turbance. He has employed no suprarenal extract since for any purpose whatever.

The effect of the solutions was not altered by their change to a pink color; they were used for six weeks. Subsequently a small amount of chloretone was added to the fresh solutions, and now there is but slight change of color, and no floccules appear.

Thirty-five cases are reported in tabulated form, showing that the usual effect of the aqueous extract of the suprarenal gland was obtained. A few operative cases bled freely, but in every instance the hemorrhage was promptly checked by a second application of adrenalin. The adrenalin was used not only as hemostatic, but for the relief of nasal congestion, as a diagnostic aid, and for the continuous treatment of acute inflammatory affections of the accessory sinuses.

The author arrives at the following conclusions:

1. Adrenalin solutions supply every indication for which the aqueous extract has been used.

2. They are sterile.

3. They keep indefinitely.

4. Solutions 1 to 1,000 are strong enough for operative work; and 1 to 5,000 and 1 to 10,000 for local medication.

5. They may be used with safety.

In this connection it is interesting to note that E. Fletcher Ingals, M. D., of Chicago, also has had a very satisfactory experience with adrenalin. In a paper entitled "Notes on Adrenalin and Adrenalin Chloride" (Journal of the American Medical Association, April 27, 1901), he reports that he experimented with solutions varying from 1 to 1,000 to 1 to 10,000 of the chloride of adrenalin in distilled water or normal salt solution, and kept careful records until satisfied of its activity. In nine cases a very small quantity of a spray of one part of chloride of adrenalin to 10,000 parts of water was applied to the nasal cavities, with the effect of blanching the mucous membrane quickly, and in most cases causing contraction of the swollen tissues similar to that caused by cocaine. The first solution used was made with distilled water, and caused smarting; normal salt solution was then used as the solvent with perfect satisfaction. The smarting may have been due to the presence of a small quantity of formalin in which the atomizer had been washed just before use.

Experiments were also made with insufflations of a dry powder, consisting of 1.5 per cent (seventy-five parts) each of biborate of sodium and bicarbonate of sodium; 3 per cent (one hundred and fifty parts) light carbonate of magnesium; one part of adrenalin to 5,000 parts of sugar of milk. This powder cleared the nasal cavities when obstructed by swelling of the turbinated bodies, and diminished the secretions decidedly. A case of daily epistaxis was relieved by sprays of a 1 to 10 000 solution. Another of conjunctival congestion from overwork was entirely relieved by the instillation of a similar solution. The author has had equally satisfactory results in

cases of conjunctivitis, laryngitis, acute and chronic; acute laryngitis with edema glottidis, acute coryza, chronic laryngo-tracheitis with acute exacerbation, and in preparation for operations upon the nose.

In conclusion, the following results are presented: This remedy will be of great value in the treatment of acute inflammatory affections of the nasal cavities, either in sprays of 1 to 5,000 or in powders of 1 to 5,000, or I to 2,500, sugar of milk. In acute coryza and in hay fever, in epistaxis from various causes, in acute inflammation of the fauces, solutions of 1 to 1,000 will have good effects. In acute or subacute laryngitis solutions of 1 to 1,000, applied with moderate force, will give very great relief. It appears probable that vocalists may obtain sufficient relief from congested cords, for at least two or three hours, to obtain normal efficiency in the use of the voice.

I

In a paper read before the Chicago Laryngological and Climatological Association, W. E. Casselberry, M. D., called attention to the fact that adrenalin chloride solution is clear, colorless, odorless, sterile, and stable, if protected from heat, light, and oxidation; it is non-irritating to mucous membranes. When applied locally it exerts identically the same vasoconstrictor influence as the aqueous adrenal extract. Sprayed into the nostrils in the strength of 1 to 10,000, it produces a visible change from turgidity to compactness of the turbinated tissues, and a decided pallor of the mucous surfaces. In the strength of 1 to 1,000, or even 1 to 5,000, it has the power to limit hemorrhage during operations, and is an aid in the treatment of epistaxis. It may be substituted for cocaine in all cases in which an ischemic effect is desired; e. g., to facilitate inspection of the deeper recesses of the nasal cavities and to make them more accessible. Adrenalin has little or no cerebral stimulant effect, exciting no desire for more of the drug, hence there is little to risk of habit-formation.

