and, pushing the kidney up to the diaphragm, packed gauze underneath the kidney to hold it up in position, or as nearly so as practicable. It could not be pushed up quite to the normal situation, but it has remained just where it was fastened. The man experienced a great deal of relief, but developed dysentery, which lasted for a week after the operation. Since that time he has improved in health, and has gained fifteen pounds in weight, but is far from a well man. A recent examination of the urine shows some albumen and tube-casts, and the probabilities are that he has chronic inflammation of the kidney operated upon, and possibly the other one. The opening in the kidney healed perfectly in fifteen days after the operation.

The second case was operated upon only a few days before my previous report. The patient was a woman, who had an abscess very much like the case shown by Dr. McMurtry to-night, except that the kidney itself was almost entirely destroyed. The woman was profoundly septic, having the characteristic sweating observed in such a condition, and had been suffering for eighteen months. The trouble was produced by pressure of the foetal head on the ureter. Three months before delivery she developed severe kidney symptoms, which had continued up to the time I saw her. I did a nephrotomy in this case, stitching the kidney up to the abdominal wound, putting in a large drainage tube-a piece of a No. 10 stomach tube-which kept up perfect drainage for several months. The patient made a nice recovery. She had pus in the urine for some time after the operation, but it is now clear. The ureter was so dilated that I could attach a syringe to the opening in the kidney and run water through into the bladder, and by putting a catheter into the bladder convey the water out into the basin. It was several months after the operation before the wound closed, and I am satisfied that the remnant of kidney will have to be removed before recovery is complete and permanent.

The third case was one that evidently started in an urethral inflammation and stricture. The patient is a young man, æt. about twenty-seven, who had been suffering for a year or so with urethral trouble, which had been followed by a cystitis. When I saw him, for several months he had been having fever and sweats; he had be

come considerably emaciated, and was suffering with pain in the bladder; he also had severe spasms of the neck of the bladder. I could put in a No. 20 American steel sound; the neck of the bladder would shut down upon it firmly, and withdrawing this sound could not introduce a soft instrument five minutes afterward. After washing out the bladder for a week or ten days, the fever and sweating continuing, in an examination of the kidney region I found considerable tenderness. over the left kidney, and after several days could make out what I thought to be an enlargement. Taking this in connection with the other symptoms, I advised a nephrotomy. His temperature at this time was 104° F. pulse 130. Cutting down upon this kidney from behind, using the transverse incision (it being straight across, do

ing less damage to the nerve and muscles than any other method), I found the kidney enlarged and very tense. On incising the convex border of the kidney, three-fourths of a pint of pus, which was damned up in the pelvis, causing great distension, spurted out through the small puncture. Exploring the kidney I found no stone.

I put a very large drainage tube-No. 10 stomach tube-in the kidney, draining it in this way. I did not stitch it up to the wound. Pus discharged freely from it, and he had very little trouble with the kidney wound. The bladder trouble continued practically the same after the operation, and pain was intense at times. I tried all manner of treatment for relief of the bladder symptoms-I treated it and let it alone-did almost everything I could think of without seemingly affecting it very much. He has no pain now, and the urine is perfectly clear. I kept the large drainage tube in the kidney for two months, then inserted a smaller tube. The wound has almost entirely healed; there is still a little leakage, and it is necessary to dress the wound once, sometimes twice, a day.

One thing I have been struck with is that all the urine discharged from this case has been perfectly clear. The case has been under observation for the last three months, and since the operation all urine which came from the kidney gave no odor at all. There seemed to be a great deal of water, but very little solid matter.

The most important thing in connection with. these abscess cases is prevention, and I think we make a mistake in allowing bladder inflammations to go on for such a great length of time without resorting to drainage. In many of these cases pyelitis can be relieved by draining the bladder.

THE HEALTH RESORTS AND BATHS OF EUROPE AND NORTH AFRICA.

BY GOWING MIDDLETON, M. D., C. M., F. R. C. I., Doctor of the Faculty of Paris, France.

