Indolent ulcers of the legs take on active changes and often cicatrize rapidly under the powerful stimulation of the alternate application of a cloth dipped in very hot water, followed instantly by one taken out of a vessel of very cold water.

are also of some value in psoriasis, and occasionally the eruption will seem to yield to them, but quite as often they are powerless, as I have frequently witnessed. Chronic, more or less generalized papular eczema, may be much benefited by sulphur vapor baths, given every other day or so; but here care must be exercised, for this very condition may be entirely caused by their use. -(Chicago M. J. & Ex.)

Very striking results are often obtained from the use of hot water in some of the forms of acne. It is apPlied by means of a cloth, as a handkerchief, dipped in hot water and held to the face until the heat of the cloth has passed off, when the performance is repeated two or three times for a period of not over three minutes to A CASE OF POISONING FROM THE USE OF five altogether; a long soaking of the face in the water which is not hot enough will aggravate the eruption, but the reaction following the brief application of very hot water, is often very remarkable. After multiple scarification of the pustules and papules of acne, prolonged bathing with tepid water is of service in encouraging the bleeding, which otherwise always tends to cease sooner than is desired.

3. Cold and hot packing in wet sheets, as practised in the water cures, is of a certain value as a remedy in cur, as boils on the surface, are to be deprecated, and are not, as is popularly supposed, either a good sign, or a good element in the treatment; we, of course, no longer believe that there is a "materies peccans" which needs to be eliminated. But the wet pack has served well in the hands of Hebra in the treatment of acute psoriasis, also in acute general eczema. The packing is made twice daily, for several hours, morning and evening.

diseases of the skin. The results which sometimes oc

THE COMPOUND TINCTURE OF CIN-
CHONA, PRODUCING PERMANENT CON-
TRACTION OF THE VISUAL FIELDS AND
TEMPORARY IMPAIRMENT OF SIGHT

AND HEARING.

BY D. B. ST. JOHN ROOSA, M. D.

Mr. B. was told that the use of the tincture of cin

In certain cases of chronic erythema, where the congestion resists other measures, the alternate application of cloths dipped in very hot and very cold water, serves to On the 3d of July, 1878, Dr. L. M. Yale asked me to break up the capillary stasis. On the other hand, repeat-see a case of loss of sight, of which the following his ed washing of ulcerative surfaces will often be quite sufficient to prevent their healing; this is often seen in ul-tory was obtained: Mr. B., æt. 50, a man of very incerative syphilides, which will sometimes resist the temperate habits as regards the use of alcohol. He had been accustomed for years to drink enormously proper internal medication as long as repeated washings of brandy and whiskey at intervals, but there were are persisted in, and yields to it almost immediately periods of varying length, from one to three or four when cotton batting is applied and left undisturbed. Varicose ulcers of the leg are not infrequently kept from months, of total abstinence from intoxicating drinks. healing by the too diligent cleansing which patients are chona would relieve him from his periodic craving for ever ready to bestow. alcohol. On June 24th of this year he began its use, that day, as well as on the 25th, 26th, 27th and 28th with a view of correcting his intemperate habits. On he continued to take the compound tincture in ounce and two ounce doses, at short intervals, literally drinking it as a beverage from a quart bottle, in which he had caused an apothecary to place as strong a preparation as possible. On the 28th, although he had taken none of his ordinary alcoholic stimulants, his clerk thought from his conduct that Mr. B. had been drinking heavily. Dr. Yale estimates that in these days the patient took an amount of the tincture which would be equivalent to 125 grains of an alkaloid of cinchona. Mr. B. has no recollection of any occurrence after the 27th. He is confident that he took no alcohol, except that contained in the preparation of cinchona during these days. This, however, may be doubtful, for the clerk of the hotel to which he went when in what proved to be a semi-conscious state on the 28th, states, that while he lay in bed he was constantly ringing the bell for liquor. It is possible that during this time some doses of alcohol were added to those of cinchona although Mr. B. does not believe this to be the case. On the morning of July 1st he was seen by Dr. Hills in the absence of Dr. Yale. He found the patient stupid or half conscious, with flushed face and conjunctivæ, and apparently unable to see or hear. Mr. B. remembers Dr. Hills' visit on Sunday, and knows that he was then blind and deaf. Dr. Yale saw the patient on Monday and Tuesday, July 2d and 3d. His hearing power improved so much in that time as to become apparently normal, but his vision remained very much impaired. On the day I saw Mr. B., the 3d, he was groping about his room, apparently in excellent general health. V. R. E.-quantitative perception of light. L. E. counts fingers at one foot. The The indiscriminate use of a mercurial or sulphur vaophthalmoscope showed lessened size of the arterial por bath when the skin is affected is highly reprehen- vessels; no abnormity in the veins, lessened number of The real utility of sulphur vapor baths in diseases of vessels on the papillæ, but no marked paleness. No the skin is in a measure still sub judice. Their anti-par-changes observed in the membrane tympani. The asitic value is fairly positive. If well used they will patient was advised to take strychina in increasing doses, cure scabies, phtheiriasis and the vegetable parasitic and nutritious diet. On July 6th he was able to walk diseases. But even in these the irritation occasioned about. V. each eye, but the visual fields were very by them is sometimes so great that the artificial erup- much contracted, so that vision was telescopic. tion produced quite masks that of the disease proper and prevents their continuance. Sulphur vapor baths

