normal condition, the hyperemia of the vasa vasorum disappears, and no new tissue forms in the intima until the blood-current again undergoes changes of speed and again makes operative the various factors originally involved in the production of the disease. small blood-vessels ruptured and drops of blood ap peared on the surface of the tumor. The abdomen was closed. When on the ninth day the dressing was re moved the tumor was found to be reduced in size and three weeks afterwards it was only of the size of an ap. ple, but, of course, grew again later on. Similar con gestions we have also observed upon opening the abdomen, although there was no rupture of blood-vessels, and we were forcibly reminded thereby of the reduced intra-abdominal pressure. If the latter, however, is the cause of the favorable results of laparotomies in tuber cular peritonities, then simple aspiration ought to have the same effect as laparotomy. The subject needs blood-current. In the same manner is the orifice of the further investigation, before we shall be able to deter mine the real cause of the favorable influence exerted by laparotomy upon the tubercular peritoneum. The Use of Nitro-Glycerin in Arterio- Now, let us see how these changes in the arterial walls will affect the various tissues and organs the nutrition of which it is the function of the blood vessels to provide for. As this degeneration is characterized by a more or less distinct swelling, the compensatory thickening of the intima projects to some extent into the lumen of the vessel and thus interferes with the blood-vessel narrowed as its point of branching off from the parent vessel. "Various and grave disturbances of nutrition may, of course, result in the organs to which these branches go, and it is conceivable that often thus a vicious circle is established. Thus, the diseased arteries supply less blood to a given organ than its proper nutrition requires, and local degenerations ensue in the organ. These changed conditions call for still less blood, and there results a further disturbance in the rapidity of the current in the affected artery. This Thomas G. Ashton, M.D., writes as follows in the Therapeutic Gazette: But little more than twenty years have elapsed since arterio-sclerosis was first causes further changes in the vessel's intima" (Peademonstrated to be a distinct and definite disease, and, as is well known, it is to Gull and Sutton we are indebted for this addition to our medical knowledge. It is necessary for us to fully understand the nature of arterio-sclerosis in order that we may clearly appre ciate the reasons advanced for the employment of nitro glycerin in its treatment. Equally important, also, is it for us to have a clear idea of the drug's physiological actions. The most commonly accepted theory explaining the manner of the development of arterio-sclerosis is that advanced by Thoma in a number of articles published in Virchow's Archives. Thoma finds the development of the disease to depend upon a series of conditions which conform to the following law, viz.: A slowing of the blood current in an artery that is not at once and completely counteracted by a proportionate contraction of the media leads to a new growth of connective tissue in the intima, which lessens the lumen of the affected vessel and thus restores the normal swiftness of the blood current more or less completely. body). Thus we will find that the same vicious circle that becomes established in the various organs of the body involves with them the arteries themselves. The vasa vasorum, sharing in the general sclerotic change, supply less blood to the arteries than is required for their proper nutrition; further degeneration of the arterial walls follows, calling for less blood for nutritive purposes, which produces, in turn, a slowing of the bloodcurrent in the vessels supplying the arteries; consequently the intima of these vessels becomes the seat of further degenerative changes. We have found, therefore, that we are dealing with a disease one marked feature of which is a mechanical interference with the blood-current, due to progressive narrowing of the lumen of the blood vessels, and that a necessary result of this obstruction is a lessening of the supply of blood essential to the nutrition of the tissues, resulting in various tissue degenerations. Let us see now what are the properties of the drug with which we propose, if not to permanently arrest the progress of the disease, at least to ameliorate its most striking and annoying symptoms. According to this law, therefore, the lesion has its origin in the media, which, in some way not known, has When a dose of nitro glycerin large enough to prolost its tone. As a result of this impairment of the duce the physiological effects is taken, there follow elasticity of the media the artery dilates, and, as a con more or less flushing of the face and a feeling of fulness sequence, the normal swiftness of the blood stream is of the head which, in some individuals, is accompanied lessened. The slowing of the blood-current produces, by dizziness. These manifestations are the result of a in turn, a hyperemia of the vasa vasorum and a new dilatation of the superficial vessels, which, according to growth of connective tissue in the intima, with which Brunton, is due to weakening or paralysis either of the there is subsequently associated a similar formation in muscular walls of the arterioles themselves or of the the media and adventitia. So soon as the growth of vaso-motor ganglia in or near them. That the effects of new tissue reaches such dimensions in any situation that the drug are