1. That the two bloods should be gathered simultane- the deviations of the glycemic function which are pro voked by a lesion of the central nervous system. This inferiority likewise shows itself in the hyperglycemia will demonstrate this by presenting in a future report the results of the analyses in each particular case. Ten Tests For Death.-It is the rarest thing in a physician's experience to be placed in any doubt as regards whether a person is dead or not. The cessation of breathing, the absence of audible heart-beat, and the physiognomy of the patient are enough. Every now and then, however, we are called upon to give some absolute test of death which is not connected with the heartbeats or the respiration. One of these criteria is the so called "diaphanous test," which consists of an absence of the translucence seen in living people when the hand is held before a strong light with the fingers extended and in contact. An English physician ralates in the Lancet an interesting exprience with this test the sugar of the economy, and the venous blood of the general circulation is always less rich in glucose than the arterial blood. This physiological sugar is, there fore, in an incessant state of formation and destruction. It is formed in the liver (Cl. Bernard) and destroyed or transformed in the capillary networks intermediary be tween the arteries with red blood and the veins with In the physiological state the comparative analyses of black blood (H. Chauveau). It is this condition of the the arterial and venous bloods practised under the con. blood which is expressed by the term glycemic func ditions above mentioned never fail to demonstrate that tion. This is, without doubt, an improper term because the venous blood is less rich in sugar than the arterial. it implies a manifestation of activity, a movement, This same inferiority of the venous to the arterial blood while it in reality is applied to a sort of static state. in respects to the quantity of sugar is noticed in all of The true glycemic function consists in active nutritive changes which prepare, transform and utilize the sugary materials of the blood. This state of the blood is commonly designated by the term glycemia. The which follows extirpation of the pancreas. The authors terms hyperglycemia and hypoglycemia are also readily used, applied to cases of exaggeration or of diminution of the normal or physiological glycemia. The glycem ic function, therefore, represents the ensemble of acts which tend to maintain, with the permanence of the glucose in the blood, an equilibrium between the dispensing and the production of this substance. It is well known that glycosuria, the essential symptom of dia betes mellitus, is due to hyperglycemia, that is to say, an abnormal accumulation of sugar in the blood. But what is the immediate cause of this hyperglycemia? Does the blood become too rich in sugar because the tissues cease to appropriate this substance of the nour ishing fluid for the needs of the nutritive acts which occur in the heart of the anatomical elements? Does this fluid enrich itself, or the contrary, in sugary mate. rial, because the liver turns more of it into the circulatory torrent, or even because other organs become aux iliary to the liver in the sugar forming function? In other words, it is the consuming of the sugar which is arrested or the production which is increased when this substance accumulates in the blood of the diabetic in sufficient quantity to provoke an elimination by the renal passages? The answer to this remains still in sus pense. The method employed by the authors in their effort to solve this problem rests entirely upon the results of the comparative analyses of the arterial and venous bloods of the general circulation. Three cases may present themselves; either the venous blood becomes, as in the normal state, less rich in glucoee than the arterial blood, and then the hyperglycemia should be placed to the account, not of a default in the consumption of the glucose, but to an excess in its production, or the two bloods show themselves nearly equally rich in sugar, which necessarily implies a poor using of this substance in the capillary networks and places in this default of consumption the cause of the hypergly. cemia; or finally, the venous blood becomes more suga ry than the arterial blood, which indicates positively that the hyperglycemia is due to a production of glucose on the site in all of the tissues of the economy. To as sure exactitude of the comparative results of the analy ses of the two bloods the authors took care to observe: He was called to see an old lady who was believed to be dead, but whose countenance looked natural and life-like, the eyes being open. The family, being extremely anxious, urged that all the tests of death be applied, and this was done in the following order: 1. Heart sounds and motion entirely absent, together with all pulse movement. 2. Respiratory sounds and movements absent. 3. Temperature of the body taken from the mouth the same as that of the surrounding air in the room, 62° F. 4. A bright needle plunged into the body of the bi cepts muscle (Cloquet's needle test) and left there, shows on withdrawal no sign of oxidation. 5. Intermittent shocks of electriciny at different ten. sions, passed into various muscles and groups of mus. cles, gave no indication whatever of irritability. 6. The fillet test applied to the veins of the arm(Richardson's test) causes no filling of the veins on the distal side of the fillet. 7. The opening of a vein to ascertain whether the blood has undergone coagulation shows that the blood was still fluid. 