PRACTICAL DEDUCTIONS indicate that the hymen presents numerous variations as to size, shape and distensibility. It is difficult in some subjects to make an intelligent examination of the hymen, unless the parts are relaxed, and this sometimes only possible under an anesthetic. With relaxed parts the great distensibility of the hymen becomes apparent. The presence or absence of the hymen is now considered of little importance. medico legally, and no sign of virginity.

In rape, however, lacerated hymen becomes significant. A fimbriated hymen may simulate laceration. The presence of corunculæ hymenales have considerable signification as regards previous parturition. It is true, the corunculæ hymenales are not a sign of labor, but they are a strong symptom. The hymen shares in vaginal and vulval inflammations, and from the presence of nerves is sensitive. The diagnosis of imperforate hymen should be made with caution, as it is easy to overlook minute openings, which have permitted discharges and penetration of semen.

The blunt ends of the porteno labia majora do not unite. Note the rugans condition of the parts about the vestibule. This is the vulva of a young person.

The newly married woman frequently suffers severe pain from the lacerated, deflorated hymen, and especially on repeated copulation. At the first copulation, and for some time subsequently, the woman should apply sweet or olive oil to the vulva and introitus vagina previous to copulation. The man should oil the glans penis. This simple precaution often avoids considerable mental and physical suffering.

The well developed hymen is more or less ruptured at the first complete copulation. The hemorrhage at first copulation is nearly always due to rupture of the hymen. Should hemorrhage require arrest, either pressure or a ligature passed about the bleeding point by the aid of a curved needle will suffice.

The hymen and orificium vaginæ are one and the same.

The hymen semilunaris is the most frequent and important form. The other forms are rare and of little practical significance.

Imperforate hymen retaining blood and discharges should be incised, after which the patient should remain in bed.

A Peculiar Case of Poisoning by Potassium Iodide.

MR

BY E. A. CRAIN, M. D.,

MISSOULA, MONT.

R. A., a chronic user of morphine to the extent of grs. iiss per day by the mouth, suffering from nerve pains in the chest, with palpitation of the heart when the stimulating effect of the morphine was absent. Was advised to take potassium iodide, grs. viiss, three times a day. He procured the medicine at 5.30 P. M. took one dose, as the pains were annoying, at 7 P. M. another, which quieted the pains. He was so much pleased with the effect, that at 8.30 he took the third dose, making 221⁄2 grains taken in three hours, the last dose taken with the idea of being free from the pains during the night. At 10.30 he began to have an uneasy feeling in the mouth, simulating toothache in upper jaw, although he had no upper teeth, they being replaced by a rubber plate. He thought he might have failed to keep his plate absolutely clean, so took it out. The pains increased, and at 11.30 he was suffering every symptom, intensely, of severe influenza, as they appear in the mucous membrane of the head. His pulse was slowed to 40, respiration 10, and sighing pain in nose, mouth, throat and ears intense. By using cocain in eyes and nose, hot water in profusion and constantly, and morphia sulph. as freely as I dared to do, giving three-fourths of a grain hypodermically, and grains two and a half by mouth during the interval between 11.30 P. M. and 5 A. M. I succeeded in quieting him so he rested until 8 A. M. He also had one-half pint of old whiskey as a stimulant during the time. When he awoke at 8 A. M., he had no pain, but his eyes were swollen and protruding, eyelids enormously oedematous, and face much swollen. The metallic taste was pronounced, even to the second day. Was it due to the fact that the secretions were locked up by the morphia, so the elimination of the iodide was slow, or was it an, idiosyncracy against the iodide?

Higgins Block.

Nosophen-Its Use in Neglected Chancroidal Adenitis.

BY T. A. HOPKINS, M. D.

ST. LOUIS.

HERE is no place where the real value of an antiseptic will be more form, so long associated with the treatment of these conditions, and considered the superlative of antiseptic dressing powders, has, during recent years, been rapidly retired until it now occupies hardly a comparative position. We hear less and less of the antiseptic "better than iodoform," in fact, two groups of antiseptics have arisen, the individals of which so far surpass iodoform that it is practically out of the race. Of these groups the. first includes all preparations formed with iodine as a base, iodoform being a member of the group; the second includes a vast array of products, each to some extent useful, some of them decidedly so, but as a class unquestionably inferior to the iodine compounds.

The class containing iodine is not composed entirely of successes. On the contrary, many and great have been the disappointments following the use of some of its members. We seem prone to expsct too much even of the best, then, too, a dressing is too often called upon to combat not alone the original diseased condition, but various surgical sins of the operator as well. It is always well to be certain that our technique has been reasonably cleanly before passing adverse judgment on a product. But we are wise in pinning our faith to the iodine group in the mazes of which can be found much which is really satisfactory. The newer compounds are largely responsible for the good repute of the group and Nosophen stands among the foremost of these.

Nosophen has already been very thoroughly introduced to the profession, but a brief resume is excusable as the subject is important and not all the profession are familiar with this agent.

Tetra-iodo-phenol-phtalein, or, by courtesy, nosophen, is a very light and impalpable, yellowish-grey, tasteless powder containing 61.7 per cent of iodine in combination. Its odor is very slight and not at all unpleasant, It is obtained by the action of iodine on phenolphtalein. It is not affected by heat up to 220° C., it melts at 255 C., giving off iodine vapor. It is insoluble in water and acids, and but slightly soluble in alcohol, ether and chloroform. In the alkalies it is very soluble, and from the alkaline solutions the salts of nosophen may be easily freed at a low temperature by carbonic acid. The sodium and bismuth salts, so produced, have been placed on the market. The former is a dark blue powder which is very soluble in water and alcohol, when exposed to action of carbonic acid it is transformed into nosophen and carbonate of soda. This property and its solubility make it a very useful companion of nosophen. The bismuth salt does not concern us at this time.

