In this connection, I wish to say that I condemn the use of synthetic salicylic acid and all other coal-tar preparations in the treatment of acute articular rheumatism. Stricker, of Berlin, introduced salicylic acid in the treatment of rheumatism the same year that Maclagan published his results from salicin. At the present day, salicylic acid and its sodium salt have largely superceded the natural neutral glucoside in our practice; but I am of the opinion that the latter is more readily accepted by the stomach and is less irritating to the digestive organs and has not the depressing effect upon the heart of salicylic acid. Whereas many

cases cannot take salicylic acid on account of its action upon the stomach and the nervous phenomenon, and the eruption upon the skin, I have not yet seen a case in which any of these accidents followed the use of salicin. In my opinion, salicin bears to acute rheumatism very much the same relation that quinine does to malaria; in other words, that its action entitles it to be regarded as possessing a special therapeutic relation to the dis

ease.

As regards accessory treatment, I have found alkalies very useful. The increased acidity of the urine and the acid sweat point to a decrease in the alkalinity of the blood and afford the indication for the administration of alkalies. Those which at the same time exert a diuretic action, like the citrates and acetates, are preferred. To be especially named are the citrate of potash and the solution of acetate of ammonia. The neutral mixture and effervescing draught are very suitable. Since there occurs in acute rheumatism a rapid loss of red blood corpuscles and destruction of hemoglobin, some chalybeate preparation will generally be required. This may be given separately, as tincture of the chloride of iron or some of the newer combinations with albumin, or it may be given at the same time as the alkalies, in the form of Basham's mixture, liquor ferri et ammonii acetatis. Where the pulse is rapid and the heart action weak, it is advisable to also combine strychnine with the preceding; or the infusion of digitalis may be given internally, combined with the alkali (such as potassium citrate or sodium bicarbonate) and the strychnine may be given hypodermically, at suitable intervals.

With regard to antipyretics, I am strongly opposed, as I have just said, to the use in this disease of any and all of the coaltar derivatives. In ordinary cases, no febrifuge treatment is required other than the neutral mixture, effervescing draught, or Basham's mixture. The temperature, however, must be frequently observed and if it rises suddenly several degrees and maintains an elevation of 103° or over, there is danger of the development of cerebral rheumatism, which is a serious and often fatal complication. While, as pointed out by Da Costa (American Journal of the Medical Sciences, January, 1875), this condition is not entirely due to high temperature, and often is accompanied by albuminuria, indicating kidney involvement, still the method of treating it with cold affusions, or the cold bath, frequently repeated so as to keep down the temperature of the patient, has given us the best results, and has succeeded in saving some apparently hopeless cases. It is well in these patients to precede the bath with an alcoholic stimulant, in order to cause dilatation of the peripheral blood-vessels. The heart should be sustained by hypodermic injections of strychnine and digitaline. The prolonged application of an ice-bag to the precordia has been recommended to combat hyperpyrexia.

Just here I may remark that small doses of morphine (grain 1-6 to 1-12) may be given from time to time to relieve pain and restlessness and to enable the patient to sleep at night. Atropine may be used in conjunction with it, but only in small doses (grain 1-200), as it should not interfere with the action of the skin. On the other hand, if the skin be too dry, small doses of pilocarpine may be injected under the skin, and warm drinks administered to assist its operation.

A few moments ago, I spoke of the congestion of the portal system and the defective action of the liver. Having this condition in mind, I invariably begin the treatment of a case of acute rheumatic fever with a cholagogue cathartic. My preference is for a good dose of calomel (10 to 15 grains), and I usually combine it with sodium bicarbonate, and in some instances with resin or podophyllin or podophyllotoxin.

One more point in the treatment. I have referred to the

tonsil as the probable portal of entry for the infectious organisms. I therefore deem it important, in every case, to order a disinfectant mouthwash and gargle, like the antiseptic solution of the new Pharmacopoeia. I also direct that the teeth shall be scrubbed twice a day. A few drops of tincture of myrrh may be dropped in the water which is used for wetting the tooth-brush.

