TANNIN FOR INGROWING TOE-NAIL.-The application of a concentrated solution of tannin to the toe, several times a day, is said to quickly lessen the pain, and after a few dressings the patient is able to move about with comfort. PISCIDIA ERYTHRINA 'AS A UTERINE SEDATIVE.-One hundred and six cases are reported by Dr. Lessona in which tincture of piscidia erythrina was given to the amount of from seventy-five to two hundred and twenty-five minims within an hour or an hour and a half, on account of after pains or threatened abortion. Favorable effects were produced in seventy-one per cent. of the cases. AN APPLICATION FOR PAINFUL DENTAL CARIES.-The following formula is recommended: R. Dry alcoholic extract of opium............ Peruvian balsam.... Chloroform 1 part. 1 part. 1 part. 2 parts. 20 parts. A pellet of cotton soaked in the solution is to be introduced into the cavity. SOLANINE: ITS ANALGESIC PROPERTIES.-Solanine belongs to the class of poisons which include eserine, pilocarpine, atropine, etc., the first physiological effect being to paralyze the nerve terminals of the non-striated muscular fibres. There are, however, certain differences in the particular action of solanine which Dr. Genevile proposes to utilize in medicine. In doses of from one to three grains its action is confined to the medulla and cord, but in larger doses the cerebral cortex is also affected, the symptoms being vertigo, heaviness and noises in the ears. Respiration is rendered deeper and slower; the pulse is not effected when the drug is given in medicinal doses. Dr. Genevill has found solanine of the greatest service in the treatment of sciatica and rheumatic neuralgia in doses of from three to four grains daily by the mouth or hypodermically. It is useful in prurigo, cystitis, and in nervous affections where restleness and insomnia are prominent symptoms. Good results have followed its administration in acute dyspepsia and gastritis, in obstinate vomiting of pregnancy, in bronchitis, bronchial asthma, cardiac asthma and emphysema. Its use is not attended by the same inconvenience as morphine and atropine, and in the place of the former it is of special service in children. Professor of Diseases of the Eye, Ear and Throat in the Detroit College of Medicine; Ophthalmic Surgeon to Harper Hospital, etc. Acute suppurative otitis media is a disease with which every physician is more or less familiar. It occurs in all classes of society, among the rich as well as among the poor, in the young and in the old, in all places, in all climates, and at all seasons. Statistics show that it occurs from five to eight times in every one hundred cases of ear disease. Its beginning is not unlike that of an acute catarrh of the middle ear, but it runs a more severe course, during which pus is formed in the tympanic cavity. This pus is evacuated or discharged through the drum membrane, which gives way as the result of softening and ulceration, together with the pressure exerted by the pent-up discharges. The disease may prove to be self-limited, and, even without treatment, the discharge may cease, the inflammation may subside, and the opening in the membrana tympani may heal up, and the parts, as well as the hearing, may return to a normal condition. But if not properly treated it may terminate in chronic suppurative otitis media, or it may, in rare instances, lead to cerebral complications and death. The disease does not always present the evidence of being severely acute in character, for, now and then, we meet cases in which there has been little or no pain and little to mark the presence of an inflammation, till the purulent discharge flows from the auditory canal. The duration of the disease varies from a few days to several weeks, or until the chronic state supervenes. In studying the pathology of this disease, it is observed that the first departure from health is one of hyperæmia, which in a very short space of time reaches a very general and a very marked congestion of the mucosa that lines the whole tympanum. In this congestion not only do the capillaries and venules, but also the arterioles, take part. From the intensity of the congestion there may occur small points of hemorrhage, due to the giving way of some minute vessel; and this will account for the fact that sometimes the first discharge is blood or bloody serum. The escape of cells and serum from the distended vessels, with more or less infiltration of the mucosa, is the next step. The thin, delicate lining of the typan88&hich in the normal condition is less than one thirtieth of an inch thick, becomes greatly swollen, and in some cases the drum cavity is almost completely filled by this swollen, infiltrated mucosa, which at points, here and there, may be denuded of its epithelium. The tubular and racemose glands become much enlarged and even cyst-like, and pour forth a large quantity of tenacious, sticky mucus. The excessive secretion from these glands, and from the whole lining of the tympanum, together with cellular elements, epithelial cells, serum and escaped blood-corpuscles, not only fill the tympanum completely, but cause the drum membrane to bulge outward. If no means are instituted to check this inflammatory process, it goes on to the second stage, or the stage of suppuration. The membrana tympani is early involved in the general congestion and inflammation. It soon assumes a bright pinkish hue, with engorged vessels