may eventually disappear, and cites several cases illustrating the fact. What are the conditions which justify a favorable prognosis in a given case of valvular heart lesion? According to the author, they are the following: (a) good general health; (b) proper habits of living; (c) no essential liability to rheumatic or catarrhal affections; (d) an origin of the valvular lesion independent of degeneration; (e) an existence of the valvular lesion for over three years without change; sound ventricles

of moderate frequency and general regularity of action; (g) sound arteries, with a normal amount of blood and tension in the smaller vessels; (h) a free course of the blood through the cervical veins; (i) freedom from pulmonary, hepatic, or renal congestion. To these must be added obedience to properly adjusted rules of health, which, however, need not interfere with the performance of the usual duties of life.

4.

The author sums up as follows: 1. There are many persons with long-standing disease of the heart engaged in the active business of life, who, without any symptom of heart disorder, have enjoyed good health and have reached an advanced age. 2. The mitral regurgitant murmurs so often encountered in chorea disappear for the most part within eight or nine years of the attack. 3. Valvular inflammations and their effects, arising in the course of rheumatic fever, do sometimes disappear and leave behind no clinical evidence of their former existence; this occurs, for the most part, in the young, but also sometimes in the middle-aged. The signs of valvular defects arising out of degenerative changes of middle life do also, on rare occasions, disappear, and, when circulatory and respiratory disturbances accompany their beginning, they sometimes subside and admit of apparently complete readjustment. 5. As there must be, in the histories, habits, occupation, and surroundings of patients with valvular disease, conditions which in one case bring about secondary disorders, and in another exempt from them, these differences should be searched for and made capable of application in practice. 6. Any systematic and critical study of the subject, likely to lead to practical issues, could be undertaken only by the Collective Investigation Committee, and not by it unless actively assisted by experienced general practitioners who possess in a special manner the knowledge necessary to the end in view. 7. A joint inquiry of the kind proposed, conducted with due patience, discrimination, and accuracy, would greatly extend our knowledge of the natural history of diseases of the heart, and largely increase our means of assisting those who suffer from them.-N. Y. Med. Jour.

HEROIC DOSE OF TURPENTINE IN CROUP.-In an obstinate and dangerous case of diphtheritic croup, which had extended into the larynx, after painting with boracic acid, and subsequently with a chloric acid application, without benefit, the child's condition becoming worse and worse, Dr. Lewentaner, of Constantinople, before resorting to tracheotomy, remembering a paper by Demlow in which turpentine was recommended in these cases, determined to give it a trial, and so administered with his own hands a teaspoonful of the pure oleum terebinthinæ, giving after it some warm milk. In a quarter of an hour the labored laryngeal breathing had given way to normal respiration sounds. That night the child slept well and was quite free from the brassy cough which had previously been present. The next morning he was quite lively and was found playing with his toys. All trace of false membrane had disappeared from the pharynx, which merely presented a reddened surface. Convalescence was rapid and uninterrupted. The turpentine, however, caused an eruption on the face, trunk and extremities, having much the same appearance as the rash of measles, but of a brighter red. The spots completely faded in two days, and were followed by no sign of desquamation.-Lancet.-Med. News

COCA AS A TONIC.-(Prof. Marius Odin, M. D., Nice.)-Madame de G., of Austrian nationality, 25 years of age, married, no children; average constitution, lymphatic temperament; sent for me February 2, 1884. I was struck at first sight with her pallor; her skin and the mucous membrane of her eyelids and lips were quite colorless. She complained of weakness and general atony, cephalalgia, dizziness, tendency to lipotynie, caused by sorrows, sitting up late at night, and generally depressing influences. There was gastralgia, with alternate constipation and diarrhea. Menstruation was irregular, and an abundant leucorrhea was accompanied with gastralgic exacerbation. Her pulse was weak and depressible; there was a blowing sound with the first heart-beat; very accentuated in the carotids. On auscultation I found weak respiratory murmurs, much prolonged expiration; dry and jerking cough. There was insomnia and a tendency to night sweats. Everything had been tried -tonics of all sorts, arsenic, iron, quinquina could not be borne; hydrotherapeutics had given no results.

I prescribed the Vin Mariani Erythroxylon Coca, from which I had had much satisfaction on several previous occasions, but which I had never used alone. Want of appetite being one of the chief symptoms,

and this keeping her general condition at a low ebb, I gave her a few doses of rhubarb, which, however, modified the situation but little. From that time I prescribed the Vin Mariani in doses of a claret glassful morning and evening, a quarter of an hour before meals.

At the first dose Madame de G. complained that it increased her dizziness. I assured her that this was a salutary and even necessary first effect of the medicine, and she consented, not without reluctance, to continue the use of the Vin Mariani. At the end of eight days there was a notable amelioration. Appetite appeared, food was taken, and the digestive functions were becoming more regular-day by day. I then advised the patient to increase the dose by two more glasses per day, either after meals or between-whenever she had to undergo some exceptional fatigue. She has since then resumed her daily occupations, and tells me, thanks to the medicament taken at proper times, she can bear, without fatigue, long conversations, and, at the same time, her vocal powers have acquired ampler development. At the end of a month's treatment, her state was most satisfactory; there remained a slight blowing with the first heart-sound, which, however, was disappearing, and was not at all perceptible in the carotids any more.

