drop is generally sufficient), given consecutively for three days, every three or four hours, with advantage; auscultation giving the usual number of beats (about eighty) in the cases where the larger dose was given.-Lancet, Jan. 23, 1869, p. 143.

6.-CARBOLIC ACID IN SCARLATINA, MEASLES, AND SMALL-POX.

By Dr. ALEX. KEITH, Normanby.

[The administration of carbolic acid internally is, we think, a new idea.]

During the last six months I have used the carbolic acid in fever, scarlatina, measles, and small-pox, with, I think, some success. I have during that period given it in 600 cases internally. Of these only five have died, and those from complication after, produced by bad nursing. I may state that, during the said time, I have had no less than 1500 cases in all. The deaths, including the five above mentioned, are twelve. The other cases were treated in the usual way, with salines, chlorate of potass, &c.

Without going further into detail, allow me to give you the "physiological effects" in few words. 1st, it produces profuse perspiration; 2nd, it rapidly lowers the pulse, so much so, that in twenty-four hours the pulse will fall from 120 to 60-skin cool and moist, with subsidence of fever; 3rd, the tongue, after the same time, will be clean, moist, and, in scarlatina, the soreness of throat much diminished; 4th, after its use for the same time, the appetite continues to improve; 5th, I have found it more useful at an early stage of the disease, although, given afterwards, it very much modifies the symptoms, and carries the patient through the different stages of the disease much more quickly than any other treatment that I have seen; 6th, in some cases the urine appears smoky, as if fine charcoal had been used with it. These are the principal points I have observed from its use. I could give you numbers of cases, but I will at present content myself with the foregoing statement, and simply add the formula in which I give it-carbolic acid and acetic acid, of each one drachm to one drachm and a half tincture of opium, one drachm; chloric ether, one drachm; water, to eight ounces. I give a tablespoonful of this mixture every four hours, until the fever, &c., has subsided. Then the after-treatment is simple. I find that, after the first dose, the patients rather like it than otherwise.-Lancet, Jan. 23, 1869, p. 143.

7.-REMARKS ON THE NATURAL HISTORY OF RHEUMATIC

FEVER.

By Dr. WILLIAM W. GULL, and Dr. HENRY G. SUTTON. [This article is an abstract of a paper read before the Royal Medical and Chirurgical Society.]

The authors are desirous of bringing under the notice of the profession a few more cases of rheumatic fever which have been treated by mint water, or, in other words, which have been allowed to run their natural course. They moreover desire to point out what appears to be the natural course of rheumatic fever with reference to the heart, and to show in what proportion of cases the heart became involved when rheumatic fever was treated by mint water. Lastly, to consider if there is any evidence to prove that the heart is more frequently involved when rheumatic fever is treated by mint water, or when treated by alkalies, by lemon-juice, or by blisters. This paper is based on twenty-five cases of rheumatic fever, twelve of which occurred in Guy's Hospital, most of them under the care of Dr. Gull, and thirteen occurred in the London Hospital, under the care Dr. H. G. Sutton. The particulars of the twelve cases have been already recorded in the Guy's Hospital Reports, and the remaining thirteen cases are recorded in the present communication to the Society. Of these twenty-five cases, eighteen were females and seven were males. The average age of the patients was nineteen years. All the patients were suffering from their first attack of rheumatic fever, and the disease was well marked. The temperature of the body during the acute symptoms reached in some cases 104° and 103°; in other patients it was 101° and 102°. Taking an average of all these cases, the temperature was about 102° during the acute stage. The average

duration of the acute symptoms, as estimated by the thermometer and general symptoms, was ten days. Taking all the cases that have been recorded by the authors, the average duration was 9.1 days. The total duration of the acute symptoms from their commencement, including the time the patients were ill before coming into the hospital, to their cessation, was on an average seventeen days. The authors next proceed to inquire if the duration of rheumatic fever is longer when treated on the expectant plan, or when treated by drugs; and they considered that no one plan of treatment has any great advantage as regards shortening the duration of the disease. Drs. Gull and Sutton agree with Dr. Barclay in considering that we are not yet in a position to say that alkalies exercise any influence in curtailing the duration of the disease. They are also of the same opinion respecting lemon-juice. With regard to Dr.

Herbert Davies's blister treatment, they remark it relieves very much the pain and sufferings of the patients in some cases; but it does not appear to curtail the rheumatic process. And the authors remark, "Our cases appear to teach that the rheumatic process runs its course under the expectant treatment as favourably as under the treatment by drugs." Drs. Gull and Sutton next proceed to inquire what evidence there is to show that the drug treatment prevents the heart becoming diseased, and they give a detailed account of the state of the heart in their twentyfive cases. Every one of these twenty-five patients were suffering from their first attack of rheumatic fever, and twelve of the number had organic disease of the heart when admitted into the hospital; two had some, but not very well-marked, evidence of organic disease of the heart when admitted; and in eleven there was no heart disease on admission. No organic disease of the heart supervened while under treatment and the heart was healthy when these eleven patients left the hospital. They remark the experience gained in these cases of rheumatic fever, which were allowed to run their natural course uninfluenced by drugs, tends to prove that, if patients are admitted into the hospital suffering from a first attack of rheumatic fever, and the heart is not diseased on admission, it will very rarely become organically diseased while patients are under treatinent. The opinions of Drs. Garrod, Dickinson, Herbert Davies, Geo. Owen Rees, and Basham are then quoted to show that the heart did not, or very rarely did, become diseased when rheumatic fever was treated in the hospital by full doses of alkali, by blisters, by lemon-juice, or by nitrate of potash, and they observe: "It appears to us that there is not sufficient evidence to prove that any of the advocated systems of treatment have power to prevent the heart becoming diseased. In concluding that the treatment has prevented the heart becoming diseased, we have overlooked the fact that there might be no tendency at the time the patients were under treatment for the heart to become diseased, and our cases show that the good results which have been attributed to the influence of the remedies also occurred when no special remedies were used. Our cases, therefore, tend to teach that these good results were due, not to the drugs, but to the natural course of the disease." The authors then endeavour to show that when the heart becomes diseased in rheumatic fever, it does so at an early stage of the disease; and if it does not become diseased during the first week of the rheumatic fever, it rarely does so afterwards; and they give abstracts from twenty-two cases of rheumatic fever to demonstrate this.

