8. For improving the nutrition of nerves. and muscles, restoring natural sensation and motion, massage may succeed when other means have failed.

9. Deep massage without friction has proved of more value in my hands than all other forms of massage put together, in the case herein considered.

10. Massage can be overdone, producing opposite effects from a moderate application.

11. Besides massage, carefully graduated exercises at regular times are valuable accessories in the restoration of motion.

12. Massage is not the only means of treatment for neurasthenia. Its selection is usually decided upon after the failure or exhaustion of every other means; in the same manner that the shrewd old divine decided that it was not wise to let the devil have all the good times to himself.

THE TREATMENT OF MIGRAINE.

A correspondent of the British Medical Journal, December 3d, 1887, states that few drugs will be found of much use in this affec

tion.

Change of scene, climate, and occupation, walking or horse exercise daily, regulation of the diet, and abstinence from tea and coffee, are the best preventive means.

During the paroxysms strong coffee is sometimes useful, and a wet bandage tightly

bound round the head is an old and wellknown remedy, as the following dialogue from Shakespeare will show :

Desdemona: Why do you speak so faintly?
Are you not well?

Othello: I have a pain upon my forehead here. Desdemona: Faith, that's with watching; 'twill away again.

Let me bind it hard, within this hour
It will be well.

Entire abstinence from food, or only the slightest nourishment,should be recommended at this time. Copious draughts of hot water taken early may mitigate an attack. The recumbent position, in a quiet room with a

guarana (30 to 60 grains), and antipyrin in two-hourly doses of 151⁄2 grains on rising in the morning, are most useful. Morphine hypodermically is good, but as the attacks are periodical, it may engender in the patient the opium habit.

ALCOHOL AS A WEAPON OF
PRECISION.*

BY B. W. RICHARDSON, M. D., F. R. S.,
Of London, England.

The whole subject of the action of alcohol in fever is one which ought to be examined by us physicians without any reference to the question of total abstinence. Alcohol in these inquiries is a therapeutical agent, a drug, and should be tested as such by abstainers from it as a beverage as well as by non-abstainers. But in the testing, the drug must be used with absolute precision, or no common truth can be arrived at. The drug must be pure, the quantity exact, the periods of administration definite; while the results, immediate and remote, must be recorded with the most scrupulous attention to details. That done, I am quite prepared to hear that alcohol reduces fever, reduces oxidation and waste of tissues, and, without shortening the course of the disease, acts, tentatively, as a remedy. At the same time, even this proof would not affect me individually toward the employment of alcohol in preference to other remedies which, in my knowledge, are less seductive, less mischievous in the end, and equally or even more effective; because, contrasting the results of treatment of fevers with and without alcohol, there is nothing I know of in medicine that is more satisfactory than the treatment of the febrile condition without an alcohol of any kind.

TO SECURE FIXATION OF THE SCAPULA.

A mode of obtaining complete fixation of the scapula is described by a recent writer in The Weekly Medical Review, Dec. 10th, 1887, consisting in the forcible flexion of the

*The Asclepiad, London, December, 1887.

shoulder joint, thus bringing the coracoid process of the scapula firmly up against the under surface of the clavicle, and retaining the shoulder blade in that position, while movements can be made with the humerus, with a view to freeing it from adhesions, if any should exist. The humerus can be rotated forcibly upon its own axis, and can be completely adducted and abducted to quite an extent before the scapula begins to follow it in its motions. In this manner adhesions can be readily broken down. The method of fixing the scapula heretofore in vogue, which consists in grasping its spine with one hand and its lower angle with the other, is an awkward procedure, and not entirely free from danger, inasmuch as fractures of the frail body of the scapula have been known to be produced by the counter-pressure exerted by the two hands. The method above described, of forcible flexion of the shoulder joint, if found efficient, will prove a ready substitute for it.

THE NITRITES IN ASTHMA. In The American Journal of the Medical Sciences for October, Professor Fraser, of Edinburgh, urges the use of the nitrites in asthma, on the ground that they relax the spasm of the bronchial muscles. If during an asthmatic seizure the presence of whistling râles is determined, and the patient inhales nitrite of amyl, in a few minutes the relaxation of the bronchial muscles will be followed by disappearance of the râles and greater ease in breathing. This makes a very interesting experiment; certainly, it is a strong point in favor of the view that the piping râles are due chiefly to spasms of the unstriped fibres of the bronchi. Fraser has found nitro-glycerine and nitrite of sodium very beneficial in asthmatic attacks, and they would probably have a more enduring effect than the nitrite of amyl.

THE TREATMENT OF GOUTY DIABETES.

Dr. Granville, in the Lancet, states that gouty diabetic patients do well when wisely. but liberally fed with meat in such quantities

THE NEWER ANTIPYRETICS.* Salol is said to cause no gastric disturbance and less ringing in the ears than salicylate of sodium, and to be equally effectual as an antipyretic in rheumatism and other diseases.

Thallin is an undoubted antipyretic of moderate and short-lived efficiency, with drawbacks in the way of chills and profuse sweating.

Kairine is readily soluble in water; has been used in various febrile diseases, where it lowers

the temperature for a short time. It has often produced gastric disturbance, and sometimes alarming collapse. There is no good reason to suppose that it favorably modifies the course of the diseases in which it has been used.

Chinoline, a derivative from coal tar-the tartrate has been used as an antipyretic.

Trimethylamine is an irritant to mucous membranes, and gives rise to local irritation when given by the stomach. In medicinal doses it causes a fall of temperature and pulse without much action on the secretions.

* A summation, by the Canadian Practitioner, Dec., 1887, of statements in Edes' " Text-book of Therapeutics and Materia Medica." (Lea Bros. & Co.)

Antifebrin does not affect the healthy temperature, but when given in a case of pyrexia the temperature begins to fall, and attains a maximum depression in about four hours. This action may be occasionally attended by chills, collapse, and the cyanosis sometimes noticed after other antipyretics. Sweating is observed. There seems to be some depressing effect upon the heart. Antipyrine is easily tolerated by the stomach, especially when taken with wine or aromatics. Full doses of this drug produce a fall of temperature, lasting five to eight hours, the minimum being at from three to five hours. It seems to be attended with fewer unpleasant results than many other antipyretics. In phthisis, if the fever is permanently high, it either does not act or produces a rapid fall of temperature, with sweating, vomiting, and collapse; with the remittent type of hectic, small doses will keep down the temperature, without unpleasant effects. In scarlet fever and diphtheria it should be used with caution, for fear of a depressing effect upon the heart. It has been used with good results for the relief of headache and neuralgia, and is slightly hypnotic. It is said to be very effectual in relieving the pain of dysmenorrhoea. On the other hand, it does not modify the course of typhoid fever, and does not control intermittent.

THE CARLSBAD CURE.*

The British Medical Journal supplies the following data of general interest in relation to life at this celebrated watering place :-

First, there is open-air life. Carlsbad provides for its visitors thirty thousand acres of fir wood laid out in every direction with wellkept paths, carefully graded and supplied with convenient seats at every two or three hundred yards. These are owned by the town and are kept inviolate from encroachments. The rest of the town is composed of gardens, parks, lodging houses and hotels.

In the morning, when the patient goes to the wells to sip his regulation number of goblets of hot saline water, he makes one of hundreds going the same way, and through

Summarized in American Lancet, Jan., 1888.

out his drinking and rambles he is entertained by the most admirable music. Two of the best bands in Europe play from half-past six to half-past eight. Thus, chatting with congenial spirits, to the tune of bright, cheering music, he rambles and drinks amid the park-like surroundings. After his drink the patient breakfasts on the most perfect bread and the most highly-aromatized coffee, with its whipped cream. Then follows the meandering through the thick woods, and the joining in one or more of the modes of recreation provided.

The mid-day meal is taken in the open air, and has been carefully arranged by the medical attendant. Yet it is palatable and wholesome. The afternoon and evening are spent in a variation of amusements that do not fatigue.

