(especially as to rheumatism and nephritis as in this patient) and warns us against blindly following the iron clad text-book rules. In conclusion permit me to thank Dr. Jno. A. Pollock, one of our most eminent physicians, for so gallantly leaving his sickbed and coming to my assistance, though he arrived upon the field of battle just as the enemy gained the victory,-after the death of the patient.

TREATMENT OF ACNE ROSACEA WITH MENTION OF A CASE.

BY C. W. HUNT, M. D., Brevard, N. C.

ATIENT, female, brunette, aet, 18; she had the usual pim

PATI

ples etc., relating to puberty and nubility. At 19 years skin was clear and smooth and remained so till she was 23 years of age; at 23 she had just ceased to nurse her second child and was in a very reduced condition. Then the above disease appeared first on the fore-head; the eruption was profuse, parts thickly covered with little pimples and tubercles very red and greatly inflamed, great itching. This continued awhile and then "black heads" appeared, eyebrows were full. Noticed this eruption was symmetrical, each half of the forehead being alike affected, the eruption remaining on the forehead for two or three months, then the violence abated, then it appeared on both sides of the chin, under side and corners of the mouth.

A great many of these pimples or tubercles were like little boils, full of matter, and being squeezed out, would refill, then finally a black head would appear in old site of the point of eruption. The affection then appeared in a very violent form on both cheeks, then over both shoulders and on both sides of the cheek. The itching was terrible and obstinate all over the body, even where the eruption had not appeared. The scalp escaped.

Suf

I do not attempt to draw a pen picture of this disease. fice it to say that it was a typical case of very severe, obstinate, acute and then chronic acne rosacea.

The inflammation was so excessive at times that in the fleshy and soft parts of the cheeks, even besides the eruption, the

deeper tissues were so inflamed, as to cause great thickening and swelling, causing a change in facial expression almost like erysipelas.

ure.

This disease continued in varying degrees of severity, with varying success and failure as to treatment, principally failWhen at the age of 23 patient had a severe attack of lagrippe-then the skin disease ran riot, and was fearful beyond description. At this date March 1894, the skin disease had been cured, having lasted 21⁄2 years, and but for the treatment last used I believe that it would have never been cured.

Treatment. I was anxious to cure the case and selected the most approved modes of treatment. I first put patient on Fowler's solution of arsenic, which did little good. Then Donovan's solution of iodine, mercury and arsenic. This did no good and such irritation of stomach and bowels, that it was discontinued. I then prescribed tablets of iodice of arsenic, each gr.-one after each meal-no good results. Then I prescribed granules of sulph. arsenic, each gr. -one after each meal. This last caused quite a degree of improvement and really did a great deal of good, but the arsenic caused such intense pain in the eyeballs, super orbital pain and frontal headache, that its use was discontinued. Up to the time of using arsenic sulph, various ointments were used without benefit. White precipitate Di, vaseline i was applied and did more good than other ointments, but was a failure as a curative treatment. By the way do not make a regular use of greasy ointments or mixtures, of vaseline or glycerine, on the face as they aggraviate the disease, make the skin soft and flabby and cause a growth of hair. If an ointment is used for any special purpose do not on any account allow patient to over-heat the face, by undue exercise or expose the face to heat of fire or sun. I will mention here that I gave a full trial to alkaline washes etc., and the regulation solutions of hydrg. chlo. corros, as an application, without the least benefit. Icthyol ointment also was a grand failure.

Now to the point as to what cured this case and others I could mention.

Allowing for some good obtained by the above mentioned internal administration of arsenic, the line of treatment and

general management that cured was as follows-I desire to lay great stress upon the general management.

Ist. Regular diet. Exclude hog meat.

Give Scott's Emulsion of Cod Liver Oil, (I might say in all cases) regularly, one teaspoonful after each meal, if the patient is reduced in flesh, or if there is any tendeney to or inheritance of tubercle. If not, the local disease is a sign of the necessity for this emulsion, even if the patient is fat and has no sign of consumption or scrofula.

B. Pills, Calcium Sulphide No. 100. (S. C. Abbotts-pure and freshly made). Sig-One pill regularly after each meal.

Of course keep liver, bowels and stomach in proper condition by appropriate treatment.

