of causes unnecessary to enumerate. In the case quoted it was probably due to infantile paralysis. The patient was a girl, seven years old; the left scapula stood out from the body. On abducting the arm to the horizontal position the scapula was nearer to the vertebral column than on the sound side and the posterior border stood out so much from the chest that the fingers could be inserted beneath it so as to grasp at least the lower third of the bone. When the left arm was put forward horizontally in front of the chest the posterior edge of the scapula receded from the thorax, causing a deep groove at this part. Elevation of the arm above the shoulder was much weakened and there was considerable diminution in the reach of the left arm. The external thoracic nerve and the muscle itself gave the reaction of degeneration. It appeared to be hopeless to expect any improvement by the usual methods of massage and electricity, so Mr. Tubby determined to try to transfer some power from a healthy muscle. He decided to attempt to utilize a portion of the pectoralis major. An incision was made over the anterior border of the axilla; a flap of skin and subcutaneous tissue was then turned down and a large part of the sternal portion of the pectoralis major was exposed; its attachment to the humors was then freed and the muscular fibers of this portion were separated from the surrounding tissue for a considerable distance. Then the serratus magnus was exposed and was found to be pale and atrophied. The cut-end of the pectoralis major was separated into several fasciculi and these were then stitched into the serratus magnus over an area corresponding to four or five digitations of the latter. The wound healed well and six weeks later there was no perceptible difference in the prominence of the inferior angles of the two scapula. Further, the child could abduct the extended arm well above the horizontal position and had acquired the power of thrusting the arm forward. The improvement had been fully maintained up to the present time and there was no loss of power in bringing the arm across the chest, in spite of the diversion of part of the pectoralis major. Although this was a single case the method deserved further trial.

DERMATOLOGY.

Under charge of A. P. WOODWARD, M. D., and ERNEST PRING, M. D. Professors of Dermatology, College of Physicians and Surgeons of

San Francisco.

Hyperidrosis Pedum and Its Treament.-WEISS (in Jour. A M. A.) defines hyperidrosis as an excessive production of sweat due primarily to anomalies of the nerve centers influencing the sweat secretion; and secondarily, circulatory disturbances depending on the altered state of the vasomotor nerves, thus endeavoring to embrace in the definition the two main central causes of overactivity of the sudoriparous glands. He reviews the physiology of perspiration, regarding it as a supplementary respiration through the skin, and, if not paramount to the lung respiration, yet in certain co-ordination to it. When the perspiration is secreted faster than it evaporates we call it sweat, and the process of doing so sweating, which more correct term than "perspiration," which really means breathing by evaporation. The sweat secretion is mainly under the influence of the central nervous system; in a minor degree it depends from the blood pressure and circulation in the capillaries, which again is influenced by the impulses which govern the state of the vasomotor nerves. The etiology of hyperidrosis pedum is not clear. At times it seems to be inherited; again, faulty circulation, due either to active or passive congestion of the capillaries, appears to be the cause. In other cases hyperactivity of the coil glands seems to be the causative factor. Sometimes the etiology is entirely wanting. The causes coincide with the etiology, as far as the pathology is concerned. Contributive external causes is the absolutely irrational footgear we use. Symptoms vary from the mild cases of moist dewy, overheated feet; through the sore and fissured ones; to the severest cases of parboiled, whitish, with red inflammatory areas, painful conditions. Perspiration of the feet becomes pathological when it is secreted faster than it can escape; then it becomes fetid by the admixture of fat with sebacious material; decomposition of both secretions through moisture and warmth occurring. Little encouragement is to be expected from systemic treatment; however, atropin sulphate, 1-100 gr., once or twice a day, or agaricin, to 1 grain, t. i. d., may be tried, on general principles.

VOL. XLVII-39.

