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reliance be placed on nutritious inunctions of the surface of the body.

(7) For rectal alimentation there exists a wider range of usefulness than has heretofore been assigned to it. It is not only appropriate in the severer forms of chronic disease of the stomach and esophagus, but is indicated and should be utilized in the management of all acute diseases when, from any cause, the stomach becomes intractable and rebellious.

(8) In diseases of the stomach, even where a portion of the food ingested is retained by that organ, only to undergo fermentation, inducing thereby pain and distress, it is more logical to resort to rectal alimentation, not as an adjunct to, but a substitute for stomachal ingestion.

(9) Certain organic lesions as well as functional disturbances of the stomach are curable by means of rest to that organ, and by no other means. In rectal alimentation we have a safe and sure means of nutrition, pending the necessary period of rest to that organ.-Dietetic Gazette, January, 1888.

NOTES AND FORMULÆ.

FOR GOUT AND RHEUMATISM.—A part of the severe pain that usually accompanies these diseases may be dispelled by use of the following mixture, which may be painted on the joints every hour or so: Ether, fifteen parts; flexible collodion, fifteen parts; salicylic acid, four parts; morphine, one part.

LAXATIVE GASTRIC TONIC.—Bardet has used the following combination with advantage:

R. Fluid extract cascara sagrada........ 3v.
Tincture nux vomica......

mpxxx.
Distilled water........

3xxviiiss. Simple syrup

ziij4. M. Sig. One drachm p. r. n.

ANTIPYRIN IN EPILEPSY.-From his studies in the effects of antipyrin in epilepsy, Dr. Lemoine concludes that it diminishes the number of epileptic attacks, and even canses them to disappear under the following circumstances: (1) When the attacks occur at a menstrual period and are apparently provoked by menstruation; (2) when the patients are subject to neuralgia and migraine. In every other instance, he believes that antipyrin produces merely transient effects.

To ABORT ACUTE BRONCHITI8.-The following is spoken of highly by Professor H. C. Wood, to abort an acute bronchitis: R. Citrate potash.........

3j.
Syrup ipecacuanha...
Lemon juice...........

Ziij.
Water.........

Ziij.
M. Sig. Two drachms every three hours.

LITHIUM AND ARSENIC IN DIABETES.—

Vigier recommends the following: R. Lithic carbonate........

grains jss. Sodic arseniat .......

grains i Extract gentianæ.....

grains 74. M. Ft. Pil No. 1. To be taken morning and night, and continued until sugar has disappeared from the urine.

CANNABIS INDICA.- In the condition of anorexia consequent upon exhausting disease, cannabis indica in small doses (five to ten minims of the tincture or one-quarter to one-half grain of the extract) have been found very useful by Dr. McConnell, of the Bengal Medical Service. In dyspeptic diarrhoea, he finds cannabis superior to opium, in that it does not interfere with the bile-forming function of the liver. If given soon after meal the liability to unpleasant cerebral symptoms is greatly reduced.

EMULSION OF TEREBENE.—Most efforts to obtain an emulsion of terebene are unsatisfactory. The following formula is claimed to be reliable:

R. Terebene,
Ol. cotton seed..........

..āå mp clx.
Pulverized gum arabic.........

3vj. Pulverized sugar.....

3ij. Water, q. s. fiat.........

fziv. Dose, one to two teaspoonfuls (ten to twenty drops).

FOR FOLLICULAR TONSILLITIS.-In seventy-five cases of follicular tonsillitis as treated by Boislimere, forty-one were reported well in twelve hours, thirty-one in twenty-four hours, three in thirty-six hours. Average, twenty hours. No local applications were used, no gargle, but solely the following formula: Benzoate of sodium .........

31-ziv. Glycerine,

Elex. calisaya bark............... ...........äā 3j. M. Sig. One teaspoonful every hour or two.

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MR. PRESIDENT, LADIES AND GENTLEMEN: In preparing this paper for your kind consideration this evening I have endeavored to be as concise, as practical, and as much to the point as possible.

Upon looking over the field, it will be found that there are quite a large number of aural affections which may complicate the course of scarlet fever; the principal of which are:

I. An acute catarrhal non-suppurative inflammation of the Eustachian tube and middle ear.

II. An acute suppurative inflammation of the middle ear.

III. An acute suppurative inflammation of the middle ear attended by serious involvement of the mucosa lining the mastoid cells, or of the periosteum covering the mastoid process.

