---Illinois druggists are very indignant because Section 10 of the new medical practice act prohibits "counter-prescribing." At a recent meeting the state pharmaceutical association denounced the act in unmeasured terms, and appointed a committee to prepare an amendment to the act which should wipe out the section, and instructed the committee to use its best efforts to have the amendment passed by the legislature-Ex.

-The increase in the death-rate of the world's metropolis, London, is stated to be for the last five weeks 50 per cent. London now loses its reputation as a healthy city and exhibits a higher death-rate than Paris, Berlin, Brussels or Rome.

-The Texas Courier-Record of Medicine reaches us this week with number 1 of volumn V, which is clad in an entirely new garb, presenting a Spanish-olive cover which is quite esthetic.

-Hutchinson says there is a notching of the upper incisor teeth affecting the two permanent central ones of the second set not due to syphilis, but which may be confused with the notching of tnat disease.

The points of distinction are that the non-syph

ilitic tooth is wide instead of narrow at its free edge, and it is hard and craggy, while that from syphilis is pointed, like a screw-driver, and worn down. A case is mentioned where such notched teeth were hereditary in a family; the defects occurred in pairs and did not damage the whole row. There existed no evidence of mercurial poisoning, nor were the first permanent molars, the test teeth of the m ercurial set affected.

-Texas, the Russia of America, with its territory so vast that a line drawn through its greatest diameter would extend from New Orleans to Chicago, and its area so great that all the people in the United States would come far from crowding it, again comes to the front with its State Medical Association Transactions. They form an immense volume of interesting reading matter, extending over 450 pages. Texas has always been known as a hard working state in her medical societies.

--For Chronic Eczema.-B Unguenti hydrargyri oleatis, plumbi carbonatis, pulv. marantæ, aa 3i; naphtholi, gr. xx; unguenti zinci oxidi, 3i. Ft. ungt. M. Sig.--Apply twice daily.

-For Styes.--B Acidi boracic, 10 grammes, aquæ dest.. 300 grammes. Dissolve. With a wetted piece of wadding drop some of this solution on the stye several times a day. It is said

VOL. XVI. No. 12.

REPORTS ON PROGRESS.

DERMATOLOGY AND SYPHILIS.

BY W. G. MOORE, M. D.

PRURITUS.

TERMS: $3.50 A YEAR.

It may not be amiss to call the attention of the younger portion of our readers to the multitude of causes from which pruritus may come, and the very serious diseases in which it may appear as a complication of the gravest tendency. It may be caused by physiological changes such as occur in women during gestation, irregularities of the menstrual function, or at the approach of the menopause. Organic diseases of the uterus and ovaries in hysterical subjects are frequent sources. It is often a prominent symp. tom in hepatic and renal diseases--albuminuria, Bright's disease and diabetes. It is intimate

In the whole category of cutaneous affec tions I know of no single symptom that gives so much annoyance as itching. Pruritus, as referred to here, is not that itching which occurs in connection with inflammatory affections of the skin-or that which results from the various pediculi—but it is that condition which has been dignified by the name of a distinct disease known as pruritus. When we come to consider the etiology of this affection it scarcely seems worthy of being called anything more than a symptom-a cutaneous expression of some internal organic derangement.

Yet so terrible is the torment sometimes experienced from this cause that patients have often sought relief in suicide. Mental derangements have also been attributed to the

same cause.

An unfortunate feature in its clinical history is the fact that its exacerbations almost always occur at night, thus robbing the patient of "nature's sweet restorer-balmy sleep."

glycogenic functions of the liver-and in all obstinate cases the urine should be carefully examined for sugar. The connection between pruritus and jaundice is well known,-Frerichs estimating that it occurs in 20 per cent. of cases while Wickham Legg says he has met with it in 68 per cent. Frequently it is a forerunner of the jaundice, and may precede it weeks or months. Legg says it is most intense at the outset-growing less as the jaundice progresses. It is frequently the most obstinate and distressing symptom.

Many observers believe that the pruritus in this connection is due to the circulation of bile pigment. It is well to state, however, that Murchison does not share in this opinion. Quite a number of diseases of the nervous system also give rise to pruritus. Various derangements of the intestinal tract-especially constipation and intestinal worms are fruitful sources of the trouble. Genito urinary diseases with polypi of the urethra in both sexes are well recognized causes.

Many more conditions giving rise to this exasperating symptom might be enumerated but sufficient has been said to serve my pur

pose-call attention to the great extent and diversity of causes-and ask that physicians investigate thoroughly before they apply some "soothing" ointment to the "itchy spot" when the source of the trouble is remotely situated in some important organ.

I will give briefly the history of a patient under my care. Ten months ago the patient was a healthy, blooming woman of forty years, boasting of health and buoyancy. Six months ago she became a widow and had to come face to face with the problem of making a living by her own efforts. In order to do this she has worked day and night and suffered the keen anxiety that is better imagined than described. The close application of the needle and confinement were not long in bringing dyspepsia with its thousand ill-sconstipation, headache,sleeplessness, etc. Then came disease of the eyes that bereft her of sight for weeks, and the gloom and despondency reached its climax in an attack of pruritus.

At first, hands and feet were attacked, and then the general surface became invaded. After suffering for weeks from this tormenting affliction she presented herself in a truly pitiable plight—having lost in the space of a few months over 40 lbs. of flesh, and her general health a wreck.

