and scarlatiniform rashes and local edema described, there is no mention in any of the reports.

This completes the enumeration of the ill effects which find a place in the records of this inquiry. Various symptoms noticed by others, such as convulsions, rise of temperature instead of the anticipated fall, etc., have

with by many of the members, I have since learned, but they are not detailed in the reports, as the importance attributed to them was trifling

As to the frequency with which these ill effects are met, all the members agree that they are very rare. Shortly after the introduction of the drug their appearance was not uncommon, due, no doubt, to the large doses then in use. Now that later experience has indicated the limit of safe administration, both ill effects and unpleasant consequence are marked by their absence, and many of the cases recorded may be explained on the ground of idiosyncrasy. Accordingly, as might be expected, their comparative importance is very insigni ficant, and the question-do they materially limit the usefulness of the drug?-receives a negative answer. Some of the members take the opportunity of protesting against allowing the general public to take these reme dies into their own hands. No one who has come across an instance of the antipyrine habit will question the desirability of using with the utmost caution, and under proper supervision, a drug that has so definite an action on the nervons system; and it would be well if the profession at large embodie its opinion in a form which would readily reach the public. If we turn to the reports of those who have not observed any unpleasant after effect or signs of intoxication, we find that the doses which those members are in the habit of giving are, on the whole, smaller. A single dose of ten grains, or five grains every three hours, is the usual practice of three out of the eight who report negative results; others give two ten-grain doses with an interval of two or three hours between. Two members state that when giving antipyrine as an antipyretic; they always combine it with a stimulant, such as sal volatile, brandy, or tinc ture of digitalis. In this way large doses, even to the extent of twenty grains every four hours, until 120 grains had been reached, were administered without depression being left. It is a point of some importance

giddiness, along with blueness of the lips and finger nails. In Guttman's case, already mentioned, the vision was affected early, and to such an extent that the pa tient was treated for amaurosis, supposed to be of syphilitic origin, at an ophthalmic hospital. Blueness of the lips and face is one of the commonest untoward effects, and was noticed in various degrees, from that which not been observed. Other minor effects have been met is just perceptible to a deep cyanosis associated with profound collapse. It is to be explained by the action on the nervous system, and especially the blood, by which methemoglobinemia is produced. In extreme doses the red cells are destroyed. The circulation of the altered blood through the medullary centers is responsible for many of the symptoms observed. Several of the reports note cardiac depression, one recording palpitation, with numbness and tingling of the left arm and hand as slighter effects. The frequency of cardiac failure in cases of pneumonia, even with doses of ten grains, has already been remarked on. Apparently none of our members have had any experience of the occurrence of hemorrhages reported by continental writers. That such an event takes place points to the necessity of great caution in the administration of antipyrine in phthisis and typhoid fever. In the former the profuse perspiration produced by the drug is a serious drawback. The effect on the skin has received much attention in the medical journals, though in this country less than elsewhere. Two of the reports mention the appearance of a rash. The following details are given by a member of large experience. A single lady, thirty-six years of age, active and vigorous, and free from all manifestations of hysteria, but the subject of spasmodic dysmenorrhea, suffered likewise from severe nervous headache. For both conditions she had for many months used antipyrine under advice, with marked benefit, especially as regards headache, and without drawback until on one occasion, having taken a fairly full dose for dysmenorrhea, she was attacked over the whole trunk and larger limbs with an urticarious rash, which gradually sudsided in two or three days. This recurred on two subsequent occasions, though less se verely after smaller doses, since which she utterly refuses to try it again. The rash was very depressing. Knorr's preparation was always used. This case accords with the experience of Dr. Prince Morrow, who, in speaking of the eruption, says, "ordinarily it is provoked to know to what extent a fall of temperature followed the by a continuous course of antipyrine treatment for ingestion of the large amount so administered. It is several days, although in a large number of cases ex probable that, if the stimulant by its action on the perimented on the symptoms did not occur in the nervous system prevented reduction of the temperture exact period during which the largest quantity of the to any degree, there would be an absence of symptoms drug was taken. It begins to subside promptly on the of depression and collapse. But even small amounts disuse of the drug, and generally, but not always, recurs may provoke unplesant consequences, though these are when the drug is again administered." Another in- confined to minor degrees of depression and effects on stance noted was that of an erythematous rash in small the skin. A case recorded by Short showed a rash and circular patches not unlike measles; it appeared over localized edema, with much distress, after a five grain the front of the chest and abdomen in a male adult after dose. This occurred on three different occasions, altwo medium doses, and gradually faded in a few days. though the patient had taken the drug frequently before. Sometimes the patches are more marked and larger, as The suggestion was thrown out that the difference in a recent case published by Eichhorst. Of the bullous might be explained by the circumstance that, before