Drs. Gull and Sutton's conclusions are as follows:

That when the patient's heart was healthy on admission into the hospital, it was very rare for it to become organically

diseased while the patients were under treatment by mint water -or, in other words, when the rheumatic fever was allowed to run its natural course.

That the evidence before the profession shows that the heart very rarely became diseased while patients were under treatment in the hospitals, and that this was the case when patients were treated by alkalies, lemon-juice, or by blisters to the joints. That there is not sufficient evidence before the profession to prove that any of the advocated remedies have power to prevent the heart becoming diseased.

That in rheumatic fever the tendency is for the heart to become diseased during the first few days of the fever; and should it escape the early days of the disease, there is each day a lessening tendency to its implication. Hence the cases would appear to show that, if at the end of the first week of the rheumatic fever the heart is free from disease, then there is little or no tendency for it to become diseased during the later weeks.

That the reason why the heart did not become diseased when rheumatic fever was treated by alkalies, blisters and by lemon-juice is to be attributed, not to the influence of the drugs, but to the natural course of the disease; for the patients did not come under treatment until the rheumatic fever had been going on some days, and until the period when the heart was most liable to become diseased had passed over.

The authors conclude by saying: "Hitherto the investigation into the therapeutics of the rheumatic process has been rendered all but valueless by the deficiency in preliminary data. At present, therefore, as regards treatment, our cases seem to show that we are limited to a careful regimen of the patient. Rest, mechanical and physiological-rest in the very outset of the disease. We ought not to wait until the rheumatic process has become well developed in the joints. To regulate the temperature. To moderate excessive skin function by sponging the surface of the body. To allay pain, by placing the patient in an easy position, and sometimes by opiates. To sustain the organic nerve power by light diet, and occasionally by small doses of alcohol. To procure rest by the simplest means, especially avoiding such movements of the body as may excite the circulation. In fine, to place the patient in a physiological state of mean rest, if it may be so termed, of the nervous, the circulatory, the muscular, and digestive systems. To do this fully will often tax all our energies, and require often more consideration that is requisite for prescribing any supposed appropriate drug treatment. We are, therefore, at present advocates of the exactest treatment of the patient under acute rheumatism, though we may doubt the value of so-called specific drugs."-Lancet, Jan. 16, 1869, p. 102.

8.—THE ALKALINE TREATMENT OF RHEUMATIC FEVER. By Dr. HENRY WM. FULLER, Senior Physician to St. George's Hospital, and Consulting Physician to the North London Hospital for Consumption.

Dr.

It has been asserted by several critics, and those of experience and good opportunities of observation, that rheumatic fever gets well just as quickly without specific treatment, as with. Fuller disputes the facts upon which these conclusions are based, and shows from their own cases that the natural duration of rheumatic fever is six weeks, and not ten to twenty days as stated by them. Dr. Fuller gives his own experience as to this mode of treatment in hospital and private practice, and then points out the causes of its failure, when failure apparently follows its use.]

First, what is meant by "the alkaline treatment?" I do not mean the administration of salines or small doses of the alkalies, such as half-drachm doses of the carbonate of potash every four hours; for, in my experience, these remedies so administered exercise absolutely no control, in either shortening the duration of the disease, mitigating the patient's sufferings, or protecting his heart from mischief. Neither do I mean the administration, throughout the attack, of large doses of the alkalies, such as a drachm and a half or two drachms every four hours, for these remedies, so administered, would depress the patient, and might even produce dangerous consequences. Moreover, experience leads me to believe that they certainly would not tend to his recovery. By "the alkaline treatment," I mean a plan of treatment in which alkalies play an important part, but which consists not only in the administration of alkalies, but in the careful regulation of the secretions, the strictest attention to diet, and the administration of tonics, such as quinine and bark, as soon as the patient can bear them. Being convinced that as soon as the system is alkalinised, as shown by the alkalinity of the secretions, a great safeguard is obtained against inflammation of the heart, or of any of the then unaffected joints, my practice is to give not less than an ounce and a half of the alkaline carbonates, either alone or in combination with a vegetable acid, during the first twenty-four hours of treatment. They should be given largely diluted with water, either in effervescence or otherwise, as is the most grateful to the patient. Sometimes the whole quantity of the alkali is ordered to be mixed with three imperial pints of water, and taken as a drink in the twenty-four hours-a form which is often very grateful to the patient-but more commonly two drachms. are ordered to be taken in effervescence every three or four hours in combination with an ounce of lemon-juice, or with