Treatment.-A saturated solution of potassium iodide was employed as follows:First week, 15 drops after each meal. Second week, 30 drops after each meal. Third week, 60 drops after each meal. Fourth week, 120 drops after each meal. Local treatment consisted in painting the spots twice weekly with a 10-per-cent. solution of chrysarobin in traumaticin. The patient was directed to take a hot bath the night before coming to be painted.

Three weeks later, on July 8th, I find the following note: Have painted spots six times and now find considerable dermatitis on shoulders, chest, and back. To-day only painted spots on legs.

July 15th. Patient came to my office complaining of a freezing sensation, with general inflammation of the skin.

July 19th. I was called to his house and found the inflammation covering every part of the body and exfoliation of the epidermis beginning. Temperature, 101°; pulse, 100. Ordered quinine, gr. v, with antipyrine, gr. iiss, to be given three times daily. Locally, applied carbolized vaselin, gr. xx to the

ounce.

July 20th. Temperature, 100°; pulse, 94; epidermis rapidly exfoliating on back and arms.

July 22d. Temperature, 99.5°; pulse, 90; ankles swollen, skin drawn tightly, and walks with great difficulty.

July 26th. Temperature, 99.5°; pulse, 82; ankles better, skin coming off palms and soles in large flakes. Ordered pilocarpine hydrochlorate, gr. 1/16 to be given three times daily.

July 27th. Temperature and pulse same as yesterday; patient very nervous and exhausted. During the past week has slept on an average not to exceed two hours in the twenty-four. The scales have fallen off at the rate of a pint in twenty-four hours. The loosening scales produce such an irritation that the patient is compelled to find relief by scratching and rubbing himself

system produced by irritation and loss of rest is such as to cause fear of grave results, as insanity is one of the consequences sometimes following dermatitis exfoliativa. In the hope of relieving the irritation and lessening the inflammation, the permanent bath was ordered.

July 28th. Entered permanent bath at 11 A.M. Relief was instantaneous and so great as to produce a condition of ecstacy. In one brief moment he was transferred from a condition of mental and bodily agony such as only the pen of a Danté could describe, to one of perfect tranquillity and comfort, which to his then tortured mind and body could scarcely be surpassed by Mr. Moody's brightest picture of a happiness beyond.

At 5 P.M. he expressed himself as being very comfortable and for the first time his temperature and pulse were normal.

July 29th. Held a consultation with my friend, Dr. W. H. Davis, who suggested thyroid extract, which was substituted for the internal treatment before given. Dr. Davis saw the case again one week later and pronounced the improvement decided. From the time of his entering the bath the amelioration was gradual, yet positive, and I shall only give the further points of interest as they occurred.

August 3d. Ate freely of clam-chowder, and temperature rose to 101°; pulse, 94, with a restless night. Ordered a purge.

August 4th. Bright-red rash in the morning, followed by sleep in the afternoon. Temperature and pulse were normal.

August 10th. Inasmuch as the sweatsecretion has been entirely absent for at least thirty days, a cabinet-bath was ordered and given under my direction, and to my surprise and gratification the perspiration began in five minutes and was kept up for ten minutes.

August 11th. Perspiration produced in ten minutes. After this perspiration came more readily and these baths were

given daily for two weeks, then every alternate day for another week, when it was manifest that the function of the sweatglands was fully re-established and they were discontinued. September 4th. Patient left the tub after being under water thirty-nine consecutive days. The skin was quite smooth and epidermis reformed. Sat up for one week, then was forced back to bed on account of an attack of furuncles in the axillæ.

September 9th. Ordered Fowler's solution, the dose of which was increased from 5 drops to 10 three times daily; but this dose made him red and itchy, and he went back to 5 drops. Continued for ten days. October 10th. Resumed work. The first point of interest in this case is: What caused the dermatitis exfoliativa? It is true that the majority of cases are said to follow psoriasis where the disease has lingered for years; but here was a case developed while the psoriasis was only a few months' old, and was not even in a chronic condition. The inflammation began around the spots where the chrysarobin was used, just as I have seen it do in almost every case in which I have used it, and by the time the dermatitis had covered the whole body the exfoliation of the epidermis began. This spreading of the simple dermatitis from the spots on which chrysarobin was used can certainly be charged to the irritating property of the drug; but why the simple dermatitis should be changed into the exfoliative variety, or why it should invade parts of the body on which no psoriasis existed and on which no chrysarobin was used must be explained in the future when our knowledge of the chemistry of the blood has advanced and when we know more of the toxic effect of chrysarobin.

