those individuals possessing congenitally deficient livers, are particularly liable to them.

The symptoms of an acute bilious seizure, are well marked. There is complete anorexia, severe frontal headache, furred tongue, 'nausea, and vomiting. Usually there is some fullness in the region of the liver, and the urine is invariably high-colored from the presence of bile acids. The bowels are either constipated or loose; diarrhea is present when the attack is passsing off. Vomiting and purging are the efforts of nature to rid the system of the offending cause; and here nature gives us a hint which we may follow with advantage in the treatment. There is another form of liver disturbance manifested by a dyspeptic condition, and accompanied by various reflex symptoms. There is frequently palpitation of the heart. Angina pectoris may also occur-not the pure neuralgic angina, but that form produced by constriction of the arterioles, and consequent high tension in the systemic circulation. Attacks of dyspnea, resembling asthma, are not infrequent. Skin affections, such as pruritus ani and urticaria, also occur. On the part of the nervous system, there are insomnia and excessive irritability of temper. The urine is heavily loaded with urates, which goes to show that this form of hepatic trouble is due to the excessive formation of lithates in the liver, a condition known as lithiasis. The first is the result of the excessive production of the bile acids.

Both forms are identical in origin, inasmuch as they are both the result of deficient oxidation of the albuminoids. The treatment of these disorders is both medicinal and dietetic.

Articles of food rich in nitrogen, of which muscular substance, eggs and milk, are the most important, should be sparingly partaken of. It is the popular belief that it is the hydro-carbons, represented, in the main, by the sugars, fats, and starch, that should be avoided in biliousness. This popular fallacy is still entertained and encouraged by many physicians, much to the detriment of their suffering patients.

We have seen that nitrogenized substances promote the secretion of bile, and that the hydro-carbons' diminish it. This hint should be sufficent to guide us in the selection of a proper dietary for these patients, varying it according to the exigencies of the case. Coming to the medicinal treatment of chronic functional disturbance, we find in the soda salts, agents of the highest value. Their mode of action

on the liver, is somewhat obscure, but, probably, the rationale isthey promote oxidation of nitrogenized substances, and neutralize the excess of bile acids.

The most efficacious preparations are the phosphate and sulphate. The ordinary crystals or powders, as sold in the shops,owing to their very bitter and disagreeable taste, I do not prescribe. The effervescent salts now manufactured, are very elegant preparations and quite free from the objectionable features of the ordinary salts. As a rule, soda should be taken in the morning, on arising; from one to three teaspoonfuls of the effervescent phosphate, is a dose, taken in a glass of water, either warm or cold. The sulphate, being more laxative, is preferable in cases where there is much constipation. Some stomachs, however, will not tolerate alkalies of any kind. In these cases we may resort to some of the vegetable hepatic stimulants, of which we have a number of more or less potency, such as aloes, colocynth, hydrastin, rhubarb, ipecac, podophyllin, iridin, euonymin, etc. For permanent use a combination may be made of some of these agents, and exhibited in pill form.

In the treatment of the ordinary acute bilious attack, we have no remedy superior to mercury, in the shape of calomel, or the blue pill. The opposition to the use of mercury is not so manifest as it was a few years ago; still, we may occasionally hear a doctor boast that he has never prescribed a dose of calomel. Among the laity we find a pretty general and strong dislike to this remedy, particularly in those communities infested with practitioners of homeopathy, eclecticism, and kindred delusions. That this agent, potent for so much good or evil, was at one time fearfully abused, we all know; but, like truth, it prevailed against all opposition, and has been restored to favor and taken its proper place in the materia medica. An acute attack may, usually, be cut short by a single dose of five or ten grains of mercurial pill, at night, followed in the morning by a saline laxative—a wineglassful of hunyadi water, or the solution of citrate of magnesia. To robust adults I have frequently given, with the happiest results, this combination: Calomel and pulv. rhubarb, each five grains; taken at night, and followed in the morning by a saline draught. If there is nausea, it is often good practice to encourage vomiting by an emetic of ipecac. If the symptoms persist after this treatment the mercurial may be repeated. Time and space will not permit me to discuss in detail the physio

logical action of mercury on the liver, but the prompt relief it affords in bilious disorders, is due, more than probably, to its action on the small intestines-sweeping out the bile before it can be absorbed into the circulation. If mercury increased the normal products of the liver, as it is held by some to do, it would be contra-indicated in the treatment of the functional derangements of this organ.

In conclusion, let me repeat that we must not lose sight of the important fact, that it is the albuminoids of our food, and not the hydro-carbons, that are the exciting cause of biliousness. If we neglect to properly regulate the diet, our efforts to relieve these cases will be met with very poor success.

