The pouring of water on the head from a considerable distance has a happy effect. The people of India, who suffer so much from insolation, prefer this curative power to all. others. When reaction has been fairly established, small doses of aconite or veratrum viride must be given, to control the fever that follows; and during convalesence quinine and iron, and general tonics will be necessary.、 Insolation can usually be prevented by the constant application of cold to the head. Persons exposed to a scorching sun should wear in their hats a sponge or kerchief, which ought to be frequently wet-and, as a further precaution, they ought to avoid the use of spirituous drinks and large draughts 'of cold water. 52 Bond Street, New York. PERISCOPE. Influence of Weather upon Sickness. Dr. Ballard, in his recent Report on the Health of Islington, for 1867, says: "1. That an increase of atmospheric temperature is normally associated with an increase of general sickness. 2. That a decrease of atmospheric temperature is normally associated with a diminution of general sickness. 3. That for the most part the increase or decrease of sickness is proportional in amount to the extent to which the atmospheric temperature rises or falls. 4. That it is an error to suppose (as is popularly held) that sudden changes in temperature are (as a rule) damaging to public health. A sudden change from cold to hot weather is indeed very damaging; but a sudden change from hot to cold is one of the most favorable circumstances that can occur when sickness is regarded broadly as respects a large population. 5. That, remarkably enough, these influences are most marked in the directions I have mentioned in the colder seasons of the year, and more certain in the winter than in the summer. 6. That rises and falls of temperature are more certain and effectual in their special operation upon public health when at the same time the daily range of temperature is lessened, than they are when the daily range is at the same time increased; rises of temperature increasing sickness more certainly and markedly, and falls of temperature decreasing it more certainly and markedly. 7. That a fall of rain lessens sickness generally, sometimes immediately, sometimes after a short interval, and that, as a rule, the reduction of general sickness is greater when the fall of rain is heavy than when it is light. 8. That drought, on the other hand, tends to augment general sickness. 9. That wet weather in the summer season operates more certainly in improving public health than it does in the winter season.-Med. Times and Gazette. Ulcer of the Leg. We make the following extracts from a Report in the London Lancet of the Hospital out-door practice: We could scarcely have chosen a more common surgical ailment than that which is the subject of the following notes. Comparison of the modes of treatment adopted for it by the authorities whose names are here collected cannot fail, we think, to be of much interest to the profession. ST. BARTHOLOMEW'S HOSPITAL.--Mr. Thomas Smith adopts the following classification as most convenient for clinical teaching and therapeutical purposes. He believes it to be of first importance to decide whether an ulcer be of syphilitic origin, or whether it be due to other causes, such as anæmia, insufficiency of food, debility, old age, eczema, varicose veins, hypostatic congestion, or local injury. The diagnosis of syphilitic ulcers he grounds on the antecedents of the patient; on the position of the ulcers, usually above the middle of the leg; their number, often more than one, or if one only is open, scars of former ulcers are usually to be found. The shape of the sore is taken into account-usually crescentic or circular, if syphilitic; the condition of the surface of the ulcer, which, unless healing, looks rotten, and generally contains a core formed of dead tissue, while the edges and environs of these ulcers are often stained a dirty, tawny red. Treatment.--Iodide of potassium and bark internally, together with black wash locally seldom fail to cure syphilitic ulcers. Inflamed, irritable, or painful ulcers in feeble people are treated with bark or quinine, and by the application of morphia ointment or water-dressing to the sore. Healing ulcers are treated with water-dressing or simple cerate. The cold ulcer, as described by Mr. Paget, is treated by tonics, with opium locally and internally. Varicose ulcers are treated on general principles; the heroic but successful treatment by ligature of the veins is not carried out, on account of its unsuitability to out-patient practice. Bandages are employed in the treatment of all ulcers. GUY'S HOSPITAL.-Mr. Bryant practically divides all ulcers into the cellular membranous and cutaneous sores : the former being invariably due to some general or constitutional cause; the latter, probably, to some local one. In the treatment of the cellular membranous sore, the remedies must be directed to the constitutional cause or cachexia which induced the disease, tonics being invariably required, and, when syphilis is the origin of the affection, combined with the iodide of potassium. In the treatment of the simple cutaneous sore a variety of measures are sometimes required; for an inflamed ulcer, which requires soothing treatment, has to be treated differently from an indolent sore, which needs stimulating; a sloughing sore, from excess of action, requires an opposite treatment to a sloughing sore due to a want of power. When a simple sore is inflamed, therefore, the local and constitutional symptoms are usually treated by opium lotion, and opium internally, with or without tonics. When a sore is indolent, it is stimulated with nitric-acid lotion, or the terchloride of carbon lotion. When a sore is sloughing from excess of action in the part, the constitutional irritability is allayed by opium, tonics, and stimulants; and when sloughing from excess of indolence in the sore, by local stimulating applications combined with tonics. GREAT NORTHERN HOSPITAL.