ignates the peculiar property of this water-soluble metal of not diffusing through animal membranes in distilled water.

Colloidal silver was first described by Carey Lea in the American Journal of Sciences in 1899; but his discovery was simply a laboratory curiosity without practical value, as his product was unstable and impure and had no field of application. Crede of Dresden, working wholly independently (Lea's experiments were found by him only in later researches), came to the conviction that an efficient general body disinfection could be accomplished only by metallic but soluble silver, and not by means of silver salts; and he instructed the Heyden chemical factory to make experiments in that direction. It is due to his work as well as to that of the Heyden factory, that, by new and improved processes, a stable and pure colloidal silver (collargolum) was elaborated. And it was Crede who developed the method of internal silver treatment.

Collargolum consists of small, hard, brittle, bluish-black, scale-like pieces. It is soluble in distilled water to the extent of 1:20 and remains stable even after months. Solutions may be prepared with ordinary drinking water. They may be boiled, but this is unnecessary, as collargolum is itself antiseptic. Lea's colloidal silver precipitates on being boiled.

Collargolum may be introduced into the organism by inunction, subcutaneously, by mouth, rectally, and intravenously. When given by inunction, absorption takes place in the upper layers of the corium. The dose of collargolum ointment (unguentum Crede) is one to three grams given one to four times daily. In chronic sepses (furunculosis, puerperal fever) up to thirty inunctions may be given.

The effects of the subcutaneous injection are less rapid and certain, absorption being slow. Per os, I: 1000 to 1:200 collargolum solutions may be given in teaspoonful or tablespoonful doses two to five times daily on an empty stomach; this is especially indicated in dysentery, gastric catarrhs, etc. As an enema, I: 500 solutions are used, a cleansing clyster being given beforehand. This shonld be given twice daily for at least eight days. The method is praised by Prof. Schlesinger and Drs. Loebl and Kornfeld for its simplicity and safety, and because

larger doses can be conveniently admistered. The action of the silver when introduced by this route is especially energetic on the neighboring organs, such as the uterus and peritoneum. But the best method is the intravenous, which is perfectly safe and is especially indicated when the blood is the seat of infection, as in endocarditis.

As collargolum is rapidly eliminated, it must be constantly supplied to the organism when a permanent effect is desired. Its efficacy is fully apparent only when the whole clinical picture, not merely temperature and pulse, is considered. In a septic process the temperature does not always correspond to the severity of the infection; and equal importance must be conceded to the general symptoms. After the use of collargolum subjective improvement almost invariably precedes. temperature or pulse improvement, occuring, when given intravenously, after four to six hours, and when inuncted after eight to twelve hours. Nervousness, headache, and stupefaction abate, the patient is relieved and refreshed, and shows more interest in his surroundings. Appetite and sleep return. Often there is a mild diaphoresis and increased intestinal activity. Collargolum directly combats the septic affection and inhibits bacterial development.

But the antiseptic has of course its limitations. It may fail to save moribund patients or those in whom the powers of heart and the vasomotors are exhausted. Nor can it affect abscesses which are out of the reach of the body fluids. Its use should be begun as soon as there is danger of the spread of a local infection.

Beyer then resumes the recent reports on collargolum by Schmidt, Wolfram, Dworetzki, Fehling, Harrison, Wenckebach, Klotz, Davydoff, Fischer, Schrage, Baracz, Arnold, Netter, and many others.

NEW ORLEANS POLYCLINIC.-Sixteenth annual session opens November 2. 1903, and closes May 28, 1904.

Physicians will find the Polyclinic an excellent means for posting themselves upon modern progress in all branches of medicine and surFor further information, address New Orleans Polyclinic, P. O. Box 797, New Orleans, La..

Clinical Reports.

CLINICAL SOCIETY OF THE NEW YORK POLYCLINIC

MEDICAL SCHOOL AND HOSPITAL.

STATED MEETING HELD MARCH 7, 1904.

The President, Dr. James Hawley Burtenshaw, in the Chair. EPITHELIOMA OF THE ORBITAL CAVITY.

