the expulsion of mucus, while a marked im provement in the local condition will be ORIGINAL ARTICLES. noted. If this effect is not obtained within GOITRE TREATED BY CARBOLIC ACID. three days after beginning the use of the drug, it is useless to continue it. Zinnis regards the iodide as a true specific in bronchopneumonia. Med. Record. common. LOCAL TREATMEnt of LaryngeAL TUBER CULOSIS.—Masséi, Revue Mensuelle de Laryngologie, d'Otologie et de Rhinologie, June 1886, classifies the laryngeal manifestations of tuberculosis into (1) the ulcerative form, (2) perichondritis arytenoidea, (3) infiltration of the vocal cords, (4) nodular deposits upon the cords. A fifth form, the polypous tubercular affection, is so extremely rare that no especial line of local treatment need be specified. The ulcerative is the most group Two symptoms of this manifestation are of especial practical importance, in that they threaten life. Dysphagia, that may lead to inanition, demands our especial anxious care, and stenosis of the larynx with threatening asphyxia, is the other. Cocaine is recom. mended for the relief of dysphagia. Menthol and caffeine are not so useful. As for the treatment of stenosis of the larynx, the writer condemns dilatation, considering it a measure of dubious efficacy in any case, and positively injurious in tubercular disease, Tracheotomy is in many cases imperat ve, and Masséi has observed that, though temporary relief may be afforded, the effect is bad in accelerating the tubercular lung process that may be going on. He does not believe that a cure can be accomplished by or after tracheotomy. BY 0. E. HAVEN, A. M., M. D., EVANSTON, ILL. It is not our intention or purpose to go into the etiology of tumors and especially that of goitre, neither is it our desire to describe the Hartz and Bohemian mountains and upon the various kinds of goitre that are seen in the higher tablelands of Central Asia and among the Hindus and Mahometans of the Himalayan territories, but simply to give a few practical thoughts about that common chronic bronchocele or goitre. enlargement of the thyroid gland known as The great majority of cases is found among the young, especially among girls about the age of puberty, but males are by no means wholly exempt. It may be caused by some external specific cause to which anyone, especially the young, being exposed, may become liable. It is probably a general infection which is seen in this peculiar local expression. But whatever the cause may be, leaving out itary and those persons who have been of account those cases which are plainly heredborn with enlarged thyroids, the history of goitre is usually that of a slight swelling to which the patient's attention is called by chance, this swelling in front of the trachea rically arranged upon both, painlessly and being upon only one side or possibly symmetslowly enlarging and extending upwards on each side of the larynx. Usually after having obtained a pretty good size, the growth the patient except the unsightly appearance of wearing a "great crop at their throats." ceases and no inconvenience is occasioned to Occasionally the growth increases until serious symptoms arise. The severity of these symptoms depends upon the part of the thyroid gland involved. Thus, enlargement of the isthmus brings difficulty in breathing, and an enlargement of the left lobe will interfere with deglutition on account of the inclination of the esophagus towards the left side. These large growths in this country are common, and the hard and calcareous masses sometimes seen in India are seldom or never met with, and we usually have to deal only with those of moderate size and of no inconconsid-venience except in the matter of appearance. To heal up the ulcers Masséi employs iodoform and lactic acid. He employs the iodoform in an ethereal solution and gives it the first place for promptness and efficacy. Before applying the iodoform or lactic acid, a solution of sublimate, 1:1000, may be inhaled as a spray. Better results follow this double medication. The sublimate spray is ered by Masséi an effective prophylactic for he larynx in established pulmonary tuberculcsis. un The treatment has usually been of a temporizing nature and usually not very successful. Billroth, of Vienna, has removed several enlarged thyroids in dangerous cases and has performed the operation successfully. But on account of the number, the large size and the free inosculation of the blood vessels, that method of procedure is only to be followed by the most experienced surgeons, as the operation is one which requires decided and unquestionable skill. The medicinal treatment in vogue is both internal and by local application. Five minim doses of tr. belladonnæ three or four times a day are sometimes efficacious in cases plainly exophthalmic in nature. Tincture of iodine and iodide of potassium internally, continued for quite a period and pushed to the degree of tolerance, are many times effectual. The local application of tr. iodine daily does many times reduce the size of the tumor. A really effective application is the officinal ointment of the red iodide of mercury. Have a small amount rubbed in well before the fire or in the sun's rays daily, and