-Mr. Gay's classification recognizes three kinds of ulcer-namely, the idiopathic, the venous, and the arterial. The treatment of the first variety is simple: 1. General.-Rest, with the elevation of the foot above the level of the pelvis. 2. Local and constitutional.-When painful and inflamed, topical bleeding by leeches, or scarifications tolerably deep across the edges; warm water dressing; moderate purgation, and opium. If the ulcer has become chronic and the base thickened, Mr. Gay recommends a slightly stimulant lotion -e. g., dilute nitric-acid and opium; or biisters, with the cautious administration of iodine, if struma or syphilis appear to exert an influence on the sore. If there is general want of power, stimulants, tonics, and good nourishment. There is a more severe form of ulcer, often coincident with varicosity, and as often without it, but very constant with discoloration-"bronzing "—of the skin, which Mr. Gay has traced to obstruction, by clot principally, either of the saphenous, or the deep venous trunks, most generally of the latter veins. This is the "venous" ulcer. Such ulcers will heal by rest and elevation of the leg; but not permanently. Free clliptical incisions along either side of the ulcer constitute the only treatment that can secure for them permanent cicatrization. The "arterial" ulcer differs materially from the former kinds of ulcer. It is the large, deep, cold ulcer, which often, with intervening islets of diseased skin, occupies the whole of the leg, from just below the knee to the ankle. As it deepens, so it invades fascia, muscles, bones, and even the deeper vessels. They are positively incurable by any means yet adopted; and amputation, except under exceptional circumstances of a favoring nature, is a very hazardous proceeding. KING'S COLLEGE HOSPITAL.-In the more acute cases of varicose ulcers, and those attended by heat and pain, Mr. Wood finds that by far the most convenient, comfortable, and effective plan of treatment is by the acetate of lead and glycerine lotion placed on lint next the sore, changed every night and morning, and surmounted by a wet bandage, carefully adjusted, and kept moist by being wetted from time to time during the day. If the pain be very great at night, five grains of the opium and soap pill are given every night, and the bowels are acted upon daily by a sulphate of magnesia purgative. When the heat and inflammation subside, which soon occurs under this treatment, the lunar caustic is applied twice a week to the edges of the sore, which is then strapped with soap plaster. In sloughing and phagedenic ulcers, with congested edges, dark-red granulations, and sanious discharge, rest in the recumbent posture is indispensable in the treatment, with aperients, succeeded by tonics and opium administered internally. The local application from the first in these cases, in Mr. Wood's practice, consists of a solution of carbolic acid in glycerine and water, of the strength of about 3 or 4 per cent. of the pure acid. This is applied on lint, and covered with oiled cotton or silk and a light bandage. This has been found remarkably efficacious in cleansing the surface of indolent, ash-colored, sloughing granulations, as well as in the more extensive sloughs, and in introducing healthy action and cicatrization. In simply indolent ulcers, the local application of the chloride or sulphate of zinc lotion, in the proportion of 2 to 3 grains to the ounce, is of the most use. If the edges of the sore are thick, indurated, and callous, the caustic chloride of zinc paste applied to the edges has been found to induce a more even and healthy cicatrization when the surrounding skin has not been too firmly bound down by induration. In weak ulcers, with pale flabby granulations, Mr. Wood uses locally an aqueous solution of the perchloride of iron in the proportion of 2 or 3 grains to the ounce, with the internal use of the tincture of the same preparation. ST. MARY'S HOSPITAL.-Mr. Norton divides ulcers of the leg into three classes-1st, inflammatory; 2d, non-inflammatory; 3d, those due to an existing local cause. In inflammatory ulcers, moderate antiphlogistic remedies, coupled with anodynes, seem to be the most beneficial. Attention is paid to the bowels, which should be frequently relieved by an ordinary rhubarb draught. Locally, the treatment adopted is emollient, as a warm poultice sprinkled with laudanum, and in a few days changed, if necessary, to a bread poultice saturated with a lotion composed of solution of diacetate of lead, five minims; tincture of opium, half a drachm; water, one ounce-applied at the natural tempera ture. Non-inflammatory ulcers he treats with a lotion of carbolic acid (five grains to the ounce); but lately he has tried largely the treatment by exclusion of air, and for that purpose has applied pieces of tissue-paper, steeped in Dr. Richardson's styptic colloid, and accurately fitted to the ulcer; or a solution of mastic in spirit made into a paste, with trisnitrate of bismuth, and applied upon lint, kept in position by a strip of soap plaster, care being taken first to wash and thoroughly dry the wound. Each application has its merits, but the latter produces no smarting of the surface; on the contrary, by means of the anodyne properties of the bismuth, it subdues any nervous irritability. Under the third head Mr. Norton arranges those ulcers due to a persistent local cause, as varicose veins, or necrosis, the treatment of which depends mainly upon the removal of the exciting agent. Mr. Norton considers that total rest is the most reliable remedy for all ulcers, but it is without this valuable agent that the surgeons of the out-patients have to deal with the disease. As a rule, also, he finds internal medicines of but little avail, with the exception of purgatives and anodynęs; and, as regards local applications, prefers the milder remeVOL. IV.-NO. 2. 6 |