II.

INTERMEDIATE CLIMATES (Continued).

ALGIERS.

BEAUTIFUL, wonderful city, lying on the

western Mediterranean shores, laved by the deep blue sea, half Eastern, half Western, half Christian and half Mohammedan, with a large number of Spanish, Syrian and Moorish Jews intermingled with those two great classes, Algiers is one of the most interesting, most fascinating historical cities of the world, and presents a most splendid appearance when viewed from the sea. The white houses and glittering towers, rising upwards and backwards, with the bright green background of the orange, eucalyptus and other trees of rich foliage, of the Sahel, is a picture one can never forget, and is difficult to describe.

To every American citizen, Algiers must be intensely interesting, and the Barbary States of

which it was the capital. Every American who knows anything of the history of his own country can but remember that Algiers was the first State to make war against the newly formed American republic. No sooner had the United States of America thrown off the yoke of the English king, and his blundering, proud, overbearing, incompetent advisers, and breathed the exhilarating air of glorious independence, than Algiers disturbed the well earned and much needed needed rest of the young republic by declaring war against it. War. was declared in 1783. Two years later-in 1785-two American vessels were captured in the Atlantic Ocean, and in 1793 eleven more prizes were made. The men on board these ships were all taken to Algiers and sold as slaves, and ten years after the declaration of independence of the United States, there were over 100 American citizens held as slaves by the merciless Algerians. The horrible sufferings of these poor wretches is beyond description. So lately freed from English rule to be sold into a slavery among the worst of tyrants, who knew no pity and respected no laws. The American Minister at Lisbon was ordered by his government to negotiate a peace, the Americans binding themselves to pay $721,000 as ransom for their enslaved compatriots, and partly also a present to the Regency, and it was further agreed that America should pay an annual tribute of $22,000 in munitions of war-and which sum, by the arbitrary system of fixing the values, was generally nearly doubled.

These facts, taken from Sir Lambert Playfair's book on Algeria and Tunis, which I have used for these short historical notes, can but be of great interest to every patriot, and will be useful to recall to the minds of the great, prosperous, smart, rich America of to-day the struggles of the early days of the republic, when only a will of iron and nerves of steel could be trusted with the helm of State to guide the vessel out of these dangerous straits into the clear, deep waters of national wealth, and power, and prosperity. One hundred years ago America had to redeem her sons from Algerian slavery and pay tribute to the infidel to secure a peace-to-day, the States reaching from the Atlantic to the Pacific Coast can laugh the whole world in the face and dictate her will to the nations of the earth.

Such are the results of self-reliance, energy and national self-respect, the building up of a splendid people, the development of a glorious nation, which has spoken more than a quarter of a century ago with a voice of thunder and said that slavery should be no more!!

Algiers is in every sense a very charming place, full of interest to the curiosity hunter, the archæologist, or the pleasure-seeking tourist-its queer mixture of men and women of all nations, in all kinds of remarkable costumes, of all shades of color, from the darkest-skinned African negro to the fairest-skinned Northern German. One may hear as many different languages spoken here in one day as one would hear in Paris in ten years. The streets, too, are as widely different as the people who crowd along them. Here you have

a fine, broad street, with attractive shops, and all the evidences and appendages of the highest Western civilization, and in the next minute can be in a narrow Arab street, scarcely wide enough for two people to walk abreast, while from the little Arab cafes or from the native sandal makers' or tailors' shops your ears are assailed by the sound of the Arabic tongue or the wailing, monotonous tones of their extraordinary musical instruments. In the town of Algiers visitors do not reside, except for very short periods. There are several hotels, two of which are most excellently kept. The Hotel de l'Oasis, on the Boulevard National, a really good, clean, first-class hotel, with an excellent restaurant attached to it, and the Hotel de l'Europe, on the same Boulevard. Both these hotels are in every respect comfortable and well managed, with satisfactory sanitary arrangements. Of the other hotels in the town I prefer to say nothing. If people stay for any length of time in the town they are liable to attacks of fever, and the sanitary system is very far from perfect. I always advise patients to remain as short a time as possible in the town, and to live during that time only in one of the good, well-drained hotels. There are a very great many advantages to visitors at Algiers. The steamers of many of the great German and American companies touch here on their way to Naples and Egypt, and visitors can generally find accommodation on board who wish to go on to Naples or the Eastern Mediterranean ports. Many Americans. disembark here, and thus leave room for more passengers.

