Rec.

To prevent infection from ringworm of the scalp, he employs an ointment of the following composition: Ointment of boracic acid, and ointment of eucalyptus, of each 3 ij.; oil of cloves, 3 ss.; oil of cocoa-nut, enough to make 3 vj. This, he says, constitutes a very elegant pomade even for general use, and is also an excellent prophylactic pomade. When ringworm makes its appearance in a family, he recommends that this prophylactic pomade be applied daily, not only to the healthy parts of the patient's scalp, but also to the heads of the other children in the family. To test its protective powers he has in three cases placed infected hairs on the heads of healthy children, and then first applied the pomade on the next day. None of the children caught the disease. The great confidence which he feels in the efficiency of the methods described above is founded upon the observation and treatment of more than one hundred cases of tinea tonsurans. -Med. Rec.

CHLOROSIS. Dr. Huchard, Rev. de Clin. et Thèrap., points out that it is a mistake to push the ferruginous treatment in all cases of chlorosis. The total amount of iron in the body under ordinary cir cumstances is not more than a few grammes, and even in chlorosis all of it has not disappeared. Any surplus iron is more likely than not to give rise to gastro-intestinal irritation. He prefers to give the iron in the form of iron filings mixed with chalk, powdered coffee, or rhubarb, in the form of a powder. Vinegar, to which chlorotic patients are often extremely partial, is not to be absolutely forbidden; on the contrary, a draught containing hydrochloric acid, taken after each meal, is a powerful aid to digestion. The constipation should be overcome by means of podophy!lin, and the uterine functions should be stimulated at the approach of the menstrual epoch by means of hot baths and an infusion of saffron internally. Massage and general gymnastics are also to be commended as adjuncts. In many cases when iron has failed, arsenical preparations, in conjunction with bitters, are successful, and the binoxide of manganese has given good results when both iron and arsenic had been tried in vain. The binoxide can be given in a powder with charcoal and powdered calumba root, or it may be given in the form of the lactate of manganese, made into pills with extract of cinchona. When iron is well borne he recommends the following formula :-R Ext. cinchonæ, ext. gentianæ, ext rhei., ãã, 5 grammes; ferrum tart., 5 grammes; ext. nucis vom., 50 centigrammes; ol. anisi, mv. ; glycerine,

SALICYLATE OF MERCURY.-Dr. W. C. Caldwell, of Chicago, Ill., in an original communication upon salicylate of mercury in the Therapeutic Gazette, concludes thus on this drug :

"1. Because the salicylate is likely not absorbed from an acid membrane, it will usually produce less derangement of the stomach than the bichloride.

"2. Because the mercury is combined with an organic radical, it will produce less irritation during both first- and elimination-contact actions than the bichloride.

"3. Because the salicylate contains less mercury and acts slower than the bichloride, it has less action on albumen and on bacteria of putrefaction and far less on digestion.

4. Because the salicylate passes through the stomach to the duodenum and there is disolved, it appears that exhibited with hydrochloric acid it would be better adapted for an intestinal antiseptic than the bichloride, which probably is dependent mainly on its elimination-contact action in the intestinal canal.

"5. Because the mercury is combined with an organic radical, it should not be prescribed with mineral salts of the heavy metals.

"6. Because iodide of potassium given with it converts it into the biniodide, the salicylate should not be exhibited at the same time, unless it be in small doses.

"7. Because the salicylate is insoluble in acids it should not be prescribed with drugs requiring an acid menstruum for solution.

"8. Because chemical change occurs when combined with muriate of cocaine, they should not be given together,

"9. Because the bichloride is probably more active and effective in syphilis, it probably is the best when it agrees.

"10. Because the bichloride has such marked climination-contact action, it is the better when such action is desired, as in acute tonsillitis, parotitis, etc."

