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and I should certainly agree with the observers quoted by tMr. Kellett Smith that large doses of this drug may produce, tor at least powerfully aid in producing, "black water,"as I have pointed out that about one - fifth of the d

ordinary acid sulphate of quinine is xanthin, which is t

physiologically and pathologioally equivalent to uric acid, so that large doses may add very greatly to the quantity a

of this substance available for solution in the blood gand thus bring about the destruction of red cells observed in fmen and animals. I may also perhaps be allowed to remind E

Mr. Kellett Smith and others who may be interested in these imatters that my own blood (and I believe that of everyone) (

varies its quality from day to day, even from hour to hour, c

with the amount of uric acid passing through it into the urine. t

I have written of "black water " in connexion with the rpoints brought out by my former colleague Dr. Wheaton in (

a paper in the Transactions of the Pathological Society, vol. xlvi., and I shall not ask for space to consider other points on which I have written at length elsewhere. But with reference to Mr. Kellett Smith’s closing paragraph ’.I should like to make the practical suggestion that living on 1a diet which is free from uric acid and using salicylates between attacks to sweep out the uric acid accumulated in the spleen and elsewhere, as well as that introduced in the ]form of quinine, might very greatly reduce the amount ofavailable uric acid and mitigate or prevent such troublesome symptoms and sequelæ as congestion of the liver and spleen,vomiting, diarrhcea, and other bilious " troubles, and eventhe "black water" itself. And some of these points I have been able to demonstrate practically in the persons of mem-bers of the profession who have returned from variousmalarial countries and have taken the trouble to follow mysuggestions. T am. Sirs. vours faithfullv.

Brook-street, W., March 28th, 1898. ALEXANDER HAIG.

CREASOTAL AND GUAIACOL CARBONATE:TWO SPECIFIC REMEDIES AGAINST

TUBERCULOSIS.To the Editors of THE LANCET.

SIRS,-In THE LANCET of Jan. 22nd, 1898, Dr. Chaumierhas published an article on "Creasote and Some of itsDerivatives." Dr. Chaumier recommends that creasotal betaken by teaspoonfuls and considers the use of the drugcontra-indicated only in fever and diarrhoea. According tothe experiences, however, which we have been madeacquainted with by the publications of the UniversityClinics of Berlin, Vienna, and Munich these contra-indica-tions do not exist; on the contrary, the action of creasotaland guaiacol carbonate is very favourable upon the fever ofphthisical patients, this disappearing after a relativelyshort period of treatment with these drugs. The causeby which Dr. Chaumier was led to believe these drugscontra-indicated in fever probably lies in the fact that heemployed larger doses than were necessary. It is neithernecessary nor is it useful to take the creasotal by teaspoon-fuls. The same remedial effects are obtained with the admini-stration by drops, as introduced by Professor von Leydenof Berlin. These small doses, besides being less expensive,are also much better borne by all patients, whereas thestrong doses as used by Dr. Chaumier cannot be borne bymany patients.The Cha’l’ité Annalen (Berlin, 1897) recently contained

an interesting report on the results obtained with creasotal(creasote carbonate) in the University Clinic of Professorvon Leyden. The conclusions arrived at by the experi-ments made under the direction of the chief surgeonsof this clinic show that the remedial effect of the drugis not a merely symptomatic, but a specific one. Afterthe administration of creasote, which drug was for-merly also used by Professor von Leyden, it has alwaysbeen noticed that the appetite disappeared, the generalhealth grew worse, and symptoms of intense disturbance ofthe stomach and intestines soon followed. The creasotalwaa free from these noxious by-effects. The followingmode of administration was adopted. Each patient beganwith five drops three times daily, increasing the dose threedrops every day until twenty-five drops were taken at adose. At this they were kept for from one to four weeks-in some cases even for several months; then the dose wasdiminished in a similar ratio until only ten drops were taken

;hrice daily, and then eventually the ascending scale wasbegun again.The results obtained in von Leyden’s clinic are fully

letailed in the above-mentioned CWarit6 Annalen. Thoughjhe greater part of the treatment was carried out during thewinter months, when the climatic influences were unfavour.able, very good results were nevertheless obtained. Thegeneral condition of the patients was markedly improved;fever, night sweats, and all the bad symptoms disappearedentirely after six weeks of treatment; the appetite rapidlyincreased. Even in cases where the patients had takencreasote before with the effect of causing a complete lossof appetite, under creasotal the appetite increased fromweek to week. Very much the same thing can be said ofthe weight, in which up to 16 lb. were gained in threemonths. Upon the night sweats and the fever the action ofcreasotal was very favourable. Cough and’ expectorationgradually diminished and finally disappeared altogether.Wherever the treatment was continued for over six months amarked improvement of the local condition was noticed,The lungs in these cases were partly cured. In some casesthe physical symptoms of phthisis disappeared entirely aftera treatment of from six to eight months, so that a perfectcure was obtained and the lungs of these patients were