Local treatment. Get the best white castile soap, carmel is the best; soap the hands and rub on the face and rub well into the skin, then wash off the soap immediately, with very warm water-do not have it too hot, as sometimes directed-then rinse the face in clear warm water;do this till all soap is removed from the pores of the skin, then dry the face with a soft towel; do not rub with towel or wipe too much downward, but simply pat the face dry. This is important. Apply and remove the soap as directed twice daily. Morning and night. For a few minutes after this make extra efforts to avoid sudden change of temperature from heat to cold.

Never use any soap but the kind mentioned.

For the first two nights after above soaping and washing apply pure vaseline all over the eruption and intervening tissue. Allow it to remain all night, then remove next morning by use of above soap and water. Use this vaseline for two nights.

The vaseline is used to soften and cleanse the skin and liberate black heads. Then the second morning after the vaseline has remained all night, wash the face in soap and water as directed, then immediately squeeze every black head out of the skin, do not use too much pressure in squeezing, avoid bruising the tissues, use just enough pressure to remove the black heads and no more. Then commence and use the following application regularly which is "drawing", healing to skin, whitening and generally curative. Remember to use soap and water reguarly as directed.

M.-Sig. Apply several times, with the fingers. Shake bottle very well.

The treatment must be used continuously and regularly; do not be discouraged; use it for months, if necessary, before expecting much improvement. The calcium pills combined with the local treatment mentioned give the best possible treat ment, purify the blood, whiten the skin and complexion, stop the itching and cure the diseases. I do not believe that any other treatment would have cured the case and the disease I believe would have remained a lifetime. I am certain that this is the best treatment, I tried about everything else and know whereof I speak. Avoid all applications containing grease, the skin has already too much grease. Of course protect face from extremes of heat or cold. The advertised face mask is no good, have tried them.

Notice at stage of treatment where vaseline was directed to be used. Bismuth sub. nit. could be used just before using vaseline, if there was excessive redness, or a thick, swollen condition of the skin or a bumpy condition beneath the skin, with red swollen arears that will not come to the surface. A few applications of bismuth will reduce inflammation, dry the skin and cause the tissues to throw off in the shape and form of black heads, the immature pimples-I might say boils. It is all important how this bismuth should be used. Mix it in pure water, make a paste and apply it evenly and well to the skin, but do not rub it in the skin, just dab it on. It is a great mistake to rub it into the skin. If rubbed in it does not give the desired result and darkens the skin. This bismuth application could be allow

ed to remain all night.

Notice, even if treatment is successful the acne will of course be more active and troublesome at time of menstruation.

I believe in fact that anything that excites or depresses the nervous system, aggravates if it does not in part cause the acne, therefore, patients should avoid causes of undue excitement, anger, worry, depressing emotions, "blues" etc. The nervous

system should receive careful consideration and all appropriate treatment.

I am aware of the fact that I have not mentioned any fashionable new medicine, but if my treatment is carried out fully and carefully to the letter, and everything watched and pushed by the physician, a cure will be the reward. Physician should not give general directions, but should see with his own eyes that the patient does everything directed, in the way it is directed to be done.

SUPRAPUBIC CYSTOTOMY FOR STONE. SOME COMPLICATIONS

BY VIRGINIUS W. HARRISON, A. M., M. D., Richmond, Va.

Lecturer on Surgery, University College of Medicine, Richmond, Va.

Ο

N May 22, 1897, I did a suprapubic cystotomy for stone on Paul A., white, age 16. After cutting through the abdominal parietes, I found the peritoneum presenting itself in front of the bladder, almost touching the pubic bone. It was some time before I was certain that the peritoneum was far enough out of the field of operation to make the incision into the bladder without doing harm to it, but this was finally accomplished, and without further trouble, a small mulberry calculus was removed. A catheter was placed in the bladder, and iodoform gauze loosely packed around it to favor rapid and thorough drainage ;and a stitch was taken in the upper angle of the wound, extra gauze being placed here to protect the peritoneum as well as possible. The patient was put to bed in good condition.

The usual preparatory treatment was administered: the bladder being washed out just before the operation, and filled with sterilized water, and the rectal bag was used.

The patient did well until 6 A. M., when he became restless and suffered pain in the abdomen; pulse 18, temperature 101.4°. At 12 M., pulse 110, temperature 103.2°, with all the symptoms.