78.-IMPROVED OPHTHALMOSCOPE.

By HENRY GREENWAY, Esq., Plymouth.

This instrument (manufactured by Weiss) is designed to furnish the practitioner with means whereby the eye can be examined with nearly the same steadiness and precision as with the large and expensive apparatus of Liebreich, and with nearly the same amount of freedom as attends the use of the ordinary

The remainder of this self-winding tape is contained in a box at the lower end of the mirror handle. and lens are represented nearer toge her than they should be, in order to economise space in the sketch.

Engraving, showing ophthalmoscope complete. Only a small portion of the tape can be seen, as the mirror

hand-mirror and lens. It is simple in construction, and consists of two parts-a double convex lens, mounted on a stem, which slides on a graduated brass bar, five inches long, at one end of which is a knob which rests against the patient's face, the other end terminating in a hook; the second portion comprises a perforated mirror, supported on a handle, from the centre of which runs a spring measuring-tape. These two parts are united by connecting the end of the tape with the hook before mentioned. To use the instrument for indirect examination of the eye, place the thumb of one hand in a ring, fixed underneath the hook at the near extremity of the graduated bar, and the middle finger in a ring attached to the under surface of the slide, and the forefinger on its upper surface; then lay hold of the mirror-handle with the other hand, in such a manner that the tape may pass between the fore and middle fingers in front, the thumb being placed behind; the patient being seated, in the usual manner, by the side of a lamp, the knob at the extreme end of the brass bar should now be placed against his face, and in such a position that the mounted lens shall be in a line between the spectator's eye and that about to be examined. By withdrawing the mirror-hand from the other, the tape can be drawn out to the required extent (about 18 inches) and be fixed by merely pressing the forefinger on it. The lens focus (from one to three inches) will be obtained by moving the slide to and fro on the graduated bar. By gently pressing the bar towards the patient's face with the thumb of the lens-hand, and by keeping the tape slightly on the stretch with the mirror-hand, the whole instrument will have the steadiness of a solid construction. further aid, the surgeon may sit the reverse way on a chair, and and make its back serve as a rest for his elbow. Should the back be too high, a thick book or other substance should first be placed on the seat of the chair.

As a

For the direct method of examining the eye, the presence of the tape will not prevent the mirror being used in the ordinary

manner.

A small black card-board screen, to be hung at the side of the patient's head, is supplied with the instrument. This will sometimes be found useful in private practice, where a screened lamp is not at hand.-British Medical Journal, Nov. 28, 1868, p. 573.

79. AN IMPROVEMENT UPON POLITZER'S METHOD OF INJECTING AIR INTO THE EUSTACHIAN TUBES IN CERTAIN CASES OF DEAFNESS.

By Dr. JOHN BRUNTON, A.M.

Politzer's method of injecting air into the Eustachian tubes is based upon the fact, that when the circumflexus or tensor palati

muscle is put upon the stretch in the act of swallowing, the mouth of the Eustachian tube is opened, and air is allowed to enter the tube.

Politzer directs the patient to take a mouthful of water; the operator then inserts a canula into the right or left nostril, as as the case may be; attached to this canula is an India-rubber bag filled with air; on the patient making a sign that he is about to swallow, the operator, closing the nostrils of the patient upon the canula with one hand, so as to prevent all egress of air, as the patient swallows, squeezes the bag, thereby injecting a strong current of air, which immediately rushes up the mouth of the Eustachian tube, which has been opened by the action of the circumflexus or tensor palati muscle in the act of swallowing.

This method is very useful in many cases, especially those of a catarrhal nature, often restoring the loss of hearing in a manner that seems marvellous to the patient. Nevertheless, advantageous as the operation may be, it has often unpleasant disadvantages. Sometimes, as has occurred to myself, the movement of the patient (the act of swallowing) and the movement of the operator (the act of pressing the bag) are not exactly in unison; and the consequence is, that unpleasant fits of coughing follow by too early pressure of the air, or no injection of air takes place by a too late pressure, necessitating a repetition of the process, which may or may not be very acceptable to the patient.

