The brilliant cure is not from the bowel symptoms, but from the totality of the other symptoms, which are sure to be primary.

FT. SMITH, ARK.

SCAR

DISEASES OF CHILDREN.

BY DR. M. H. VAN TINE.

CARLATINA and Scarlatiniform Eruptions following Injuries and Operations: Dr. J. E. Atkinson (Journ. of Cutan. and Vener Dis.) October, 1886, infers that the increased liability to scarlatina and its peculiar eruption in persons who have suffered injury or who have undergone surgical operations is due to diminished power of resistance from disease, and may hold with regard to other specific fevers, which it notably does, in respect to erysipelas, hospital gangrene.

True, scarlatina may be considered present when the epidemic tendency of the symptoms under consideration is shown after injuries. or operations: a rash, not dependent upon the scarlatinal poison occasionally accompanies septicamia.

Scarlatina is capable of exerting a most noxious influence in obstetrical practice.

Eruptions induced by the use of cinchona and its preparations are frequently attributed to scarlatina or septicamia.

The same authority in a paper read before the Clinical Society of Maryland (International Journ. of Med. Sciences) alluded to the frequency with which renal, catarrh accompanies attacks of scarlet fever; being often 'unobserved, in its first [advances, since microscopical examination alone can demonstrate its occurrence by the pres-ence of casts in the urine. There is considerable variation in the severity of the renal affection during different epidemics. Albuminaria may be present in from 5 to 70 per cent. of the cases-and dropsy may occur from I in 3, to 1 in 10. Both albuminaria and dropsy appear more frequently after the first week, although no period of the attack is wholly secure from their invasion.

The first indication may be suppression of urine and uræmic convulsions. A diminution in the quantity of urine excreted during an attack of scarlet-fever should be regarded as a sign of great importance. Less danger is apprehended from renal complications occurring after the fourth week. Scarlatinal nephritis, as a rule, pursues a mild and favorable course. Dropsy is the first sign, appearing in the face, and often confined to that locality. It may, however, extend more gener

ally, and may involve the serous cavities. Desquamation is often completely arrested upon the supervention of dropsy. The tongue loses the "strawberry" aspect and becomes pale, flabby, and coated, and the child becomes dull, listless, and feeble. Hæmaturia is tolerably common, especially during the third or fourth week, but ordinarily adds little to the gravity of the case. The amount of albumen present in the urine varies greatly, and is of less importance than the total quantity of urine passed. Glax was enabled to draw important conclusions from the amount of urinary water in scarlatina. He recog nizes three types: 1. The total urine is only lessened during the condition of fever, returning to normal on its subsidence. 2. There is increased diuresis at the beginning, followed by diminution. Here the course is protracted, desquamation imperfect, and the heart's action weak. Anemia frequently develops cutaneous oedema not seldom ; but the urine remains free from albumen. 3. Micturition, diminished during the fever, quickly returns to the normal during defervescence, and then suddenly diminishes and remains scanty until death, or after several days polyuria develops, which slowly sinks to normal diuresis. A lessening of the proportion of urine secreted to fluid ingested (23) not unfrequently foreshadows the approach of uræmic systoms, even though the urine contain no albumen. The dropsy is indicative of the amount of the renal derangement, but cases are occasionally observed in which dropsy follows scarlatina, but without albuminuria, and this has been especially marked in particular epidemics.

Scarlatinal nephritis is not associated with any especial type or phase of scarlatina. It is as frequent after mild as after severe attacks; indeed, the care shown in nursing the graver attacks may actually be the means of warding off the renal complications in severer cases. Violent nephritis may follow an attack of scarlatina so mild as to have escaped recognition.

Treatment. The patient should be kept in bed for at least a week after the fever is controlled. Sponging and the tepid bath to be continued daily during convalescence.

As a preventive of nephritis Jaccoud relies upon a rigid milk diet, in all cases of scarlatina, and Dr. A. considers it the best diet where nephritis has already supervened. Five to four pints daily are sufficient, the latter quantity even for an adult. Liebermiester extols the action of hot air or steam baths, also the hot plunge bath, in rousing the surface to normal activity.

Leeching, or cupping over the kidneys, and the application of sinapisms or poultices are employed by some practitioners, and where the ascites. is excessive paracentesis may be required.

Infantile Eczema.-According to Dr. Deury (Cin., Academy of Med. icine) eczema is a catarrhal inflammation of the skin,-simple: non-contagious acute, or more frequently chronic in form, beginning either as an eruption or an erythencatous redness- scattered, or in groups of vesicles, papules, or pustules, or all of them together. There is more or less redness and swelling of the skin, with severe burning and itching, followed by moisture and the formation of crusts, partly yellow and gummy, partly green and brown, or by a dry scaly eruption upon a red

base.

He considers the disease precisely analagous to catarrh of the mucous membrane. The intense itching characteristic of this affection, compels the patient to scratch and tear away the protecting crusts and new cuticle, increasing the inflammation and extending the disease to neighboring parts of the skin.

As the restlessness which it induces may impair the general health, and as there is no danger to be apprehended from the rapid disappearance of the eruption, it should be cured as soon as possible.

In the acute form, irritation and stimulating applications are not admissible. The garments worn should be as little irritating as possible. Ordinary soap should not be used.

In eczema intertrigo, so common in the groin and nates of infants, absorbent cotton dusted with finely triturated powder should be constantly applied, so as to come in contact with the inflamed surfaces and separate them. Boracic and salicylic acids, each one part to two of subnitrate of bismuth, and five of oxide of zinc, is a good powder. Camphor mixed with ointments or washes relieves itching. A two-percent. solution of acetic acid, or a one-per-cent. solution of aluminium acetate in water, frequently gives relief. Carbolic acid is one of the most efficient remedies for itching.

