In order to eradicate it, it would be necessary to expel all the bacillary colonies in the skin. Saboraud places in order of merit for local application, sulphur, tar, and mercury. Drugs such as salicylic, tartaric, and acetic acids are useful as mordants to aid penetration. Of the tar preparations he prefers oil of cade. Pyrogallic acid and chrysophanic acid are useful, and the former may be replaced by hydroquinone, which does not stain. Mercury is best applied in the form of cinnabar or yellow oxide. Saboraud does not place much reliance on medicated soaps, because they are washed off too soon for the drug to have much effect.

The following are examples of local applications recommended by Saboraud:

1. Pityriasis Sicca with Alopecia.-Wash in the morning with soap and sponge, and apply with brush an alcoholic lotion containing one of the following: Salicylic acid, 1⁄2; tartaric acid, I; perchloride of mercury, 1-10; salol, 4-5; chrysophanic acid, 1-20 per cent. This is followed by: Oil of cade, 10 parts;

Cacao, 10 parts;

Benzoated lard, 20 parts;

Sulphide of mercury, I part;

Ichthyol, 1⁄2 part.

2. Seborrhea of Scalp.-Apply milk of sulphur, i.e:

Or,

Sulphur precip., 10 parts;

Alcohol, 90 per cent., 10 parts;

Aqua destillata, 50 parts;

Aqua rosæ, 50 parts.

Calcium sulphide,

Sodium bicarbonate,

Sodium sulphate,

Potassium sulphate,
Sodium chloride,

Tartaric acid, equal parts.

One drachm of this powder to a pint of water.

When the flow of sebum is diminished salicylic acid may be used, which aids the evacuation of the bacillary cocoon. Chrysophanic acid or hydroquinone may also be tried-e.g.:

Chrysophanic acid, 30 parts;
Pyrogallic acid, 3 parts;

Salicylic acid, 30 parts;

Sulphur precip., 30 parts;
Oil of cade, 15 parts;
Cacao, 15 parts;

Benzoated lard, 10 parts;

Cinnabar, I part.

If these are not successful, friction with the following may be tried. Massage of the scalp is also useful.

Alcohol, 90 per cent., 150 parts;

Coal tar, 50 parts;

Ether, 50 parts;

Aqua destillata, 50 parts;

Hydrochlorate of pilocarpine, 1 part;

Perchloride of mercury, 3-10 part;

Salicylic acid, 3-10 part.

The treatment of seborrhea capitis is tedious, and the affection often recurs; but as long as the hair follicles are not sclerosed, a new growth of hair may result.

THE PRESENT TREATMENT OF DIPHTHERIA.

Ramsey contributes to the St. Paul Medical Journal for May, 1904, an article on this subject. The points which the writer especially emphasizes in this paper are:

I. That antitoxin if given early is a specific in fully 95 per cent. of all cases of diphtheria.

2. That even in late cases the mortality is greatly reduced.

3. That sufficient amounts of antitoxin should be given to produce the desired results.

4. That death results in many cases from the damage done to the heart and nervous system before antitoxin is

given, and that in these cases absolute rest in the recumbent position and sufficient stimulation are factors of the greatest importance.

5. That there is a certain small percentage of cases apparently in which antitoxin has no effect even when given early.

6. That postdiphtheritic paralysis is apparently no less frequent than before antitoxin.

7. That intubation and tracheotomy, where the heart shows evidence of weakness, should be done with the patient in the horizontal position.

8. That heart symptoms sometimes arise as late as several weeks after the patient is apparently well, and that careful examination of the heart should be made daily.

9. That alarming symptoms are sometimes produced by antitoxin, and that we should employ it with some reserve, using every means at least within our power to make a proper diagnosis, but always in doubtful cases deciding on the side of safety, and giving antitoxin the benefit of the doubt.

CARBONATE OF CREOSOTE IN PNEUMONIA-A

REVIEW.

By I. L. VAN Zandt, M.D.,

Ft. Worth, Texas.