There are express steamers to Marseilles almost every day, making the voyage in from twenty-six to thirty hours. There are railways to Bikra for those who wish to see the desert and its wonderful date palms-to Oran and to many other places of interest. Tunis can also now be reached by rail from Algiers. The many kinds of silk, brass, silver, gold and ivory work to be bought in Algiers is quite amazing. Much of it, however, is not worth possessing, and very much dearer than can be obtained elsewhere. Cheating is of course the rule. Whatever price is asked it is only safe to offer one quarter. They will appeal to God, to their prophet, or (if Jews) to the beard of Abraham or the holy place to bear witness that they are cheating themselves by asking such a low price, but they end by taking a quarter or a third of the price originally asked, and they are very glad to get it too, all the same. The brass pierced and inlaid work is very beautiful and very cheap. There is a shop kept by Syrian Jews from Damascus, situated near the Cathedral, which is the best. The owners are the most fair dealing men of their class in the town. I cannot give any descriptions of the many beautiful Moorish and Turkish houses, mosques and other buildings. of Eastern architecture. They can be found in Murray's Handbook on Algeria, written by that great Arabic scholar and archæologist, Sir Lambert Playfair, H. M. Consul-General at Algiers, but we must pass on to Mustapha Superior. This is a suburb of Algiers, situated on the slopes of the hills south of Algiers, two miles

them all. Algiers is no doubt as well suited to incipient tuberculosis as any other climate of the same kind, and neither better suited or worse suited, but its real advantage over all the climates I have mentioned is in (1) bronchial asthma, (2) bronchitis and (3) emphysema, and for the reason that on the one hand the temperature (as in most humid climates) varies much less than in a dryer atmosphere, and the risk to feeble or elderly. people of taking a chill is greatly less, while the air, being charged with a certain degree of moisture, is soothing to the chronically congested and thickened bronchial mucous membrane. I have seen cases of bronchial asthma, cases of emphysema and chronic bronchitis do exceedingly well here-better than anywhere else—and for the reason that the air is not as dry as the air of Nice, and on the other hand the temperature is higher and the air warmer than that of Biarritz, and less humid than Tangiers. Algiers is even of Algiers is even of greater therapeutic value in certain nervous cases also. There are many functional derangements of the heart which have until recently been ill understood, but which we begin to look upon as due to some defect or disturbance or derangement of its innervation-there occur periods of unaccountable palpitation, fainting or pain, resembling angina pectoris (not the true disease of course) or again, the heart action apparently suddenly fails, or the pulse rate is greatly quickened; auscultation and the sphygmograph gives no indication of any organic mischief. In these cases Algiers is a place of the first importance; the heart action becomes regular, and the abnormal symptoms pass away rapidly.

Another class of nervous malady for which I place Algiers in the first rank is hypochondriasis with restlessness. For simple hypochondriasis with depression, Naples is preferable; but for restless hypochondriasis Algiers is a real blessing: Patients lose their fidgety tendencies and settle down into a quiet, easy state, and the spirits and general bodily and mental tone is raised, the digestion improved, and sleep is sound and good. Algiers then is of the first importance for :

Ist-Bronchitis, emphysema, bronchial asthma. 2nd-Various functional heart affections which I have already described.

3d-For hypochondriasis of a restless type.

It is of secondary importance in other nervous affections, while for rheumatism, gout and digestive or kidney affections, better climates than Algiers can be found for them, as we shall discover in future articles.

women.