The author expresses the opinion that adrenalin should afford relief in asthma associated with bronchitis and vaso-motor paralysis, although he would expect little benefit from its use in asthma characterized by bronchial spasm. It may be formed into an ointment with vaseline or mixed with stearate of zinc, powdered starch, or sugar of milk, to make powders for nasal or laryngeal insufflation. The bibliography is very comprehensive, covering the literature of the subject down to the present date.

GONORRHEAL RHEUMATISM.—In an interesting account, based upon an analysis of 250 cases of gonorrheal rheumatism, G. Lorimer (Quarterly Med. Jour., Nov., 1900) finds that the ages ranged from 17 to 58, and that by far the largest number of patients were males. This he explains is more. due to difficulties present in recognizing the disease or the chronic discharge in females. The time from the onset of the gonorrhea to the occurrence of the arthritis averages three months in women and six weeks in men. An hereditary tendency to rheumatism was observed in so few cases as to be merely coincidental. Pyrexia was generally present, usually of subacute type, though acute and chronic cases were not infrequent. In two

instances the pyrexia was distinctly hectic in type. The absence of a tendency in the arthritis to shift from joint to joint was a characteristic feature except in those cases in which the initial fever was acute. The degree of pyrexia was observed to regulate the amount of perspiration and the concentration of the urine, and the peculiar acid odor of the perspiration of acute rheumatism was always absent. The absence of hyperinosis and oligocythemia was a fairly distinctive feature, but seemed to depend more on the degree of fever. Cardiac complications were rarely present. There was no evidence to show that previous attacks of rheumatism had any influence in increasing the liability to gonorrheal arthritis except in the acute type. The order of frequency of involvement of joints was as follows: Knees, ankles, hands, and wrists, hips, shoulders, temporo-maxillary joints, cervical joints, and sterno-clavicular joints. Other complicating affections were non-purulent conjunctivitis, sclerotitis, and iritis, neuralgia of the lumbar plexus and of the sciatic nerve, myalgia, and painful affections of the fasciæ, especially the plantar. There was generally noticed a much greater liability to chronic articular changes than in ordinary rheumatism. Muscular atrophy, usually proceeding pari passu with the arthritis, was occasionally observed. Salicylates only proved of value in those cases

in which the onset was acute, in which case their efficacy disappeared with the advent of subacute symptoms. In conclusion the author asserts that the explanation of gonorrheal rheumatism is still sub judice, but he inclines toward the toxemic theory.-Medical News.

THE CAUSE of Acute SPLENIC TUMor in Cases OF POISONING AND OF ACUTE INFECTIOUS DISEASES: PHYSIOLOGICAL FUNCTION OF THE SPLEEN.-G. Jawein (Virchow's Archiv.). Dogs were poisoned with potassium chlorate and with toluylendiamin, and the blood carefully studied by count and stained preparations until death occurred. The spleen was then examined microscopically. In every case in which the spleen increased in size the red blood corpuscles were reduced in number, and where the red cells did not decrease, the spleen did not grow in volume. The broken down red corpuscles were found in large numbers within the cells of the splenic pulp, and splenic hyperemia and hyperplasia ran parallel with the hematolysis. It appears, then, that in cases of poisoning the splenic tumor is due to the destruction of red blood cells whose products are heaped up in the spleen, where they cause an increase in the functional activity of the pulp cells. This increased function must of necessity be accompanied by hyperemia, hypertrophy, and hyperplasia. As the acute infectious diseases owe their organic changes chiefly to the poisons elaborated by microorganisms, it seems rational to suppose that the splenic tumor occurring in such diseases is similarly dependent upon the destruction of the red blood corpuscles. In malaria, typhoid fever, recurrent fever, anthrax, septic diseases, and typhus fever the splenic tumor and the diminution in the number of the red cells occur coincidently; while in influenza both the blood count

and the size of the spleen vary greatly in different cases.

On the other

hand, diphtheria shows neither an acute splenic tumor nor a diminution of old blood corpuscles; nor do measles, varicella, dysentery, etc. In pneumonia the spleen is not enlarged, the red cells are slightly diminished, probably owing to the bloody exudation. It is an interesting fact that Matthes and Eichhorst declare that just after the crisis, that is, during the absorption of the bloody exudation, the spleen is enlarged. In the different forms of anemia, chlorosis, and leukemia, the presence of a splenic tumor would indicate the process to be one of blood destruction; its absence one of insufficient blood formation.

It seems very probable that one of the chief functions of the spleen is its action as a filter, more especially for the red blood corpuscles, in virtue of which the blood becomes cleared of broken-down red cells.-Archives of Pediatrics.