This is most conveniently accomplished by placing two blankets lengthwise upon a bed, and over them a sheet dipped in cold water. The patient then lies naked upon this, which is closely folded over him up to the chin, and the blankets are then wrapped closely around, and the whole done up with bands, so that the patient is immovably fixed, helpless indeed. The first sensation is that of a pleasant glow, and before long perspiration ensues, which should be encouraged by draughts of water frequently given; the packing lasts from two to five hours. It should never be forgotten to place an urinal between the thighs of the patient before envelopment.

Under this treatment the scales of psoriasis disappear, and the red patches daily become less visible. Few patients in this country will submit to this treatment, but when it is desired to remove the existing eruption in the shortest possible time, it is of value. Packing is not of service in many affections of the skin, and should seldom be prescribed, although in the water cure establishments all eruptions are submitted to this The profession need more accurate scientific information in regard to the precise effects and the therapeutic indications of this powerful remedy.

course.

sible.

On July 16, 1878, both visual fields were found concentrically limited. The measurements, drawn on a

blackboard 14′′ distant, were as follows: Right field, vertical, 9 inches; horizontal, 7 inches; limitation most marked in temporal side. Left field, vertical, 7 inches; horizontal, 8 inches; limitation more regular. B. found this symptom rather novel than troublesome. The optic papille looked very pale, and the arteries were narrow. July 23, V.-20 cach eye. Patient states that he can see perfectly well in a straight line, but that when walking about a room he has some dif ticulty in seeing small articles of furniture.

Sept. 10th.-The same condition is maintained. The strychina was taken until grain had been reached at a dose, and was continued for two months. The visual field remains as on July 16th.

NOTE ON THE TREATMENT OF ACUTE
SUPPURATION OF THE MIDDLE EAR.

BY DR. EDWARD T. ELY, NEW YORK. The tendency to spontaneous recovery, manifested by so many acute diseases, is observable also in acute suppuration of the middle ear. Probably this is not a new thought to any reader of this paper, but it seems to the writer to be too much ignored in practice. Great labor has been required to lead physicians and laymen to consider acute suppuration of the middle ear as of any importance. This work has involved much writing and discussion as to the nature of the disease, and as to the necessity for prompt and efficient April 23d, 1879, Mr. B.'s condition remains substantially treatment of it. It is natural that many practitioners, the same. He continues to abstain entirely from the having thus been laboriously awakened to its importuse of alcohol, and carries on a large business success-ance, should hold exaggerated ideas as to the remedies fully. His vision is still 20 each eye. The visual field required for its cure. has increased somewhat in the left eye. It now measures 9 inches vertically and 16 inches horizontally. F. of R. E. 6" vertically, 9" horizontally. Limitation most marked at upper-inner quadrant. The optic disks are pale and the arteries small. There are no other ophthalmoscopic appearances.

Remarks.--Mr. B. had taken no Alcohol for some months prior to his beginning the use of the Cinchona, and he took none until he became unconscious on the fourth or fifth day. Although he went about and transacted business on the fourth day, he has no recollection of what he did. When found, he had an empty bottle (holding a quart) in his room, labeled and giving positive evidence of having contained Cin chona. He certainly did not take many drinks, if any, after he reached the hotel, for the clerk, knowing his former habits and supposing him to be suffering from an ordinary debauch, refused to answer his demands. It is not known that he took anything but the Cinchona at any time after he began the treatment of the alcohol habit.

