systemic or local which must be first removed, when menstruation will recur. An undeveloped uterus should not be whipped into bleeding by the use of drugs. Amenorrhea itself is productive of no harm, and is only a symptom and not always indicative of disease. Gossypium is one of the so-called emmenagogues. The varieties of cottonwood have not been studied out, either as to an accurate classification, a complete physiological action, or an intelligent bedside use; and it would seem that some investigation of the above would yield more profit than much of what is now called "original research.

Hydrastis canadensis is perhaps one of our most valuable gynecological drugs, contracting the unstriped muscular fibres and the lumen of the small arteries and having special action on catarrhal inflammations of the mucous membrane, it has a most excellent action in all hemorrhages caused by a relaxed condition of these tissues, in subinvolution and in so-called chronic metritis and endometritis. Viburnum prunifolium on the other hand has almost a reverse action from the above and is absolutely contraindicated in the above conditions, being of use as a uterine sedative and antispasmodic, as in threatened abortion, spasmodic dysmenorrhea and virginal dysmenorrhea, having however an ultimate injuricus effect when there is congestion and loss of tone in the pelvic organs.

Cimicifuga is a most excellent remedy for dysmenorrhea of the congestive type and applicable to that class of cases in which viburnum is contraindicated. For this reason cimicifuga may often with profit be combined with ergot or hydrastis.

Again, we have pulsatilla, a drug more adapted to the class of cases of dysmenorrhea in young girls subject to amenorrhea. This drug has for years been a favorite with our friends the eclectics, and has certainly been greatly neglected in clinical investigations by the regular school.

Aletris, guaiac, cannibus indica and senecio aureus are also deserving of attention, as also stypticin for uterine heomrrhage, but time will not permit to go into more detail.

An intelligent use of the above remedies, with others of like actions, singly rather than combined, in connection with constitutional and hygienic treatment would certainly place the treatment of menstrual disorders which constitute so large a per cent of gynecological cases on a more certain footing, and perhaps we might learn that fewer patients require dilatation, curettment and local interuterine treatment, for we believe that the minor diseases of women have been overtreated and understudied.

How much good to the patient may be accomplished by topical treatment in the physician's office?

We believe the actual good to be derived to be greatly exaggerated. First, regarding the tampon for which the best material is coarse lamb's wool excepting when we pack to control hemorrhage, and then a three-inch gauze bandage is preferred. The chief uses of the tampon are (1) as a hemostatic, though this belongs more to obstetrical than gynecological work; (2) or when we have a retro-deviation of the uterus which requires a few supportive tampons before a well fitted pessary will retain the uterus in normal position; (3) as a carrier and retainer for medicines intended to act upon the internal organs; (4) and very occasionally there are cases in which the adhesions may be stretched, exudates absorbed and

congestions relieved by their use. This is the full extent of benefit from the tampon, but the actual permanent benefit derived therefrom is very little, the majority of such treatment being simply to prepare the way for other remedial treatment or for some surgical procedure.

As regards topical applications to the cervix and endometrium, we believe that applications should not be made beyond the internal os. Cervical inflammation involving the deep cervical glands and producing a hyperplasia are not permanently relieved by the local treatments and ultimately require either a trachelorrhaphy, amputation of the cervix or the application of the thermo-cautery.

Other minor conditions are as well treated with the introduction by the patient herself of appropriate combinations of the soft boroglyceride suppositories of which we have many which are excellent.

Electricity has disappointed us, the chief value being that of its analgesic power, which is obtained from the high tension current, although the galvanic and faradic are also of use. The electric current as an absorbent in chronic pelvic inflammatory conditions and as a cataphoric is very largely a myth.

In most cases which are improved the electric anodyne simply lulls the patient into a more comfortable state while nature, the physician's senior partner, should be credited with the improvement made.

The galvanic battery has been better in theory than in actual practice. Time being the largest factor in galvanic treatment. The use of 100 to 200 milliamperes in fibroids of the uterus is not productive of sufficient good for the time and money expended. More often the results are negative, sometimes harmful.

Perhaps some of the above may seem radical, yet when these office cases are analyzed and the true pathological conditions considered it would seem that our patients should receive permanent relief sooner, or we have not fully understood the conditions.

Office treatment should consist more of medical attention with regulation of mode of life and proper hygienic care rather than prolonged topical applications.

I

SKIN THERAPY.*

L. H. Warner, A. M., Ph. G., M. D., New York.

T is a notable fact that the average medical practitioner lacks the time to carry out the minute details of examination which are necessary to the successful treatment of skin diseases. Erythematous affections belong to a group of hyperemias or congestions, in active or passive stages. Active hyperemia is associated with increased and rapid flow of blood through the capillaries produced by local irritants on the skin, disturbance of the vasomotor nerves or other toxic agents, causing increase in local temperature and inflammation of the skin. Passive hyperemia

* Read before the Florida State Medical Association, April 20th, 1905.

represents a stasis produced by local pressure, causing a decrease of local temperature, and may lead to suppuration or gangrene. One of the simplest forms of skin disease we find in impetigo simple which appears unaccompanied by constitutional disturbances, although cases are noted which are preceded by constipation, malaise, anorexia, but no febrile symp

toms. It appears as a pustular eruption, a few pustules at a time, which do not coalesce when grouped together. They differ in size, never larger than a dime, are round or ovoid in outline semiglobular in form, greenish yellow in color, tense and firm to the touch and surrounded by red inflammatory areola. They may appear on any part of the body. Impetigo, if combatted from its incipiency may be easily cured. To achieve this it is necessary to recognize the lesions, and when once recognized not to place

too much confidence upon the various ointments, soaps and lotions supposed to cure any and all skin diseases. Modern clinics, such as the New York Skin and Cancer Hospital and Post-Graduate Hospital depend While a great deal upon the microscopical findings in all skin diseases. working at the former institution I examined the blood, scales and skin

exudates, urine, etc., of hundreds of cases, and the findings therein have become of practical use in the treatment of skin diseases. I also learned that the application of unguenta created nervous disturbances in many I elicited this information from many patients, whose previous blood examination showed no trace of severe nervous disorder, and a later one appeared conspicuously on account of the high percentage of eosino

cases.

philes. Questioning the patients I learned that the sticky, greasy feeling caused them a great deal of annoyance and was aggravated by the fact of the soiling of underwear.

Much has been said and written about the antiseptic and prophylactic properties of echinacea, a plant found in the Western States, in fact I saw it

used by the Indians in Stika, Alaska, while I was stationed at the U. S. Naval Hospital there. The Indians employed the herb in the form of both a moist dressing and tea. They collected the roots, sliced them into narrow strips made a tea of same, and subsequently covered ulcers and sores of all kinds with the steeped root. These facts escaped my memory until my attention was called to several pharmaceutical products which held