The Action of Europhen upon the Tubercle Bacillus -Dr. F. Christmann (Centbl. f. Bakt und Parasiten Kunde; Med Prog.) says:

each attack, the drug was administered in a solid form and very useful in neuralgia of the fifth nerve, sick not compeletely dissolved, whereas formerly it had al- headache, etc. In phthisis one observer gives it as an ways been taken in solution. atipyretic, and finds it act without increasing the nightACETANILIDE (Antifebrine).—Since its introduction sweats Its depressant action on the nervous system in 1886 acetanilide has been chiefly used as an antipy- and heart is manifest only when large doses are given, retic, its power of relieving pain being uncertain. Its small amounts taken frequently being borne without ill action in lowering temperature is striking, but the dis- effects. The drug has already engaged the good' opinion advantages attending it have seriously limited its admin of the general public, and for the relief of pain is much istration. The frequent occurrence of symptoms of affected by individuals who consider they have “a weak intoxication, and the alarming appearance they some- heart." It is not, however, absolutely free from unpleas times assume, led many practitioners to abandon its use ant consequences, as the publication of a recent case very early, and we have not the same amount of ex- by Eisenhart shown. A patient, an adult male was perience to guide us that we have with antipyrine. Eight given for pain in connection with a carious tooth, three members report results after a considerable use of the powders, each containing fifteen grains of phenacetine, drug, and among them a few speak of its great value within three and a half hours; half an hour after the when used with due care. The dose generally given last powder, palpitation and oppression increased, the varies between five and ten grains, but give as low as palpitation was greater, dullness of hearing came on, three grains to an adult. The expriences of every one and then nausea and vomiting. With the onset of seems to be that the larger doses are not exhibited long sickness, all traces of intoxication has vanished, and before symptoms of intoxication make an appearance. the patient felt well. Skin eruptions, chiefly urticariHere again some practitioners combine the drug with a ous, are said to be met with D. R. Paterson M.D., in stimulant, brandy, or digitalis, or caffeine, with excel- The Practitioner. lent results. The intervals between the doses are greater than with antipyrine. The concensus of opinion gathered from the report coincides with that generally expressed, that symptoms of depression and collapse are more readily produced and are more marked than with the other drug; and this may be explained by a fall of temperature being greater and more rapid. Rebound of temperature is met with, not infrequently ushered in by shivering. One observer, whose extensive use of acetanilide makes his opinion very valuable, states there is less collapse in children than with antipyrine. In pneumonia the depressent action on the heart renders it very unsafe. Most of the reports mention cyanosis, and to a greater degree than after antipyrine. Anemia may be induced by the continued use of the drug, and become a grave condition. Some reagent glass and suspended in the hermetically closed time ago I saw a lady who has been ordered five-grain tabloids of acetanilide on account of rise of temperature accomanying subacute rheumatism, two and some times four tabloids being taken daily. After a few weeks the patient exhibited marked pallor, with shortness of breath on slight exertion. On stopping the drug recovery from her original symptoms soon set in, but it was many months before she lost her bloodless appear ance The anemia is due to action of acetanilide on the red blood cells; minor forms of it are noticed after a few doses, and the comparatively early onset should be borne in mind in all cases.