I can only explain this by the fact that, owing to stricture, enlarged prostate and other obstructions, it is more difficult for men to empty the bladder. What astonishes me is the assertion by Dr. Parker that "cantharides, cubebs, copaiva, balsam Peru, oil of turpentine, sandal wood, benzoic acid, buchu and such remedies I have discarded as worse than useless."

I do not know in what doses Dr. Parker has used these drugs, but I can truthfully declare that with these very remedies and similar ones, I have during a practice of forty years cured hundreds of cases of acute and chronic cystitis in women. My method in selecting drugs is according to the law of similars. All the above will causeacute and chronic cystitis. In acute cases, where the symptoms of the patient call for, say, cantharis, I prescribe it in the 3-10 to 6-10 attenuation. In this stage the discharge from the mucous surfaces of the bladder is thin, transparent, like diluted white of egg, and the pains denote intense congestion and hyperæthesia.

When the inflammation becomes chronic, and the discharge becomes thick, tenacious and offensive, then the appropriate remedy should be given in larger doses, even the tincture or decoction. One reason for this is that the extreme sensitiveness of the mucous surfaces is much less than in acute cases, and requires a greater quantity to make a curative impression upon it.

Another reason is that chronic cystitis is a secondary effect of the above named drugs, and all secondary symptoms and pathological states require larger doses than do acute conditions. Still another reason is that no drug can cure disease of the mucous membrane of the bladder and urethra, unless it is eliminated through the kidneys and saturates the urine. This is the explanation why hydrastis or geranium are of no value. internally. They are not eliminated by the kidneys. I have on several occasions proved the truth of this assertion by curing gonorrhoeal ophthalmia with aqua copaiviæ, and curing gonorrhoea by injecting it into the urethra.

It may interest the readers of the TIMES if I mention the drugs which in my practice have brought about the best results in catarrh of the bladder :

Cantharis, cannabis saliva, equisetum and corn. silk I prefer in the acute stage; the latter acts best when given in doses of 10 or 15 drops. of the fluid extract, because it is primarily a sedative to the mucous surfaces of the urinary organs. In chronic cases I have found chimaphila the most generally useful of all the drugs I have used.

With it I have cured cases which had resisted the most vigorous internal and local treatmentcases where the muco-purulent, offensive sediment formed 30 per cent. of the whole volume of the output from the kidneys. It acts best in 10 to 20 gtts. of the fluid extract. The next most important remedy is eucalyptus, but in order to get its best effects it must be given in doses of 5 to 10 drops every three or four hours.

It has been found that both species of chimaphila contains arbutin-a glucoside also obtained

from uva ursi (bear-berry). This glucoside appears in long, colorless brilliant needles, soluble in cold water, I part to 8; in alcohol 1 to 16. It is a powerful antiseptic, its effect being due to the hydrochinone which is set free in the organism.

Dr. Borisburg, of St. Petersburg, who has experimented largely with arbutin, says it "has a decided diuretic effect, due to the stimulation of the epithelium of the malphigian bodies and urinary tubules, and to increase the circulation of the blood through the kidneys. It exercises a distinct antiseptic influence in lessening the formation of pus, in cases of purulent inflammation of the bladder and kidneys." It has been used successfully in renal hemorrhage. Beside chimaphila and uva ursi, mitchella, ledum, callura, vaccinium (several species) pyrola, gaultherna and gaylussacia and epigovea repens all contain arbutin, or an analogous glucoside. They are all sedatives to the urinary tract, all antiseptic, and have all been found curative in chronic catarrh of the bladder. The doses of arbutin vary from 5 to 60 grains daily. I would advise o grains of the I-IO trituration to begin with. If no improvement appeared in two or three days the dose can be gradually raised to 5 grains of the crude, three or four times a day.