Notwithstanding the efforts which have been made to bring patients with acute aural disease under treatment, the majority of them continue to be neglected by themselves and by their family physicians. The numerous cases of acute suppuration of the middle ear which have recovered and which are constantly recovering, in spite of neglect or of bad treatment, afford proof of a tendency to self-limitation in the disease. Every aurist sees many patients who, in stating their history, refer to former suppurations of the drum which have ceased spontaneously. The drumhead is found to be well healed, although it may present extensive cicatrices, and the hearing is either perfect or only slightly impaired. It cannot be denied that many of these patients have fared as well as if they had been under the most skillful management.

Admitting these facts, should they not influence our practice somewhat? It is not intended here to underrate the importance of having every case of this disease under the observation of a competent surgeon from the outset. Nor is it designed to make any arWe have here, then, a case of hyperemia of the ves-gument against the greater part of the treatment ususels of the ear from the use of Cinchona and alcohol-ally employed, but simply against the use of astringa hyperemia which passed away without going on to an exudative process; but the same condition in the vessels supplying the retina continued until a true vasculitis, with its consequences, resulted.

The future condition of this patient, even if he never assumes the alcohol habit, cannot be regarded without anxiety. It is to be feared that in time the macula may be insufficiently nourished from further contraction of the vessels. The peripheric parts of the retina have now very little, if any, perceptive power; the nerve is perhaps undergoing atrophy. It is, I think, undoubted, from many experiments, among which are my own, that Cinchona causes at least temporary hyperæmia of the vessels of the base of the brain. I am fully aware, however, that, although certainly there was absolutely no loss of sight until the poisoning by Cinchona occurred, there may have been changes in his circulation induced by alcohol prior to this attack, and I also do not forget that there was enough alcohol in the preparation which he took to prevent the case from being a typical one of Cinchona poisoning, yet the quantity must have been too small to have added much to the effect of the other drug. He may, however, have drank considerable brandy on the day of which he has no recollection, and some also after reaching the hotel. Certain it is, however, that he reached the unconscious state upon doses of the Tine ture of cinchona alone. Imperfect as is the case in some respects, it may, I think, be regarded as a contribution to our knowledge of the effects of Cinchona upon the nutrition of the eye.-(Arch. of Ophthal.)

TRICHINE.--Alcohol, as well as Salicylic acid, in quantities of 10 to 15 grams (t to oz.), cause the rapid disappearance of trichinæ,

ents or caustics before they are certainly indicated. We are assuming that the pain and congestion of the first stage have been subdued and that we have to deal only with a perforated drumhead and a suppurating tympanic cavity. Under these circumstances, would it not be preferable, in every case, merely to keep the car clean, and to watch it for a few days, to see what it is disposed to do for itself, before resorting to any more active treatment? It will surprise a person who has never done this, to find how often the drumhead will heal and the disease be cured before this watching process is finished. The application of an astringent or caustic is certainly needless in many instances. The use of them, morcover, has certain disadvantages. If, in such a condition as we are considering, the surgeon immediately applies them, he complicates the problem before him. If the ear does not happen to do well, he is at a loss to know how far this is due to the disease, how far to erroneous treatment. Any person who has treated a severe case of purulent ophthalmia, threatening destruction of the eye, knows how embarrassing our uncertainty as to the choice of remedies may become. If, on the contrary, a suppurating tympanic cavity has been watched long enough to determine its natural tendency, any needed remedy can be adapted to it with far more accuracy. The choice of even such mild remedies as our weakest solutions of zinc or alum is not a matter of indifference. We have all seen cases where they seemed to increase the swelling or the discharge or the loss of tissue. The following one seems to show a still more serious effect:

Miss H., aged 20, consulted me November 30, 1877, with acute suppuration of her left middle ear of ten days duration. There was a free discharge of pus,

f

II. Miss J. H., aged 21, came on March 11, having had severe pain in her left ear since 3 A.M. The drumhead was found ruptured, and there was purulent discharge. The hearing on that side was six-fortieths. Leeches and the hot douche were ordered, and they seemed to arrest the pain at once. After that the ear was simply syringed occasionally with warm water. THE MICROSCOPE AS AN AID TO SURGICAL On the 13th the perforation was nearly closed. On the 18th it was completely healed, and the hearing was forty fortieths.

