dotted with a number of small white points. The surfaces were not raised, on the contrary smooth, and the edges ending abruptly into the surrounding tissues. I touched the sores every third day with dilute nitric acid, using locally an Iodoform dressing, and in two weeks they healed nicely. During the first part of October my patient complained greatly of headache and insomnia. The headache, very severe in its attacks, was confined principally to the right frontal region, and was not relieved by any form of treatment. Symptomatic dosing was faithfully tried, followed by goodly prescriptions of morphia, bromide and chloral, but still the headache and insomnia held high carnival, driving the patient well nigh distracted during its siege of three weeks. I became anxious about the case and inquired more particularly into the matter, and found that some two months previously a roseola rash had made its appearance over the whole body, lasting a few days and passing off. The lady was visiting friends at the time and she thought the rash due to flea or mosquito bites. I now examined different parts of the body and found a scattered rash, with no elevation, which disappeared on pressure. Two days afterward I found the rash decidedly marked, the glands in the groin and axilla tender and swollen, both eyes sensitive to light with the eyelids swollen out of shape, and some rheumatism in the left shoulder. There was no doubt left in my mind now, and I at once prescribed the Iodide of potash in five grain doses, three times daily. I saw the case again October 18th, and found the swelling on the forehead and eyelids had disappeared somewhat, but the eyes were still weak. The chin was now swollen much in three well defined bunches, which were very tender, with similar enlarged bunches back and over the left ear; the roseola syphilitica was noW more plainly defined. Con tinued the same treatment. On the 21st of October the patient was about the same, except the headache was better; and she had slept soundly the previous night, which was the first night's sleep in three weeks. Continued the Iodide. October 25th. Better, but cannot sleep soundly without an anodyne; wakes up with a headache, which passes off during the forenoon; (the headache is not due to the sleeping medicine, as she has the headache as bad when not taking any quieting potion.) Eye-balls very sore, conjunctiva quite red; the roseola syphilitica is more marked, and spots darker colored; the enlarged glands have decreased somewhat in size; the appetite which has been very poor, is now improved, and the rheumatism disappeared. Discontinued the Iodide of potash and gave instead the Proto-iod. of mercury, of a grain after each meal ; constipation has been marked during the last month, but the continued use of Podophyllin, one half grain every night, has produced a free movement of the bowels daily. October 29th. Better, sleeps well and the headache does not trouble so much. The swollen glands are decreasing to a natural size, but the body is covered with the roseola quite as marked, more especially across shoulders and thighs, but the face is improved; appetite excellent; the roseola irruption is in spots quite dark colored, and especially the patient becoming chilly or cold, the rash then resembles a lead color. Slightly increased the mercurius and discontinued the podophyllin. November 3d. Miss K. has been taking for several days one grain of the Proto-iodide daily, which has produced the well known effects of pain in the bowels, with a diarrhoea, which causes two or three stools daily. The headache has now entirely ceased to annoy. Her spirits and feelings which during all these weeks have been very much depressed, are now greatly raised, and she again begins to take more interest in wordly affairs. The roseola does not seem so prominent. Continued with the same drug and dosage. November 17th. The rash has disappeared entirely from the arms, body and limbs. It can be seen now only on the face, and there in some places it is quite marked, which, of course, greatly disturbs the patient and causes her much worriment. The physiological effects of the mercury have subsided some days ago, so I gave directions to increase the dose until the bowel symptoms again appear. November 26th. Face is somewhat improved. She is taking 1 grain of the mercurius daily, which produces two movements from the bowels daily Continued same. January 24th. Has been taking daily for the last two months from one grain to one grain and one half of the protoiodide. She is in good health generally. The only thing complained of is that a few scattered pimples are constantly coming and disappearing on the face. I gave directions to continue the same dosage. February 10th. The gums are inclined to be sore, and the teeth very tender; due, no doubt, to the action of the mercury. The only new and unfavorable symptom is a marked pityriasis of the scalp The dose is now reduced to grain daily. April 6th. The case has continued to progress favorably, with the exception of two ugly sores, one on the chin, the other on the right cheek near the nose, which have developed within the last six weeks. The lady has been absent visiting since I last saw her, and by a continual picking with her finger nails, these two sores have grown from small pimples into unsightly objects, resembling seed warts, and are almost the size of a nickel. She complains of them much, and when I ask if they pain her, she says "no, but they cause a burning sensation." I now discontinued the internal use of the proto-iodide and prescribed "Munn's Stillingia Compound", one tea spoonful three times daily, and externally, on the sores, a mercurial ointment made of the red oxide, a little to be applied morning and night. June 1st. My patient has decidedly improved; the sores which disfigured the face so much have outgrown their usefulness, and only two bright red spots are left as monuments to mark the locations where once unwelcome guests "flourished ast he green bay tree." She now tells me the inside of the nose is sore, and upon examination I find the color to be a fiery red, resembling a piece of raw beef, and the nasal bones very tender upon pressure. I order a small swab to be made of lint and to lightly touch the inner surface of the nostrils twice daily with the red oxide ointment. The stillingia compound