perfectly healed and quite normal again. Considering thatin these cases only 300 grammes of creasotal were required toobtain a perfect cure and that physicians can obtain fromtheir druggists 1 oz. of creasotal at the average price of28., it will appear that the expenditure for the remedy,distributed over several months, is no drawback, and thatalso the poorest patients can afford to take part in thebenefits of the drug.

In the report of Professor von Leyden’s clinic the authorconcludes by saying: We think we are entitled to assume aspecific action of creasotal. Reviewing our experiences wecome to the opinion that any case of incipient or not toofar advanced phthisis may be treated with creasotal with theexpectation of a good result. Naturally a nourishing dietand general good hygiene must go hand in hand with it,And here is the chief advantage of creasotal over creasote,inasmuch as it improves the appetite and does not irritatethe gastro-intestinal canal it permits us to enforce the

proper dietetic treatment of the disease at the same time.Very much the same favourable views in regard to creasotalare expressed in the recently published reports of theuniversity clinics of Vienna and Munich.l I believe theseexperiences prove that Dr. Chaumier’s objection to the admini.stration of creasotal in fever is deprived of foundation.As above mentioned the presence of fever is, perhaps, to beconsidered as a contra-indication for the enormous doses ofcreasotal which Dr. Chaumier employs, while on the otherhand the small doses as recommended by Professor von

Leyden effect the disappearance of the fever.In THE LANCET of Aug. 8th, 1896, Dr. F. R. Walters

expressed his opinion to the effect that creasotal is an excel.lent remedy against tuberculosis, but that it appears to betoo expensive as compared with creasote. I believe also thisopinion cannot be agreed with. Here in Germany at leastthe patient buys the creasote in form of creasotal consider-ably cheaper than creasote pills and capsules. It must beborne in mind that the creasotal is administered by dropsin liquid form, whereas the creasote can rarely be taken ina pure state, but is dispensed in the form of mixtures orcapsules. By this its cost is increased so much that creasotein the cheapest emulsion-viz,, tinct. creasoti-costs morethan twice as much as an equivalent quantity of creasote inthe form of creasotal. In the form of capsules creasote isstill more expensive. I believe in England there will bean analogous proportion. In consideration of this fact itappears also that from an economical point of view thecreasotal treatment is to be preferred to the administrationof creasote in tinctures or capsules, so that in every respectthe balance is greatly in favour of the new method.

T am Sirs yours faithfully

Radebeul, Germany. R. SEIFERT.

AN UNKNOWN LARVAL PARASITE.To the Editor8 of THE LANCET.

SIRS,-There has recently come under my notice a parasiticaffeotion of the 6 kin of which I can find no mention in text-books, and I should be glad if any of your readers who have1 Vide Professor Ziemssen’s Annalen der Münchner Krankenhäuser.

961

special knowledge of tropical diseases would give me thebenefit of their opinion on the matter.Three men started on Jan. lst to come into Balawayo from

Fort Filabusi, ninety-six miles distant. The journey occupiednine days and although the weather was mostly wet stillthere were fine days and on such occasions two of the menbathed on every opportunity but the third man abstainedfrom so doing. During the journey they always slept on theopen veld (field) at night but were well covered up, althoughat the Fort it was not unusual for them to sleep with veryscanty clothing on. Of the three men who came in onepresented himself to me on Jan. 22nd. He stated thaton Jan. 20th, when undressed he noticed little red spotsscattered over the sides of his chest and putting his handsround beneath his armpits he could feel other and largerpimples on his back. On the 21st the spots caused a greatdeal of irritation, with pain of a sawing nature, and on the22nd I saw the patient for the first time. I found that hehad scattered over both sides of his trunk a number of whatat the time I considered to be boils, which very closelyresembled the boils seen at the nape of the neck in manypeople. A few of these spots were also to be seen in themiddle of the back, one on the buttock, and one on thethigh, but the limbs with this exception and the face werefree. I told the man to bathe the boils with hot water andsqueeze the contents out, and I ordered him some red oxideof mercury ointment. Soon after the patient had left thebuilding one of the hospital orderlies brought me a smallworn which he alleged he had squeezed out of one of thesespots. When the man presented himself again on the

A semi-diagrammatic representation of the parasite under themicroscope, 1/6in. objective.

