed that in cases where the intoxication is acute, the mental disease manifests itself habitually under the form of an acute toxic deli rium like alcoholic delirium (this is the case in uremic poisoning); when the intoxication is slow and chronic the state is one resembling melancholia, or, more rarely paralytic dementia.

3. The diathetic psychoses resemble acute toxic delirium, and in the interval of attacks they frequently manifest themselves under the form of general paraly sis or paroxysmal mania more or less periodical, and almost always with melancholic character. The referees have also noted that these paroxysms of madness appear to correspond to variations in the composition of the liquids of the organism (hypoazoturia, hypophos phaturia, oxaluria, etc.), notably to discharges of uric acid, frequent precursors of the end of the crisis, and also to modifications in the urinary toxicity which is found to be inferior to the normal.

Under the head of "Facts of Therapeutical Order," the referees state that the antiseptic treatment, general or local, often gives most excellent results.

It is true that in the treatment of the psychoses of acute infectious diseases a tonic and supporting regimen is necessary to combat the state of exhaustion and inanition, the agents of infection being unknown; but in the visceral psychoses, linked to diseases of the stomach liver, kidneys, etc., very good results have been obtained from the employment of purgatives, lavage of the stomach, and antiseptics.

At the same meeting, Ballet, of Paris, gave some interesting facts concerning the toxicity of the urine of insane persons, which were strikingly confirmatory of data previously furnished by other authorities. At the same time, he cautions against exaggerating the importance of these researches; the study of urinary toxicity in the insane has without doubt its utility, but it would be impracticable to found nosological distinction on this alone. In one instance, cited by him, the toxicity of the urine was extreme, the patient was an hysterical girl who manifested no delirium or mental aberration, and had no apparent disorder except hysteria. Boston Med. and Surg. Jour.

From this case Kronig draws the following conclu sions:

1. During a pregnancy of 243 days, reckoned from the fertile coitus, a mature child can be developed. [This amounts simply to saying that an eight months infant usually appears mature, a statement which no one can gainsay-REP.]

2. Spermatozoa retain [that is may retain] their vitality in the lochial secretion.

3. Ovarian activity does not entirely cease during pregnancy; the follicles ripen so that they may reach maturity very soon post partum.

4. Menstruation and ovulation may occur independ ently of each other.

5. In strong and healty persons in the puerperium the endometrium may rapidly reach such a degree of regeneration that it is possible for the impregnated ovum to obtain a nidus very early in the convalescence. In the discussion Rosger remarked that he had seen in the dead subject, as early as two days post partum, glandular crypts in which an ovum could take root. The customary representation of the puerperal endometrium as a wound-surface holds good only for the placental site. Rosger cited, as a curiosity, a case of coitus intra partum.

Variations in Intensity and Rhythm of the Cardiac Pulsations.-Although in general variations in the intensity of the heart sounds depend upon the strength of the systole, there are a number of other circumstances which may cause variations. Potain (L'Union Medicale) finds that among the most obvious of these are increase in thickness of the cardiac walls, or those of the chest, the interposition in front of that organ of gas or liquid or the presence of a portion of the lung, possibly in an anomalous anatomical position. Special sounds may be accentuated in certain diseases, as the aortic sound in Bright's and the pulmonic where there is an obstacle in the pulmonary circulation.

In most cardiac affections there is great acceleration of the rate, though sometimes retardation is observed. Impregnation During the Puerperium.-The latter, however, does not usually depend on a leKronig (Centralblatt f. Gynakologie) at a meeting of sion of the orifices, and is often more apparent than

Irregularity of action may depend on simple digestive disturbances, especially intestinal, but is usually a symp. tom of valvular lesion and it is well worth knowing that it is observed especially in patients who have been under treatment by digitalis.