66

CANCER OF THE TONGUE.-Jacobson (Am. Jour. of Med. Sci.) emphasizes the need of recognizing the precancerous stage at the beginning of tongue cancer and the early removal of the growth. The precancerous stage he defines as a stage in which inflammatory changes only are present, any ulcerative and other changes in the epithelium which may be present not amounting as yet to epithelioma, but on which epithelioma inevitably supervenes." To recognize this stage he considers the duration of the ulcer, its obstinacy to treatment, the age of the patient, absence of duration or fix

ity, careful scraping of the surface of the sore, and microscopic examination. For the small percentage of permanent cures he blames both the sur geon and the patient for delaying the operation and cultivating the cancer. Even where permanent cure is impossible, not only are months of life gained by the operation, but much comfort, because death from recurrence in the cervical glands is less painful and noisome than from the original lesion.

He considers four methods of operation-Whitehead's, Syme's, Kocher's, and that by means of the écraseur. Of these he prefers Whitehead's, of which he has made some modifications. He prefers to perform a preliminary laryngotomy and to plug the fauces in cases where the growth extends back into the posterior third of the tongue, when the surgeon is doubtful regarding his ability to control the hemorrhage, and when the floor of the mouth is at all involved. He also splits the tongue before removal, because it is then easier to control hæmorrhage, and in certain cases it may be safe to leave half of the tongue. He combats the opinion that leaving half of the tongue is useless, and maintains that, on the contrary, the patient has most serviceable control over the half which is left. When the disease is very far back and unusual difficulties are present, he slits the cheek as far back as the anterior border of the masseter. He does not approve of preliminary ligation of the linguals.

A brief description is given of Syme's and Kocher's methods. Both are severe and should be reserved for cases in which Whitehead's operation would be insufficient to remove the disease on account of the involvement of the floor of the mouth or of the cervical glands.

The écraseur he does not recommend, because, however well behind the disease, the loop is placed, it tends to come forward, as it is tightened closer and closer to the diseased tissue, until, if it does not encroach on this, it may upon tissue in its close contiguity ready to take on disease and also because of its failure to successfully divide the lingual arteries. The galvanic écraseur is mentioned only for condemnation.

For some days before the operation Mr. Jacobson makes the patient practise washing out his mouth frequently with Condy's fluid, sitting up, with the head alternately dependent on either side. Also he makes the patient accustomed to feed himself with a tube attached to a feeder-spout and passed by himself to the back of the throat. After the operation he brushes over the surface with a solution of zinc chloride, gr. x to 3 j. or of iodoform ether. Morphine is given freely, and ice to suck. Food is administered by means of a soft œsophageal tube.

The causes of failure as he enumerates them are Septic diseases of the lungs, hæmorrhage,

cellulitis, erysipelas, pyæmia, exhaustion, more rarely shock, oedema glottidis, suffocation from falling back of the tongue, and recurrence.-N. Y. Med. Jour.

PATHOLOGY OF CHRONIC ALCOHOLISM.-The Pathological Society of London has devoted much time recently to a consideration of the pathology of chronic alcoholism. The discussions have been prolonged and very interesting. The following brief review of them, taken from the Quarterly Jour. of Inebriety, April, 1889, will prove of interest.

Dr. Payne, in his opening and closing of the debate, insisted clearly on stating his belief that the ordinary pathological conception of cirrhosis needs reconsideration. He demurred to regarding it as a mere inflammation of the interstitial stroma of the liver set up by alcohol introduced through the portal vein, and producing great quantities of new fibrous tissue, which by pressure destroys the hepatic cells. He insisted that the destruction of cells and the hyperplastic inflammation of connective tissue take place concurrently, and in this view he was supported by Dr. Lionel Beale, who held that the essence of cirrhosis is atrophy of cells, and not inflammation of connective tissue. Dr. Dickinson stoutly maintained that the overgrowth of fibrous tissue is the essence of cirrhosis; and Dr. Sharkey showed specimens of apparently healthy liver cells side by side with masses of newly-formed connective tissue even in advanced cases of cirrhosis. He suggests that the liver cells seen in such connection with newly-formed fibrous tissue may be newly-formed cells; his hopeful view of the formation of new cells and new bile ducts is especially noteworthy; in other words, there may be a restoration of tissue in a diseased liver, a possibility supported, as he says, by clinical experience of cases of recovery from grave degrees of hepatic disease.

