tween the malleoli and without pain. The joint was weak and required some support, but it was sound.--Med. Times and Gazette, May 15, 1869, p. 514.

123.-IMPACTED FOREIGN BODIES IN THE NOSE.

By W. M. BANKS, Esq., Liverpool.

[For a description of Dr. Thudichum's instrument refer to the article on ozana in this volume by Mr. Banks, p. 145.]

There are two surgical accidents in which I am sure that Dr. Thudichum's înstrument will not unfrequently be found of service. The first of these is the case of impacted foreign body in the nostril. Children, as every one knows, seem possessed of a mania for putting beads, marbles, beans, and similar objects into the nose. They seldom put them very far, or very firmly in, and there is no doubt that the actual impaction, or fixing of them, is often produced more by misdirected attempts to get them out than by anything else. I should certainly, before using any forcible efforts at removal by instruments, see what effect a rapid stream of water passed up the other nostril would have in dislodging the foreign body. In the number of the Lancet for December 17th, 1864, Dr. Skinner, of this town, shewed that long before Dr. Thudichum's paper appeared he had been practically making use of the principle upon which it is constructed. Dr. Skinner discovered

it by mere accident, the instrument he employed being one of Higginson's syringes. In this letter, he gave the following very interesting account of the removal of a bead from the nostril. "In June, 1860, the child of one my patients was brought to me,—a little girl. two years of age, who had pushed an Indian bead up the right nostril. The mother had made vain attempts to pull it down, and succeeded in pushing it entirely out of sight, accompanied with profuse bleeding and terrific squalling. While the mother held the child's face over my basin, I forcibly injected some tepid water, by means of Higginson's syringe, up the left nostril, when the bead with one single compression of the elastic cylinder made its appearance in the bason." -Liverpool Medical and Surgical Reports, Oct. 1863, p. 110.

SYNOPSIS,

CONTAINING A SHORT ABSTRACT OF THE MOST PRACTICAL ARTICLES IN THIS VOLUME: SHOWING, AT A GLANCE, THE MOST IMPORTANT INDICATIONS OF TREATMENT PUBLISHED BY DIFFERENT WRITERS WITHIN THE

HALF-YEAR. (ARRANGED ALPHABETICALLY.)

AFFECTIONS OF THE SYSTEM GENERALLY.

ALCOHOLIC STIMULATION IN FEVER.-It is quite an error to conceive of alcoholic stimulation as a proper substitute in cases of fever for ordinary food. Milk is the normal food of most persons in acute disease, and there are very few persons, even in severe fevers, who cannot receive it to the full extent of their powers of assimilation. To give brandy and beef-tea every hour or half-hour, and to continue this practice for days and nights together, even wakening up the patient in order to give him his food and stimulant, is the surest of all ways to destroy whatever remains of natural appetite. The proper use of alcoholic stimulants is to quicken and develope the appetite for real food, and the power of assimilating it. The proper and normal time therefore for giving these stimulants in fever, is along with the food. There are doubtless many cases of fever which are benefitted by them, but this is by no means the rule. (Dr. W. T. Gairdner, p. 17)

CANCER. The author recommends highly the use of arsenious acid as a caustic for the removal of cancerous tumours. He uses the following formula: Arsenious acid, 3 ij., mucilage of gum acacia, 3 j., well mixed together and made into a thick paste. No tumour more than four square inches in superficies should be treated on this plan. The paste is to be spread on a piece of lint an inch square, and applied over the tumour. In the course of twenty-four hours the surrounding parts will commence to swell, become red, and to a certain extent inflamed, but the pain caused is by no means severe. At the end of forty-eight hours to three days bread poultices are to be applied. A line of demarcation is soon seen extending round the mass, which separates gradually from the surrounding healthy tissues and comes away entire, leaving a healthy cuplike depression. On the removal of the first piece of lint it is in most cases desirable to repeat the application of the caustic, even several times, according to the size of the tumour. The value of the arsenious acid depends on its power of selection; for if put on with ordinary care the cancer alone is attacked. (Dr. A. Marsden, p. 42.) GOITRE.-Hypodermic Injection of Iodine.-The author treats goitre by hypodermic injections of iodine. He began with four or five drops of the tincture and gradually increased the quantity, repeating the injections every eight days or so. (Prof. A. Lücke, p. 227.)

RHEUMATIC FEVER.-Rheumatic fever on an average only lasts seventeen days when it is treated by mint water. This is quite as favourable a result as follows the exhibition of alkalies, or the employment of blisters. (Drs. Gull and Sutton, p. 26.)

In rheumatic fever the tendency is for the heart to become diseased dur

ing 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. (Dr. Gull, p. 28.)

In the commencement of a case of acute rheumatism great and immediate benefit is often derived from the administration of aconite. The inflammatory process ceases, the skin cools, and the pulse decreases in frequency. It should be given in doses of two drops of the tincture every three hours. (Dr. S. Wilks, p. 37.)