8. The subcutaneous injection of ammonia (Monte Verde's test) cause the dirty-brown stain indicative of dissolution. 9. On making careful movements of the joints of the extremities,of the lower jaw,and of the occipito frontalis, to pollute the water. Every filter should be abolished rigor mortis is found in several parts. Thus of these nine tests, eight distinctly declared that death was absolute, the exception, the fluidity of the blood, being a phenomenen quite compatible with blood preternaturally fluid and at a low temperature, even though death had occurred. 10. There now remained the diaphanous test, which we carried out by the aid of a powerful reflector lamp yielding an excellent and penetrating light. To our sur prise the scarlet line of light between the fingers was as distinct as it in our own hands subjected to the same experiment. The mass of eviedence was of course dis tinctively to the effect that death was complete; but, to make assurance doubly sure, we had the temperature of the room raised and the body carefully watched until signs of decomposition had set in. I made a visit myself on the succeeding day to assure myself of this fact. This experience shows that the diaphanous test is not a trustworthy one.- Med. Rec. that cannot be easily and frequently cleansed. Perhaps the best is a table charcoal filter; but even this cannot be depended on for the removal of all germs. For perfect safety the water shonld be previously well boiled and then filtered. A filter from which great things were expected was the Pasteur Chamberland Filter, but our contemporary, the Med. and Surg. Reporter, writes of this: The fact has been asserted for a considerable time that the Pasteur Chamberland filter was not proof against bacteria. This was disappointing as is was hoped by all and believed by many, that the Pasteur filter would remove all organic, as well as inorganic, meterial from the water which passed through it. Several tests have been devised for proving the passage of bacteria through the bougie of the filter. Smith and Moore (Centrablatt f. Bakteriologie) describe an extremely simple method. A bougie from an ordinary Pasteur filter is inverted in a large glass tube, the top of which is plugged abont the bougie with cotton. It is then sterDrainage in Abdominal Surgery.-Howard ilized by dry heat. A culture of the germ to be tested, Kelly (Arch. of Gynec.) considers that the drainage which has grown for a few hours only, is transferred to tube is used too much. If operators would take more the tube by means of a sterlized pipette. By means of pains in small details, in checking all hemorrage, in lim- air pressure a portion of the liquid is forced through the iting the spread of contamination, and in cleaning up bougie into the tube. The filtered liquid is perfectly the field, drainage would be seldom called for. Five clear. The filtered culture liquid in the tube will remain years since, Kelly drained from 75 to 85 per cent. of all clear until it is rendered turbid by the multiplication of cases; now he drains in but 10 to 15 per cent. The bacteria which have grown through the walls of the bouglass tube is not free from danger. After the second or gie. The authors found that the hog cholera germ third day, it becomes infected with the white skin would grow through the tube in from five to ten staphylococcus. Suppuration is doubtless rare, but it days. The experiments made were sufficient to show sometimes occurs. He insists that his assistants should that the pores in the tube are large enough to admit of take minute precautions wher handling the drainage the passage of bacteria the size of cholera spirillum or tube. A long, narrow gauze bag containing several typhoid bacillus. They also show that there is a differstrands of gauze, is safer and better than a glass tube. ence in the pores of different tubes. [These facts conIt is an error to believe that all the blood which tends firm in a measure the statements of M. Dujardin-Beauto collect in the pelvis come away through the tube. At metz that, "filters are of no use whatever, and thus ana necropsy where the tube had been used after operation, other cherished illusion is likely to disappear"]. Kelly found clots scattered around it. The gauze bag fact should be borne in mind that thus far there has is flexible, and it requires no cleaning out; it is there been no filter devised that is capable of turning out fore the best form of drainage for the abdominal cavity. water "germ free" after it has been used for a considerIt removes all fluids rapidly, and that remaining is quickly able time. The only reliable method of obtaining absorbed. In widespread peritoneal infection, two or wholesome drinking water is, if the water is cloudy more openings for drainage are needed. An abundance from holding earth in suspension, to filter it to remove of gauze should be packed into the infected abdomen; yards may be needed. In this way, desperate septic cases will be saved. We must drain but seldom, but when we drain it must be done thoroughly. The the dirt, boil it to destroy the bacteria and keep it until used in a sterilized vessel placed in a refrigerator. This is important at all times, but more especially during the coming season when cholera may dangerously contaminate the water supplies in many sections of our coun try.-Pop. Med. Month. Freckles.-Freckles can be removed, according to Hager, by the application every other day, of an ointment composed of white precipitate and sub-nitrate of bismuth, each 1 dram; glycerine ointment half an ounce. Filters and Germs.