not due to its action upon the sympathetic the normal swiftness of the blood current is thereby reacting upon the muscular structure of the arteries established, the sensitive nerves are restored to their through the vaso-motor centre, he demonstrates by 1 showing that the nitrites lower the blood-pressure in animals even after the cord has been divided just below the medulla. Nitro glycerin, therefore, lowers blood-pressure by producing a dilatation of the arterioles, and it is upon this dilatation of the arterioles that the value of the drug in the treatment of arterio-sclerosis depends. We found that in arterio-sclerosis, because the tissues receive too little blood for their proper nutrition, local degenerations occur, and that these local degenerations, disturbing again the equilibrium of the circulation, cause still further sclerotic changes to occur in the arterial walls By causing a dilatation of the blood vessels, and thereby supply the tissues with a larger amount of blood for their nutrition, not only will the progress of degenerations in the various organs and tissues be retarded, but the course of the disease will also be ar rested in the arteries themselves by supplying them, in the same manner, with a larger quantity of blood. The effects produced by nitro-glycerin upon the pulse vary somewhat, though not materially, in duration in different individuals. In one of my cases the effects of a dose just sufficient to produce the physiological actions did not disappear from the sphymographic trac ing for nearly three quarters of an hour. According to Murrell, however, whose observations upon the subject. have been made with great accuracy and have come to be regarded as authoritative, the tracing resumes the normal in less than half an hour. As the effect of the drug is but transient, therefore, the interval between the doses should not exceed two or three hours. Nitro glycerin tends to arrest the oxygen-carrying function of the red blood corpuscle, and it is therefore important not to give it in doses larger than necessary to produce the desired effects, and during long conti nued courses of the drug to interpose frequent periods of abstinence from its use. Arterio sclerosis is a progressive disease, and it is not claimed, therefore, that nitro-glycerin will effect a per The most important clinical manifestations of arterio sclerosis are directly due to the condition of the blood-manent cure. It is claimed for the drug, however, that vessels which interferes with the blood supply to various organs. it will retard the progress of the affection and alleviate many of its most distressing and serious manifestations. As previously stated, the chief symptoms of arterio sclerosis are due to the malnutrition of various organs The Dangers of Overfeeding in Children. resulting from a lessened blood supply; nitro-glycerin relieves these symptoms by increasing the blood-supply of any given tissue. The cardiac hypertrophy, however, so common an attendant upon this disease, is caused by increased peripheral resistance. By lowering the bloodpressure and, according to Bartholow, by removing the inhibition exercised by the pneumogastric nerve, there by lessening the work of the heart, nitro-glycesin re sults in relief of this condition. The advantages from the use of the drug in attacks of angina pectoris are too well known to require discussion. Because nitro-glycerin lessens arterial tension and thereby diminishes the amount of urine voided and lessens the output of albumin, and because it increases the blood-supply to the kidneys and therefore improves their nutrition and prevents further degenerative pro cesses, is its exhibition advantageous in the renal changes accompanying arterio sclerosis. Nitro-glycerin is best administered in the form of a centesimal solution, or as tablet triturates, each con taining 1/100 grain of the pure drug. Inasmuch as the susceptibility to the action of the drug varies very greatly, the dose cannot be stated in advance. It is therefore advisable to begin, with a dose of 1/100 grain, watching its effects, and increase it until the physiological actions of the drug become manifest. In some individuals small doses will continue to maintain the physiological effects of the drug, while in others, as in a case some time since reported by Dr. D. D. Stewart, of Philadelphia, a remarkable tolerance, even to massive doses, becomes established. According to my own experience, those cases respond best to the use of the drug in which small doses continue to maintain its physiological manifestations. The Mercredi Medical summarizes a recent thesis by Dr. Paul Bellot in which the author calls attention to the frequency of disturbances due to overfeeding, not only in infants at the breast, but also in those who are older and take ordinary food (N. Y. Med. Journ.). He has made a study of these disturbances as they affect the digestive canal, the liver and the kidneys, the locomotor apparatus, the skin, and the nervous system. It is not sufficiently recognized, he says, that hepatic colic is apt to attack overfed children, especially those who live in cities and therefore lead a sedentary life not very favorable to the combustion of fatty food. Although less frequent than in adults, hepatic colic is not positively rare in children. Rouisson found concretions in the biliary passages of the new-born, and Heiu observed hepatic colic in a child twenty-five days old. Undoubtedly heredity and a sendentary life may of themselves play an important part in the etiology of this morbid assemblage of symptoms, but it is not the less true that it is in a measure to