Dickinson that, as alcohol does so much harm, it surely must do some good. But, so far, the good that it does or the evil that it prevents has not been made very manifest. They need more definition. Dr. Izambard Owen says the statistics of the Collective Investigation Committee show that the consumption of alcoholic liquors appears to check malignant disease. This statement should now be tested very rigidly. Malignant disease is said to be on the increase. We have seen the demolition of the belief that alcohol is a preventive of tubercle; it would be some set-off against the mischief it works if it could be shown seriously to antagonize

cancer.

The views and opinions of the many leading men who participated in this discussion were expressed in a scientific spirit, not as absolute or final, but as the most probable facts sustained by our present knowledge of the subject. -Med. and Surg. Rep.

The Premonitory Symptoms of Alcoholic Paralysis.

BY JAMES ROSS, M.D., LL. D., F. R. C. P.,

PHYSICIAN TO THE MANCHESTER ROYAL INFIRMARY; JOINT PROFESSOR OF MEDICINE TO THE OWENS COLLEGE.

NOTHING helps us so much in the treatment of a disease, if it be of such a nature as to be capable of cure or amelioration, as an early recognition of the symptoms of its incepThis statement, true with regard to most affections, assumes additional significance when we have to treat a disease like alcoholic neuritis, which can be readily cured in its early stages by the simple withdrawal of the poison, without any special treatment, but which, when fully established, may resist all treatment or prove rapidly fatal.

Alcoholic paralysis, on attaining the stage of double wrist and ankle drop, loss of the patellar-tendon reactions, and high-stepping gait, is now readily recognized by every moderately well informed practitioner, and accurate descriptions of it have found their way into ordinary text-books of medicine. It is, therefore, quite unnecessary for me to give in this place a detailed description of the condition. I will also pass over such well-known signs of alcoholic poisoning as a bloated face, lightning-like and neuralgic pains in the extremities, morning retching, and muscular hyperæsthesia, in order to direct special attention to three symptoms which

I believe to be hardly ever, if ever, absent as forerunners of this form of paralysis, although they are by no means peculiar to poisoning by this agent, being met with in other forms of peripheral neuritis. These symptoms are: (1) Disorders of the tactile sensibilities of the extremities, which patients usually describe as numbness of the fingers and toes; (2) vasomotor spasm of the extremities, named by Raynaud "local asphyxia," and which the patients refer to as "deadness" and "coldness" of the fingers and toes; (3) severe cramps, which are most frequent and severe in the muscles of the calf, although these muscles are by no means the exclusive seat of them.

In order to give greater vividness to my description of these symptoms, I have instructed my clinical clerk to note down in my presence the statements of five patients, the subjects of chronic alcoholism, now under treatment in the wards of the Manchester Royal Infirmary. In order to avoid details I shall only give such a rough sketch of the present condition of these patients as I think will enable the instructed reader to fill in the clinical picture presented by each from his own knowledge and experience.

CASE I.-G. C, aged fifty-one years, a lawyer's clerk, states that he has drunk freely of beer, but only occasionally indulged in whisky or brandy. His lower extremities, his body (especially over the loins and buttocks), and his left upper extremity are cedematous, but there is little or no swelling of his face or eyelids, even in the morning. The area of cardiac dullness is enlarged; the apex is displaced slightly downward and outward; the first sound at the apex is impure, the sound at the base is highly accentuated; and the action is very irregular; while the pulse beats 110, and is feeble and intermittent. Scattered sonorous rhonchi are heard over both lungs, and the patient expectorates a moderate quantity of frothy mucus. The urine contains a small quantity of albumen, but its specific gravity is 1020, and it deposits a considerable quantity of urates on cooling. The patient's grasp is feeble, and he experiences some difficulty in performing special movements with the fingers and thumb, but there is no distinct wrist drop. patient is very feeble on his legs, but there is no ankle-drop, and no distortion of the toes. The patellar tendon reactions are, however, absent, and the muscular masses of the extremities are very tender to pressure. The diagnosis of this case is that, although the urine contains a little albumen, the

The

anasarca is due, not to renal disease, but to dilatation of the heart caused by the abuse of alcohol, the condition being aggravated by the presence of a little bronchitis.

CASE 2.-A. G—, aged forty-nine years, market porter, states that he drank freely of beer, but had whisky or spirits of any kind only on rare occasions. The patient is suffering from ascites; he has been tapped once since his admission, and now is filling up again. The liver dullness is only about an inch in vertical extent, and the veins on the surface of the abdomen and chest are distended and fill from below. The patient is feeble and emaciated, but there is no special paralysis, and the patellar tendon reactions can still be elicited, although they are very sluggish. The diagnosis is alcoholic cirrhosis of the liver. There is no tenderness or pressure of the muscles.