24th I admitted him and on the 25th I examinedthese spots closely. They were hard, deep-red in colour,about a quarter of an inch in diameter, and stoodup well above the level of the skin ; at the apex ofeach was a small scab. On removing this scab a verysmall drop of cloudy fluid escaped, which under themicroscope showed pus corpuscles and a few red corpusclesbut nothing more. Looking now at the spot I could see asmall channel blocked by a small black speck, and on gentlysqueezing the projection from its base upwards out slid aworm. After evacuation of this worm the spot was swabbedwith perchloride of mercury solution and it gave no furthertrouble. The worms varied in size, but on an average theywere about a third of an inch long ; they were of thecolour of an ordinary silkworm; one extremity, the head,was narrow and had dark marks visible through its integu-ments, and the other extremity was blunt and rounded. The

poison of the worn in the man :10."&’& was " U" UIBA

surface-wards and the body lying in a channel extendingobliquely down towards the subcutaneous tissue. Thebody of the worm was annulated from one end to the otherand about as thick as a No. 3 gum elastic catheter. Theywere very energetic in their movements, crawling along likean earthworm without the aid of any feet. Within an hourof removal from the host I placed a worm on a sheet of paperand marking the position of his tail I stirred him up; hecrawled exactly three quarters of an inch in thirty seconds.

I next endeavoured to examine the worm under themicroscope, but I was considerably handicapped by the wantof proper appliances. However, I could make out a distincthead from which projected a sort of proboscis with a mouthsurrounded by four small circles (? suckers) leading to agullet which was bounded on each side by a dark streak,probably a blood-vessel ; these dark streaks extended downuntil they became lost amongst coils of intestine. The coilsof intestine occupied a central position and were flanked oneach side throughout the length of the body by longitudinalvessels from which branches arose on both sides. But whatstruck one particularly were a great number of hooksscattered over the entire surface of the body. These hookscould be distinguished easily with 1 in. objective; close tothe head they were arranged in two definite and closelyapproximated rings, further down was a second singlering, and ver the body generally they, were irregularlyscattered, finally near the tail the ringed arrangement againobtained although somewhat imperfectly. The hooks them-selves had a brown colour and under 1/6 in. objective closelyresembled ordinary rose thorns.

In considering the probable life-history of these wormsI came to the conclusion that they were most likely a stagein a cycle and I determined to endeavour to see their furtherdevelopment. Accordingly I kept three healthy - lookingspecimens which I obtained on Jan. 25th and regularlyevery morning I placed them on fresh raw beef. As soon asthey were so arranged they buried sometimes a half of andsometimes the entire body in the meat, and would remainquite quiet until removed for their next meal; on takingthem out of the meat their bowels always acted freely. Iexamined some of their motion and with a 1/6 in. objectivecould distinguish nothing beyond finely-divided fat. Forthe first three or four days they grew rapidly, thelargest attaining a length of about half an inch, but afterthis time they did not increase in size. I failed, how-ever, to see the next stage in their life-history, forthey all died, the last one about fourteen days afterhaving been removed from the host. I made inquiries frommine prospectors and others and I gathered that these wormsare common in dogs and Europeans in the Murchison Rangeof the Transvaal, Natal, and the Tuli district of Rhodesia.Native races do not seem to be affected. The generalopinion was that a fly, of which I could get no reliabledescription, deposited worms or eggs on the skin. Somesaid that the "bite" of this fly was painful but others deniedthis. My patient had no recollection of having been bitten.Again, it is said that these flies infest water-courses, but hereagain evidence was contradictory. My patient certainly hadbathed frequently.The chief interest, medically, would appear to be in these

cases to distinguish them from boils. I found that mymethod of squeezing out the worms intact and swabbingthe wounds with corrosive sublimate solution gave instantrelief without any further attention being necessary.

I am, Sirs. yours faithfully,FRANK ARNOLD, M.B. Lond.,

Resident Surgeon, The Hospital, Bulawayo, Rhodesia.Feb. 16th, 1898.

ENGLISH SANATORIUMS FOR THE TREAT-MENT OF PHTHISIS.

To the Editors of THE LANCET.

SIRS,-From many years’ experience and practice in theAlpine climates I am convinced that such institutions as theabove-named could be made to attain a large measure ofsuccess; and although the supreme advantage of mountainair would not be available in our somewhat dreary winterclimate the nutritious and appetising English food wouldcount for a great deal in the treatment of pulmonaryphthisis.

It seems that of late years medical discipline has beenregarded by many of those whose state of health would