frequently the size of the tumor is decreased. But this above outlined medication and these applications do not always produce the desired result and some cases are not cured. And now we come to the object of this pa per, to describe the treatment of these tumors by the injection of carbolic acid. In many cases both in my own practice and in the experience of a large public clinic in the city of Chicago, I have not met with one case which has not been materially benefitted by the treatment, and in almost every It has been the custom to inject 20 to 35 minims of a five per cent solution of carbolic acid once or twice each week, into the substance of the gland itself. case a cure has resulted. To do this thoroughly the needle of the hypodermic syringe is inserted one-half to one inch into the gland and then the injection is made. Little or no pain is experienced, but only a feeling of dizziness, of which they all complain, and which passes away in a very few minutes. Usually this injection causes a contraction and a hardening of the connective tissue of the tumor and a gradual lessening of the blood supply, and in the course of eight or ten weeks, a complete disappearance. Out of the 150 or 200 cases treated in this manner, there were only two cases where any inflammation and feverish symptoms appeared, and in these cases they only lasted a day or two. The treatment is simple, almost entirely painless, as the smallest needle of the hypodermic syringe can be used and is entirely effective. No other treatment can show such uniformly successful results. The reader briefly reviewed some of the more recent literature of the subject, citing from it the various theories regarding the etiology of chorea. Those adhering to the rheumatism theory he separates into three groups. First, those who believe that rheumatism, from the fact that it is very often followed by anemic and debilitated conditions: of the system becomes thus a frequent predisposing cause of chorea. Second. Those who believe that there is a more intimate, but as yet undiscovered relation between the two affections. Third. Those who adopt the embolism theory, believing that chorea results from capillary emboli forming in the brain and spinal cord, from the vegetations of endocarditis. He mentions the familiar arguments against the rheumatism theory, showing how they have assumed new interest on account of the recent agitation of the embolism theory, growing out of the experiments of Dr. Angel Money. Dr. Money, by injecting small particles of matter into the blood vessels of animals. produced capillary embolisms in the brains instances, when the emboli were in the cord, and spinal cords of some of them. In some choreic movements followed-or "involun tary movements indistinguishable from those of chorea." He does not discuss the Money experiments, but believes them to be of value in studying the pathology of the disease. He does not believe that the embolism theory explains all the phenomena of chorea. Two leading arguments against the theory are as follows: First, The clinical history of general embolism is now pretty well understood, and chorea doos not appear to be a frequent symptom of this condition. Secondly, It is by no means clear that the cardiac affections, so frequently observed in chorea, is identical with that complicating rheumatism. An attempt is made to explain these two facts and account for other of the phenomena of chorea, by a new theory of the disease set forth by Dr. C. R. Stratton, in a paper read last year, before the British Medical Association, on "The Prechoreic Stage of Chorea." Dr. Stratton suggests that the phenomena of chorea, including the heart and joint affections, the psychical symptoms, and other symptoms and signs, that have not been so carefully observed as these, are due to a specific disease. He hints that the heart and joint affections are not those of ordinary rheumatism, but something characteristic of this supposed disease. He adduces some important facts, and makes an ingenious and attractive argument in support of his theory, but we cannot pass upon it until we know more. Other authorities speak of chorea as only a symptom, they do not regard it as a disease sui generis, but consider it to be a phenomenon that may appear in the wake of various pathological conditions of the nervous system. Opposed to these are others who consider it to be a disease per se. They are led to the opinion from the fact that there are, in the great majority of cases, a certain constant assemblage and sequence of symptoms. They place it, temporarily, at least, among the neuroses, accounting for its incipiency in some undefined, probably functional, disturbance of the nerve-centers, the anemia, heart and joint affections, etc., being complications of the original trouble. caused the chorea to disappear entirely for the first time in nine years. All of us could cite instances where a rational selection of remedies has given fortunate results, but when a patient is presented having choreic movements, we are too prone to simply call it chorea and commence giving arsenic. In the use of arsenic we have stumbled across a medicine that fills many of the requirements in treating the general