At the time the exfoliating process began the spots of psoriasis had scarcely commenced to decline, but when the epidermis began to exfoliate they disappeared as the summer-dew before the rising sun.

Chrysarobin is laid down by all our textbooks as the best local application for psoriasis, and the manner in which I used it, with traumaticin, is the most conservative way of applying it. Hence, I feel that this unfavorable result was due either to the peculiar chemical condition of the blood at the time or to the idiosyncrasy of the patient.

The second point of interest was the success attained by the permanent-bath treatment. The week spent in bed was one of untold agony to the patient, and one in which the disease held sway with vigor unrestrained, but, on entering the bath, the patient experienced immediate and complete relief and from this time the disease began to decline.

The temperature of the water at first was that of a hot bath, but as the temperature of the patient declined, that of the water was also reduced. The scales which had been falling off and causing so much irritation now dissolved and, came off easily and, as time progressed, the kindly effect of the water on the inflammation soon caused them to cease entirely.

At first a little sodium bicarbonate was used in the water, but it seemed to dissolve the scales so rapidly, leaving the skin denuded and sore, that its use was discontinued. The water was changed twice daily and sometimes the patient was given a folded sheet or quilt to lie upon, but, as a rule, he rested just as well without these things.

During the first week of the bath-treatment he spent four nights in bed, but after this the bed had no charms for him, and, all told, he spent thirty-nine days and thirty-five nights in the water.

During his immersion, with the exception of the day he ate clam-chowder, his appetite remained excellent and his bowels and kidneys performed their functions regularly. The only thing radically changed in this line was the fact that he seldom cared to drink any water, enough being absorbed by the skin, evidently.

The finger-nails and toe-nails, which showed every sign of coming off while the patient was in bed, seemed to tighten up and assumed a more healthy condition, and, as a final result, none were shed. Had it not been for the kindly influence of the bath, I am convinced he would have lost the entire twenty nails.

I do not mention the length of time spent in the tub as a record-breaker for this kind of bathing, for many patients have remained for months under water, but what I do wish to call attention to is the very short time required by this plan of treatment to cure a typical case of dermatitis exfoliativa.

According to statistics given by the textbooks, the time required for a cure averages from months to years.

I was unable to see any benefit from my local or internal treatment, given while the patient was in bed, and must, therefore, date the beginning of his recovery from the day on which he entered the bath. This would then reduce the time really occupied in curing the case to the thirty-nine days spent in the bath, which as a curative agent is certainly a record-breaker.

The idea of treating certain dermatoses by the permanent bath is not a new one, but as it is so seldom employed I have given some time to the minutia, feeling certain it might be used in many more cases, where it would not only have a curative effect on the disease, but would relieve the suffering of the patient as if by a magic touch.

Subsequent Note.-Up to date, January 24th, the patient has remained healthy except that a few isolated spots of psoriasis have appeared, but they showed no signs of activity and readily yielded to local treatment, such as a weak ethereal solution of pryogallic acid painted on the spots twice weekly. The skin generally has become pliable and smooth. The palms and soles, which remained dry and thickened for some time, have finally regained a normal condition.

A FRACTURE OF THE RADIUS WITH
SINGULAR FEATURES.

BY STEPHEN HARNSBERGER, M.D.,
CATLETT, VA.

I AM led to offer the following notes of

a case:

Mr. Ed. W., a young white man, farmer, applied to me on Thursday, October 20th, with this brief history: On Monday he was husking corn, and, after pulling over a shock, he felt a twinge of pain in his left forearm a few inches above the wrist; but as it was not great he paid no special attention to it. He continued at work Tuesday, Wednesday, and Thursday. Late in the afternoon of the latter day the pain returned and became gradually more severe. About 8 o'clock that evening he called at my office to have me look at his arm. A thorough examination discovered the left radius broken transversely across at least three inches above its articular surface. No displacement; very slight dorsal tumefaction; linear pain on pressure; scarcely noticeable loss of motion of radius and some crepitus on rotating the bone while. the hand was drawn down. It occurs to me that this is an unusual point of fracture of the radius. Certainly it is unique from a causative point of view, to say nothing of his having been able to use the arm at constant work for four days with little or no inconvenience. It seems to me remarkable that the use of the arm was not impaired.

Abstracts.

Tabetic Arthropathy Without Ataxia. At a meeting of the Medical Society of the Hospitals M. Dalos spoke of the case of a man, 54 years of age, who, with the exception of ataxia, presented almost all the features of locomotor ataxia (paralyses of the anterior muscles of the eye, amblyopia, partial ptosis, temporary dysuria, etc.). He