LOSS OF MEMBRANA TYMPANI, MALLEUS, INCUS, AND STAPES, WITH GOOD HEARING.-Dr. C. F. Clarke, of Columbus, Ohio, reports in the Archives of Otology, a most remarkable case, in which, after a prolonged and extensive sloughing periostitis of the tympanum and deep meatus, the following condition presented: With the exception of a small area of the upper anterior wall of the external meatus, no soft tissue is to be seen either in the bony canal or the tympanum. All is clean, ivory-like bone. The ossicles are absent, and on the inner wall of the tympanum is to be seen the fenestra ovalis, and, less distinctly, the fenestra rotunda. The outlines of the fenestra ovalis are clear cut and distinct, but it seems to be closed by a pellicle or membrane. Careful testing showed, notwithstanding this extensive destruction of tissue and loss of conducting elements, a hearing power in that ear for ordinary conversation at thirty-five feet, and for whispered words at sixteen feet. The case illustrates, not only the possibility of a fair degree of hearing in the absence of all the ossicles, but also presents the unusual phenomenon of the separation of the stapes with the preservation of a membrane closing the fenestra ovalis and retaining the peri lymph.

It is reported from Ingersol, ten miles west of Texarkana, Ark., that a woman gave birth to four finely formed and well-developed girl babies on January 11th. The mother is doing well.

ON THE RELATION BETWEEN SCARLET FEVER AND

DIPHTHERIA.

BY H. L. ROSENBERY, M. D., MILTONSBURG, OHIO.

Without going into the discussion as to the possibility of the poisons of diphtheria and scarlet fever being identical, I wish to report the following cases:

I. On November 5th, 1886, I was called to see Mrs. Steele, a lady aged about forty; married; had seven children; had always been healthy. She had just returned from a visit five miles distant, with a sore throat. On examination, I found her quite ill, suffering from what is termed tonsilitis. The right tonsil was swelled so tensely as to crowd the tonsil nearly across the throat. I thought there was pus in the tonsil, and, while preparing the knife, the abscess opened spontaneously, discharging a large amount of pus. I left her an anodyne, and came home.

I heard no more of her, nor any of the family, until November 17th, 1886, when I was recalled to see a daughter, Miss Annie. She was suffering from well-marked scarlet fever. She was a well-nourished girl of seventeen, whom I had often seen, and who before was always the picture of health. What to do with these six children, was the problem. We needed Mrs. Steele, and she had a child of seven months who was nursing. I concluded, best to let it remain with its mother. An older sister, Lillie, had slept with the patient for three nights before I saw them, so I concluded to retain her, feeling satisfied she would contract the disease.

The other four children were sent to Mr. Steele's mother, who lived a short distance away.

Miss Lillie, aged twenty, contracted sore throat on the 21st of November, and I thought she was taking scarlet fever; but when she had been sick eighteen hours, I found her with well-marked diphtheria. She did not get dangerously ill, and in four days was up; and at the end of a week she was able to resume light household work. It was not so easy with the scarlet fever patient, for she had several complications-1. Glossitis, 2. Scarlatinal 2. Scarlatinal rneuma

tism, 3. Nephritis, 4. Dysentery-and did not recover until in

January.

None of the four children sent to neighboring houses, contracted the disease. After thorough disinfection, at the end of six weeks, they were allowed to come home.

II. December 15th, 1884. A family by the name of Stephen, had scarlet fever; four cases; two died and two recovered. The cause of death in the first case was malignancy, the child dying in thirty-six hours. n the second case it was due to a severe adenitis.

When the two cases were recovering, the oldest daughter, Elizabeth, aged eighteen, contracted diphtheria. She was seriously ill for two weeks, but made a good recovery. The deposit filled the nasal cavity, and there was a slight tracheal deposit.

III. In January, 1886, I was called to see two children, W. N. and K. N. W. N. had well-marked scarlet fever; the other, K. N., had diphtheria. They recovered after a considerable time.

IV. On January 3d, 1890, I was called to see the same children. Willie had diphtheria, and Katie N. had scarlet fever, but not very ill.

I do not offer these cases as "posers" for any one, but the question arises in my mind, may not the two diseases be the result of the same poisons, with different manifestations? It seems to me that this series of cases can hardly be explained on the ground of co-incidence.

SCABIES.-The very best treatment for scabies is:

R Beta naphthol .....

Unguenti zinci benz.....

Misce. Apply locally twice a day.

grs., xxxx,
3 j.

If there is much irritation of the skin, diminish the amount of beta naphthol. The old treatment was by the use of sulphur, which was most efficacious when dusted over the surface of the skin; but it is too disagreeable to use in private practice on account of its odor.-Shoemaker.