-The filtering of drinking water is of very great importance if there is any sus picion that the water is bad; and in many places, owing to the scarcity of water caused by heat and drought, the water is in danger of being polluted. But many people live in a fool's paradise; and they think they are safe when they put their drinking water through a fil ter that has been used without cleaning or changing the materials for years. The only thing such filters can do is REVIEW. Now is the time to subscribe for the MEDICAL MEDICAL SOCIETIES Association of American Physicians.— The eighth annual meeting was held at Washington, D. C., May 30, 31 and June 1, 1893 (Boston Med. and Surg. Jour.). SPORADIC CRETINISM IN THE UNITED STATES, by William Osler of Baltimore. Dr. A. C. Wood thought, that, although cretinism was a rare disease, yet it was more common than ap peared from Dr. Osler's paper, because persons have not reported the cases which have occurred to them. He recalled two very positive cases which he had seen in his own experiance, entirely outside of any insti tution. rurbance of the system, this seems to be due mainly to the large amount of debris in the blood, which cannot properly be disposed of by the excretory organs. Inflammatory or chemotactic processes are absent and the degenerative changes may be accounted for without assuming the presence of alkaloidal or proteid poisons orig inating in the micro-parasite. An important fact which hitherto has not been brought out in the study of infectious diseases is the indefinite persistence of the micro-parasite, in very small numbers, in the blood of insusceptible cattle from. the enzootic territory. Such blood is capable of producing the acute disease in susceptible animals. In other words, a complete symbiosis between an other. wise fatal parasite and the host seems to be compatible with and perhaps necessary to immunity. This disease is probably transmitted exclusively in nature by an ecto parasite-the cattle tick (boophilus bovis). This important fact opens an interesting and only partly explored field of inquiry in the transmission of human malarial affections. Dr. P. C. Griffith thought that what Dr. Woods had said was probably the case. He had seen a case the past winter which had been brought to the Children's Clinic of the University of Pennsylvania. He asked Dr. Wm. H. Welch was quite familiar with the how old the "baby" was, and was told five years. The development of Dr. Smith's work, and was extremely parents lived at Lancaster, Pa., which is not a mount. interested in the results. The etiology of Texas cattleainous region. There was no nervous disease in the fever has become, through Dr. Smith's researches, family, and there seemed to be no way of accounting probably clearer than that of any other protozoan dis ease. We now know, not only the character of the micro-organism inside the body of the animal, but also the media of development outside of the body, in the cattle tick. Dr. Smith's paper is an important con. tribution to science, and is an illustration of the value of governmental aid in solving a problem of both scientific and economic importance. for the child's condition. SOME PROBLEMS IN THE ETIOLOGY AND THE PATHOL by Theobald Smith, of Washington. The course of Texas tever may be divided into a first stage (acute), and a second stage (mild or relapse) which may follow the first after an interval of two or more weeks. The first is characterized by a high fever and a rapid destruction of red blood corpuscles, amount ing to half a million or more per cmm. in twenty-four hours. The second stage, or relapse, differs from the acute fever in its mild, non-fatal course, its fluctuating temperature and a much slower destruction of red corpuscles. In the acute fever, the number of infected corpuscles which circulate in the blood is small, and rarely exceeds two per cent. The micro parasite contained in them is fully developed. In the mild fever, or relapse, the number of infected circulating corpuscles is, as a rule, much greater and it may reach fifty per cent. The micro-parasite, in the mild fever, is always in a very young stage in the corpuscle. The probable explana tion of this curious phenomenon is a partial immunity of the affected animal acquired in the acute attack, in virtue of which a retardation in the development of the intraglobular parasite is brought about. THE BACILLUS PYOCYANEUS PERICARDItidis, by Harold C. Ernst, Boston. The material from which the bacillus was isolated was fluid drawn from a case of pericarditis. The fluid contained plenty of tubercle bacilli and this new bacillus. With this new bacillus a long series of tests were made upon a large number of different media and under dif fering conditions of temperature. The only two organisms with which it is likely to be confounded are the bacillus pyocyaneus of P. Ernst and the bacillus pyocyaneus of Gassard. Every step in the investigation of this bacillus was checked by and compared with cultures of the bacillus pyocyaneus derived from four different sources. Dr. Ernst gave in detail the essential differences, both macroscopic and microscopic, between this bacillus and those with which it has been possible to compare it. As the result of these tests, it appears justifiable to conclude that the bacillus is a distinct variety of organism, resembling in many respects the bacillus pyocyaneus but perfectly distinct from it. Dr. A. C. Abbott, of Philadelphia, thought that in the The reaction of the organism of the host in the pres bacillus described by Dr. Ernst, we have another adence of the invasion seems to proceed along lines