Clinical experience with nosophen and its salts has been very flattering in all departments of surgical work, but especially so in venereal and geni

to urinary practice, where the test is unquestionably severe. Having strong bactericidal characteristics, being unirritating and nontoxic, and being to a certain extent anasthetic, astringent and haemostatic in its action, it naturally appeals to the doctor. Add to this the fact that it is almost odorless and you will find that it appeals to the patient as well. In healthy surgical wounds and non-infected injuries it is an entirely satisfactory dressing, but it best shows its strong points when brought to bear on infected surfaces. In a very interesting paper* on the rapid treatment of chancroid, OhmannDumesnil, of this city, has shown that it very materially shortens the life. of these distressing sores and obviates complications and sequallae very frequently. My own experience entirely agrees with that of the writer, as does that of a constantly increasing number of clinicians. In addition to his treatment, which consists of cleansing with hydrozone and dressing with nosophen, the use of an antinosine wash varying in strength from I per cent up to 3 and 4 per cent will be found advantageous. In the post-operative treatment of neglected chancroidal adenitis, it will be found equally useful. These cases usually come to the surgeon when "adentis" has ceased to describe the situation, for the glands are already almost if not quite destroyed and we have in reality to deal with inguinul pockets filled with chancrodial pus. That primary union is out of the question, is patent. We must deal with fact rather than theory, more time will be made by opening freely and dealing with it as we would with a chancroid elsewhere, than by attempting to cleanse and close with a hope of no further trouble, the latter course is almost never a success.

While the local treatment is the feature in these cases, a general house cleaning is of almost equal importance. The system is poisoned and before operating, or at the time of operation, a system of renovation should be inaugarated, all channels of excretion should be open, but especially the bowels; dyspepsia and constipation are almost invariably present in these cases. A rather generous dose of salts to open the way and the persistent use of a mild laxative for some days will work wonders. Cascara is eminently fitted for use here, and if given in combination with maltine, all indications for internal medication will have been met, in so far as the alimentary cause is concerned. This combination masks the characteristic bitter taste of cascara, and if given in small doses, will keep the bowels open and that without any disagreeable features. The quantity of maltine in it is too small to show much of its characteristic and happy effect, still that it aids digestion, stimulates the appetite and is nourishing, will be evident even from these small doses. Should a more decided action in these regards be indicated, and it often is, plain maltine or maltine with pepsin may be given simultaneously.

The operative technique in these case is very simple, the abscess should be opened very freely, curettement should be thorough, and the wound carefully cleansed; the use of antinosine solutions brings its antiseptic principle, nosophen, to bear on pockets and obscure points where the powder, if used alone, might fail to reach, In dressing the wound nos*St. Louis Medical and Surgical Journal, June, 1898.

ophen is dusted into and over it, about half the quantity of this powder being used that would be thought necessary were some other selected. The usual dressings (gauze, cotton and bandage) are then applied. The beauty of this treatment will be apparent on the first removal of the dressing, the wound will be found sweet and clean, comparatively free from pus, and already showing evidence that healing is under way. The speedy subsidence of pain and all the more prominent subjective symptoms lessens the time of necessary confinement, and allows the patient to resume his duties with little delay and little inconvenience. Dressings are to be renewed every second or third day, as indicated. Not infrequently all signs of infection will disappear after the first or second dressing; of all the cases under my observation in none has there been persistent pus formation, and in spite of past neglect healing has commenced with the beginning of the treatment.

The strong point of this treatment is that the recovery is rapid, the long-drawn-out cases, those which haunt the doctor's office for weeks and months have not been given the benefit of this antiseptic. Nosophen not only reduces the time-limit by about half, but also insures an uneventful recovery, this is a record that justifies enthusiasm, and fully explains the fact that it is fast superseding other antiseptic powders. There is no contraindication to its use, and everything in its favor, that it needs the assistance of a rational oversight of systemic conditions is true, it is unfortunately a fact that local measures are too often compelled to work alone, and as a result many a valuable agent is condemned as unable to do what has been claimed for it. It is surprising how irrational it is possible to be sometimes.

SUBSTITUTION.-We have been told that there is in this city a manu. facturing house which is supplying the drug trade with drugs and chemicals built on a plan to make it possible to substitute for almost any product, whether it be proprietary or other. In fact, it seems to be their object to encourage substitution and that in its worst form, while the crime is left to the man of drugs the temptation comes from this house as it never has from another. In selling to the trade they are careful to protect themselves, they have names of their own for all of their products, but the customer is told that various of them are each exactly the same thing as the corresponding individuals of a list of the most popular and reliable proprietaries; the price is about one-half that asked for the proprietary, and in some instances less than it is possible to buy the crude drugs entering into the composition of the reliable preparation. It is no joke to practice medicine at the best, but the pleasure is entirely taken away if we cannot feel certain that our patients are getting just what we prescribe. The physician owes it to himself and to his patients to cultivate an acquaintance with the bottles on the druggist's shelves and behind the compounding counter; if he finds the store stocked with inferior goods his reputation and success in practice demands that he see that no more of his formulas go there. What applies to proprietaries applies equally to official drugs, such a concern should not be allowed to make the ingredients of horse medicine.