and immaturity of the cellular elements at once stamped the specimen as a different species from the others.

with remarkable rapidity; and in every case the expres sion of comfort from its use has been very emphatic. I would not be without it," "I would not take five While enabled to detect, in this way, the class to dollars for it," "I would not part with it," are common which a given specimen may belong, we are often forms of expression after a patient has used it for a puzzled to determine what particular form of tumor short time. Although ulcers, varicose veins and ecwe have; but, as Richardson says (Med. Microscopy, zema may be cured by other means, the great advan p. 306): " On the other hand, however, the student tage of the rubber bandage is, that it permits patients can comfort himself with the assurance that he will to go about and pursue their avocations. They do this meet with numerous examples of malignant and non- with great comfort, and without at all interfering with malignant growths, when, with ordinary care and the process of cure. Indeed, I am of the opinion that attention, he may with confidence promptly answer it is a great aid to cure for patients to be about. The the questions propounded to him; and just as he general health is invigorated, and they experience the gains more experience in the work, and becomes more tonic effect of feeling and being as comfortable and skillful in the use of his microscope, will the propor-vigorous as ever. Every one has observed how curation of insoluble problems diminish, until their num- tive this mental state is in almost every class of disease. ber becomes very small indeed." It is a therapeutic measure eargerly to be sought after. It may be well to inquire how the pure rubber bandage accomplishes the result in these cases. It does so by the gentle, equal and continuous pressure it maintains. It supports and assists the capillary circulation. This pressure also promotes the absorption of the fibrinous or serous deposits in the tissues. The rapidity of the absorption is sometimes very surprising. It is not necessary to raise the question as to how this is accomplished-whether by the effect upon the lymphatics or by the capillaries. It also mechanically expels the blood from the over-distended and weakened veins, which it supports and compresses. Often there is a weakened condition of the heart. In these cases the feeble circulation is aided by the elasticity of the bandage. The continuous warmth and moisture, and the exclusion of the air, are other elements contributing to the favorable result.

Having determined the anatomical character of a morbid growth, I apprehend the therapeutist has made little progress in devising means to cure his patient. The clinical student, however, will have a more definite conception of prognosis and treatment, and, to my mind, a far more rational and comprehensive knowledge of the etiology of the case in hand. This, how ever, is not the object of the paper, which is simply intended to call out the experience of our surgeons as to the value of the microscope in diagnosis.

Not to multiply instances, or unduly lengthen this paper, I will simply call attention to one additional fact in this connection. In lithiasis, it is well known, both the microscope and urinalysis frequently fail to determine the existence of urinal stone; in one instance the urine will be found very heavily loaded with calculous elements, and no stone exist; in another there will be entire absence of such indications, and yet large stone found. But here comes in the value of the microscope, etc. Having detected the stone, the fact of its vesical or renal origin, i. e., local irritation, or general constitutional disturbance, can be determined; and thus, also, learning the density and hardness of the calculus, lithotomy, or lithotripsy may be attempted each in appropriate cases. No man could hope to cure the oxalic diathesis, or even that of uric acid, by a single application; he would recognize the necessity for medication. So with a phosphatic or calcareous connection; he might often hope to remove the whole trouble by mechanical removal of what has now become both a cause and an effect of the morbid action.

TREATMENT OF ULCERS, VARICOSE
VEINS, ETC.

BY F. H. STUART, M. D.

The mode of application is important. It should be applied so as to make gentle, even pressure. It should not give the sensation of squeezing. It is only neces sary to put it on tight enough to keep its place. It does not readily slip. Each fold should overlap the previous one about half an inch. It is not necessary to make any reverse turns-only to wrap it round continuously. Its elasticity makes it fit everywhere with equal smoothness and comfort. It should always be begun at the toes. It is applied directly to the surface, no protective being anywhere necessary. I always direct the patient to take it off after getting into bed, having previously made ready two basins of water by the bed-one to sponge the leg and the other to wash off the bandage. Then simply cover the ulcer or eczematous patch with muslin, so as not to soil the bed clothing. The bandage is hung over a chair till morning. It is to be re-applied before rising. No ointment or grease of any kind should ever be used, as it soon destroys the rubber.—Proceedings Kings Co. Med. Soc.