be imputed to overfeeding. By causing congestion of the liver this sets up inflammation of the biliary passages. It follows that the mucus secreted by the glands and these canals acquires an acid reaction and decomposes the biliary acids, which then lose their solvent power and allow pigment and cholesterin to be deposited in the form of small concretions, or biliary sand, the starting point of calculi. Cases of this kind are not rare, and M. Bellot cites one that is very striking. In common with hepatic colic, nephritic colic is not very rare in children during the second infancy, or even during the period of nursing. Sometimes the new born present uric-acid infarctions in the canals of Bellini, in ABSTRACTS MEDICINE. Pathogeny of Bronchitis. The relation of bacteria to bronchitis has been elucidated by two recent writers, Marfan and Claisse, (Boston Med. and Surg. Journ.). A large division of bronchitis comprehends specific infectious forms; another division, the non specific bronchitis. Every bronchitis, however, according to Marfan, the calices, and in the pelvis of the kidneys. The origin The specific forms attend measles, whooping cough, small pox, influenza, etc., and are dependent on the microbe that causes causes the disease. These forms are "exogenous" or "hematogenous;" the germ is brought by the air or by the blood. Most bronchites are exog. enous, but those of small pox, glanders, malaria and secondary syphilis are hematogenous. The non-specific infectious bronchites constitute a large and important class. Under this head are included common bronchitis(a frigore), the bronchitis. that attends chronic naso pharyngeal affections, chronic affections of the lungs and pleura, hay fever, gout, heart disease, Bright's disease, etc. To this division is assigned the bronchitis which is present as a complica tion in all adynamic and cachectic states, as in infectious endocarditis, diphtheria, typhoid fever, diabetes, etc. Bronchitis is the rule in typhoid fever, but it is only a secondary element, and is not due to the presence in the bronchi of Eberth's bacillus. Marfan's explanation of bronchitis from "catching cold" is substantially as following: As regards the genesis of certain skin diseases, such as urticaria, following the abuse of drink, often ob served in persons with dilated stomachs, a reflex action upon the cutaneous vaso motor nerves must be admitted or, in a weaned child, a direct action of ptomaines taken in excess into the system with articles of food. In other cases, on the contrary, and these are the common. est, where it is a matter, for instance, of impetiginous eczema, or seborrhoic eczema, or ecthyma, or different Acute bronchitis is sometimes occasioned by the forms of acne, strophulus, etc, the pathogeny is proba respiration of a cold atmosphere which penetrates the bly different, in that case involving the direct elimina- bronchi suddenly and violently. But it is not by the tion by the sweat glands of volatile fatty acids which, direct contact of cold air with the mucous membrane in their passage through the skin, alter the anatomical of the respiratory passages that bronchitis is ordinelements of the integument. Among these various skin diseases there is one-eczema seborrhoicum of the hairy scalp and of the face-that is observed in large, fat children, who assimilate the great quantity of food which they take-that is to say, who bear overfeeding without gastro-intestinal troubles. One point it is very important to recognize-namely, that digestive derangement is not at all necessary to the production of skin diseases in an overfleshy or overfed child. In all these conditions it is a prime requisite of treatment to reduce the amount of food taken. arily produced. It is generally by a sudden chilling of the cutaneous surface, and especially when the body has been overheated by prolonged exercise and is perspiring. Marfan remarks that some persons have a susceptibility to cold when this is limited to certain anatomical regions; for instance, one will have bronchitis if the feet are allowed to become cold, another, if he remains an instant with arms or chest bare, etc. Moreover, cold and damp climates and chilly seasons have a great influ· ence on the development of bronchitis a frigore. The same may be said respecting sudden changes of weather. Infants, old people and feeble cachectic subjects are par obvious. Emergency Hospital at World's Fairticulary susceptible, for reasons which are sufficiently There were treated at the World's Fair Emergency Hospital, 18,500 cases, and there were twenty three deaths at the institution. But how does a chill act in provoking an inflammation of a mucosa? The old medical writers supposed two sets of properties are in part dependents on the nervous system. It is likely that the profound perturb. ation produced by the cold on the internal calorification brings about a disorder of the vaso-motor innervation which causes congestion and places the organism in a state of lessened resistance, and just in those localities (respiratory passage, skin, intestine) where microbes are normally present we see inflammations set in of mi that the sweat glands were closed by the cold and that the excrementitious matters of perspiration were retained in the blood. Hence, a general toxemia, with inflammatory manifestations in parts of least resistence. This notion is now abandoneded. Experiments have shown that in animals which are overheated, there is considerable dilatation of the cutaneous vessels; the blood circulates there with force and abundance. If now a sudden chilling is brought about, the blood crobic origin