Lead

real, some beats being too feeble to be felt in the pulse salicylic acid, employed for their antiseptic properties. or even to be heard by attentive auscultation. This Boric and benzoic acids, saccharin and hydronaphthol condition has great prognostic value as it indicates a were not found in any of the samples examined. Tin is change for the worse in the condition of the patient. the most common metallic contamination, being present The fetal rhythm, recently insisted upon by Huchard, in every can that has been put for any length of time. depends upon an accelerated cardiac action accompanied Tin poisoning from the use of canned goods is not often by a modification in the duration of the pauses, so that alleged although Hehner and other experimenters have the intervals between the two sounds seem of equal found stannous hydrate to exercise a marked poisonous length. action on guinea pigs and other small animals is freely nsed by the packers both in the solder and in lower grade tin plate; but there is little danger of lead poisoning by the use of canned goods, for tin precipi. tates lead from its solutions and is not attacked by acids in the presence of as much tin as is found in the tin At times three, or even four, sounds, may be heard plate used. There is more danger of lead poisoning with each cardiac revolution, at others, only one, in the from the sheet lead top of glass jars than from the sollatter case it is usually the first sound which is lost or der or lead of the tin cans. The quantity of copper rather becomes so faint that it cannot be heard. Re- needful for "greening" amounts to only a quarter of a duplication may be normal and is then dependent on grain per pound, but much more than this quantity was the respiratory movements, the reduplication of the often found. The temperature required to destroy second sound being produced at the end of inspiration spores in vegetables tends to disintegrate many of them and at the commencement of expiration, while the re- and render them less attractive in appearance; hence the verse is true for that of the first. The reduplication of need of salicylic acid. Doses of one-half to one and a the second sound is due to the premature closure of the half grams of this acid have been given and taken daiaortic flaps from the increased tension of the blood in ly by experimenters for periods of many months withthat vessel, and results from purely mechanical causes. out affecting the system in any notable way. NeverThe physiological reduplication of the first sound is theless its action on the kidneys is recognized, and in much rarer. The pathological reduplication of the exceptional cases of renal disease its continued ingestion second sound may be the only sign of mitral stenosis, in the quantity present in canned goods may be harmful. which otherwise gives no evidence, either general or In dyspeptic cases, also, the antiseptic may do harm by local, of its presence. It is independent of respiration interfering with the normal action of the digestive ferand accompanies all cardiac pulsations. Being due to ments. changed conditions of pressure in the two arteries, at A trade journal criticises the report for conveying the the beginning of the disease it is due to premature impression that there is a widespread use of injurious closure of the aortic valves, at the end to premature antiseptics in injurious quantites, and points with closure of the pulmonic; midway in the course of the emphasis to the fact that over one thousand affection there is no reduplication, but only an accen- millions tuation of the second sound. The reduplication of the second sound due to premature aortic closure is also seen in general pericardial adhesions, and the differential diagnosis can only be made by looking for other signs of this condition. The two conditions may, of course, be co existent.-Boston Med. and Surg. Jour.

year in

cated

of cans are packed and consumed every this country alone and no well authenticase of sickness has been traced to them, which could not with equal force be attributed to the use of smilar articles not canned. The chemists, however,do not intend to convey that impression nor to urge a prohibition of the use of copper salts and preservatives but they claim the right on behalf of the people, of being informed by notice on the lable of the can whether any ingredient foreign to the vegetable is present. Packer should not be permitted to use these substances without notice plainly given of their presence and quantity, for the purchaser should be accorded the privilege of electing whether or not he will take the doses.Jour. Am. Med. Asso.

Canned Vegetables -The Chemical Division of the United States Department of Agriculture has just issued another part of its Report on Foods and Food Adulterants, technically known as Bulletin No. 13. The present issue, Part VIII, deals with canned vege. tables, especially with regard to methods of preserving, the preservatives employed, the character of the vessels used and the food value and digestibility of the articles. A few words concerning this report may be of The Pathogeny of Diabetes.-Drs. Chauveau use, inasmuch as owing to the publicity given to it, and Kaufmann (Med. & Sur. Rep.) regard the pathogemedical practitioners may be questioned as to their ny of diabetes as one of the most important subjects in view on the subject. Tin and lead were found, derived progressive general physiology. The glycemic function from the can and solder; copper from salts of the metal plays a most important role in the nutritive activity. used for "greening" the vegetables; zinc in some sam. The blood studied in a fasting subject constantly conples of French goods, and sulphurous and particularly tains glucose. The subhepatic veins contain most of