The first step in the process of healing seems to be the subsiding of the swelling in the surrounding tissues. Hence whatever tends to remove this swelling promotes the healing process. One of the most important and certain means of securing this is by compression regularly applied. Bandages of various kinds have been used for this purpose for many years. Plaster dressing and adhesive plaster have also been recommended. The success of Baynton's method is due to the compression of the vessels and tissues, and not, as he supposed, to the effect upon the lymphatics alone The terebene preparations destroyed the odor and This is one of those curious instances where a practical precipitated the bacteria in flaky masses, but left some man suggests a valuable remedy, but gives an errone-free, isolated, and almost motionless ones in the field. ous explanation of its action.

EXPERIMENTS ON DISINFECTANTS.-By Dr. J. L.. Nutter. Carbolic acid subdued the offensive odor, while the quite free bacteria are persistent, though diminished.

In the pure rubber bandage of Dr. Martin, of Boston, is found a most valuable addition to the means of cure of a large class of diseases. It meets indications that are almost essential to success. My experience of over a year does not warrant me in speaking of it as enthusiastically as its author does. Yet cases of ulcer, varicose veins and eczema have improved and been cured

Chloride of lime destroyed the putrefactive odor and the bacteria themselves, no free bacteria being visible. microscopic characters, but the bacteria scemed to Permanganate of potash (Condy) presented similar elongate, and torule were developed.

Very similar characters were presented by M'Dou gall's disinfecting liquid-the odor being affected to a very small extent, while the activity of the bacteria, though very slightly diminished, is persistent in the interspaces; while some are precipitated others appear in the zoolea form.

Burnett's fluid acted similarly, but a very slight odor remained,-Phila. M. and S. R.

CACODYLIC ACID.

BY A. F. PATTEE, M.D.

Cacodylic acid is composed of seventy-five parts arsenic, seven parts of hydrogen, twenty-four parts of carbon, and thirty-two parts of oxygen.

It is in the form of large oblique, rhomboidal prisms, brilliant, transparent, colorless, inodorous, and tasteless, soluble in water, alcohol and glycerine, "not at all poisonous, although it contains fifty-four per cent. of arsenic."

It is liable to contain cacodylate of mercury, unless it has been very carefully and skillfully prepared. I have seen several samples that have contained the mercuric salt; they had the peculiar metallic taste and the disagreeable odor of cacodyl, and were highly poison

ous.

Cacodylic acid has been recommended and used as a remedy for asthma, neuralgia, chorea, hysterea, etc., in doses of from one to two grains three times a day in water.

fragments and decomposable debris, and not to the use of instruments, was a genuine and valuable discovery. A few years ago Mr. Clover invented a syringe to remove the sand left by the lithotrite, but the diameter of his tube did not permit fragments of even moderate size to pass, and its employment produced therefore no modification in the operation of lithotrity. The large tubes of a size supposed impracticable before Otis had shown the capacity of the human urethra, and the evacuating apparatus devised by Dr. Bigelow first made a thorough emptying of the bladder possible. Here, then, was an operation which rids the bladder of a stone as thoroughly as a lithotomy, but leaves no wound behind it.

Dr. Bigelow's new lithotrite is a valuable instrument, but should not be regarded as an inseparable part of his method. The ball-handle, the locking of the screw by a turn of the wrist, the rectangular blades, and the peculiar construction of the jaws to prevent impaction of fragments are great improvements, as is also its size, which enables the operator to crush the hardest as well It probably has no effect whatever upon the system as the largest stone. This instrument, without the when pure, as it is "an exceedingly stable compound." essential features of "rapid lithotrity with evacuation," "It is not effected by nitric or nitro-hydrochloric acids; however, would not have saved the traditional operait may be boiled with them without the least change." tion of lithotrity.-Boston Med. and Surg. Jour. Therefore cacodylic acid passes out of the body unchanged, the arsenic in it being not set free, and this is the reason it is not poisonous.