On account of this, the improvement which is described below suggested itself to me, in consistence with those movements of harmony which abound in the human system. My improvement, as shown by the accompanying woodcut, consists in allowing the patient to be himself both the subject and the operator.

The apparatus consists of an India-rubber bag (10 oz.), to which is attached a sufficiently long flexible tube, so that the bag may rest on the floor. To the other end is fixed a gum elastic canula, which the patient passes into his nostril. He then takes a mouthful of water, and as he swallows, holding his nostrils tight with the fingers, presses the bag with his foot, and thereby injects the requisite air.

I have used this apparatus a good many times, have found it invariably satisfactory, and free from the unpleasant results above-mentioned. The movements are in unison.

The accompanying woodcut represents the patient in the act of applying the instrument. Any instrument maker can supply the apparatus, the cost of which is trifling.

It has been stated that a late distinguished aural surgeon sacrificed his much-valued life, while investigating the means to allay ringing noises in the ears, by the injection of medicated

vapours, such as the vapour of chloroform, ether, hydrocyanic acid, and the like. If he had used such an apparatus as this, perhaps he might have been still spared to us. I have on several

occasions injected the vapour of sulphuric ether and chloroform with ease and without discomfort, to the advantage of the patient. It is only necessary to separate the bag from the tube and pour a few drops of the ether into the bag; the ether immediately becomes volatilized; adjust the tube, and then proceed as with common air.-Glasgow Med. Journal, Nov. 1868, p. 38.

80.-HOW TO USE THE NITRATE OF SILVER IN
ERYSIPELATOUS INFLAMMATION.

By JOHN HIGGINBOTTOM, Esq., F. R. S., Hon. Fellow of the
Royal College of Surgeons of England.

[Mr. Higginbottom complains that his mode of using nitrate of silver has been carelessly and incorrectly reported in all the medical and surgical works which have professedly copied the plan from his published work.]

The method of applying the nitrate of silver is as follows:The affected part should be well washed with soap and water, then with water alone, to remove every particle of soap, as the soap would decompose the nitrate of silver; then to be wiped dry with a soft towel. The concentrated solution of four scruples of the nitrate of silver to four drachms of distilled water is then to be applied two or three times on the inflamed surface and beyond it, on the healthy skin, to the extent of two or three inches. The solution may be applied with a small piece of clean linen, attached to the end of a short stick; the linen to be renewed at every subsequent application. As the solution of nitrate of silver is colourless, it is necessary to pass a little linen, just moistened, over every part where it has been used, in order to be equally diffused, so that no part be left untouched.

In about twelve hours it will be seen whether the solution has been well applied. If any inflamed part be unaffected, the solution must be immediately reapplied. Sometimes, even after the most decided application of the nitrate of silver, the inflammation may spread; but is then generally much less severe, and is eventually checked by repeated application. It is desirable to visit the patient every twelve hours, until the inflammation is subdued.

By these means we have complete control over the disease.

For the successful application of the nitrate of silver the ordinary brittle stick, either solid or in solution must be used. Not the "lunar caustic points perfectly tough," nor the crystals and cake used for photographic purposes.-Practitioner, Jan. 1869, p. 34.

81.-ON THE USE OF SULPHUR IN ITCH.

By Dr. TILBURY Fox, Physician to the Skin Department, Charing-Cross Hospital.

[The writer says that not a week passes but he sees cases in which sulphur has been much misused, producing evil instead of good.]

Sulphur is a remedy which can do a great deal of good and a great deal of harm. That I may prevent some of the latter, I again call attention to one or two therapeutical points of practical importance touching the cure of itch, which by reason of its very commonness is apt to have a stereotyped treatment. Now scabies is usually treated as though all the eruptive phenomena seen in the body of a scabious subject were really "scabies;" that is, as though there were some parasite to destroy wherever a rash exists, and acari were present in or immediately about the papules and vesicles of which the erup