syncracy, may be prevented by the administration of Fowler's solution of arsenic, conjointly with the iodides.

There is a great tendency on the part of the profession, to recommend various new and questionable preparations in the treatment of syphilis. Certain vegetable preparations have enjoyed a more or less long-lived popularity in this respect. Sarsaparilla was long thought to be a specific. Among the new preparations are cascara amarga, herberis aquafolium, stillingia, and other drugs, alone or in combination. I advise you to try these drugs, in the firm belief that you will soon discover their fallacies, and come back to our reliable friends, iodine and mercury. As bitter tonics they are more or less useful, but as specifics they are arrant humbugs. Tayuga is another remedy of doubtful origin which was recommended some years ago, and which Dr. J. Nevins Hyde, of this city, after giving it a fair trial in syphilis, claims negative results. The bichromate of potassium has been recently recommended, but I have had no experience with it. It is best to be liberal, and give different remedies a fair trial, irrespective of their origin, and such has been my custom, but I think you will find that the proportion of cases of syphilis which is curable by the judicious use of mercury and iodine, is so large, and so gratifying, that you will waste no unnecessary time upon new and strange drugs.

Two remedies which are decidedly beneficial as a tonic in syphilis, are the fluid extract of coca, and iodoform. Coca is an excellent tonic when used conjointly with strictly antisyphilitic treatment, and tends decidedly to relieve the nervous depression from which most syphilitics suffer. Iodoform will be found most useful in cases which do not tolerate mercury and iodine well, and should be combined with the exsiccated sulphate of iron or the iron by hydrogen, the latter perhaps being the most useful and convenient.

In conclusion I desire to direct your attention to the local management of the disease. Mucous patches sometimes give great annoyance, and refuse to yield to purely constitutional treatment, becoming sluggish and indolent. In such an event, the pure acid nitrate of mercury will be found to be the best application. Before applying it, the lesion should be dried with a piece of bibulous paper or absorbent cotton. The surface should then be thoroughly cauterized, after which it is again dried. The nitrate of silver may be used in the same manner. Sometimes cauterization is not tolerated, the sore becoming inflamed and irritable. In such cases the tincture of benzoin

coca will be found most effectual. It coats the lesion with a deposit of the gum benzoin, and in addition to its mildly stimulant and antiseptic action, protects the surface from irritation. When mucous patches hypertrophy, and form tubercles or cordylomata, an application of hydrangea bichloride in collodion in a strength of four to twenty grains to the ounce, will be found to remove them very rapidly. Calomel, zinc oxide, salicylic acid and iodoform are also quite useful applications. Washing the parts in salt and water followed by the application of calomel is also of service, as nascent bichloride is formed and acts very powerfully upon the lesions. In case of secondary or even tertiary lesions upon the face which are non-ulcerative, the solution of bichloride in collodion will be found to remove them quite rapidly. Be careful, however, not to cause severe blistering of the skin by too powerful or too frequent applications. In case of ecthymatous or rupial ulcerations, frictions with the oleate are beneficial. Gummy ulceration, especially when situated in the mouth or pharynx, will be best treated by the application of benzoin. Although iodoform is also quite effectual, it is far more unpleasant, for most people do not like to have such an odorous application, in so close proximity to their nasal and digestive organs.

ORIGINAL TRANSLATIONS.

GERMAN LITERATURE.

TRANSLATED BY GEORGE GUNDLACH, M. D., ANN ARBOR, MICHIGAN. CAUSE AND AVOIDANCE OF CORROSIVE SUBLIMATE POISONING IN OBSTETRICAL IRRIGATION OF THE UTERUS AND VAGINA; TO DIMINISH THE DANGER OF SEPSIS TO THE LYING-IN.

In a paper upon the above subject Dr. Otto Von Nerff arrives at the following conclusions:

(1) It is safe to state that the vagina, either from the contraction of the sphincter vaginæ, or of the levator ani, sometimes becomes distended and retains a considerable quantity of the injected fluid.

(2) After irrigation of the vagina or uterus of the parturient, symptoms of intoxication is caused chiefly by absorption of the injected fluid by the mucous membrane of the vagina, as the uterus soon contracts firmly after injection, consequently the danger of absorption through it is very slight.

(3) Absorption from the vagina is not possible, unless the disinfected fluid is retained a considerable time, but is favored if during its retention there is at the same time increase of pressure in the vagina, which condition does not exist at the time of the injection.

(4) In the recorded cases, the accounts show that it is probable the absorption was principally by the vagina, in two cases particularly, vaginal irrigation only having been resorted to.

(5) Direct entrance of the corrosive solution into the peritoneal cavity, or into the blood-vessels, results from long retention of the fluid, with increased pressure in the vagina from contraction of its walls, or when an unusual patulency of the Fallopian tubes exist; this, however, is a rare condition, and the occurrence can only happen with imperfect escape of the injected fluid.