PHENACETINE-This substance, which has been used since 1887, was introduced as an antipyretic and anal gesic; but it is almost entirely as the latter that it has established a reputation. It is more free from ill effects than either of the other two substances, as may be gathered from the fact that several reports note considerable experience of it without observing any symptom symptom of intoxcation. It is generally given in doses varing from five to ten grains,

Siebel in 1891 published his bacteriological investigations of europhen from which he concluded that this substance is at least as efficient as iodoform. He failed, however, to extend his experiments to the bacillus of human tuberculosis. Christmann has recently investi gated the action of various substances upon tubercle bacilli and among them that of europhen.

For his expriments he employed pure cultures of this organism with exception of a small series of expriments with tuberculous sputa The europhen was either directly dusted on the cultures or placed in a short

culture glass or employed in the form of a concentrated solution in olive oil.

The animals for the experiments comprised exclusively Guinea pigs, since, according to Koch, these are more susceptible to tuberculous injection than rabbits, and for this reason it might be expected that they would react even on greatly attenuated bacilli. The inoculations with a few exceptions were made intra peritoneally, the punctures being always made in the posterior half of the abdomen on the left side. The cultures were derived partly from a Guinea pig inoculated with a piece of spleen from a tuberculous cow and partly from cultures furnished by Professor Metschnikoff, of Paris. All had been cultivated on glycerine-agar and showed a vigorons development. Their virulence of each of the cultures employed was tested on one each of the animals and after the last inoculation again tested with a parallel culture.

In the first series of experiments a culture seventy days old was dusted with europhen and placed in a thermostat at a temperature of 33°. Five Guinea pigs were

inoculated. Inoculation with cultures subjected to the position, that is the separation of iodine. This occurs action of europhen for respectivly seven and fourteen not only when europhen is in direct contact with an days causad heath in ninety-three and 160 days; the aqueous substratum (as in series one and four), but also autopsy in the first aminal revealing numerous bacilli, if it is present in an atmosphere surcharged with and in the second only a few scattered ones in the aqueous vapor although not in dircet contact with the glands. The animal inoculated with cultures acted culture (series three), that in the latter case a consider. upon by europhen for twenty-one twenty eight and able quantity of iodine is liberated, is clearly demonthirty-seven days respectively, showed at the autopsy no strated by the following expriment: sign of tubercle or bacili.

In the second series a culture 50days old was exposed to the action of the europhen as described above and four animals were inoculated after an exposure of thir teen, twenty-seven, thirty six and forty-four days respectively. The first of the four showed no signs of tuberculosis at the autopsy except three swelled mes entric glands, the others no tuberculous lesion of any kind.

A test tube is filled to a height of about 3 cm. with water, and without boiling sufficient starch is added that an undissolved residue settles at the bottom. Into this tube a smaller one half filled with europhen is placed, after which the larger receptacle is hermetically closed. If this is put in a thermostat there is observed at an early period a blue ring around the starch. It is possible, however, that in a case of "dry culture" the action would have have been correspondingly feeble. In the third series a culture fifty nine days old was It is entirely different with europhen oil. Notwithscraped off and rubbed together with a concentrated standing the high percentage of europhen in the solution of europhen in olive oil and allowed to remain solution while it could be positively demonstrated that a in the dark at the temperature of the room. Before the a diminution of the virulence of the culture had accurred inoculation it was stirred with a gla-s rod and injected at the end of four days, this did not become more in quantity of 1 c. cm. The inoculations were made marked, but remained stationary; the injection of bacilli after an exposure of the culture to the action of euro- subjected for twenty-five days to the action of europhen phen oil varying from four to twenty-five days. The therefore, produced almost the same lesion as those animal inoculated with the culture exposed for four made at an earlier period. days was killed 163 days later, the others died after a period of form 163 to 165 days; all presented marked tuberculosis lesions.