in this case acted as a tonic, and again as an alterative. The increased appetite, a number of pounds gained in weight, and the bloom returning to the cheeks are a tribute to the beneficial action of the drugs which have been prescribed as the indications appeared. It would seem unnecessary to follow the case further in this paper. At the present writing, January, 1891, no unfavorable symptoms have as yet reappeared. The redness and irritation in the nose have long ago ceased to trouble, and the olfactory member is an ornament and blessing to its owner, while on the face there are no blemishes to mar its beauty, the skin being as soft and clear as an infants. As regards the vagina, I am satisfied, its purity and chastity is guarded as sacredly as a crow would watch an ear of corn, while her nightly prayers might properly close with: "Dear Lord, take the drummers to the lake, where there is a tariff on fire and brimstone." HYDROGEN DIOXIDE; A RÉSUMÉ cient than carbolic acid but, as usually BY JOHN AULDE, M.D., PHILADELPHIA, Member of the American Medical Association, of the Medical Society of the State of Pennsylvania, of the Philadelphia County Medical Society, etc. WITHIN the past ten years the use of hydrogen dioxide (peroxide hydrogen) has become quite general among practitioners whose business has led them to give special attention to some particular class of disorders. Many general practitioners, however, have not availed themselves of the benefits afforded by this comparatively recent addition to our therapeutic resources, owing to the expense and the care required in looking after details, together with the uncertainty which attended its employment. These difficulties no longer exist; but, when we consider the advantages to be gained from its use, the process of evolution has been remarkably slow, notwithstanding the sporadic attempts which have been made to attract the attention of the medical profession. Novel methods of treatment are too frequently shunned without investigation by regular physicians, while, on the contrary, these innovations are readily adapted to the wants of the quack. In the present instance, although the furore for antiseptics continues unabated, the true position of oxygen has been ignored by those who should have given it their first attention. Long-continued and persistent effort has erected an imposing superstructure upon a theoretical foundation, losing sight of the marvelous influences constantly at work in nature. The corner-stone of this ornate edifice originally adopted was carbolic acid; the pilasters which gave strength and beauty to its walls were composed of carbolated gauze, while cornice and roof were made of a protective which had been submitted to a carbolizing process. This highly flavored substance has given place to a number of others, some of which are safer, but no more useful; others are more effi employed, are far more dangerous. As the foundation for asepsis rests upon absolute cleanliness, so the foundation. for antisepsis must rest upon an equally safe basis as regards the patient. The only agent known at the present time which fully meets our requirements is oxygen in some of its forms. While the spores of anthrax bacilli resist our most poisonous products-such as solutions of hydrochloric acid (two per cent.), boric and salicylic acids in concentrated solutions-oxygenated water alone, in sufficient quanity, was shown by Paul Bert and Regnard to possess the power of destroying the bacteria. The wonderful properties of ozone are but partly understood; like some other powerful agents, it can not be safely handled, but it gives great promise of usefulness in the future. The statement has been made that ozone is but an allotropic form of oxygen, and that it is identical with hydrogen dioxide (the subject of the present article), and for all practical purposes, from a therapeutic standpoint, they may be considered substantially the same. Having, then, at our command a remedy possessing such remarkable properties as a bactericide, one which is perfectly harmless when brought into contact with healthy tissues, it will be worth while to study the indications for its use in the treatment of disease. In the first place, however, I should say a word with reference to the causes which have contributed to prevent its universal employment by physicians-causes already referred to incidentally. 1. The expense of an outfit and material for administration of this agent need not exceed five dollars for sufficient to cover a period of from six weeks to two months. The medicinal peroxide can be purchased in original packages at about the cost of filling a prescription at a first-class drug store. An atomizer and vaporizer combined, especially required for this substance, costs no more than one equally complete for ordinary use. 2. The inconveniences attending the exhibition of hydrogen dioxide, by means of the vapor or spray, are purely imaginary. The use of these instruments by patients requires but little manual dexterity, and the instructions in regard to inhalations may be comprehended by the merest tyro. Children rather enjoy the mechanical features of the apparatus with the novel phenomenon of having the vapor expelled through the nostrils. 3. The uncertainty following the employment of the peroxide has arisen from various causes, and, as this is a subject of paramount importance, the items will be considered in detail. In the pure state hydrogen peroxide is exceedingly unstable, and, in order to render it less susceptible to the action of the heat, which causes it to part with nascent oxygen rapidly, minute quantities of hydrochlorid and phosphoric acids are added to the usual fifteen volume solution; but this, instead of retarding, rather heightens the effort of the remedy when applied to unhealthy structures, especially mucous surfaces. When the container is allowed to remain in a warm room, or when it is not properly stop pered, the activity of the preparation is materially lessened, if not entirely lost. An excess of acid is objectionable, however, as it renders the peroxide irritating instead of soothing. Commercial peroxide, which is used extensively for bleaching purposes and in the arts, is doubtless responsible for unsatisfactory results, but as compared with the medicinal preparation, it is a very inferior product, sold at