run of cases. It is the best single remedy that we possess for this affection, yet, on this account the most liable to abuse. We may easily be disappointed, if we do not use it with due care. In each case we should carefully watch the tolerance of the patient, else we will not be able to increase the dose in the proper manner to get the desired effect. If we are not very careful to have the bowels constantly regulated, we will soon have to contend with a gastric congestion, sometimes of a troublesome nature. We should not allow constipation to exist for a single day when we are giving large doses of arsenic, And yet, even when we have observed all the prescribed precautions, we shall find in a certain proportion of cases, that either for want of tolerance on the part of the patient, or from an absence of beneficial effects, we cannot rely upon it but must seek other remedies. Dr. W. B. Cheadle has recently writ The problem of chorea is not yet solved. ten a very instructive paper on the treatment There is an incentive to study it in all its of chorea with arsenic. He concludes it by phases with much care. To this end we saying: "I would not have it supposed that I should seek diligently in every case for an regard the whole treatment of chorea to conexciting cause; and in so doing, we should al- sist in pouring so many doses of liquor arsenways have prominently in our minds the inti-icalis down the patient's throat. There are mate association that exists between the periphery and the central nervous system. It is needless to recite what have been assigned as exciting causes of chorea. We are familiar with many, yet with care we will find others. Dr. A. Jacobi, of New York, has recently reported some cases, which were examples of many that he had seen, in which he finds chorea of the face, sometimes of the upper extremities or even general chorea, resulting from pathological conditions of the nasopharyngeal regions, as congestion, swelled muciparous glands, large tonsils, etc. In these cases he says that the chorea may last for almost an indefinite time, unless the cause be recognized and removed. The reader had very recently seen a case of this kind. He also mentioned a case where the exciting cause of a continuous hemi-chorea of nine years standing in a well-developed young woman 19 years of age, appeared to have been in an irritable condition of the ovaries; at any rate treatment that relieved this conditionedy. many other essential measures to be adopted it FURUNCULOSIS. According to Braithwaite, Unna, of Hamburg, advises in furunculosis, carbuncles, abscesses, panaritia, phlegmons and all suppurative processes that depend on the presence of micrococci, as the best of all remedies, a plaster containing mercury and carbolic acid. Applied at an early stage causes rapid subsidence, and in the latter stages so diminishes the extent and severity that an incision is frequently unnecessary. In furunculosis of hairy parts, where the plaster cannot be applied, a ten per cent ichthyol salve is efficient. For internal medication the calcium sulphide is the best rem WEEKLY MEDICAL REVIEW, of the free services of dispensaries are abun EDITED BY THE MEDICAL PRESS AND LIBRARY ASSOCIATION 914 LOCUST STREET, ST. Louis, Mo. Contributions for publication should be sent to Dr. I. N. Love, Secretary Executive Committee, Cor. Grand and Lindell Aves. SATURDAY, SEPTEMBER 11, 1886. THE HOSPITAL APPOINTMENTS. We congratulate Mayor Francis, the Health Department and the medical profession of St. Louis upon the appointment of Dr. H. C. Dalton as resident physician to the City Hospital. He is admirably equipped for the position, with knowledge, executive ability and experience. The appointment is especially grateful to all of the old internes of the Hospital who feel that one of their number has been promoted to a position that his early experience coupled with hard work and many years of varied experience eminently fits him to fill with credit to them and himself as well. The assignment of a superintendent to the Insane Asylum was, we think, a very appropriate one. We have every confidence in the judgment and discretion of our bright, talented and aggressive mayor, and believe that the medical appointments so far made are an earnest that those to be made in the coming, spring will be wise and proper. FREE CLINICS. "One of the greatest evils in the profession to-day in large cities," says the Philadelphia Reporter, "is the abuse of medical charity. We, of course, do not mean to say that those who are honestly unable to pay for it should be denied the benefit of medical treatment; but we do say most emphatically that a large proportion of those who avail themselves dantly able to pay for medical services, and it is only a spirit of contemptible meanness, unworthy of a true man or woman, that induces them thus to accept, as a charity, that for which they are fully able to pay. The remedy lies in restricting the service of dispensaries to those that furnish evidence that they are unable to pay a physician for his services. Do this and give the young man a chance." We certainly endorse this strongly. Is it necessary that a medical institution, in order to instruct or attract a few