among them those of the skin, cooling the body by excessive drenching of the surface with evaporating perspiration, and trophic paralysis. This is unphysiological treatment. The toxines may to some extent be removed by the copious sweats, but the nerves are paralyzed, with danger ever present. A better way is by removing the cause of the fever, as indicated, allowing the system to resume its physiological action. "Tolle causam, effectus subla

tur."

Treatment of Exophthalmic Goitre by Sulphate of Quinine.

Paulesco, in collaboration with Raynier (Revue de Thérapeutique MédicoChirurgical, February 1, 1899) has made certain studies in regard to the pathogenesis of exophthalmic goitre. He believes that the principal trouble in this affection is the vasodilatation which affects the blood-vessels of the neck and head. As the result of this distention we have the tremor, the goitrous swelling, and active congestion of the thyroid body which produces in its turn a hypersecretion of the gland, and which has a distinct physiological action. Paulesco claims that he has employed the sulphate of quinine with remarkable results, arising from its influence in producing vasoconstriction of the vessels of the head and neck. He gives fifteen grains of it at night after supper, and again a quarter of an hour later. He states that this treatment decreases the tachycardia, diminishes. the exophthalmus and the size of the goitrous swelling. Therapeutic Ga

zette.

·

Lactic Acid in Vaginitis and Endometritis.

Ilkewitsch favors the use of lactic acid in the treatment of vaginitis and endometritis, basing its value upon the fact that the normal acidity and consequent germicidal power of normal vaginal secretion is due to lactic acid. He applies it to cervical erosions and to the diseased uterine mucosa in strength varying from 50 to 100 per cent. and in other cases in irrigating solutions of 3 per cent. Journal of Medicine and Science.

A FEW OF THE CLINICAL USES OF LIQUID AIR.*

BY C. T. PEARCE, M.D.,
CINCINNATI,

CLINICAL LECTURER ON DERMATOLOGY AND SYPHIL-
OGRAPHY, CINCINNATI COLLEGE OF MEDI-
CINE AND SURGERY.

The use of liquid air for the removal of obstinate superficial, and even deep lesions, some of which have resisted all ordinary methods of treatment, including the knife, has certainly opened up a new field in medicine and surgery, which I am convinced will be productive of some wonderful results.

It has been my good fortune to be present at the extensive and convincing experiments made with liquid air by Dr. A. Campbell White, of New York, at Dr. Lusk's dermatological clinic, at Roosevelt Hospital, and in the dermatological service of Dr. Geo. H. Fox, at the Vanderbilt clinic, New York.

Its use as a local anesthetic was certainly most satisfactory; under the anesthesia produced by the intense cold minor operations were performed successfully, no injury being done to the surrounding tissue by the spray of air used. The application is painless, save for a slight tingling sensation when it is first applied.

It certainly appears to be a specific in all forms of neuralgias. In sciatica the air is applied over the exit of the nerve, and the relief from pain is instant. The cases experimented on several weeks ago declare there has been no return of the symptoms. In intercostal and facial neuralgias the same success has been met. Dr. White says that in no case that he has treated has there been a return of the symptoms. In the neuralgic pain attendant with herpes zoster, the air applied to spinal end of the nerve affected caused prompt relief of the pain and was followed quickly by the lesions themselves drying up and disappearing.

The case of erythematous lupus, illustration of which is given, is an extensive one, involving both sides of the

The photographs used in this article were made especially for it, and are protected by copyright.

neck, after the pus had been removed the carbuncle was completely frozen with liquid air spray. Three days later it was reduced one-half in size and the inflammatory process was aborted. To insure success another application was made, and on his visit to the dispensary three days later the carbuncle had entirely disappeared, leaving only a small, healthy granulating ulcer about the size of a ten-cent piece. The patient said save for an hour after the first application of the air that he had been entirely free from pain.