The January number of the Therapeutic Gazette contains an article "Regarding Croupous Pneumonia, especially its Treatment with Carbonate of Creosote," which prompts the following:

The writers, Drs. Scott and Montgomery, seem to be without prejudice, and though not indorsing the remedy, at the close recommend a continuance of the study of its clinical effects, with increased dosage.

With regard to statistics compiled by me (1130 cases, 56 deaths, reported by seventy-one physicians, from 22 States, Indian Territory, Ontario, Mexico, and Honduras) they say: "It is obvious....that the result of five, or ten, or fifteen cases in one physician's hands can be combined with the results of others to show most excellent percentages."

"

To one not seeing the table published, the remark might seem discreditable to it; but when it is recollected that I published every report sent me, even three reporting a loss. of one hundred per cent., and that they came from such a wide territory, with such varied climates, it seems that the imputation of what can be done should not be held against the report. Had I been disposed to make statistics, by omitting eleven reports I could have shown sixty reporters, 999 cases, 29 deaths-a little less than three per cent. But when I sent out my circular of inquiry to almost seventy-five journals and a very few individuals, I determined to make an honest report, and so I did.

They say: "It is a noteworthy fact that of the seventyone contributors, twenty-six are from Texas." What use they expect their readers to make of this statement I do not know. The fact mentioned is susceptible of explanation without discredit to Texas physicians, who, I suppose, will compare not unfavourably with those of any other section.

On January 8, 1894, I observed beneficial effects in a case of pneumonia to which I had the day before given creosote for another indication. Continuing to prescribe the remedy and getting good results I told my friends, and some of them began its use and continued with such results, so that when I read my first paper on the subject, in June, 1898, before the North Texas Medical Association, then the largest medical association in the South, I had several present who could and did indorse my teaching. This started the ball rolling. January, 1901, I read a paper before the Central Texas Association, covering another area of the State. In October of the same year, by request of the chairman of the section of practice, I furnished a paper to the Southwestern Tri-States Medical Association. These papers read before Texas audiences, and the first published. only in a Texas journal, naturally brought forth more fruit. in Texas than elsewhere.

The writers then give a report of sixty-seven cases treated in the Pennsylvania Hospital and at the Philadelphia Polyclinic, with ten deaths, 14.9 per cent., with abstract of fatal cases. They say, "the degree of toxemia in all cases, barring fatal ones, was mild," but do not say whether in their opinion this was attributable to the remedy or not.

In January, 1901, I wrote: "In cases which persist longer (than two or three days) there is generally an amelioration of symptoms and the coming of an appetite to which I was formerly a stranger in pneumonic cases.'

Scanning their abstract of fatal cases we find No. 1 was sick eight days before the treatment began. No. 2, complicated with erysipelas, showed on autopsy bronchiectasis of left lung (right was pneumonic), acute hemor rhagicnephritis, cirrhosis of liver, splenic tumor, and edema of larynx, and this note follows: "Had his liver been normal he might have withstood the erysipelas better, though the renal condition was actively responsible for his death."

No. 3 was sick twenty-three days before admission and ought to be left out of the table. Passing by Nos. 4 and 5, we find No. 6 had pneumonia five days when an erythematous rash developed, followed by desquamation and later by nephritis, which caused his death, he having "seemed convalescent" twelve days after admission. This case should be in the list of recoveries, he, as it would seem from their report, having died from a sequel of scarlatina.

No. 9 had "left-sided hypertrophy of the heart, with mitral regurgitation." No. 10, sick twenty-two days before admission and three days after, should be left out.

Leaving out Nos. 3 and 10, and placing No. 6 on the other side, we have 65 cases, 7 deaths, a little less than II per cent. a result not very discreditable to the carbonate of creosote considering the material.

I will say, as I have said before, I do not believe that pneumonias from different infecting micro-organisms are equally amenable to treatment by creosote. I have lately treated with good result a case, shown by the microscope to be streptococcic, with streptolytic serum; and I predict that the findings of the microscope will at no distant day be made the basis of treatment of pneumonia.

COPPER IN SYPHILIS,

A. F. Price, Medical Director U. S. Army, after an experience of thirty-five years in the treatment of syphilis in the navy, has come to the conclusion that the use of copper is of value as an addition to the accepted treatment,