Control expriments with pure cultures showed that no diminution of virulence had taken place after fortyfour days, the aminals inoculated at that time dying at the end of ninety days, and presenting marked signs of tuberculosis so that the diminished virulence of the culture treated with europhen was not attributable to action of time.

This solution of europhen in oil is characterized by its stability. According to Goldmann, "when shaken with water it gives off a soluble combination of iodine."

This latter fact, in Christmann's opinion, explains the physiological action of the solution. He believes that in consequence of the moisture adhering to the bacilli a certain amount of iodine is set free from the solution; this decomposition, however, will be confined within very narrow time limits proportional to the quantity of water present, and for this reason the action of the iodine must be rapidly exhausted. After this has occurred europhen oil will act as an indifferent

In the forth series of expriments the influence of europhen upon tuberculcsis sputa was tested by rolling the infected sputa in quantities of one half centimeter fluid. in the powder until it was completely covered. The According to the author the effect of europhen is due sputa thus treated were placed in two hermetically closed to the iodine set free while iodoform exerts a specific glass jars the one specimen (a) being kept at the temper action. Troje and Tangl have found that iodoform dis ature of the room and the other (b) at 33°. The control solved in olive oil destroys tubercle bacilli in three Guinea pig died twenty-eight days after peritoneal days; in the dry state (rubbed together with the culinoculation with marked tuberculosis lesions. Three Guinea pigs were inoculated with material from specimen (a) after exposure of the action of europhen for a period of seventeen, thirty one and thirty-seven days respectively. Of these the first died in the forty-seven days with marked tuberculosis changes, the other two died in thirty-one and twenty-seven days respectively of enteritis no tuberculosis being present. Two animals were inoculated with sputa from specimen (b) after ex posure to the action of europhen for twenty six and thirty-seven days respectively and presented no evidence of tubersulosis three or four weeks later.

tures), in some instances in fourteen days, but posit ively in three weeks; in form of vapor not even after a month, but usually after fifty days. If iodoform was sprinkled on the culture the bacilli produced a cold abscess even after sixteen days' action. On the other hand, the above experiments showed that europhen dis solved in olive oil has no marked effect even at the end of twenty five days, but when dusted on the cultures it destroys the tubercle bacilli sometimes in fourteen days, but positively in twenty-one days; and in the vaporous state in twenty-seven days, while in the latter case it considerably arrests their growth in thirteen days.

Now is the time to subscribe for the MEDICAL

In Christmann's opinion these results demonstrated that europhen exerts a powerful germicidal action in alli cases where the conditions were favorable to its decom- REVIEW

This little book is a multum in parvo work in the guage."-Medical Record. truest sense of the word. It possesses many features that should commend it to physicians. The fact that it is written by a well-known medical editor is sufficient guarantee of its merits.-Nashville Medical and Surgicol Journal.