In the commencement of papular on vesicular eczema powdered starch, talc, lycopodium powder or rice starch is good for dusting. Crusts should be removed by soaking them with oil, or by poulticing and subsequently washing them with warm water. If the surface be moist the above powders may be used instead of ointments. Lately salicylic acid has come into use as a solvent for crusts. An ointment of salicylic acid drachm to 11⁄2 oz. of vaseline, rubbed in hourly, or applied thickly spread on lint, in a few days renders the surface clear. An effnctual way of applying ointments to the scalp or face is by spreading them thickly on lint and binding them on by means of the skull cap and mask already described. Where the skin is red and desquamating the milder ointments should be used.

Instead of water thin flax-seed tea or bran water are good substitutes, and very soothing to the irritated surface.

Having removed the crusts, the moist surface is to be cured. To this end he recommends diachylon ointment, the emplast, plumbi and vaseline, as p, e, or zinc ointment, which renders the eczema dry and scaly. Saponis virid two parts, spirts rectificat one part, where healing takes place too slowly.

This is to be poured on moist flannel and rubbed in, then removed with tepid water, the ointment to be reapplied after drying.

An ointment made with one part tannin to ten or fifteen parts vaseline is advised for the face, or parts where the lead or zinc ointments cannot be applied.

The above treatment renders the surface squamous, but the eczematous patch is still infiltrated, hyperasmic and desquamating.

Moderately stimulating applications are now essential, and tar is recommended as being the best agent.

Tar is too penetrating to the skin to be employed in moist eczema, but at this stage of the disease may be used with alcohol, in the proportion of one part tar to two or three parts alcohol.

Professor Widerhofer of Vienna has flannel washed in soap and water until it is filled with lather and with this rubs off the eczematous eruption. Then a strip of linen, smeared with a five per cent, bismuth salve. Lanolin 50, subnitrate bismuth 25 parts, is applied morning and evening. Lanolin salve is more easily borne because it forms fatty acids more slowly than other fats and vaseline when in contact with the skin, the surface of children being very sensitive to the action of those acids.

As no internal remedies are mentioned it may be well to refer to the benefits wrought by the use of Mezerci 200, a single dose being accredited with having cured some obstinate cases of this disorder.

The tincture of Corydalis for. in material doses, has cleared away the unsighhtly crusts, and restored the completion to its former fairness.

The fluid extract of burdock dose 1 to 3 drops night and morning for for two or three weeks has been known to cure some very intractable cases where other remedies had signally failed.

Rhus ven. 200 and the tissue remedies calc. sulph. and kali sulph. have also been successfully employed.

23 SMITH ST., BROOKLYN, N. Y.

BOOK REVIEWS.

PHYSICIAN'S MANUAL OF SIMPLE CHEMICAL TESTS. Part II. CONSTITUENTS OF URINE. BY CLIFFORD MITCHEL, A.B., M. D. Author of Students' Manual of Urinary Analysis; Clinical Significance of the Urine, etc., etc. Chicago: Gale and Blocki. GEE.. 1886. This small volume, a pamphlet of about thirty pages, is of greater

practical value to the practitioner than many more pretentious works. In small compass it gives, the physical characteristics of normal urine, the clinical significance of changes in the proportion of its constituents, abnormal constituents, their clinical significance, and the tests required. in analysation of urine. It is concise, practical and reliable and should find a place on the table of every physician.

HASCHISCH. A novel. By THOROLD KING. Chicago: A. C. McClurg & Co. 1886.

It is not often that it falls to the lot of the editor of a medical journal to review a novel pur et simple. There are a good many things which come under his notice which might justly be classed as works of fiction, but which he hardly dare place in that category. We believe in fiction, that is in its place, a good novel may even at times become a remedial agent, and still oftener a means of prevention of mental disorders. However this has nothing to do with the volume under consideration, which is able to stand alone. As a story 'Haschisch' is well constructed, and although somewhat on the sensational order is in the vein of the modern novel. It is well planned and well written, the story runs easily, the situations are effective, and the portion involving the "Haschisch" experiment, upon which the plots turns, is ingeniously managed. As a whole the book is to be commended; and we congratulate our editorial brother, Dr. Charles Gatchell, of the Medical Era, upon the success of venture. If he continues his literary work we predict for him a success equal to that which he has already attained in professional life.

GOTHAM AND THE GOTHAMITES. BY BARON HEINRICH OSCAR VON KARLSTEIN. Translated by F. C. VALENTINE, translator of "Claire and the Forge-Master," etc., etc. Chicago: Laird & Lee, Publishers, 286 South Water Street.

On reading this volume one has no need to ask with Burns :

"Oh that some power the gift would gie us

To see oursel as ithers_see us."

Though we doubt whether the Gothamites will be pleased with the picture the author has drawn of them, although he takes pains to assure them that he "**** Nothing extenuate nor naught set down in malice."

In the outset he describes it as a “marvel of graudeur and a charnelhouse of squalor, a colossus of charity and a giant of bigotry, a mountain of freedom and an abyss of slavery, a statue of virtue and a cesspool of vice-it is a cosmos." Certainly a city which is at the same time a charnel-house, a colossus, a giant, a mountain, an abyss, a statue and a cess-pool ought not to complain. The book, although exaggera ted and somewhat imaginative, is nevertheless worth reading and deals some very fair hints against the faults and follies of metropolitan life. The translator has done his part well and made a readable book which is not always the case with a German translation, while at the same time he has closely followed the original.