The exciting cause is exposure to cold and dampness. The attack of the acute form is frequently sudden. The joints swell, more or less, and become painful. The fever is sometimes high, and the disease frequently extends from joint to joint. The pain is generally excruciating. The urine is scanty and saturated with uric acid.

The proportion of complications with pericarditis is about ten to twelve per cent. It is very liable to recurrence, and often results in chronic derangements of the valves of the heart. It may result also in the thickening of the synovial capsules, and degeneration of the cartilages, which may finally disappear; but there may be produced in the central portion of the epiphyses, atrophy; and osteophytes may form upon the periphery, which disfigure the joints and impede locomotion.

Treatment. I usually commence the treatment with one or two drops of the tincture of the leaves of aconite every three hours, especially where there are thirst, dry, hot skin, stitching pains in the chest, with quick pulse and great swelling of the affected joints. And then follow that with the Keasbey & Mattison's salicylate of Lithium, in doses of twenty to thirty grains in half a glassful of water, to be drank while effervescing. I would call the attention of the profession to this new chemical; give it a trial.

I have found that where the pain is less in moving about, that rhus toxicodendron, in one or two drop doses, is one of the best remedies. I have treated several cases of that kind recently that had resisted other treatment, but were cured by this remedy. On the contrary, if the pain is increased by motion, then the remedy cimicifuga will generally relieve it readily. I give it in doses of ten to twenty drops every three hours. If the pain is burning, tearing or jerking, then colchicum will do good service. It may be given in doses of ten to twenty drops every four hours; it should not purge.

In the chronic form, with obtuse, heavy, aching pains, worse in damp weather, and especially connected with a syphilitic taint, phytolacca, alternated with iodide of potassa, will act well, and may be given in doses of ten to twenty drops,

three times a day. If the pains are inclined to shift from one joint to another, or where only one side is the seat of the disease, then pulsatilla often gives relief. It may be given in doses of three to four drops, three or four times a day.

In lumbago, where the pain is very severe and cutting, I have frequently relieved it by the application of electricity, or by applying a common smoothing iron, wrapped up in a cloth wet in good vinegar. It should be as hot as can be borne without actual discomfort, and often renewed. This acts promptly in many cases.

BY JOHN A. HENNING, M. D., INDIANAPOLIS, IND.

Much has been written concerning salicylic acid and its salts, and opinions vary widely in regard to their medicinal value. Wonderful efficacy is ascribed to them by some, while others consider them highly overrated.

The longer I use the remedy, and the better I become acquainted with the indications for its use, the more I like it.

We may admit, that it will not cure a single disease, yet its physiological effect in some diseases is so marked, and so effective for the better, that its power and usefulness should be unquestioned.

When salicylic acid is given in from two to ten grain doses, it will act as a sedative and reduce the temperature several degrees in many forms of inflammatory or febrile disdiseases, and hence becomes a valuable auxiliary in the treatment of these grave disorders.

It has been highly recommended in rheumatism. Sometimes it cures, and sometimes fails. The fault is not in the remedy, but in the character of the disease. When rheumatism is caused by a superabundance of lactic acid in the system, then the salicylic acid, or the salicylate of soda, given in from three to ten grain doses every three or four hours, will effect a cure. In such cases the specific indication is that the tongue has a full, leaden or purplish appearance.

"We may promise with

Prof. See, of France, writes: almost certainty the cure of febrile or apyretic rheumatism in from two to four days."

Prof. See has also used it with success in gout, promptly arresting the most painful paroxysms, preventing relapse, and promoting the removal of deposits.

It is an excellent remedy in diphtheria, given internally when the temperature is high, and applied locally in solution, with an atomizer.

When properly applied and administered, much benefit is derived in nasal, vesical, and uterine catarrh; follicular stomatitis and acute coryza.

About a year ago I had several cases of catarrhal and purulent conjunctivitis. I used the following prescription.

Apply every three hours to the parts affected, with a camel's hair brush. This speedily arrested the disease, and in a few days, effected a permanent cure.

I have found it a good remedy in pyrosis, and some forms of dyspepsia. It will prevent fermentation, and promote digestion, nutrition and assimilation.

SELECTED.

Diagnosis and Treatment of Fracture of the Rim of the Acetabulum.

We extract the following from the Virginia Medical Monthly, where it is credited to the transactions of the State Medical Society of Wisconsin.

A most thorough and critical examination while the patient is profoundly under the influence of an anesthetic, is always necessary to establish a positive diagnosis. If spontaneous reluxation does not follow immediately after reduction has

"

been accomplished, and there are sufficient symptoms present to warrant a suspicion of the presence of the injury, it would be advisable to test the functional integrity of the acetabulum by flexion, adduction and rotation of the thigh; if any part of the rim has become defective by fracture, reluxation will be sure to take place. This maneuver, associated with the presence of crepitus, may be regarded as the crucial test.

The differential diagnosis must consider fractures of the neck of the femur with displacement and simple dislocation. To distinguish this fracture from the fracture of the neck of the femur, it is necessary to compare their most prominent symptoms:

FRACTURE OF THE RIM OF THE

ACETABULUM.

FRACTURE OF THE NECK OF THE
FEMUR WITHOUT IMPACTION.

Position of Limb.

Thigh and leg flexed, adduct- Thigh and leg straight and ed and rotated inward. rotated outward.

Mobility of Limb.

Mobility of limb is dimin- Mobility of the limb is inished.

creased.

Crepitus and a tendency to reluxation are the symptoms on which we place the most reliance to differentiate this fracture from simple dislocation. The akystopeurastic of Middeldorpf may be of great service to determine the existence of fracture of the rim. After reduction has been accomplished, a long, stout needle is passed through the tissue to the supposed seat of fracture. By lateral movements of its points, the defect in the margin, as well as the roughness of its surface, is ascertained. An effort should now be made to fix the detached fragment with the point of the needle, and, by rubbing it over the broken margin, a rough crepitus is elicited.

The indications to be fulfilled in the treatment of this class

of injuries are: 1st. To reduce the dislocation. 2d. To re

tain the head of the femur in the socket until union has taken place between the fragments.

The dislocation may be reduced by manipulation or by extension; in both instances, flexion constitutes an important step in the operation. Bigelow says:*"These displacements, especially the displacement backward, demand the usual attempts at reduction by flexion. Although the bone inclines to slip from the socket, it can be retained there by angular extension, with an angular splint attached to the ceiling, or some other point above the patient; or if any maneuver has reduced the bone, the limb should be retained, if possible, in the attitude which completed the maneuver.'

In seventeen of the cases reported, the manner of reduction is specified as follows: By extension, eleven (in most of these cases, extension and flexion were combined); by manipulation, two; by manipulation and extension, one; by manipulation over Sutton's fulcrum, one; by extension with pulley, two. In all but one of the cases the displacement was corrected without difficulty. In Pooley's case it was supposed that the detached fragment prevented reduction by being placed between the head of the femur and the acetabulum. In my own case, the use of the pulley was required from the length of time that had elapsed since the injury had been received. Had I been aware of the nature of the injury, no attempt would have been

* Dislocation of hip joint.