which are properly designated infectious, which distends the peripheral vascular network is non-specific. cooled in mass and by repercussion cools the organ ism. The sudden loss of heat causes profound disturbances in the internal organs. Severe congestions result. But the experimentation stops here, and cannot explain why the fall of the internal temperature engenders bronchitis. It is easy to conceive that a first attack of bronchitis diminishes the power of defense of the bronchi and leaves behind certain microbes that are more virulent, and this naturally favors recurrence. What is said of bronchitis a frigore is just as applica. ble to coryza from cold, and when the two co exist, the explanation may be as follows: Either the cold acting The bacteriological study of the sputa completes the in the same manner on the nasal and bronchial mucosa data furnished by experimentation. Note in the first place, that the upper air-passages and bronchi contain microbes independently of any pathological state. Among these the four following species have been observed which have pathogenic pro perties: the staphylococcus pyogenes (aureus et albus), the steptococcus pyogenes, the pneumococcus, the pneu mo-bacillus of Friedlander. Let now a bronchitis of whatever nature supervene, and it will be seen that these microbes are more abundant in the sputa; new species appear; protei which are pathogenic and even pyogenic when inoculated in animals; two saprogenous microbes, the one resembling Eberth's bacillus, the other, the bacterium colis commune. Cornil and Babes remark that these microbes are found in all the bronchites a frigore, in influenzal, tuberculous, morbillous bronchitis, etc. Marfan, beside those above mentioned, has also found the pneumococcus in the exudation of almost all the bronchites which he has examined. Pausini declares that the streptococci are the only micro-organisms met with constanly in the sputa, both in bronchitis and in health. He describes eight different species of these streptococci, several species of fungi, twenty one species of bacilli, ten species of micrococci. Frick has studied the chromogenic bacteria which gives to sputa their green color. Marfan, in summing up these bacteriological results, asks what conclusion can be drawn therefrom concern ing bronchitis a frigore? Although the direct demon stration has not been made,it is difficult not to think that all these microbes have a real pathogenic influence. Whether they live normally in the respiratory passages or whether they come from the atmosphere, it must be admitted that cold favors their fixation and their pullulation in the mucosa of the bronchi. favors the microbian invasion, simultaneous or success. ive, of the two mucosa; or the coryza alone is produced by the cold, and the microbes having acquired their virulence in the nasal fosse invade later, by simple propagation, the tracheo-bronchial mucosa. There is nothing at the present time that indicates which view of this pathogency is the more correct. Certain it is, however, that bronchitis a frigore is generally preceded by a coryza and it is regarded from a clinical point of view, a descending bronchitis. The article of Claisse (Semaine Medicale, 1893, p 297) adds to the above statement the notion of intoxications by microbe secretions. The presence of the microbe in the bronchi manifests itself by local effects on the tubes and by general toxic effects. The local effects are expressive of the secretory re action of the bronchial tree; this, in certain conditions, may lead to more or less extensive obliteration of the air passages and give extreme gravity to the prognosis. But the bronchial secretions may also have a marked toxic influence; this is a pathogenic factor that has been too much overlooked. The toxemia explains the general phenomena, the temperature, and to some extent, the dyspnea. Claisse has made some interesting experments to determine the nature and quality of these toxines, and has worked out the bacteriological problem with consider. able success; but the details of these researches may be considered later. The Untoward Effects of Antipyrine, A cetanilide and Penacetine.-The recognition of the relationship subsisting between the chemical constitu tion of drug and its physiological action marks one of the greatest advances in therapeutics, and the applica The solution of the problem then consists in knowing tion of principles established by the labors of Lauder why the perturbation caused in the organism by the Brunton, Fraser and others has led to the introduction cold, favors this development of micro-organisms. In the normal state the system defends itself against mic robes by the bactericidal properties of the serum and the phagocytic properties of the anatomical elements. These of many remedies of undoubted value. Of the large number of synthetically prepared bodies that have at tained such general notoriety as the three substances known as phenazone (antipyrine), acetanilide (antifeb rine) and phenacetine. We are ever on the look out for as these have been observed in children, where regulameans to lessen the sum of human suffering,and the rapid tion of the dose is not so exactly carried out, although and extensive use of these remedies proves that they the amount borne by a child is often relatively much have at least engaged the good opinion of the public. larger. Several of the reports call attention to the In this country the rapidity with which antipyrine frequency of depression in pneumonia, and express the has risen in favor is phenomenal, though we have not opinion that the use of the drug should be very guarded reached the point I once saw attained in a Continental in that disease, one member holding that it is hospital where more than half the prescirptions consist- positively harmful even in small amounts, It may be ed of that drug. This affords matter for some reflec- mentioned that in Falk's excellent resume of the ill tion, and perhaps it was fitting that the Therapeutic effects of the recently introduced antipyretics there is Committee of the British Medical Association should recorded a case of pneumonia where death occurred select this subject to give Prof. Gairdner's ideas practi- one hour after the administration of antipyrine, which cal effect. Under stimulating was regarded as the cause of the fatal result. The ANTIPYRINE.