dif- dition to make to the group of green-producing microferent from those which are followed during the course organisms. Some of its characteristics are very differof bacterial diseases. While there is a profound dis- ent from those common to the ordinary green-pus or. ganism: the essential difference between the organism the experimental rabbits given to him by Dr. Trudeau described by Dr. Ernst and the ordinary bacillus fluorescens liquefaciens, being the production of the bluegreen color upon which Dr. Ernst lays stress. Dr. Smith had seen all variations in the color producing power of the saprophyte, and in some cases the color was a very dark green. GONORRHEAL MYOCARDITIS. by W. T. Councilman, Boston. not quite so extensive as in the control animal. The animal treated by the filtrate was of most interest, because the filtrate is said to possess distinct curative or preventive properties. This case turned out just as Dr. Trudeau might have wished. There was no extension of the tuberculous process. There developed a small, a year ago. There were three rabbits, each inoculated! in the same way with a pure culture of the tubercle bacilli, both in the eye and in the pleural cavity. One was a control animal; another was treated with bacterioproteid; and the third by the filtrate from liquid cultures of the tubercle bacilli. The control rabbit developed a caseous inflammation of the inoculated eye. It went through the typical changes and developed caseous panophthalmitis; all the media became obscure, There have always been two opinions held about the the cornea became vascularized, and subsequently there secondary infections following gonorrhea; one that they was atrophy of the bulb. The animal treated with are due to the accidental infection with other organisms bacterio-proteid became very emaciated, developed abwhich enter through the lesions in the urethra, produced scesses and ulcerations of the skin in different parts, and by the disease. Gonococci have been found by various finally died without anything to show for the immeobservers in these secondary lesions. Other observers diate cause of death except the extreme emaciation. have failed to find them. The most prominent second. There was extensive caseous disease of the eye, but ary lesions consist of the various joint affections, of peri- and endo carditis, and of inflammation of the neighboring lymph glands giving rise to the bubo. Chronic inflammation of the Fallopian tubes in the fe male is now very generally regarded as due to a previous infection with gonorrhea. In a case recently seen at the City Hospital there was an acute urethritis, acute grayish-white, slightly opaque nodule at the upper inflammation of the joints and an extensive peri- and myo carditis. Gonococci were found in all of these places. The lesions in the urethra closely similate those described by Bumm in his experimental work on the disease. The gonococci were found only in the superficial layers of the epithelium. In the sub-epithelial tissue there was marked round-cell infiltration. It appears probable from a general consideration of the secondary infections that they are true infections resulting from the presence of the gonococci. In the cases in which organisms have not been found it is very possible that they were so few that the ordinary micro scopic investigation would not reveal their presence. That the affection is not due to the presence of pus or ganisms is shown from the fact that cultures made from these secondary lesions are so generally sterile. Dr. Reginald H. Fitz had no recollection of ever seeing a case like the one described by Dr. Councilman. Cases of infection through embolism from urethral disease, especially in consequence of surgical operations are not so very uncommon. quadrant of the eye in the anterior chamber, which became adherent to the iris, then grew smaller, and finally just a scar was left, without any caseation and without any secondary tuberculosis in the eye which could be determined during the life or after the death of the animal. Dr. Whittaker said that from some reports made to a previous session of the Society the impression seems to have gone out that tuberculin wat not only useless but for the most part actually injurious. Since that time new light has been shed on the nature of the tuberculous process which shows how laboratory tuberculosis differs from human tuberculosis. Dr. Whittaker has administered tuberculin daily since it was first sent out, both in private and hospital practice, and has never seen any reason for a modification of Koch's first opinion as he expressed it in regard to cases of pure tuberculosis. He has observed that under this treatment there has been a singular and early relief from the depressing action of the disease, first of all, and more so than from any other method of treatment. Dr. Alfred L. Loomis reported a case which had been Although a minority of the cases show an exaltation, a very misleading, due to a mixed infection. The patient spes phthisica, yet in most cases there is a marked j had gonorrhea for four or five weeks and then suddenly tendency to melancholy. After five or six injections developed in endocarditis. Within twenty-four hours of tuberculin, patients experience relief from this conhe had pains in his joints that had not existed before. dition, and they continue to show this relief until some A relative in the same house at the same time, came complication occurs. Patients who only have tubercudown with diphtheria; and in two or three days after losis in its inception, having perhaps a light bronchial the endocarditis, the