a cost of about eight cents a pound. Physicians should know that this product always contains a large proportion of acids (two to five per cent.), hydrofluoric, sulphuric, hydrochloric, oxalic, and nitric acids, and, knowing this to be the case, they should be careful to examine the reactions and see that the medicinal preparation obtained by patients is supplied in original packages. The commercial product is not "just as good" nor will it "do as well" for the patient; and if these suggestions are kept in view, the success for the peroxide is assured. Another important thing which I have learned is, that the mixture of the peroxide with glycerin does not make "glycozone," but,instead, a mixture which generates slowly but constantly secondary products, which appear to possess irritating properties almost as toxic as those of formic acid, well known in Central Africa as a deadly arrow poison. I am of the opinion also that when the peroxide is used in the form of an inhalation by heating with water, a considerable proportion of the nascent oxygen is transformed into ordinary oxygen before reaching the affected tissues, and while I can readily understand how this must detract from its efficiency, remarkably prompt results have attended its administration in this manner. The only obstacle in the way of securing immediate and favorable results from the exhibition of this agent is our inability to command at all times a freshly prepared and thoroughly reliable product, free from the impurities incident to its manufacture; but that difficulty, I believe, is no longer an excuse, as it can be supplied by the principal druggists throughout the country. Pharmacology.-In order to estimate with some degree of accuracy the ultimate changes effected in living tissues from the employment of oxygen, and especially nascent oxygen, our study must embrace a recapitulation of the metamorphoses taking place in the protoplasm. This seems all the more necessary for the purpose of meeting objections which have been urged against the use of oxygen, owing to the supposed dangers of hyperoxygenation and a consequent increased rapidity of combustion, although these notions are altogether fanciful. Alkalinity of the blood enhances the oxygen-carrying capacity of the red corpuscles; hence the utility of alkaline mineral waters, which increase cell-activity. Ehrlich has shown that the func tion of the cell is to generate acid products of tissue-waste; but when these waste products accumulate, cell function is diminished or arrested, no more combustion taking place until acid products are removed or neutralized, thus indicating that we have to deal with a species of cell automatism. Another sig nificant question presents itself in this connection, viz.: If increased alkalinity of the blood favors oxidation, how does it happen that the cell is not entireley consumed? This is explained by Ehrlich on the assumption that all protoplasm is enveloped by cell-juice (paraplasm), which expands or contracts in proportion to the demand of the cell for oxygen. Contraction of the cell takes place when there is no demand for oxygen, and at the same moment, the increased thickness of the paraplasm prevents the absorption of oxygen. Alternate contraction and distention of the cell affects the thickness of the layer of cell-juice, and increases or decreases cell combustion; in other words, it prevents the too rapid oxidation of protoplasm. In the light of the foregoing demonstration there can be no hesitancy in ascribing the therapeutical value of oxygen, in whatever form employed, to its influence upon cell activity. The entire organism being composed of cells, the conclusion is inevitable that all agents which increase the normal function of the cell increase in like manner resistance of the organism to the inroads of disease. This is further exemplified by active oxidation (combustion) which takes place when the peroxide is brought into contact with unhealthy tissues and still no deleterious action is noticeable upon the normal structures, a statement of fact which can be applied to no other known antiseptic. Pus and all other unhealthy discharges are promptly destroyed, the affected structures being left clean and perfectly free from microorganisms. Therapeutics.-From the peroxide of hydrogen we may obtain, in the form of a vapor or spray, the therapeutic effects of nascent oxygen, and as a surgical application or antibacterial substance this product is far superior to the gas itself. Used in the form of a vapor by inhalation, it increases the secondary assimilation by favoring the elimination of excrementitious products through the stimulating effect upon internal respiration. Just as pure mountain air arouses the activity of functions which have been depressed and promotes health, so oxygen evolved in this manner increases tissue change and prevents the suboxidation which attends upon the arrest of cell function. Oxygen is a tissue-builder as well as an oxidiser of carbonaceous and excrementitious products. When it is introduced into the alimentary tract, abdominal fermentations are arrested by the destruction of the germs which produce them; unhealthy mucous secretions are destroyed, while the vitality of the cells lining the walls of the intestine is augmented, and their power against the absorption of ptomaines and leucomaines greatly increased. The surgeon will find the peroxide an efficient and most convenient antiseptic, as it can be freely used in cavities, in discharging sinuses, and upon the most delicate tissues, without danger of producing the slightest irritation. In all cases of threatened collapse, in low conditions of the system, and during convalescence from severe illness, the physician should bear in mind the wonderful revitalizing properties of this remedy. Perhaps the reader will gain a more practical idea of the applications by a reference to some of the more prominent indications, and I shall briefly pass in review some of the diseases in which it may be used with beneficial results. In anæmia and chlorosis, along with suitable diet and exercise as adjuvants, the inhalations will prove most valuable; appetite increases, digestion improves, and there is a marked change for the better in the appearance and in strength. The feeling of malaise disappears within a few days after beginning treatment, list |