Prof. Schroff, in Pharmacologie, states that he observed no diuretic effects from pere arbutin 71⁄2 grains, while Dr. Hughes found ursin, which is identical with arbutin except that it contains gallic acid, to possess diuretic properties (all the above plants contain tannin or gallic acid). This observation leads me to assert that we must not expect to obtain all the characteristic effects of any drug by giving its "active principle," whether it be a resinoid, alkaloid or glucoside, or all combined. There are other constituents which go to make up the individuality of the plant. I believe a carefully prepared, powdered solid extract, which ought to contain all the constituents of the plant, will be found to be the best preparation.

Hydrangea seems to resemble closely the drugs which contain arbutin, as well as another class, among which are cornsilk, triticum repens and galium. Hydrangea was held in high repute among the people, in domestic practice, as a remedy in gravel, dysuria and other disorders of like nature, before it was used by physicians. I have found it of great value in gravel, both uric acid and phosphatic; in renal colic, irritable bladder, chronic cystitis; but I am not sure that it influences the muco-purulent discharge as does chimaphila. It is singular that so little has been written about this remedy since King mentioned it in his Dispensary in 1860. He says it was introduced to the profession by Dr. S. W. Butler, of Burlington, N. J., as a remedy for the removal of calculus or gravelly deposits in the bladder, and for the relief of the excruciating pain attendant on the passage of calculi through the ureter.

It must have some considerable medicinal action on the general system, for King says: “If taken in overdoses it will produce some unpleasant symptoms, as dizziness in the head, oppression of the chest, etc." I wish the "etc." symptoms had been given. King asserts its value in

alkaline urine, chronic gleet and mucous irritations of the bladder in aged persons." Dose the same as chimaphila.

There are cases where neither chimaphila or eucalyptus will remove the putrefaction going on in the mucus of the bladder. In such cases boracic acid, saccharin, or salol are indispensable.

Copaiva, cubebs, oil of sandalwood, pichi, uva ursi, benzoate of lithia and creosote have been useful in my practice.

I advise my patients to drink freely of soft spring or rain water, Poland water or Lithia water. There is no objection to tea, weak coffee, cocoa or lemonade. Mate, a tea much used in South America, and now imported into our large cities, is an excellent beverage in such cases. It is sedative to the urinary passages. I insist on all wool undergarments, and the wearing of high shoes or boots to keep the feet warm and dry.

PSYCHOLOGICAL FEATURES OF THE HANNIGAN AND AUB CASES.

BY HON. ABRAM H. DAILEY, BROOKLYN, N. Y.

YOUR request for contributions upon the psychological features of the lamentable AubLangerman case is timely, and thoughtful responses will vastly aid in throwing light upon a subject of which so little is known. Nothing but continuous effort can awaken deserved attention to psychology and kindred subjects; in fact their respectful consideration has been enforced. Even now, the hypnotic power and the possibilities of the psychical part of the being we denominate man is so little understood, that thousands who plume themselves upon their intellectual attainments are not only unconscious of their own powers, but stupidly deny their existence in any. In the recent case of Hannigan, acquitted of murder on the ground of insanity, the many very able medical experts saw in the prisoner a sensitive, nervous organization, one likely to be greatly wrought upon by the shocking calamity which had befallen a much loved sister. They saw that a wrong which had produced such disastrous results was constantly in his mind, inseparably connected with her death. The natural tendency of the human mind is to lead the body whose actions it controls, to wreak vengeance upon the person of the man who had done so great a wrong as Hannigan felt had been inflicted by the betrayer of his sister. For him to dwell upon such an occurrence was almost certain to blot out a realization of the enormity of the act he was about to commit, and to set into irresistible action those mental forces which would compass the death of her betrayer. Predicating their opinions, at least in part upon these considerations, they could conscientiously testify that at the time of the homicide Hannigan was So far mentally unbalanced as to not be conscious of the nature of his act, or to realize that he was doing wrong. The impulse to slay was irresistible, uncontrollable. Here was a cause for the production of the mental condition of the