A suppurating bubo, in which the suppuration had just started, was treated after the same manner as the carbuncle, with prompt relief from

cumference of the glans two inches back, with sloughing edges, about ready to unite with one another, a thorough application was given with the spray; three days later, at his next visit to the clinic, the edges and bases of all the chancroids were perfectly clean. No other application was made, and the sores healed rapidly. There was no other treatment save the application of subnitrate of bismuth.

A large number of varicose, perforating and sluggish ulcers of the leg were treated with the spray. They were quickly stimulated to healthy granulation, the spray having all the effects of a caustic without its attendant inflammation. In a number of these cases an artificial skin seemed to quickly form over the surfaces of the ulcers. These cases healed more promptly than the others. It seems impossible to explain this phenomenon, and experiments are now in progress to definitely determine just what it is.

These few random cases illustrate the success of the experiments with this new and mysterious medium of treatment. Even more extensive experiments will be carried on by Dr. White at Charity Hospital, Blackwell's Island, where there are a great number of chronic cases of skin diseases that have resisted all forms of treatment, and will

severely test the virtues of liquid air. Experiments will also be continued at the Vanderbilt clinic.

Heredity and Environment.

These have not had their histories recorded. For the weak environment is more than heredity. They are weak because this is so. The strong overcome the limitations of environment, they alter it to fit their measure. Children of energetic criminals might be supposed to thrive in an orderly way when transplanted and the right direction given to their activities. The only fatal thing in weakness, is stupidity. The gods themselves are powerless before it. The live dog always excels the dead lion; and the wicked man, even before he turns from his wickedness, is a more hopeful subject than the weak one.Med. Brief.

RECENTLY Dr. H. W. Hill, of the bacteriological laboratory of the Boston Health Department, made an examination of a large number of public telephones in that city. In a number of transmitters harmless microbes were found, and inoculation of guinea-pigs failed to reveal the presence of any pathogenic micro - organisms. - Med. Age:

HUMAN HEMOGLOBIN IN HIGH
ALTITUDES.

This subject is discussed in a very careful article by Bergtold in the late number of the Philadelphia Monthly Medical Journal.

The observations number

one hundred and five in all, covering a total of sixty-nine individuals, ten of whom were healthy, while almost twothirds of the remainder were the subjects of tuberculosis in some form. The method of estimating the amount of hemoglobin was not by the Fleischl instrument, as is so commonly the case, but was computed from the specific gravity according to the method of Hammerschlag. It will be remembered that this method is dependent upon the fact that two liquids of respectively higher and lower specific gravity than that of the blood, yet not mixable with the latter, may be added in such proportions to one another that their resulting specific gravity may be made the same as that of normal blood at sea level, about 1059. The liquids usually used are chloroform and benzol, the

former heavier, the latter lighter than blood. If now a drop of fresh blood, free from air, is added to the mixture, and sinks to the bottom, add chloroform; if, on the other hand, it rises to the top, add benzol. One or the other is added a few drops at a time until the blood droplet becomes stationary. The specific gravity of the mixture is then taken just as we take that of the urine, and the result denotes the specific gravity of the drop of blood; because the fact of the drop remaining stationary in the mixture indicated that it was of the same specific gravity as the surrounding medium. A specific gravity of 1059 at sea level indicates that the amount of hemoglobin is normal, 100 per cent.; a specific gravity of 1030 indicates 20 per cent. of hemoglobin, and from this various tables have been compiled for each degree of specific gravity, with its corresponding amount of hemoglobin. The principal objections to this method are that the tables have not been carried above 100 per cent., and even below this point they are subject to slight variations by different observers.

Bergtold's observations were all made at the same point above sea level, 5,200 feet (Denver). They were made at various times after the patients' arrival in Denver, from a few days, indeed, to many years; but taking into consideration all cases, the average specific gravity was 1060. Leaving out the cases of chlorosis and anemia, which would have been far below par at any level, the specific gravity averaged 1062. The author makes some interesting points on reviewing his subject from the standpoint of time. The average specific gravity of cases within three weeks of their arrival in Denver was 1059 (a strange coincidence that it was just normal). But the average