(6) It is always important, in all vaginal and uterine irrigations of corrosive sublimate solution, to use every care possible to secure free escape of the fluid, in order to prevent it being held in the uterus, especially in the vagina, where the greater danger exists, due to the possible increase of pressure, by contraction of the vagina.

To further lessen the danger of septic poisoning to lying-in patients the author advises the following precautions:

(1) Careful disinfection of the physician, the midwife and attendants.

(2) At the commencement of labor, careful washing of the external genitals with weak solution of corrosive sublimate, and cutting off the hair on the pubes.

(3) Prophylactic irrigation of the vagina, in the course of normal labor, is not necessary. If there is reason to suspect infection on the part of the midwife, or of beginning decomposition of the discharges during the course of a tedious labor, injections of the vagina with a weak solution, one to five thousand or one to three thousand, should be made.

(4) After normal labor, prophylactic uterine injections are unnecessary. In unusual conditions only as follows: After the introduction of the hand into the uterus, or if decomposition from any cause has taken place in the uterus, or results of conception be dead or putrefying, the uterus at the termination of labor should be irrigated with a weak solution of corrosive sublimate, of the strength above stated.

(5) When the confinement and labor are normal, disinfection with corrosive sublimate solution is unnecessary, and may

be harmful under some circumstances. Such injections, however, are not to be omitted if it be probable that by their use a possible infection may be avoided. On the other hand, puerperal diseases and conditions which require intra-uterine treatment, irrigation of the genitals with mild or strong solution of corrosive sublimate is demanded and immediate good results usually follow.

(6) The stronger solutions of corrosive sublimate, one to one thousand especially, are not necessary, only in special conditions the occurrence of severe septic puerperal fever.

(7) In all irrigations by corrosive sublimate, vaginal and uterine, either by weak or strong solutions, the following rules are to be strictly carried out:

(1) Only small quantities of the irrigating fluid are to be used, one, and at the most, two quarts.

(2) Irrigation should be conducted as rapidly as possible. (3) Pre-eminently, free escape of the fluid must be obtained, during and after the injection, to avoid the bad results of retention and production of increased pressure above mentioned.

(8) In atony of the uterus, and in extensive wounds of the genital canal, irrigation by solutions of corrosive sublimate are strictly contra-indicated; in anæmic patients and such as suffer from kidney disease; and in women who have been in any manner previously treated with mercury, irrigation is to be used with great care.-Archiv fur Gynækologie.

HOSPITAL REPORTS.

MICHIGAN STATE HOSPITAL.

SURGICAL CASES.

SERVICE OF DONALD MACLEAN, M. D.,

Professor of Surgery and Clinical Surgery in the Medical Department of the University of Michigan.

REPORTED BY W. P. MUNN, CLINICAL CLERK.

VARICOSE ULCER.

Louisa B., aged twenty-eight. Admitted June 1, 1886. History.-Four years ago while running, she struck her left ankle with the heavy shoe on her right foot. In a few days the bruised spot ulcerated, and became quite painful. She was treated nearly five months in the hospital at Gerifinald, Germany, where she was benefited but not cured. She had phlegmatia dolens of the left leg about five years ago.

Present Condition.-Just above the inner malleolus is a circular blue spot as large as a silver dollar. It is very painful on pressure, the patient shrinking at the slightest touch.

June 3.-Clinic: Professor Maclean diagnosed the affection a varicose ulcer, and ordered a dressing of black wash, (calomel, three grains; lime water, one ounce); and the application of the rubber bandage.

June 11: There has been little or no improvement.

June 14.-Clinic: A circular incision was made in the sound skin around the ulcer extending just through the skin.

June 23: Painful condition greatly improved but not wholly corrected. Wound healing rapidly.

June 30: Little tenderness. Wound healed.

LYMPHADENOMA.

Discharged.

John N., aged eighteen. Admitted May 18, 1886.

History.-Eleven months ago a cystic tumor was removed from behind the ramus of the inferior maxilla, right side. The tumor appeared suddenly and was growing very rapidly. Two months ago another tumor began to grow in the same place and has rapidly increased in size. One month before this second tumor appeared on the right side, one similar to the first came in the same position on the left side, which disappeared under medical treatment.

Clinic. The present tumor is deeply attached and intimately connected to the adjoining tissues. Other smaller enlargements are found forming a chain along the sterno-mastoid muscle.

No operation justifiable. Advised to keep clear of the knife and quacks. Ordered to take arsenic and iodide of mercury.

GENERAL CORRESPONDENCE.

PARIS LETTER.

PTOMAINES AS CAUSES OF ERROR IN TOXICOLOGICAL RESEARCH-THE ACTION OF CHLORIDE OF ETHYLENE ON THE CORNEA.

PTOMAINES AS CAUSES OF ERROR IN TOXICOLOGICAL RESEARCH.

At the meeting of the Academie de Médicine held June 28, 1887, M. Bronardel read a communication of MM. Ogier and Minorici on ptomaines as causes of error in toxicological research, of which the following is a résumé: