disease to profit-when he can. The subject of the affection is always aware when the attack is "on," except where the seizures are so frequent as to be continuous, when the disease assumes a distinctly automatic state.

The disease, when in this form, is found to be curable to a certain extent-to a certain length, as it were; but even this requires extremely large doses of punitive measures in conjunction with full quantities of grace.

In the hereditary or constitutional form, the sufferer does not seem to be aware of his malady. The hereditary form is also sometimes curable by rigorous treatment practiced in early childhood.

The disease is rarely known to be fatal; from a scientific stand-point it does not effect a great deal; it is seldom really destructive, to others, until it takes the form of printer's ink. When brought in every-day life and face to face with the world, it is usually easily detected-readily diagnosed. But when put in type--when the affection takes that shape, it often looks puzzlingly like its opposite the truth. With due regard to the claims of religion and history (the law long ago learned the art of protective inoculation), we think medicine has been the greatest sufferer from the effects of the disease under notice. Fully one half of the time of the good and honest and true men in medicine has been consumed in correcting the statements, undoing the discoveries, unmasking the marvels so studiously and persistently, in season and out of season, heralded by the unfortunate victims of the affection.

A very deplorable fact in connection with the subject, as it affects medicine, is found in the circumstance that individuals who are the subjects of the malady in its more severe forms not only display and disport themselves in the journals of the day, but actually write books. But life is so short and art is growing so rapidly, that if such people must write, they must needs be forbidden to muddle the pure springs of science, and made to write novels only.

D. T. S.

DISINFECTANT FOR THE MOUTH.-Thymol, 5 grs.; benzoic acid, 3ss; tincture eucalyptus, 3iij; water, Oj.

Notes and Queries.

Editors American Practitioner and News:

I hoped that while in Paris I would see enough of interest for my bi-monthly letter, but regret to say I was disappointed. Of the many peculiarities of this people, one that seemed to me especially odd was that the medical men have no signs "swinging in the breeze," not even a door-plate. So you can imagine the difficulty a stranger has in finding a doctor. I had a letter to Dr. Landolt, and, on going to the house indicated in the address and failing to find any sign, I naturally imagined that the doctor had changed his abode since my friend visited him. But upon consulting the directory I saw the very address. that had been given me, so I marched back to the house, and after much trouble I succeeded in ferreting out the doctor's office, which was on the third floor of a very large building. Dr. Landolt is an eye-man, and from his surroundings I should say was doing well. He speaks English fluently; which, I was surprised to find, is a rare accomplishment among foreign medical men. The doctor seemed glad to meet an American and anxious to be of some service to me. He gave me a letter to Pèan, the foremost surgeon of Paris, which was the means of my being invited to one of his laparotomies the following day at the Saint Louis Hospital. Pèan is a very large man, with a big head, iron-gray hair and side whiskers, and I should say he is about fifty-five years of age. He speaks very little English. The laparotomy was on a private case. About a dozen visitors were present, and I the only English-speaking one. The patient was a large fat woman, over fifty years of age. Chloroform was the anesthetic used. Pèan sat in a chair at the foot of the table in his shirt-sleeves and a large rubber apron. The patient was brought to the edge of the table. After making an incision of about six inches down to the peritoneum, this was opened up, and an immense quantity of fluid flowed into the operator's lap. When this had ceased Pean filled the abdominal cavity with linen napkins, pushing the intestines well upward, so as to get them out of the way of the tumor, which turned out to be a fibrous

growth as large as a small cocoanut, growing from the broad ligament. This was now drawn out the abdominal wound and, its pedicle having been transfixed and tied with a stout silk ligature, was removed, and the stump dropped back into the cavity. The abdominal wound was closed with the interrupted silk suture passed through all the tissues.

Pèan's assistant is an older man than he, and yet during the operation he had to stand any amount of scolding and swearing from the operator. Pean, as you know, arrests hemorrhage by the application of compression forceps, allowing them to remain on for some time after the operation. A gentleman told me of seeing him, after an amputation of the tongue, send the patient into the ward with more than a dozen pairs of forceps hanging out of his mouth. In the operation I witnessed he had within his reach over a hundred pairs of his compression forceps, a dozen of Spencer Well's ovariotomy forceps, such as are used in seizing the cyst, and half a dozen clamps. The antiseptic used, I think, was carbolic acid for the instruments. No spray. The sponges were cleansed in very hot water.

I went through the wards of the Hotel Dieu with one of the attending surgeons, but saw nothing of interest. He had such a crowd following him that it was impossible to get at all near the beds. Not being very conversant with the French language, I took an interpreter with me, thinking I might gather some interesting points, but failed. I did not see the great Pasteur, as I was told that he was very much indisposed from overwork. I have no doubt he is worried almost to death by visitors, and so I did not care to swell the list. I can well understand the great frequency of hydrophobia in Paris, as I should judge that every family in the city must be supplied with one or more dogs-the majority of the canines being of the bull species. Having somewhat of a mania on the subject of dogs, I was constantly busy while on the streets in keeping out of their way.

From Paris I went to Munich, where I remained two days, and spent my time sight-seeing. I left for Vienna the day King Ludwig was drowned. Unfortunately I struck this

town during a church holiday (Whitsuntide) and found nothing doing at the hospital.

I was about the hospital two days before finding an English-speaking person, and when I finally came across one he knew very little German.

I do not doubt that Vienna offers enormous advantages to medical students who are conversant with the language, but why those who have only a slight smattering of German should come here when they can get all they may want in either London or Edinburgh, I can not understand.

At one of Billroth's clinics I sat between two Americans, who have been over here all the winter, and who told me that they understood the lecturer perfectly. When I asked about a case he had up, each gave me a different account of it. One said that the woman had been operated on, two years ago, for what was considered a malignant tumor of the stomach, and such infiltration of the mesenteric glands was discovered that she was sent out to die; the other said that the woman appeared at the clinic, two months ago, with what was considered an abdominal malignant tumor, and on account of the enlargement of the mesenteric glands no operation was advised, but she was sent out to die. And now she appears with not a sign of the growth present. My latter informant was certainly right so far as the operation was concerned, as I could see no evidence of laparatomy having been done, but whether he was otherwise correct I had no means of knowing. At Carl Braun's clinic at least a half dozen babies, about twenty-four hours old, tied up like papooses, were passed around the class like pathological specimens while the lecture was going on, but what it was all about I had not the slightest idea. Finally, a young woman, about twenty years of age, came in in her gown, and, after being put upon the table and her gown drawn up to her arms, had a vaginal speculum introduced-no sheet being used. In what the lecturer had to say, I caught frequently the name of Emmet, and, upon examining the case, I found it to be one of lacerated cervix. No operation was performed.

These hospital people clearly have no regard whatever for womanly modesty, and sometimes

I doubt whether the women themselves possess any. I confess I came away with a decided sense of disgust at the coarseness of things.

I heard Ultzman lecture on a bladder case, but understood so little he said I learned nothing. I saw Wölfler and Salzer each remove a cystic tumor of the neck, and was very favorably impressed with their method of operating. A free incision was made over the growth parallel with the sterno mastoid, and when the sac was exposed it was tapped and partially emptied. The wound made in it was now closed with a pair of compression forceps. The jugular vein was ligated before it was divided. In dissecting out the sac, instead of catching the vessels as they were divided, an aneurism needle with a double thread was passed around all vascular adhesions and the tissues divided between the ligatures. In this way the operation was almost bloodless. Over a dozen ligatures were used by each, many of which might have been dispensed with, I think, if the adhesions had been secured with compression forceps and divided between them. Another surgeon, who did an amputation of the breast, removed the axillary glands and fascia in the same way.

All the surgeons here are firm believers in antiseptics. They use both carbolic-acid and bichloride solutions, and always dress their wounds dry with gauze well impregnated with iodoform-no spray. Silk is the universal ligature and suture. Deep sutures are tied over a bit of sponge. They operate in clean linen dusters, and are especially careful to cleanse their hands thoroughly with soap and nail-brush before commencing work.

I had not the pleasure of seeing Billroth do any cutting, but heard him deliver a clinical lecture. He has a student to come into the amphitheater and examine each patient, and then tell what he thinks of the case, which of course is little or nothing. When he is through, Billroth addresses this student-without once looking at the class-in a conversational manner, and says his say of the case. He talks in a tone so low that his voice does not reach the upper seats. The first case introduced was the woman before mentioned. The second case was a recent dislocation of the shoulder in a strong,

healthy man. Reduction was accomplished in a rather novel manner. The patient was seated on a chair, while an assistant, standing upon a stool behind him with a hand on each of his shoulders, made sufficient pressure to steady the scapula, when Billroth, by manipulation, threw the head of the bone into its socket. The manipulation was very gracefully done.

Case third was a stricture of the esophagus. A stomach-tube about as large as a No. 12 catheter, and made of rubber, was passed through the mouth into the stomach. And instead of allowing it to hang out at the mouth, where it would have been a constant annoyance to the patient, he slipped a flexible instrument through the nostril, and attaching it with a string to the end hanging out the mouth, drew it (the stomach- tube) through the posterior nares and out of the left nostril; then, to prevent its slipping, he tied it to the left ear. Through this tube the patient will be fed by means of a syringe. He of course intends that the tube shall remain in for some time. Whether or not he expects to gradually dilate the stricture, I could not find out.

Case fourth was a stricture of the urethra. Billroth introduced a series of steel sounds. His manipulation of these instruments, though above the average, was much less graceful and finished than that of Sir Henry Thompson.

The last case was a urinary fistula above the pubes in a young man on whom a supra-pubic lithotomy had been performed eighteen months ago. He had in the fistula a large catheter with its mouth corked. When the catheter was removed, a great flow of urine occurred through the fistula. Patient passes none by the urethra. This is the first time Billroth has seen the case. Patient states, so my linguistic friends tell me, that the fistula has been closed and has reopened eight different times. Billroth simply introduced a catheter in the bladder through the urethra, tied it in, and put a compress over the fistulous opening. Whether or not he intended resorting to operative interference to close the opening I did not learn. This matter of fistula is one of the great drawbacks to the supra-pubic lithotomy, and very likely is due in most cases to the drainage-tube being kept in too long after the operation.

By the way, I have heard a good deal of talk among English surgeons of the stand Sir Henry Thompson has taken in reference to the suprapubic operation. They can not understand why the perineal operation, which in most surgeons' hands is followed by so few deaths or bad results, should do so badly in Sir Henry's practice. The great operator is down for a paper on the subject for the British Medical Association, which I hope to hear.

Billroth is a large, fine-looking man, I should say he is nearing sixty years of age, fully six feet in height, and of aldermanic front; hair, originally sandy, is now mostly gray; very long, full beard; a good and intellectual face. He resembles your friend Mr. Sachs exceedingly. All the others I mentioned are large, fleshy men, except Salzer, who is of spare build. Carl Braun is the largest and plainest of them all. He sits in his chair while lecturing, and his delivery is very monotonous. I did not see him do any operations, but would imagine, from his appearance, that he must be very clumsy.

This is certainly the largest field in the world. for the practical study of obstetrics. From ten to twenty cases of labor, I am told, occur here every day. One morning, in passing through one of the obstetrical wards, I counted six women in labor at the same time. When the patients make application for admission, their name, address, and date of expected confinement is taken, and in due time the hospitalwagon is sent out for them. I saw the ambuI saw the ambulance bring four patients to the hospital in one morning. In the immediate neighborhood of the hospital (which contains over two thousand beds) is a large two-story building used as a polyclinic. There are three clinical lectures going on in this structure at the same timeall day-and the material is unlimited.

For a long time I have been intending to make a report on Jamaica dogwood in certain neuropathic conditions, but have postponed it for want of time, and now must forbear for the same reason, and because, as the warm days come work-impulses wane, and I shall soon be off where patients cease from troubling and, my day-dreams will not be disturbed by remorseless fiends that cry, "Physic!"

But, before I go, let me say there is really something in the communication of Dr. Mayes, as I can attest from practical observation. Two years ago I became so well satisfied of the fact that I sent to P. D. & Co. for packages of Piscidia erythrina and fluid extract Jamaica dogwood, to try on patients who could not pay for the luxury and on whom I might experiment a little, and tried both on myself. I found the fluid extract of Jamaica dogwood to be slightly exhilarant and satisfying to the central nervous system in conditions of weariness. A slight sense of cerebral fullness followed its use in two-dram doses; a tingling sensation plainly perceptible when sought for, and diminished sensibility to esthesiometric tests followed by an inclination to rest and sleep.

In cases of exhaustion and delirium following drink and the long habitual use and withdrawal from opium, I have used it in a combination something similar to Dr. Mayes', but never got satisfaction from it uncombined, in very high degrees of pain or extremely low states of nervous depression.

The salutary psychical therapy of a physi cian's visit, and prescription following it, must be considered in discussing its power over the uterine contractions, but it undoubtedly has some power to effect central-nerve tranquilization as well in man as in fishes.

The piscidia is locally benumbing when taken on the tongue, and to abraded surfaces something like cocaine, but less powerful.

Coca, celery, dogwood, and Hoffman's anodyne make a happy combination for nervous depression, which I have often used with great satisfaction, differently proportioned, especially in the opium habit and the shattered nervous state following excessive alcoholic indulgence.

M. S: Tablespoonful-to replace each dose withdrawn, of the preceding prescription.

As soon as practicable withdraw coca from the prescription and then the Hoffman's anodyne, and finally all but the celery.

Quinine in ten-grain doses in the beginning, about ten A. M. and three P. M.; reduce to five grains twice daily; later, to one daily, and finally discontinue.

But I did not mean to write all this, and if I don't stop I shall get too deeply into the the subject for these hot days—and I have promised myself a rest, and now I shall take it. You probably wish I'd taken it sooner.

Piscidia has neither the good nor the bad properties in full of opium, but it will do to produce effects somewhat similar but in lesser degree, and it must be taken in very full doses to do that. Yours very truly,

C. H. HUGHES.

ARSENIC IN SKIN DISEASES.-The editor of the Journal of Cutaneous and Venereal Diseases is desirous of ascertaining to what extent arsenic is used by American physicians in the treatment of skin diseases, and also the results of their experience as to its therapeutical value.

Information upon the following points is requested of every physician who reads this:

Are you in the habit of employing arsenic, generally, in the treatment of skin diseases?

In what diseases of the skin have you found arsenic of superior value to other remedies? What ill effects, if any, have you observed from its use?

What preparation of the drug do you prefer, and in what doses do you employ it?

Will you kindly call attention to this in next number of your journal.

Address, Editor of Journal of Cutaneous and Venereal Diseases, 66 West Fortieth Street, New York.

LEMONADE TABLETS.-Take of powdered white sugur, 800 parts; bicarbonate of sodium, 100 parts; tartaric acid, 100 parts. These are intimately mixed, flavored with 5 drops of oil of lemon, and made into a mass with 200 parts of alcohol. The mass is now pressed into any convenient mold (previously well oiled with cocoa butter), and dried well in a drying closet. The lozenges must weigh about 20 grams, which will be sufficient for a tumbler of water. Other flavors may be obtained by substituting the above-mentioned quantity of oil of lemon with 2 drops of oil neroli, or 5 drops oil of sweet orange, or 2 drops attar of rose.-Dieterich, in Pharmaceutische Centralhalle.

THE POPULAR SCIENCE MONTHLY for August will open with a richly illustrated article of great economic value, entitled "Woods and their Destructive Fungi." The author, Mr. P. H. Dudley, a civil engineer of rising reputation, has for several years been studying the structure of those woods most commonly employed in the arts, with reference to the agen

cies concerned in their deterioration. The results of his investigations put quite a different aspect from the generally accepted one on the process of decay, and promise to be of vast industrial importance in their practical application.

"I AM just as much opposed to intemperance as any body," said Smith, "but, nevertheless, liquor rightly used is a blessing to humanity. When I was ill last year, I really believe it saved my life." "Very likely," said Brown, "but how does that prove that liquor is a blessing to humanity?"