Fearful Cholera Mortality Aong Pil- ment of the University of Georgia heartily indorses. grims. "During May last over 6,000 pilgrims left the principal features of the bill as printed in the Atlan Tunis for Mecca and about 3,000 more sailed from ta Med. and Surg. Journ., December, 1893, pages 612, the other ports on the coast (Calcutta Med. Report.). 613 and 614, captioned, "A Bill to Be Entitled an Act It is estimated that of these, 4,500 persons perished on to Establish a Board of Medical Examiners for the their way to or from the Holy City. The steamers State of Georgia, and to Protect the people from Illegal bringing those back who had made the Haj arrived and Unqualified Practitioners of Medicine," which bill here about ten days ago. The pilgrims were landed on was passed by the Senate of Georgia at its last session. the quarantine island of Zambia, in the Gulf of Tunis, Resolved, That a committee of three members of this and, after medical inspection and disinfection, were Faculty be appointed and charged with the duty of allowed to come on shore at Tunis. At about three appearing befor the Legislature of Georgia and using o'clock in the afternoon of the day when they were ex all honorable means to secure the enactment of said pected, the different Tunisian sects with the friends bill. and relations of the returning pilgrims in number Resolved. That this Faculty, through the said com. about 12,000, marched down to the quays, carrying mittee, requests the Senator from this Senatorial dis banners and singing hymns. At length the pilgrims trict, and the Representatives of the Lower House from landed, and it was then learned, for the first time, that this county, to exert themselves to secure the passage of scarcely 2,000 of all who had started from Tunis had said bill. come back. Heart-rending cries of wailing and lamen- Resolved, That this College points with pride to the tation arose from the vast throng of women of whom fact that it was the first medical school in America to some were carried away fainting, while others threw insist upon the necessity of higher medical education themselves on their knees and supplicated the Prophet in the colleges of the United States. This fact is shown with frenzied fervour to restore to them the lost. The first, by the record that in 1825 the first Board of pilgrims themselves, as soon as they set foot ashore, State Medical Examiners was organized at the request and before they sought their relatives turned their of the Board of Trustees of this College; second, in the faces towards Mecca, and prostating themselves, offered early history of this College the term was 5 months. In thanks to Mahomed for their salvation. The pilgrims 1845 the Faculty of this College attempted to have all tell a terrible tale of their experience. On June 24th, medical colleges in America require of their students two days before the Courban Bairam, upwards of attendance on two full courses of six months each as a 100,000 Mussulmans-Arabs, Turks, and Indians, had requisite to graduation. This Medical School only gathered on the Sacred Monnt to hear the solemn receded from its then advanced position, because forced address which is delivered to those who wish to become to do so by refusal of all other colleges to join in the Hoj. Many of these people were in the most wretched movement, no other college having expressed a willing condition, and some had not even a loaf of bread. The following day the onward movement to the Holy City began. Those who got away were fortunate. The Mount was like a battle-field, strewn with dead and dying. Cholera had decimated the great concourse of pilgrims. So frightfully did the pestilence rage that it was impossible for any living creature to approach the place. At length a battalion of Turkish troops was sent from Soana to bury the dead and remove any people who still lived. The battalion, when it reached the Mount, was 700 strong. After the work had been done 200 men only remained to go back to the coast. Five hundred of the soldiers had died of cholera."

University of Georgia.-The Medical Depart ment of the University of Georgia is against the abolish ment of the Board of Medical Examiners by the State Legislature, and makes an earnest appeal that it be re established. The professors of the Medical College adopted the following resolutions:

ness to join in the crusade against the disgraceful prac tice of yearly graduating large numbers of ignorant and unqualified medical students.

Resolved, That it is, in the opinion of this Faculty, a blot upon the escutcheon of the State, to permit Georgia to be without a Board of Medical Examiners to protect her citizens against medical pretenders.

Native Opium in China -An extremely inter esting section of the last British consular report from Wenchow is devoted to native opium. It appears that in the province of Chekiang opium was first manufac tured in the prefecture of Tai chow, lying between Wenchow and Ningpo, whence the still common name of Tai chow "paste." The poppy next began to be grown for opium in other prefectures as well, Wenchow among them; but for a considerable time it was cus tomary to hire Tai-chow men to collect and prepare the juice. Their monopoly of opium harvesting sent up their wages and checked cultivation until such time as WHEREAS, It is an indisputable fact that since the Wenchow hands learnt the secret. Nowadays the ser Board of Medical Examiners of Georgia was abolished vices of Tai-chow men are not required, but Tai chow by act of the Legislature, Georgia has been a veritable opium keeps its old pre eminence. In 1879, owing to paradise for quacks who have been driven out of other the appalling famine in Shansi, the Pekin Government States. vigorously interdicted the cultivation of opium, on the Resolved, That the Faculty of the Medical Depart ground that it interfered with the growth of foodstuffs.