students, should gather in a thousand cases for gratuitous treatment? We would aid the medical student in every possible way that is just, but it is not just to rob the young practitioner and encourage pauperism. Medical charities are all right, medical robberies are not. CAPRICES OF JUSTICE. A remarkable illustration of the facility with which the administration of justice may be made to face both ways and take diametrically different directions on identical presentations of fact, was seen this week in this city, in the Court of Criminal Correction, in the trial of Peter De Carne, the professed physician, who administered cantharides to some children, in the southern part of the city last week, who were suffering from whooping cough, the effect of his medication being the dangerous illness of both the little sufferers, although happily they are now out of danger The charge upon which the prisoner was tried was for practicing medicine without a license, as provided for by the Practice Act, approved April 2, 1883, After a brief hearing the prisoner was sentenced to jail for one year, that being the maximum period of imprisonment provided in the act named. The prisoner, De Carne, was evidently without money or friends, no counsel appearing to defend him. The surprising feature in connection with this appears, however, when it is remembered that in the case of the State vs. McCoy, tried before a jury in the same court, upon the same charge, in January, 1885, Judge Noonan, after lengthy deliberation, directed the jury to return a verdict in favor of the defendant, he declaring the act in question to be unconstitutional, and this, too, in the face of a decision of the Supreme Court of this state, to the contrary. No fault may be found with the sentence imposed upon De Carne, as it is in strict accordance with the law in the case; but it is to be regretted that the scales did not fall from the judicial sight at an earlier day when there was already abundant light, and which would have prevented the scandal of there appearing to be in this city one law for the poor and another for the rich, and one for the weak and another for the strong. The motives that lead to action are not always apparent, and the wayfaring man is often sorely puzzled to reconcile results and conclusions that appear conflicting and irreconcilable in themselves. SENSATIONALISM IN THERAPEUTICS. The profession has fallen upon strange times or at least a part thereof. No sooner is a drug found to possess some peculiar property or some property quite common to other agents in a somewhat extraordinary degree, than hosts of men come rapidly to the front with their experience with the newly discovered drug, well or ill digested, according to the logical or illogical temperament and the opportunities for observation or eagerness for hasty notoriety of the particular person, but more often with overdrawn enthusiastic and misleading conclusions. The new drug or its new use, like a new fashion in society, becomes a sort of craze with the medical enthusiasts and dudes of the day who are made happy with each new style of treatment. The hydrochlorate of cocaine, for example, furnishing the fuel for the latest popular flame, has been fanned by the fiery sensa tionalists until the very embers will give nothing but ashes. In the midst of the new excitement the virtues of the ordinary agencies of similar power are seldom mentioned, and the work of predecessors in discovery with the same agent, in these articles designed for the public, is scarcely referred to, and thus misleading and false impressions, as to the previous weakness of the profession are made. The subcutaneous anodyne power of morphia, the local anesthetic effects of ether, rhigoline, of chloral and camphor, and chloroform are obscured in the dazzling brilliancy of the new light. The final crowning therapeutic triumph has come! Henceforth there is need for nothing more. But the sober discriminating judgment of mature observation comes with time, and cocaine takes its place as a good but not omnipotent local anesthetic, to be succeeded maybe by a better one of wider range of utility. After a patient trial with cocaine Fleischl, in Vienna, makes the modest announcement through the medical press that he finds the salt of value in the cure of the opium and alcohol habits, and beneficial after the sudden or gradual withdrawal of the drug. No notice is taken of such an announcement because it is not sufficiently startling or sensational. It does not strike the popular medi cal mind with amazement, or disturb the public pulse with wonder. It is too plain and business like and coldly allied to fact. To take with the public it must be tinctured with a large quantity of fiction. Opium under the sway of this new therapeutic power loses all of its terrors; hysteria, melancholia and insanity are to be no more. The truth about cocaine is that it is a tonic and stimulating exhilarant of some power in melancholia, mental depression and nerve weariness. That it acts rapidly but much more evanescently than morphia. That excessively used it intoxicates and converts melancholia into mania. That given largely in the upright position it is capable of inducing vertigo, whether, |