This patient was presented by Dr. W. E. Lambert. Two years ago his eye became diseased, and was removed. Three weeks ago he visited Dr.Lambert's clinic. Abcesses filled the entire orbital cavity. It was opened, and a large quantity of pus evacuated. A section was made of a small indurated portion of the lower lid for microscopical examination, and it was reported to be epithelioma. The cavity was carefully explored, but no contents were found. The man had a peculiar voice, and examination revealed an opening in the hard palate which at first seemed to lead to the posterior nares, but later was found to communicate with the antrum. A section was removed from the upper portion of the antrum wall for examinationn. The speaker said that this was an example of a removal of a growth from the orbital cavity too late to obtain good results. Undoubtedly the abcess had invaded the cells of the antrum. If this should prove to be an epithelioma of the antrum, what could be done for it? He did not think that further surgical interference would have any effect on the growth. X-ray treatment might be of some benefit, although the progress which the disease has already made renders this doubtful. The prognosis in cases of this character is often uncertain. In one instance a patient presented himself two months after operation with induration of all the contents of the orbital cavity and a return of the disease in the lower part of his face. The induration tissue was removed, the operator

cutting as deeply as he dared, and the patient was advised to go home. Three years later he reported that he was in better condition than at the time of the second operatino.

STRABISMUS.

The first

Dr. Lambert also showed three cases of strabismus. patient had been operated on nine years ago, and soon afterward her eyes turned upward. Although there was practically no vision in the affected eye, she desired a second operation. A ́ perfectly straight eye resulted. The second patient was a relative of the first, and her primary operation was performed at the same time. Her eyes also began to turn upward. At present there is also an immense amount of protrusion, and the vision in one eye is very much poorer than in the other. The third patient was a child who had been operated on with very good results. The position of the eye was improved, as was the vision. The speaker called attention to the three different results from one operation, and said that in the majority of these cases a very high degree of narrow refraction produces a poorer vision in one eye than in the other. The vision, however, sooner or later becomes normal.

STRICTURE OF THE RECTUM.

Dr. J. M. Lynch showed a specimen of stricture of the rectum, in which all the anatomical relations were preserved, showing bladder, uterus, and other appendages, and in which could be produced the tactile sensation of the stricture. It also showed the cicatrix of an ulcer which existed when the speaker first saw the patient. The ulcer rapidly healed under enemas of peroxide of hydrogen and boric acid with local applications of 50 per cent. argyrol. The patient was about thirty years of age, and gave a negative family history. Personal history of several abortions during the past ten years, peritonitis following the last one, about four years ago. She suffered from a gradually increasing and persistent constipation from infancy, relieved only by cathartics. Three years ago she was operated on for stricture, a posterior proctotomy evidently having been performed. Dilatation was not kept up after the operation, however, and the stricture returned and the constipation was as severe as before. She also

suffered from pain in the rectum and sacral region, exceeding nervousness, frequent urination, flatulency after eating, a discharge of mucous, pus, and blood with the stool, and had to strain considerably. When she first consulted the speaker, about two months ago, she was consuming large quautities of alcohol under the impression that it relieved her nervousness. She took about a pint a day, and the result was a chronic gastritis, with the usual morning vomiting which was relieved by lavage. The allowance of alcohol was limited to three ounces a day. She gave a negative history of syphilis, and there were no evidences that she had ever had this disease.

An examination of the rectum, which was exceedingly painful, showed an annular stricture some two inches above the anus. At this point the lumen of the gut was considerably diminished, not large enough to admit the tip of a small index finger; below the stricture was an ulcer about the size of a dime. An examination through the vagina above the stricture was so painful as to lead to the belief that ulceration existed above the stricture as well. Palliative treatment was useless, unless continued for the remainder of the patient's life, and the only hope of relief was in a radical operation. A resection was decided upon, and the patient was prepared for the operation by the administration of an enema of peroxide of hydrogen and boric acid twice daily for two weeks. The ulcer was healed by the application of argyrol. She commenced taking alcohol secretly in large quantities a few days before the date set for the operation, and one day suddenly expired in uremic convulsions.

RADIOGRAPH OF INCOMPLETE COLLE'S FRACTURE.

Dr. J. A. Robertson showed a radiograph of what is referred to by Dr. Roberts as a "rare, incomplete, reverse Colle's fracture.” In addition the radiograph showed a break, which was knitted, of the styloid process of the radius and a fracture of one of the carpal bones.

PERFORATING GASTRIC ULCER.

Dr. J. A. Bodine reported this case. The patient, while out shopping and in apparently good health, was siezed with sudden violent pain in the abdomen and fell to the floor in a faint. She