TREATMENT OF CONSTIPATION.-According to E. Roos (Münch. med. Woch., October 23, 1900), one factor constantly overlooked in the treatment of constipation is the part played by the normal intestinal flora in producing free movements. Accordingly, the author obtained the coli bacillus from feces, grew it on agar, and filled the culture in gelatin capsules which were covered with collodion and keratine, each capsule containing one platinum loopful of the pure culture. Five such doses were given to several patients during five days, with the result that they were relieved from constipation for the following two weeks. Experiments with dead bacilli proved negative. The bacillus acidi lactici, employed in a similar manner, caused increased peristaltic action and flatulence, but hardly relieved constipation. The addition of sugar to the diet did not increase the action. The author then experimented with yeast, which has already been successfully employed in scurvy and furunculosis. Half a gram two or three times daily in keratinized capsules produced no gastric disturbances or flatulence, but on the second day or later the desired cathartic action. Dried yeast exposed to heat seemed to have an even more beneficial action.-Medical News.

UNUSUALLY LARGE URINARY CALCULUS.-Delore, in the Gazette des Hopitaux, reports the case of a man over sixty who had presented symptoms of stone since childhood. On several occasions he had had attacks of retention, and for some months had had perineal fistula. Finally, a few days before he was seen by Delore he began to have a discharge of urine from the umbilicus. He died a few days later, the autopsy revealing a stone with cystitis and perforation of the bladder with infiltration of the urine into the subperitoneal tissues and a secondary perforation through the umbilicus. The chief interest centered in the size of the stone, which was 14 cm. in length and 8 cm. in diameter. It weighed three hundred and ten grammes (just about ten ounces). Chemical examination showed it to be composed of oxalate of lime.—Albany Med. Annals.

Special Notices.

THE psychological depressions and neuralgias so common in the period following a debauch are lessened or disappear altogether by the use of Celerina.

AN ADDITION TO OUR NEXT MATERIA MEDICA EARNESTLY RECOMMENDED.— For many years I have prescribed Sanmetto extensively, and I should assassinate truth were I to assert that, in a single instance, the results were otherwise than wholly satisfactory. There is not a form of genito-urinary inflammation wherein I have not used it. I can sincerely and earnestly recommend its addition to our next Materia Medica. A. MAZETTA ROWE, M. D.,

Glasgow, Ky.

PEPSIN is undoubtedly one of the most valuable digestive agents of our Materia Medica, provided a good article is used. Robinson's Lime Juice and Pepsin and Arom. Fluid Pepsin (see another page in this issue) we can recommend as possessing merit of high order.

The fact that the manufacturers of these palatable preparations use the purest and best Pepsin, and that every lot made by them is carefully tested before offering for sale, is a guarantee to the physician that he will certainly obtain the good results he expects from Pepsin.

SPERMATORRHEA.-Having a case of spermatorrhea of several years' standing, which came under my care about nine months ago, I prescribed the usual remedies in this case, viz., bromide potash, ergot, ferrum, digitalis, belladonna, and cimicifuga, with very unsatisfactory results. Seeing your preparation, Celerina, recommended for this affection, I procured some, and administered it in this case with such marked results after the use of the first bottle that I immediately ordered two more bottles, which have entirely cured him of this affliction. I have two other patients now under treatment with Celerina which are progressing very favorably. After a practice of twenty-nine years I have no hesitancy in saying that it is the most effectual remedy that I have ever prescribed in the above disease. H. E. RAUB, M. D., Quarryville, Pa.

A LABORATORY FOR POISONS.-It's a wonderful laboratory, this human body. But it can't prevent the formation of deadly poisons within its very being.

Indeed, the alimentary tract may be regarded as one great laboratory for the manufacture of dangerous substances. "Biliousness" is a forcible illustration of the formation and absorption of poisons, due largely to an excessive proteid diet. The nervous symptoms of the dyspeptic are often but the physiological demonstrations of putrefactive alkaloids. Appreciating the importance of the command, "keep the bowels open," the physician will find in "Laxative Antikamnia and Quinine Tablets" a convenient and reliable aid to nature in her efforts to remove poisonous substances from the body. Attention is particularly called to the therapeutics of this tablet. One of its ingredients acts especially by increasing intestinal secretion, another by increasing the flow of bile, another by stimulating peristaltic action, and still another by its special power to unload the colon.