HOW SHALL WE PREVENT THE SPREAD OF SYPHILIS?— I believe this object can only be achieved by police I would not advise its use, for, when pure, it is inert, supervision of houses of prostitution, and the frequent and precious time is wasted, it may be, in experiment-medical examination of the prostitutes, and of all men ing with it, when the patient should have had the ad- who desire to have commerce with them. vantage and benefit of some well tried and reliable remedy. I have given from ten grains to three drachms of pure cacodylic acid in the twenty-four hours to dogs, cats, and rabbits without the least observable effect whatever. Medical Brief.

Dr. D. G. Brinton, who has been active in urging the profession to take some practical step towards the prevention of syphilis, graphically says: "To fold our hands and let this monstrous fungus grow, rank and rotten, in the night and dirt of our cities, is most unwise, unkind and wicked. Spreading up from the vile soil, syphilis and its sequelæ will wreak a terrible retriTHE NEW TREATMENT OF STONE.-There has, per-bution on our chaste daughters and sturdy sons, and haps, been no greater revolution in any department of on their progeny to the third and fourth generation." surgery in a brief space of time than that which has -W. LINDLEY, Pacific M. and S. J. occurred during the past two years in the management| SINGULAR TREATMENT OF MENTAL ALIENATION.-The of stone in the bladder. When lithotrity was first in- director of an insane asylum in Vienna has introduced troduced it was thought that the dangers and terrors of lithotomy were to be a thing of the past, a memory of He has established a journal in the editorial charge of a singular innovation in the treatment of insanity. the Middle Ages; but gradually it was discovered that the patients. Disputants are selected from among the this operation was also not without its sufferings and monomaniacs, who are pitted against each other in dangers, and many ingenious instruments and much argument. For example, one who is convinced that his skill and practice were employed to reduce these to a nose is made of sugar candy, and who always drinks minimum. The perfection of the modern lithotritist through a straw to avoid getting it wet, is appointed to was supposed to have been realized in that distinguish- refute a second who believes that his beard is a green ed London surgeon, Sir Henry Thompson. Here was the man who could count his cases by the hundreds, grass plot, and who waters it regularly to keep it from whose delicate touch with an instrument of his own madmen is sound and full of good sense as long as it We are assured that the logic of these poor withering. device was supposed to have conquered that dread has no reference to their respective hallucinations. A sequel of the operation, cystitis, if it was within the similar plan had already been devised by Lauret, exlimits of human skill and ingenuity to accomplish it. cept that in the latter case the contradictor was the The accumulation of a few great surgeons in the Eng-physician himself instead of a patient.—Ex-Union Medlish metropolis made it possible to collect valuable sta-icale. Ohio Med. R. tistics on the different modes of operating-to compare the old with the new, lithotomy and lithotrity. An inventory was accordingly taken some two years since, when, alas! for modern science, the prestige of the latter operation was about to wane. In vain had Sir Henry perfected himself in his art, in vain had he reduced the manipulation of the bladder to an almost incredibly brief space of time; many of his colleagues, led by Sir James Paget, were about to tender their alle giance once more to lithotomy. It was interesting to those whose privilege it was to witness the experiments quietly going on in this country at that time to watch the ebb and flow of the discussion, and to note with no small satisfation how thoroughly each master stood committed to his own favorite procedure. As lithotrity was on the point of being abandoned, the key to the problem was discovered in the new operation which Dr. Bigelow has given us, rising, as it were, from the very ashes of the old. The establishment of the principle that the dangers of lithotrity were due to sharp

HYDROCELE.-Dr. Levis, of Philadelphia (Boston Med. and Surg. Jour.), injects 20 to 30 minims of pure carbolic acid, after drawing off the fluid of the sac. efficient and painless.

It is

DR. EUGENE ROLLIN CORSON, formerly of the house staff, W. I. Hospital, has formed a partnership with Dr. L. A. Falligant, and will hereafter reside in Savannah, Ga. Dr. Corson's many friends will be glad to hear that he has sufficiently recovered his health as to warrant his attempting the practice of his chosen profession.

IN-GROWING TOE NAIL.-Dr. Fanning, in the Medical Brief, gives what he terms "a most happy plan of treatment" for this painful affection. He applies a solution of caustic potash, of the strength of 3 iij, to water, 3j, twice daily. The granulations soon recede, and then he raises the nail and inserts a wedge shaped piece of cork. This ends the trouble.