running across it near the malleus handle; and this bright pink quickly passes into an intense red. Finally it becomes more or less soddened, infiltrated and thickened. In the normal condition the membrana tympani is about as thick as thin letter-paper or fine gold-beater's skin; but in disease it is usually infiltrated, and may be swollen to several times its normal thickness. In this condition its resisting power is greatly diminished, and it soon yields to the pressure from within the tympanum, and the discharges escape into the external auditory canal. The lining of the mastoid cells is more or less congested in all severe cases of suppurative otitis media, and in some cases severe inflammation and abscess occur in this portion of the auditory apparatus, but they cannot be considered in this short paper. The Eustachian tube is probably always in a state of acute catarrh. ear are numerous. The causes of acute suppurative inflammation of the middle They may be classed under two general heads-predisposing and exciting. Certain constitutional conditions, such as scrofulosis, tuberculosis, syphilis, etc., may be considered among the predisposing causes, but to what extent they do really predispose patients to attacks of this form of ear disease it is difficult to tell. The exciting causes are numerous, and I quote the following from Professor Knapp's report of one hundred and eighty-two cases, to show the relative frequency with which it occurs as the result of these different causes. My own experience corresponds closely with Professor Knapp's, except as regards sea-bathing-bathing in fresh water with no surf not being a very frequent cause of this disease. His report of one hundred and eighty-two cases is as follows: Pharyngitis and rhino-pharyngitis...... Coryza and assignable exposure.. Sea-bathing 68 cases. Scarlet fever. Diphtheria Measles..... Pneumonia....... Improper use of nasal douche...... Cold water and alcohol poured into the ear.... Mumps Varioloid...... Causes unknown...... We see that of the one hundred and eighty-two cases, one hundred and sixteen, or more than sixty-three per cent., were the result of exposure to cold or atmospheric conditions, manifesting themselves in inflammation of the nasal, or naso-pharyngeal, mucous membrane. Owing to the continuity of structure, this inflammation passed along the Eustachian tube to the lining of the tympanic cavity and involved this delicate structure. Long after the inflammation of the nasal or naso-pharyngeal mucous membrane subsides, the suppurative process may continue in the ear, and this is very apt to be the case where improper treatment, or no treatment, has been instituted, and, under any circumstances, when the disease occurs in connection with scarlet fever. Acute suppurative otitis media prevails to a much greater extent during the winter and spring than in summer. From December 1 to June 1 nearly twice as many cases occur as during the period from June to December. It is much more prevalent in early childhood than at any other period. More than one-half of all the cases occur before the end of the tenth year. The greater liability to catarrhal affections of the air passages in children, the greater prevalence of eruptive fevers, and, possibly, dentition, may help to account for the frequent occurrence of this disease in early life. The diagnosis of acute suppurative otitis media is not difficult. The signs and symptoms differ somewhat in the different stages, and it will be better to consider them separately. The subjective symptoms in the first stage will usually be, tinnitis aurium, a sense of fullness in the ear, impaired hearing, a throbbing sensation synchronous with the heart's beat, and pain which may vary in degree from quite slight to very severe. The last symptom is the most important, for usually it is the painthe earache-which leads the patient to seek relief, or attracts attention to his condition. This pain is nature's language— nature's warning-and if we interpret it aright it may prove a blessing to our patient. "Earache" seldom occurs except in connection with, and as the result of, inflammation in the tympanic cavity. How comes it that an inflammation of the mucous membrane of the ear-drum should be attended with severe pain --sometimes excruciating pain-while inflammations of mucous membranes elsewhere are comparatively painless? It must be remembered that the tympanic mucous membrane is intimately associated with the periosteal covering of the bony walls of the tympanum. Von Troeltsch has said that in every case of severe acute inflammation of the tympanic cavity we have virtually a periostitis; and while this may not be strictly true, it shows the views which this great aurist held upon the subject. The patient will experience more or less constitutional disturbance, and in severe cases will be feverish, irritable and restless. Vertigo and nausea may show themselves in some instances, and, in the early stage, will probably depend upon the intra-tympanic pressure. The objective signs in the first stage will consist mainly in the congested, reddened appearance of the drum membrane, the absence of the umbo or light spot, and perhaps a bulging of the drum membrane. Just previous to the rupture of the membrane it will often look soddened and necrotic around the part at which the perforation is about to occur. The external auditory canal is frequently congested and |