Not the least interesting part of the debate was that having reference to alcoholic paralysis and other forms of nervous disease produced by alcohol. What is eminently worthy of the attention of practitioners in this connection is the frequeney of tuberculous disease in cases of alcoholic paralysis. In fact, the association of chronic alcoholism in all forms, and tuberculosis was brought out by almost every speaker, including Dr. Payne, who said truly that the inaccurate impression that habits of alcoholic excess are in any way antagonistic to tubercular diseases must be regarded as swept away. Dr. Dickinson's investigations into the comparatively much greater frequency of tuberculosis in publicans and others whose occupations and habits expose them to the evil of chronic alcoholism, were the first to open the eyes of the profession to the fallacy that alcohol antagonizes tubercle. Many eminent medical men have

felt with Dr. Dickinson that, as alcohol does so much harm, it surely must do some good. But, so far, the good that it does or the evil that it prevents has not been made very manifest. They need more definition. Dr. Izambard Owen says the statistics of the Collective Investigation Committee show that the consumption of alcoholic liquors appears to check malignant disease. This statement should now be tested very rigidly. Malignant disease is said to be on the increase. We have seen the demolition of the belief that alcohol is a preventive of tubercle; it would be some set-off against the mischief it works if it could be shown seriously to antagonize cancer.

The views and opinions of the many leading men who participated in this discussion were expressed in a scientific spirit, not as absolute or final, but as the most probable facts sustained by our present knowledge of the subject.----Med. and Surg. Rep.

MENIERE'S VERTIGO.---Brunner, of Zurich, formulates the following conclusions regarding this disease (Annales des Maladies de l' Oreille.)

1. The name Ménière's disease is no longer applicable to any special and distinct affection, but rather to a complex set of symptoms; hence the name should be changed to Ménière's vertigo.

2. Under this head there should be placed only those cases in which the attacks come on suddenly, without known cause, at distinct and prolonged intervals, without fever, preceded by a more or less intense subjective noise in the ear, and followed by a more or less rapid deafness. This definition excludes vertigo dependent upon mechanical causes in the middle ear, as well as permanent vertigo due to acute labyrinth diseases.

3. Without doubt cerebral lesions, and especially cerebellar lesions, can produce Ménière's vertigo without any positive diagnostic sign. This difticulty does not often occur, because it is rare that such lesions produce deafness, excepting in cases of pressure on the fibres of the acoustic nerve.

4. Ménière's vertigo has generally as a fundamental cause some pathological change, either primary or secondary, in the labyrinth.

5. Nosologically we must distinguish between the grave cases and the light ones, as those consecutive to otorrhoea.

6. Some of the grave ones may be connnected with hemorrhages in the labyrinth; some of the light ones with a vaso-motor neurosis.

7. Generally, Brunner thinks, too important a role is ascribed to hæmorrhage, although many cases are doubtless due to a pathological modification of the blood-pressure in the labyrinth: an obstacle in the efferent canals of the perilymph and ndolymph is an important factor in the pathogeny of this disease.

8. In favor of the vaso-motor origin of Mén

ière's vertigo there may be adduced the following reasons: (a) The vertiginous aura preceding the attack. (6) Slight functional troubles show themselves only slowly. (c) A certain regularity in the frequency of the attacks. (d) The effect of quinine or even galvanization of the cervical sympathetic in moderating or arresting the attacks.

9. According to the experience of oculists, large doses of quinine provoke ischemia of the retina, and, as we all know, the labyrinth is also thus congested. We can thus explain the favorable action of this drug in cases of Ménière's vertigo.----Am. Jour. of Med. Sci.

TREATMENT OF JAUNDICE FROM RETENTION.Dr. Le Gendre gives (Concours Méd.) the following treatment for this affection :

1. Absolute Milk diet, consisting of five pints of milk taken pure or in an alkaline medium, in quantities of eight ounces every two hours.

2. Intestinal antisepsies, for which the following powders are to be taken :

R.-B. Naphthol (finely powdered), 23 grs.

Salicylate of bismuth, . . . . 15 grs.-M. Divided into ten powders; one to be taken every time that some milk is taken.

3. Sponging the body every morning and evening with cold water, to which the following has been added:

B. Chloroform water, 150 parts; mint water, 30 parts; water, 120 parts.--M.

Or, from eight to ten drops of the following mixture in a wineglass of water: R. Tincture of nuc. vomica, tincture of gentian, tincture of anise, aa 3 j.; chloroform, gtt. xx-xl.-M An appropriate diet and oxygenated waters at meal times form part of this treatment.

3. Methods of Drs. Regnault and Leseque.This treatment applies particularly to painful dyspepsias with dilatation of the stomach: R. Chloroform water, 150 parts; orange flower water, 50 parts, water, 100 parts.-M. One dessertspoonful to be taken every fifteen minutes, until the pain ceases.

Dissolve and mix. Dose, a teaspoonful.

As a gargle for inflammatory troubles, Dr. Abra

R.-Potassi chloratis,

IGNIPUNCTURE OF THE TONSILS.-Dr. Wilhelm Roth, of Fluntern, finds that in order to reduce the size of the tonsils without risk of troublesome hæmorrhage, which is not uncommon, especially in young subjects, the best plan is to employ ignipuncture, as has been recommended by Krishaber, and more recently by Verneuil. The tonsils and neighboring parts are first brushed over with a ten to twenty per cent. solution of cocaine. The finest point of the thermo-cautery, heated to redness, is then inserted to a depth of about five millimetres in three or four spots a few millimetres apart from one another on the tonsils. The instrument is not allowed to remain more than one or two seconds in the tissue. The whole operation, including both tonsils, can be performed in a very few minutes without any bleeding and with scarcely any pain. It must be repeated four or five times at intervals of two or three days, and this is usually sufficient to cause the tonsils to return to their ordinary condition.-Lancet.

DANGERS OF CHOLOROFORM IN LAPAROTOMY.. Professor Zweifel, of Berlin, has remarked several times that pneumonia has occurred after laparotomy has been performed under choloroform, either at night or on dark days when gas has had to be used. In some cases which were done in a small, badly ventilated room, where a good many bystanders were present and two or three Argand gas burners were in use, a peculiar cloud of partly decomposed choloroform vapour was very noticeable, not only to the eye, but by the effects produced on the respiratory organs of the operator and his assistants. When ether was used instead of choloroform these effects were not observed. Pending the establishment of the electric light, Professor Zweifel commences with a mixture of alcohol, choloroform, and ether alone, the patient being put under the influence of this in another

Tr. ferri chloridi,
Glycerini,
Aquæ,

q. s. ad f 7 viij.

Dissolve and mix. Used as a gargle and internally in doses of half ounce.-Med. & Surg. Rep.

TREATMENT OF ANAL FISTULA WITHOUT OPERATION. Fistula which do not cause pain should not be operated upon The clothing should be soft and smooth, and extreme cleanliness should be observed, the general condition of the patient should be attended to, and of systemic remedies a mixture of the bromides and iron is especially valuable. The following is an excellent remedy: Bromide of potash, 10 grams; citrate of iron, ammoniated,gram; syrup of bitter orange peel, 190 grams. Tablespoonful should be taken morn ing and evening.

Topical appliances should be made after each stool Here is a good formula for suppositories: Iodoform 'ogram; extract of belladonna gram; cocoa butter, q.s. This should be applied after each defecation and on going to bed.-Professor Guyot, Jour. de Méd.

AN UNUSUAL ACCIDENT ATTENDING TOOTH EXTRACTION.-To the record of the numerous casualties which may follow tooth extraction Mr. Ackery, at the Odontological Society of Great Britain, has added another probably unique case. A molar was extracted from a patient while under the influence of nitrous oxide gas; the apex of one root, however, was left behind. A sinus subsequently appeared, and this did not heal upon the removal of the remaining portion of the tooth. Eight years after the original operation a substance was discharged from the sinus, which proved upon examination to be the point of one of the jaws of a tooth forceps, which had doubtless been broken and left in the alveolar process at the time of the endeavor to extract the tooth.-The Lancet, February 9, 1889.

THE CHOICE OF A HYPNOTIC IN INSOMNIA.Chloral has fallen into disfavor of late years, and deservedly. It weakens the heart's action, lowers the powers of self control, and creates a craving for its continued use. The depression and general disturbance of function produced by opium contraindicate its use in a large majority of cases. The bromides are useful as a sedative, but loss of bodily weight and blood impoverishment follow their frequent exhibition. Sulfonal has been hailed as the hypnotic par excellence, and certainly it has given satisfaction in most cases; but there are instances where it is slow in its action or contrary in its effects. These objections can be urged, however, against every known remedy, and should not de tract from the value of this new sleep-producer. Dr. Clouston (Am. Jour. of the Med. Sciences, April, 1889), throws the weight of his authority in favor of the claims of paraldehyde as the best hypnotic. It is so valuable, he says, so reliable, so free from risks, that it cannot be too widely known by the profession. It acts so quickly that the patient is often asleep in five minutes after getting the dose. After a paraldehyde sleep there is no headache, no lassitude, no loss of appetite, no disagreeable feelings. It restores the sleep habit of the brain in many cases. As to the dose of paraldehyde, begin with forty minims or a drachm, and go up to two, three, or even four drachms, if necessary. Give it mixed with tincture of quillaya in cinnamon water. Its bad taste cannot be got over.

CONSANGUINEOUS MARRIAGES.-The author of a recent work on this subject calls attention to the curious ideas which have been generally received in reference to the infecundity of, and physical degredation consequent on, consanguineous marriages. So far as the data given may be trusted and it is hardly to be supposed that the author holds a brief on the opposite side-there is absolutely nothing to show that marriages between near kinsmen are lacking in fertility, or that they are peculiarly liable to give issue to deformed or diseased offspring, There is no lack of instances of enforced consanguinity, in the matter of marriage, in isolated communities, according to M. Huth, to disprove the assumption that physical degeneration is likely to result from the practice. An investigation into a number of unions between uncles and nieces, nephews and aunts, and cousins in the first and second degree, give an average of children rather above than below the general average, though this is attributed to some extent to the comparatively early age at which such unions are generally contracted. Breeders inform us that the results are markedly in favor of consanguineous unions between healthy well-bred animals. Unions between men, or animals, of widely different varieties, on the other hand, have a de

cidedly injurious effect on the offspring, and beyond a certain limit are almost absolately sterile. Mulattoes and the half-breeds of India and America are striking examples of the deterioration to which such racial disparity gives rise. The great point to bear in mind is that the union of individuals with the same morbid tendencies intensifies the taint, and that, too, quite irrespective of any consanguinity. The moral, according to the author, is that the reasons which have led to the prohibition of marriages within certain degrees of relationship are social, and not physiological.— Med. Press and Circular.

DYSMENORRHOEA-William Wiles. M.D., Snaresbrook, Essex, says: I used Aletris Cordial especially ia a case of severe dysmenorrhoea of considerable standing. The first period that occurred after taking the Cordial was passed through with considerably less pain than usual. The patient took the medicine for a week before the menstrual period was expected for six months. At the end of that time no difficulty or pain was experienced. So that, considering the time the patient had been suffering before, the benefit was very marked.

TREATMENT FOR CATARRHAL AFFECTIONS OF THE THROAT.-Dr. G. B. Hope, 34 W. 51st Street, New York, Attending Surgeon Metropolitan Throat Hospital, and Professor Diseases of the Throat, University of Vermont, says: "For a long time I have been employing Horsford's Acid Phosphate as a constitutional treatment for catarrhal affections of the throat. I consider it to be among the very best tonic excitants of the vocal organs, and huskiness of voice incident to those who pursue a particularly applicable in relieving the fatigue and professional career of actor or vocalist, and far preferable to the various forms of wines now so generally recommended for this purpose. I have seen no other allusion to its employment in this recommending both from a theoretical and practidirection, which I believe you are perfectly safe in cal point of view.”