-Antipyrine acts upon the nervous stage of collapse is not infrequently ushered in by a system, and its administration is usually directed to feeling of anxiety and great prostration, and the sympeither of the two main therapeutical indications of that toms are sometimes relieved by vomiting. The intensity action, namely the reduction of temperature or the re- of the depression that may be seen after even a mod. lief of pain. For the former it is largely used in all erate quantity of antipyrine is illustrated by a case rekinds of fever, specific and others, and there is a tend- corded by the late Paul Guttmann, which was sent into ency to give it frequently in enteric fever, pneumonia hospital last autumn as one of cholera. The patient, a and phtisis. The amount given for this purpose aver- well-developed man, had the symptoms and appearance aged, as stated in reports to the Association concerning of the asphyxial stage of cholera morbus, except that ill effects following the use of antipyrine, antifebrine the bowels were confined. On the chest and abdomen and phenacetine, from ten to twenty grains, perhaps was a dull red miliary rash. It was ascertained that, repeated at short intervals for one two doses. for five days previous to his admission, he had taken Kept within these limits, there was on the whole a for headache a fifteen-grain powder of antipyrine freedom from ill effects, except in one or two instances twice a day, consuming in all 150 grains, when he fell attended by special circumstances. It is as an analgesic into this remarkable condition. that the drug is prescribed so largely by practitioners treatment he recovered rapidly. and valued so much by the general public, and all are depression are represented by unpleasant diaphoresis, agreed that it is an invaluable remedy. For sick head which may be so profuse as to prostrate the patient ache, neuralgia and spasmodic dysmenorrhea its use is temporarily. One member, a practitioner of great exattended with such great and striking success as to perience, notes that "a few patients to whom it has make it in this respect alone one of the most welcome been given for nervous forms of headache have comof the recent additions to therapeutics. In this connec plained of a feeling of greater depression after recovery tion doses of five to ten or fifteen grains are generally from the attack than when antipyrine has not been given, sometimes repeated every three or four hours. given." Continued use of even small doses not infreLarge doses depress the nervous system. Of the quently leads to a condition in which the patient com. twenty-five reports, seventeen note positive results plains of having lost his energy, is disinclined to exert varying from an unpleasant diaphoresis to severe collapse himself, and becomes depressed mentally; in short, Most of them may be referred to the action on the there is established an antipyrine-habit. It varies nervous system, producing exhaustion and collapse fol in degree in individuals according to various circumlowing the fall of temperature; and there may be dis- stances, and it may be so marked that, as I once heard turbance of the circulation for the same reason or sec a very intelligent patient say, "the relief of pain is more ondarily from the effect on the blood corpuscles and than counterbalanced by the irritating feeling of the production of methemoglobinemia. Other symptoms, uselessness antipyrine after a time induces." It may such as affections of the skin and pronounced psychical even go further, and instand of the expected relief bring disturbance, are more rare. Depression with collapse on headache and general malaise. This is borne out has usually been noticed after doses given with a view to by the experience of a member who has used the drug reduce fever; thus, a dose of twenty grains was followed largely in hospital and private practice. He reports a in a male adult in a short time by great collapse and fall case where antipyrine was ordered for migraine and of temperature, requiring hypodermic injections of ether vertigo in a male adult with relief at first; the patient and digitalis to tide the patient over the difficulty; and got into the habit of taking tabloids at any time up to particulars are given of a case where half that amount (ten forty or fifty grains a day, and the result was his grains) in a lady convalescent from influenza, led to orginal troubles came back tenfold. There was comextreme depression and collapse, the patient becoming plete relief when the habit was discovered and stopped. deeply cyanosed,unconscious,and pulseless,and requiring Falk mentions headache, giddiness, and other nervous free stimulation before she was considered out of danger symptoms, as occasionally brought on by antipyrine. twelve hours later. A small proportion of results such One of our members reports blurring of the vision and |