Thus, Carlsbad provides for its little world. of visitors every healthy attraction that can encourage life in the open air, moderate exercise, rest of mind and an attractive and wholesome diet, and everything except the bare cost of living is provided by the town free of cost. There is no charge for drinking the water or listening to the music. The gardens, woods and parks, laid out with an intelligent eye to beauty and comfort, watched with vigilance,and kept with an elegance which few noblemen's parks can boast, are all at the free disposal of the visitors.

The medical men attend to the needs of such as summon their advice. Their general control of the town and its visitors is firm, yet unobtrusive. No doubt the hot alkaline water does have a remedial influence, but, unaccompanied by the conditions just mentioned, it would be shorn of most of its power for good. The whole conduct of these springs presents a lesson to such as may develop the virtues of a watering place in America. If only the conditions surrounding the visitors. to such springs are such as will induce people to forget dull care, anxious foreboding, and to substitute those influences that will call into harmonious exercise all the agencies by which an exhausted or diseased action may be cast off and a rested, sound one developed in its

place, then will there resort to such place the lame and the halt, the careworn, and those afflicted with diseases of all sorts, and most will obtain a new lease of life.

MASSAGE FOR GALL STONES. Under the head "Pumping the Liver," in Progress, Dec., 1887, Professor Comingore reports the case of a physician, about fortyfive years of age, who had been on a long ride in a cold north wind, a part of the time in sleet. He had a chill, followed by an agonizing biliary colic. Two neighboring physicians were called in, and, after exhausting every means they could suggest for the patient's relief, with no sign of improvement, they called Dr. Comingore, who, after hearing what had been done, suggested massage, or palpation, for the purpose of forcing out the contents of the common bile duct. Systematic pressure and relaxation was made for half an hour, when something seemed to give way with a gurgling sound. The patient, in a few hours, having slept in the meantime, passed a large mass of small gall stones, some of them half as large as a garden pea.

-The constant use of carbonic acid water or soda water, such as is dealt out so largely in our drug stores, is said to impair the sexual functions.

-Prof. Parvin finds frequently that pregnant women suffering from pruritus of the vulva are relieved by the application of cloths wrung out of hot water, to the parts.

between a blistering plaster and the skin, to -A thin piece of gauze should be placed prevent particles of the plaster adhering to the exudation and undergoing decomposition.

-To diagnose intracapsular fracture of hip joint, place patient upon his abdomen and carry foot backward; if able to carry nearly to a right angle with body it is undoubtedly a fracture. (Prof. Forbes.)

-Prof. Holland ordered for a eczema rubrum :

case of

M.

-Prof. Da Costa ordered the following treatment for ulcer of large intestine: An

the patient were not pregnant. There need be no hesitation in giving quinine, for example, and giving it freely, unless some idiosyncrasy forbids its use. If abortion or premature labor follow the use of quinine in malarial

fever, the result is that of the disease, not of the medicine. (Prof. Parvin.)

--Sometimes when called upon to apply a plaster dressing we are much irritated, perhaps mortified, to find, for some reason or other, that the plaster lacks life, in other words, refuses to "set." In such an unpleasant state of things, no fresh plaster being at hand, an easy way out of the difficulty, which may not be generally known, is the following: Place the plaster in some cooking utensil-a spider answers the purpose very well-and set the same on the stove and let it cook, if such a term can be applied to the process. A bubbling of air and steam takes place from the plaster, which soon assumes a fine granular appearance: when this process ceases the plaster may be known to be "done" and ready for use. It is gratifying to know that now it will be sure to act nicely, and readily adapt itself to the uses we desire.

-As sponges are important articles in surgery they should be clean and white. A pound of small sponges can be purchased for a small sum and will go a good way in private practice. The following is a convenient and short way to bleach them: First beat the sponges upon a flat surface to break up any large pieces of calcium deposit, then place them in dilute hydrochloric acid (1-10) for a few hours, and shortly the lime disappears and they are ready to be thrown into a solution of permanganate of potassium (3j to Oiv of water). Stir well for five minutes and change to a solution of oxalic acid (3j to Oiv); wring out and repeat in the solution of the same strength with the addition of hydrochloric acid ss; by this time the sponges are

generally very clean and white and but little damaged. The oxalic acid can be washed out by passing the sponges through water several times, and they are ready for the antiseptic solution.