If I now summarize the treatment of a case of acute rheumatism, I would say that it consists in placing the patient in a bed in a well-ventilated, comfortable room, in order to afford complete rest to his muscles. I would allow him a moderate amount of food, principally broths, stale or toasted bread and butter, and weak tea or coffee, with an occasional egg, avoiding articles that ferment readily in the stomach, such as pastry and Meat is only allowed after the decline of the fever, when convalescence seems assured. The affected joints are gently rubbed with a liniment such as the following:

R Olei Gaultheria, 3ij.

Lin. Saponis, q. s. ad žij.— M.

They are then to be enveloped in cotton, and this is kept in place by a flannel bandage.

Internally, my prescription would be:

B Salicin, gr. x.

ft. Charta. no. j. Mitte no. xij.

To be given every two or three hours, after the alimentary tract has been emptied by a cholagogue cathartic.

Another prescription to support the heart and counteract the anemia would be:

R Strychnine acetatis, gr. 2.

Ferri citratis, 3j.

Liq. ammonii acetatis, iv.

Syr. aurantii rubri, q. s. ad 3vi.— M.

Sig. Give a tablespoonful every three hours, in a wineglassful of water.

In patients suffering with malarial infection, from 8 to 12 grains of hydrochlorate of quinine may be added to the daily treatment; or this may temporarily take the place of the salicin.

During convalescence, recovery may be hastened by vapor, or hot-air baths, given once daily. Should infection occur as manifested by endocarditis or pericarditis, the salicin should be continued, perhaps in larger doses, and measures should be taken to counteract the septicemia by stimulants, injections of normal salt solution into the colon, and the application of blisters to the joints, carefully guarding against strangury. Painting the surface of the skin with tincture of iodine also exercises a revulsive effect.

As sub-acute rheumatism is merely a mild form of the acute, I will not dwell upon it; the principles of treatment are the same. As regards chronic rheumatism, here we have to do with some of the sequelæ of former attacks, as well as a tendency to recurrence of the acute affection. There may be fibroid thickening, and adhesions between muscular bundles, which limit the movement of neighboring articulations and cause pain on motion. It is in these cases especially that iodine is so serviceable, both as an external application and internally in the form of potassium or sodium iodide.

Rheumatism may occur in a gouty subject, and in these cases it often attacks the smaller articulations. In such cases, the lithia preparations, especially the mineral waters containing lithia, are of great use, especially when combined with the classical treatment with colchicum. These remarks do not apply to rheumatoid arthritis, or so-called rheumatic gout, which is a distinct disease, and calls for codliver oil and phosphorus.

Finally, I would call attention to the value of local treatment in chronic rheumatism, especially by massage and the dry heating apparatus. Static electricity is a powerful stimulant to the nerves and blood-vessels of the part, and also can be utilized with great advantage in the treatment.

COLLODION, commonly used to seal a puncture wound, as after aspiration, will not adhere if the spot is wet or bleeding. To obviate this, pinch up the skin, wipe it dry, apply the collodion and continue the compression a minute or so until the collodion has begun to contract.- American Journal of Surgery.

Becords, Becollections and Beminiscences.

SPECIAL NOTICE.

The Association of Medical Officers of the Army and Navy of the Confederacy will hold its Ninth Annual Meeting in the Medical Department of Tulane University, Corner of Canal and Villere Sts., New Orleans, La., Wednesday, Thursday, and Friday, April 25th, 26th, and 27th, prox. The first session will be called to order at 10 A. M., Wednesday, April 25th, 1906.

C. H. TODD, M. D., President.

NINTH ANNUAL MEETING OF THE ASSOCIATION OF
MEDICAL OFFICERS OF THE ARMY AND NAVY
OF THE CONFEDERACY.

BEFORE the issue of the next number of this journal the time. for the annual meeting in New Orleans of the Association will have passed, and from all indications at this time, we hope in subsequent issues to report a most successful and enjoyable occasion. A recent communication from Dr. Hermann B. Gessner, Chairman of the Committee of Arrangements, gives the very satisfactory information that everything is well under way, and more elaborate and complete preparations have been made than on the occasion of our last meeting in the Crescent City.

The meetings will be held in the Medical Department of Tulane University, corner of Canal and Villere Streets, and all who may attend are requested to come at once to the place of meeting on reaching New Orleans, where members of the Registration and Information Committees will be on hand to give the members and visitors every possible assistance. In addition to the Address of Welcome and Response, the President's Address, Reports of the