Permanent cures are only to be expected when our footgear becomes rational, natural, and hygienic, as was that of the ancients. As to palliative treatment, he discusses the question: Is there reason to fear suppression, and should excessive perspiration of the feet be treated? and concludes that hyperidrosis being a pathologic overactivity it may be combated with impunity, as we do seborrhea or polyuria. All the usual remedies are mentioned fully and fairly. Then the treatment advocated by the writer is introduced as being free from all danger and the unpleasantness of the remedies mentioned. Permanganate of potash is the remedy which may be used in all stages of the disease. The theory of its employment is a threefold one. First, its facility to give up its oxygen in the presence of organic matter; second, its precipitation on the skin as manganese dioxid in a layer proportionate to its concentration; third, the exsiccating and in stronger percentages its keratotic action on the epidermis. The treatment starts with a warm foot-bath of borax water and soap, followed by a thorough scrubbing and drying. With a cotton pledget soaked in benzine the foot is now cleansed from all epithelial debris. Then the foot is immersed in a 1 per cent solution of permanganate, temperature 104 degrees. This done, the foot is placed on some old toweling to drain and not rubbed off, but left to dry. The patient now goes to bed, covering his feet only lightly. Next morning the foot is dusted with the following powder: Potasse permanganatis, 13.0; alumnis, 1.0; talci, 50.0; zinci oxydi; lapidis calaminaris; a. a., 18.0. The next evening the permanganate bath is again taken, and so on for two or three weeks, increasing the strength of the solution gradually up to 6 per cent. The advantages are thus summarized: 1. The remedy employed is absolutely devoid of any danger, is painless and heals the dreaded fissures without the previous painful application of nitrate of silver. 2. It can be employed in every stage and form of sweating feet. 3. Relapses are less common than any other method and rarely appear before the third month. 4. The use of dusting powders has in some cases made the interval even longer. 5. Its action consists in its reducing power and consequent keratisation of the epidermis. It stands to reason that it penetrates into the secretory cells of the coil glands, inhibiting or

decreasing their physiological over-activity. 6. After desquamation the new epidermis is not sensitive, and walking is not impaired as after the use of chromic acid. The mode of employment-medicated foot-baths-is a pleasant

one.

ERNEST PRING, M. D.

MATERIA MEDICA AND THERAPEUTICS.

Under charge of EMIL WESCHCKE, Ph. G., M. D.,

Lecturer on Materia Medica, College of Physicians and Surgeons of
San Francisco.

The Alkaloidal Clinic, Chicago, reprints and comments upon the following views published in the Medical Record, Brooklyn:

"Untrustworthy' ought to be written after the name of many of the fluid extracts of medicinal plants usually found upon our druggists' shelves. I have a habit of tasting at subsequent visits all the medicines I prescribe, and find that there are a large number of fluid extracts in many of the official and unofficial forms prepared for our use by the pharmacists which taste exactly alike. That taste is a peculiarly stale, dirty, gritty one, often entirely wanting in the special aroma peculiar to the plant in the green state; and just here I make no doubt is the secret of the untrustworthiness of many of these medicines. Instead of the fluid extract being made from the recent or fresh green herb, it is often made from a dried and more or less inert plant from which the active principle has perhaps wholly evaporated. How's that? May we not say, 'I told you so?'

"One of the largest and most reliable firms of the old style manufacturing chemists of this country publishes this announcement in their catalogue and heads it, 'This is true.' Of course it is! And when they try to improve upon matters and commendably offer the doctor a fluid extract or tincture of the green drug, they are trying to give him something containing the active principle (i. e., the curative material) which the plant contains.

"Were we unable to do better, this would certainly be an advance upon the old untrustworthy' fluids; but we have been able to isolate and obtain in appreciable quantity the active principles themselves. There they are, we know what they will do, how much as a rule will do it; and

the only drawback possible would be the measuring and dividing of such potent materials; but that drawback is absolutely done away with by machinery which takes any quantity of the active principle and with mathematical precision divides it into portions of gr. 1-67, gr. 1-134, or any other proportion desired. This quantity is then covered with a soluble sugar coat, and there the doctor has in a little vial an extract quantity of the active remedial principle of the plant, enough to treat any and many conditions, and representing from a pint to a gallon of fluid, which at best contains alcohol, plant-dirt and other extraneous matter which should not be put into any stomach, to say nothing of the presence or absence of a variable quantity of the activity which it is supposed to contain.

"So well recognized is this fact that to-day every chemical house of merit makes or offers for sale concentrations, alkaloids, resinoids and glucosides, and makers of proprietary medicines now buy these and add syrup, water and flavoring or coloring matters to make bulk. Will the thinking man pay for this bulk-this extraneous and often. positively harmful excess of matter? Syrup and alcohol are both often injurious; and anyhow, where is the ordinary common sense of giving a tea or tablespoonful of an aqueous saccharine or alcoholic fluid in order to get the tenth of a grain of some supposed-to-be-active principle contained therein? Why not use the active principle itself and know what you are doing?"

In the foregoing our alkalometric friends find great consolation for advocacy of their own highly concentrated and isolated alkaloidal manufactures, but it is certainly going too far to laud them as the only correct means of medication. It is, of course, true that the old-fashioned dispenser of "roots and yarbs" is not popular except with old grandma and the "shakers," and that the modern physician largely discards the infusion and decoction, yet many of us know that e. g. in the case of the administration of digitalis decidedly more accurate results are obtained from a properly prepared infusion than from the often uncertain digitalin or digitoxin, which latter is the active glucoside.

It is going too far to accuse pharmacists as unreliable. It is the doctor's fault if he patronizes an untrustworthy