This observation seemed to me very interesting and conclusive in this respect, viz: that it shows the action of the Vin Mariani, when administered without any other medicament, and, what is no less interesting, it shows its useful effects upon the vocal organs—a fact first determined by the eminent specialist, Professor Charles Fauvel, who has given to it the name of "Tensor of the Vocal Cords."—Gazette de Therap.

PREVENTION OF Scarlatina MALIGNA.-Before an English medical society Dr. Michie read a paper on the use of the vapor of an impure preparation of carbolic acid in the treatment of scarlet fever during a severe outbreak which occurred some time previous in the fishing village of Cove. He held that his treatment at once reduced the malignancy of the disease, and soon removed the poison from the place. The number of cases was thirty in all, mostly children of school age. The outbreak commenced in a very grave and fatal form, and, in the absence of eruptions, could only be designated as diphtheria of the worst type. The first three cases died on the second day without any eruption, the next two on the fourth day, when a dark, hazy eruption was making its appearance. In all, however, great swelling of the throat and extensive membranous exudation were early symptoms. Three other cases of the same

kind having occurred, and isolation being impracticable, Dr. Michie was led to abandon curative for prophylactic treatment. There was immediate relief. The membranous exudation began to exfoliate; and in twenty-four hours the process was complete, and the dusky skin gave place to an extremely abundant scarlet eruption. All three recovered. A few less severe cases occurred in houses where the disease had already existed in the malignant type, and where the vapor treatment had already been instituted. These were followed by several cases of a progressively milder type, and finally the outbreak was quelled, after having invaded nine houses and affected thirty children, of whom five died. From the above description there could not be the least doubt of the value of the treatment. As an illustration, Dr. Michie cited that of a house of two apartments, three beds and ten inhabitants, in which two of the fatal cases occurred. These two children were treated in a room where four other children slept, where the food for the household was cooked, and where the family congregated during the illness of the two children. The vapor-treatment was commenced in this house only an hour or two before the death of the second child, and was energetically continued for some days, when four of the family suffered, not from scarlet fever, but from a "catarrhal pharyngitis." or "scarlatina sine eruptione." No one else in the household suffered. Another case was that of a boy aged eight, who suffered from the anginous variety, with rash on second day, and who occupied one of three beds in a room measuring 13x14 feet, in which seven other persons, including three adults, slept. Here the vapor-treatment was early adopted; the boy made a good recovery, and no other member of the household suffered even from sore throat. Dr. Michie was of opinion that the quality of the carbolic acid had a good deal to do with the success of the treatment. It had a heavy, black, tarry appearance, as if so much coal-tar oil had been carried over in the process of distillation. Half an ounce of this was vaporized every three or four hours by placing it on a flat piece of heated iron. In this way a vapor of great density and volume was produced, which penetrated into the utmost recesses of the sick-chamber, and into the clothes and respiratory tracts of the occupants. Dr. Michie thought the success depended (1) on getting the full antiseptic value of the acid in a state of vapor; (2) on the quality used, partly tar, partly acid; (3) on the frequency with which it was applied; and (4) on the continuance of the treatment for days after the last case in a house had recovered. The more malignant the type, the more value was to be derived from the early application of

the tar and acid in a state of vapor; and, whatever the type, the sooner the disinfectant treatment was brought into use, the sooner they would be able to eradicate the outbreak of so infectious a disease.

CASCARA CORDIal as a Vehicle and CorrigenT.-In a paper read before the Medical and Surgical Society of the Kanawha Valley (Med. and Surg. Reporter), Dr. R. S. Henry, of Charleston, W. Va., says: "While much may be done by the proper selection of the concentrated and improved forms of medicine, and by administering nauseous drugs in pills and granules or capsules, there still remain many drugs which it is necessary or expedient to administer in fluid form. It is to render this large class of preparations acceptable to the palate that the physician often tries the whole line of vehicles without satisfaction to himself or to his patient. A vehicle which would combine the properties of compatibility, permanency, and innocuousness, and above all possess the quality of disguis ing and rendering positively agreeable to the taste many of these nauseating and bitter preparations, must necessarily meet with the universal appreciation of practitioners, and be a priceless boon to their patients. It is the purpose of this note to call attention to such a vehicle and corrigent, and to suggest a few illustrative formula which will indicate its very wide range of application in every-day practice. We believe that that combination of aromatics and carminatives with Cascada sagrada, known as cascara cordial, introduced by Parke, Davis & Co., fulfills every required indication. In addition to its power of disguising the taste of such bitter medicines as quinine, its gentle laxative properties render it peculiarly well adapted for addition as a corrigent to the many preparations which, given alone for any length of time, tend to interfere with the normal action of the bowels, such as the various preparations of iron and opium, than which no others are more frequently indicated and more used by physicians."

[We have used the cordial in this way for some months, and with very great satisfaction.-J. F. B.]

MANY instances can be found in which the medicine prescribed by the physician has been changed for a cheaper substitute by non-reliable druggists, among which we have seen mentioned one in which thirty grains of quinine produced no signs of cinchonization, but the same doses in Warner's pills produced marked evidences of it. Another in which four ounces of a mixture of bromide of potassium and chloral, with tincture of hyoscyamus and fluid extract of cannabis Indica, in