man had a diphtheritic spot. Had it not been for the occurrence of diphtheria, the endocarditis would doubtless have been ascribed to gonorrheal origin. DISCUSSION ON TUBERCULOSIS. catarrh at the apices, or are still in the prephysical state of tuberculosis, where we only make the diagnosis by the discovery of the bacillus, when treated with tuberculin are completely rescued in the majority of cases. It does not take so long a time to effect a cure as is commonly asserted. Most of these cases are Dr. Wm. H. Welch reported the results obtained in rescued in two or three months under careful use of the remedy, and these cases do not fall back into the condition of patients who return home from Colorado improved, who fall victims anew to the disease. Tuberculin is the only specific remedy for tuberculosis. All other remedies act only through the avenues of nutrition and resistance to invasion. Where we have mixed infections, as in the case in the latter stages of phthisis, tuberculin does little or no good and for the most part harm. It is the reckless administration of tuberculin in these cases of so-called hectic fever that has brought tuberculin into disrepute. NOTES: AND ITEMS The Southern Surgical and Gynecolog. ical Association will meet in New Orleans on the 14, 15 and 16 days of November and we have been informed that prospects are splendid for a successful meeting. In Memoriam.-Dr. Nicholas Guhman died FriThe following officers were elected for the ensuing day, Sept. 22, at the age of sixty years. In the depart. year: President-Reginald H. Fitz. Vice-President-Wm. Osler. Recorder-J. Minis Hays. Representative on the Executive Committee of Congress of American Physicians and Surgeons-William H. Welch. Alternate Representative-M. Allen Starr. Drs. George Dock, of Ann Arbor, and T. M. Rotch, of Boston, were elected to membership in the Asso ciation. ure of Dr. Guhman from this world the St. Louis Medical Profession has lost one of its most estimable members. The open and honest character of the deceased as well as the interest he took in the meetings of the St. Louis Medical Society of which he has been Vice President and a regular attendant are well known to all, and he leaves many friends in the profession to mourn his death. The South Carolina Disaster.-The sanitary condition of the whole Carolina coast, resulting from the hurricane recently has become most serious. Phy. sicians in the vicinity of Beaufort and St. Helena are reporting to the Marine-Hospital Service a very large number of diarrheal and malarial cases. It is almost impossible, they say, to care for the sick, and to provide the necessary disinfectants. The President has detailed a medical officer to take charge of the sanitary with their legs and arms broken and bound in positions of deformity. One little girl had both eyes gouged out. Instruments, which had been used in producing physi cal deformities, were discovered in the cellar. After the children (who had been stolen) were sufficiently deformed, they were sold to other persons for begging purposes. The Effects of Large Doses of the Bro-measures at Beaufort, and has placed a revenue cutter at his disposal. mides in Epilepsy.-Ch. Fere (Rev. de Med., Brit. Med. Journ.) reports fully 20 cases of epilepsy in which The Manufacture of Cripples.-A horrible from 16 to 21 grammes bromide of potassium or stron disclosure has been made in Biskupitz, Austria, by the tium were taken with the following results: Only arrest of a gang of men who for some time have been 1 lost weight very considerably; in 9 other cases engaged in crippling children for the begging trade. there was loss of weight, but of little importance gener- Several unfortunate children were found in the house ally; 4 remained stationary; and 6 others increased in weight during the treatment. Eleven of the 20 showed premanent, and 7 temporaty, improvement. In only 2 cases no benefit was noticeable. Doses of 15 to 20 grammes of the bromides are harmless when watched, and produce improvement in cases which have resisted smaller doses. Bromide of strontium may be given in place of potassium bromide with success. Attention during the course of bromide treatment consists in a frequent examination of the patients to ascertain the condition of the skin and take the weight in order to make up the balance sheet with regard to nutrition. When cutaneous lesions or a permanent diminution in weight exists it is necessary to look after the digestive organs with the greatest care, especially when the patient is in a condition of physical or moral depression and when the temperature is very low. In these conditions the accidents of bromism would necessarily be serious. The use of the drug must be immediately stopped, and elimination by the intestine hastened with the aid of purgatives, and by the skin with the aid of subcutaneous injections of pilocarpin. The Cure of Hay Fever.-The treatment of hay fever is subject to criticism such as comes to no other disease, namely, from societies of the sufferers themselves (Boston Med. and Surg. Jour.). It is interesting to note that the patients are not as enthusiastic over, and do not report such good results as a society of their medical advisers would be likely to do. The United States Hay Fever Association have recently held their annual meeting in Bechleham, N. H, and listened to papers largely on the disease from the pa tients point of view. It appears to be the general opin. ion that the only certain relief is to be found in the White Mountains, and that most therapeutic measures are of little or no use, and some of them harmful. The |