This is a disease wherein the genius of the physician will find the greatest possible scope. His tact and patience be put to the severest test and frequently unsatisfactory results, if not failure, be his reward.

The prognosis should always be guarded, inasmuch as the cure will depend upon the cause and our ability to remove it. In the patient above referred to, contact with cold for a few seconds was sufficient to bring on a paroxysm of itching; such as putting the hands in cold water, touching any cold object, etc.

It is needless to say that such a case requires every effort on the part of the physician. The most most searching investigation should be made to discover the real cause if possible and under no circumstances should he content himself and delude his patient by

the application of certain antipruritics to the skin.

Treatment is of necessity varied; and will be determined by the cause. It is needless to go into the endless details of treatment that may become necessary in the course of this disease. Suffice it to say that both local and constitutional treatment will be demanded.

External remedies are principally indicated in local varieties of the disease. However, alkaline baths, warm or cold, as preferred, are sometimes a means of relief in general pruritus. Perhaps the most useful local remedy is carbolic acid 5 to 20 m to the ounce of water. For the innumerable list of remedies that have been suggested in pruritus, I would refer the reader to the text books on the subject. Tonics, laxatives, alteratives, all come into use; and in this disease, as in all others the patient should have the benefit of the best hygienic surroundings.

Apropos to what has been said above are the following ideas taken from à recent article written by Tom. Robinson, M. D., of London. (Jour. Cutaneous and Genito-Urinary Diseases). His observations would lead him to believe that in all cases where itching of the skin comes on without the presence of pediculi or some appreciable lesion of the skin to account for it-its true source will be found in disease of the nerve centers. Furthermore, we know that there are nerve centers which govern speech, micturition, perspiration, etc., and why not a special nerve center presiding over the sensations of the skin.

The author has frequently observed that in men advanced in years, whose nerve centers are beginning to give way, this itching of the skin is a frequent precursor. In proof of the idea of the existence of a special centre for the sensations of the skin, he cites the familiar spectacle of a class of students scratching themselves when seeing a patient afflicted with body lice. The mere discussion of itching diseases or mention of lice will have the same result.

Dr. Robinson thinks not enough attention has been given to the relation existing be

tween the skin and the mucous and synovial membranes. A patient has a thick prurigi. nous skin, i. e., it it irritable; he or she is also bilious, that is the mucous membrane is easily irritated; they have headaches, etc.

This goes on through a series of years, and other membranes become catarrhal, and joint diseases often follow. A case was cited, in which the patient had large eczematous patches, which underwent marked changes alternating with a copious diarrhea.

The writer justly deprecates the constant subdividing the classes of skin diseases-as serving no practical purpose and inevitably causing confusion. The essay closes with

the following conclusions:

1. There is not such a disease as prurigo. 2. That all cases of itching skins have a recognized and discoverable cause.

3. That all the group of symptoms known as prurigo are the result of scratching and are only symptoms.

4. All scratched skins which have advanced to an elephantoid state, and which have set up enlargement of the lymphatics, are beyond the reach of remedies or hope.

5. That the pruriginous skin of children has its origin in developing hair follicles, which progresses from birth to puberty, and stops.

6. That itching does not occur in those situations where the hair grows luxuriantly. 7. That what is known as winter prurigo is due to imprisoned hairs.

8. That an irritable state of the skin is always associated with an irritable state of the mucous and synovial membranes.

ORIGINAL ARTICLES.

REPORT OF A CASE.

BY B. F. FORTNER M. D. AND OLIVER BAGBY M.D. VINITA, IND. TER.

Every year medicine is becoming more surgical, and surgery is becoming more medical, as the following case may to some extent show. A little boy, æt. 6 years, had been

under competent medical treatment for more than a year, with the following history:

Was seized with a continued fever, supposed to be malarial, ushered in with violent pain in the abdomen. When after months the fever had disappeared, the pain, though greatly ameliorated, continued in a rather intermittent form. Comparative immunity lasting one or more weeks. Regained usual amount of flesh, but recently began to lose flesh again and to suffer more. Now keeps one hand constantly upon the pubes, making a sawing motion. No pains of parent could break the habit. Erections frequently occurred with this motion, but was not constant. Bladder irritable, diarrhea and constipation alternately. Bowel constantly leaking, so that patient had to wear napkins. Rather thin and pallid. Cries out ocasionally with. pain deep in the abdomen and pelvis, sometimes lasting for many minutes and recurring at intervals of hours. Put him upon alteratives, laxatives and tonics, including iron, with the phosphites, zinc, bromide soda, etc. Improvement only temporary. The foreskin was slightly more than medium length, orifice good size. The prepuce was adherent two lines in circumference behind the corona and mounting just to the plane of the glands. This seemed too insignificant to account for so grave an ensemble of symptoms, and just therein lay the interest attaching to the case. Chloroform to complete anesthesia was given to aid rectal examination especially. The finger deep in the rectum touched feces slightly hardened, which under the consequent straining effort came away in a mould fully 12 inches long. Thorough evacuation was encouraged by deep manipulation, and the rectal mucous membrane red and irritable was extended in ample folds. Not yet fully satisfied as to the cause of the whole trouble, we by way of experiment circumcised and broke up the before mentioned adhesion and put the child back to his tonics and laxatives. Were the story discontinued here, to many observant physicians, the cause of this group of symptoms and the result of the experimental operation, would be equally uncertain and