CASE 3.-G. C—, aged forty-nine years, coachman, admits that he indulged freely in alcohol, although he never got drunk. His regular habit was to have a glass of rum in milk when he got up in the morning; he had a glass of beer in the forenoon, another to dinner, and a third when he got home at night, to be followed by whisky when he could get it. He is suffering from anasarca of the lower extremities and trunk, but the upper extremities and face are free from any swelling. The cardiac dullness is enlarged. and the apex is displaced slightly downward and outward. A soft systolic murmur is heard at the apex, and the second sound at the base is highly accentuated. The urine is pale, specific gravity 1010, and contains a considerable quantity of albumen, while a few fatty casts have been found in it. The grasp is feeble, and the patellar tendon reactions are absent, but there is no wrist or ankle drop, and no evidence of particular paralysis beyond general weakness. The muscles of the calf were tender on pressure when the patient was admitted to the infirmary about six weeks ago, but this has now disappeared. It is possible that in this case there is a renal complication, but the absence of oedema from the upper extremities and face seems to indicate that the anasarca is due to cardiac dilatation, of alcoholic origin.

CASE 4.-J. S-, aged forty-six years, tramcar conductor, says that he drank freely of beer and whisky. He suffering from double wrist and ankle drop, high-stepping gait, loss of patellar-tendon reactions, muscular hyperæsthesia, and other sensory symptoms which are usually met with in a moderately advanced case of alcoholic paralysis. -London Lancet.

A New Treatment of the Transverse Fracture of the Patella.

AT the meeting of the Clinical Society of London, held May 24, 1889, Mr. Mayo Robson related a case of transverse fracture, which he treated by a new method, to secure bony union without opening the joint (Lancet, June 1, 1889.) The bone was broken just below the middle, as the indirect effect of a fall. He pointed out how unsatisfactory were the results obtained by the methods usually resorted to, and added that, although he had never met with an accident in wiring the fragments, yet it was impossible to shut one's eyes to the fact that the patient was exposed to a great risk. He had, therefore, applied himself to the discovery of a method whereby the advantages of bony union might be secured without incurring the risk of opening the joint. In this case the skin over and around the joint was cleaned and rendered aseptic, and the joint was then aspirated. He then obtained two long steel pins with glass heads, such as ladies use for fastening the bonnet, and having thoroughly purified them he drew the skin well up over the upper fragment, and introduced the needle transversely through the skin and muscle just above the level of the upper fragment, repeating the operation with the other needle at the upper end of the ligamentum patellæ. Gentle traction on the pins then easily brought the fragments into apposition. The ends of the pins were then clipped off, leaving about half an inch on either side, and the whole covered with antiseptic gauze. This dressing was left undisturbed for three weeks, and when it was removed there was no redness or other sign of irritation having been caused. Temperature was never above normal, and the patient felt very comfortable all the time. The fragments seemed well united, and the needles were, therefore, withdrawn, a plaster of Paris splint applied, and the patient allowed to go home. We pointed out that the only precaution necessary was to draw up the skin over the upper fragment, in order to avoid undue traction upon it when the fragments were approximated. The integument should be rendered aseptic as well as the pins, and the latter should be stout enough not to bend when drawn upon. If there was much effusion it would be desirable to aspirate. As union occurred without the throwing out of any amount of provisional callus, it

was always well to insist upon the use of a Thomas splint for some time after. The advantages of the operation were its simplicity, the absence of risk, and the obtaining bony union. He said that this was the second case of the kind upon which he had operated, and more recently he had performed the same operation in a case of fracture of the olecranon, but it was as yet too early to say anything as to the result.-Therapeutic Gazette.

A Solvent for Diphtheric Membrane.

BY WILLIAM C. WILE, A. M., M.D., OF DANBURY, CONN.

THE following case will illustrate the value of a new solvent for diphtheric membrane, which I fear is not fully known to the profession.

James B., an American, twenty years old, was taken with diphtheria on the 10th day of May of the current year. When I first saw him I found all of the characteristic symptoms of this grave disease. Both tonsils were covered with a tough, grayish mass, so pathognomonic of diphtheria, with all of the constitutional symptoms well marked. I put him on the bichloride of mercury, one twenty-fourth of a grain every three hours, gave a brisk cathartic, and locally ordered a gargle composed of equal parts of sulphocalcine and water to be used every hour. The next morning when I saw him there was but a thin coating over the tonsils, and all of the symptoms were better. On the morning of the 11th there was a still further improvement and the membrane was all gone. The bichloride was given at longer intervals, and everything went along nicely, the gargle being used only two or three times a day, and then simply as a prophylactic. On the 15th he took a cold, and I was sent for hurriedly in the evening. I found that both tonsils, uvula, pharynx and the whole vault of the mouth was completely covered with a thick diphtheric deposit. I had never seen a case of diphtheria which had relapsed get well, so I gave a very unfavorable prognosis, deeming it an impossibility for the patient to recover, with such an extensive deposit present. I, however, increased the bichloride to every two hours, and commenced painting the membrane over with a camel's hair brush every fifteen minutes with an undiluted solution of sulphocalcine, beside having him use the half and half gargle every half hour.