IV. An inflammation of the labyrinth or internal ear.

In our consideration of the subject we will say but little of Number IV, except that fortunately it is rare, that it occurs most frequently by an extension of the inflammation from the mucosa of the middle ear, that it is attended by great vertigo and by complete loss of hearing. Little can be done to check the progress of the inflammation once it is well established, and little to restore the damaged hearing.

* Read before the Detroit Medical and Library Association.

In this connection I may mention a case of inflammation of the middle and internal ear, which was seen in Dr. Lundy's clinic, the case followed scarlet fever, and was attended by great vertigo and by complete loss of hearing on both sides. In fact, when first seen, the child had gone totally deaf, and nothing could be done to restore the lost function.

Firstly, then, let us consider acute non-suppurative inflammation of the Eustachian tube and middle ear. The pathological conditions found here are characterized by hyperæmia, swelling and exudation.

The venules as well as the capillaries and arterioles participate in this hyperæmia.

The mucous membrane lining the Eustachian tube and middle ear is reddened and swollen, and the sub-epithelial connective tissue stroma is infiltrated with the serous and some of the cellular elements of the blood.

The tympanic cavity will be found contracted by the swelling of its mucosa, and partially filled by mucus, by serous exudation from the blood-vessels, and by epithelial debris. The lumen of the Eustachian tube is greatly contracted, and the middle ear is not ventilated, as it should be during the act of deglutition.

The drum membrane is swollen, reddened, and in a state of active hyperemia. If the disease stops here these pathological changes are capable of complete retrogression without destruction of tissue, and the mucous membrane may resume its former condition, the sub-epithelial infiltration disappearing the serous parts by absorption, and the cellular by fatty degeneration and by absorption.

The symptoms may be subjective and objective.

If old enough our patient will tell us that there is pain in the ear and side of the head, that the ear feels full, that the hearing is impaired, and that there are a variety of noises, known technically as tinnitis aurin, in the ear. These noises may be of a roaring, hissing or cracking character.

If, however, the sufferer be of a tender age, the case will present more difficulties. The little one will roll its head from side to side, it will moan or cry out with pain, and the little hand will be observed to be carried frequently to the ear and side of the head. In this condition the ear is hypersensitive, and often noises, which to healthy ears are quite natural and cause no unpleasant sensations, jar forcibly on the ear, even cause actual pain.

It will be observed that these symptoms bear a distinct resemblance to those of cerebral meningitis, but they are very suggestive of the form of ear trouble under consideration, and when they occur in one suffering from scarlet fever, should always lead to a careful investigation of the ear and of the mastoid process, when the conditions enumerated below under objective symptoms will be found.

The symptoms found upon inspection of our patient are fever of a greater or less intensity, swelling, and some redness of the skin, of the auditory canal and parts surrounding the ear. Upon pressing upon the tragus, or deep into the parts below the lobule of the ear, pain is elicited. I would call your attention particularly to this last point, as I believe it to be one of considerable value from a diagnostic stand-point; it is always at hand, easily applied, and of tolerable accuracy. It indicates an inflammation of the middle ear, and is not found in cerebral meningitis. Upon looking carefully at the drum head it will be found to have lost all the land-marks to be observed upon looking at a normal drum; the handle and short process of the malleus and the shining spot are lost to view in whole or in part, the drum is reddened either in its whole extent, or around its circumference, and down its center where the handle of the malleus should be seen, it may be bulging. The complication to which this affection is, both are an extension of the inflammation to the internal ear or to the meninges, and in some very rare instances a serious involvement of the mastoid process in the inflammation; this last complication, however, is rarely seen in this form of middle ear inflammation, but much more frequently in the next form of disease which we will consider, namely, acute suppurative inflammation of the middle ear.

Acute suppurative inflammation of the middle ear may follow the affection which we have just described, or it may be a suppurative process from the beginning.

While statistics show us that probably not more than three per cent of all cases of acute suppurative inflammation of the middle ear are due to scarlet fever, still the large number of chronic cases which we meet, whose primary lesions in their acute stages were associated with scarlet fever, would indicate that this per cent is entirely too low, and that in reality the role scarlet fever plays in the etiology of this disease is greater than has been supposed.

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