The Alkaline Treatment.-The alkaline treatment of rheumatism has this great advantage, that the per centage of cases in which the heart becomes affected is only one in 48, whilst under non-alkaline treatment it is 1 in 4. The conclusion is arrived at from a careful observation of 158 cases, 48 of which were treated by alkalies, and 110 by other plans of treatment. It was observed that under alkalies the duration of the disease was shorter than under most other plans, a point, however, of little importance as compared with the safety of the heart. In the beginning of the disease where there is a rapid production of acid, the alkalies should be given freely, and, above all, frequently, but towards the end of the case they should be given in less quantities. The urine is the best guide as to the doses of alkali to be given. Perhaps a simple solution of citrate of potass in water is as effective and as little objectionable as anything. This salt may be given in the general quantity of about an ounce in the twenty-four hours; rather more at the beginning of the disease, less towards the close. (Dr. W. H. Dickinson, p. 38.)

Unless the alkaline treatment" of rheumatism is properly understood, failure and even mischief will result from attempting it. The urine is to be rendered alkaline within twenty-four hours, and for this purpose from an ounce and half to two ounces of an alkaline earbonate must be given in that period, dissolved in a considerable quantity of water. Two drachms may be ordered to be taken in effervescence every three or four hours, in combination with an ounce of lemon-juice, or with half a drachm of citric acid. The amount of alkali must be rapidly diminished during the next three days, then if the urine still remains alkaline, a cinchona draught three times a day must be substituted for the alkali: with the bark scruple doses of bicarbonate of potash may be given if thought desirable. The bowels should be unloaded early in the case. No solid food should be allowed, and wine and spirits forbidden. (Dr. H. W. Fuller, p. 28.)

The reason why in some hands the alkaline treatment fails is that the doses given are too small, and time is lost. Half an ounce of acetate with half a drachm of nitrate of potash as a maximum dose, given every two hours until nausea is produced, or until the sweat ceases to redden litmus, will usually relieve the pain in twelve hours. (Mr. A. Fleischmann, p. 249.) SCARLET FEVER.-If scarlet fever appears in a family, let the patient or patients be washed all over once or twice a day with diluted carbolic acid. This will always prevent the spread of the disease to the other members of the family. It should be used of the strength of one drachm to the pint of water. (Mr. A. Beardsley, p. 25.)

If chlorine gas be properly used in the sick-room of the patient, the contagion of scarlet fever will be confined to that room. Direct large coarse towels to be saturated with a solution of chloride of lime, and hung over the backs of chairs, and a sheet to be hung in front of the bed-room door. We may judge of the quantity required for disinfecting the room by smell and taste on going into it. This process should be continued throughout the course of the fever. (Dr. P. Hood, p. 23.)

The stomach having been relieved by vomiting, whether by the operation of nature or art, and the liver and bowels also by the administration of an efficient dose of medicine, quinine is our sheet-anchor. This drug is as powerful in destroying the scarlatinal germ as it is potent in the cure of ague. It should be given in doses of a grain and a half, to a child eight years of age, with a few drops of sulphuric acid and syrup of orange peel, in

water.

The dose may be repeated about every six hours. The pulse will

be found to diminish in frequency, and the soreness of throat and difficulty of swallowing to be scarcely complained of. In the worst forms of the disease, iron should be combined with the quinine. When this treatment is pursued, it is necessary that strict attention should be paid to procuring a daily alvine evacuation. (Dr. P. Hood, p. 23.)

Digitalis. For some years it has been the custom of the author to pre. scribe digitalis in cases of scarlet fever, combining it usually with nitric other and nitrate of potash. It controls vascular action and lowers the frequency of the pulse. One drop of the tincture every three or four hours should be given to a child a month old, though as much as five drops is tolerated. (Dr. S. Fennell, p. 25.)

Carbolic Acid in Scarlatina, Measles, and Small-pox.-The author has given carbolic acid internally in six hundred cases of the above-named diseases. He usually gives a tablespoonful of the following mixture every four hours, until the fever, &c., has subsided. 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. It produces profuse perspiration, and rapidly lowers the pulse, so much so, that in twenty-four hours it will fall from 120 to 60; skin cool and moist, with subsidence of fever. (Dr. A. Keith, p. 26.)

SCURVY.-Sea-scurvy is not owing to a deficiency of potash in the food, but is caused by mal-nutrition owing to the indigestible character of the food. Salt meat and dry biscuit will remain undigested for five or six hours, hence the digestive powers become exhausted, and the gastric juice deficient in quality. Lemon juice, lime juice, wines, all kinds of vegetables, act as anti-scorbutics, as does nearly every nameable article of diet, but this is on account of the variety of food. The acid fluids, such as lime and lemon juice, also act by assisting the digestion of the fibrine of meat. The great desideratum should be that the sailor should be provided with good fleshfood; and since salt meat must of necessity always form the basis of his dietary, every care should be taken that it be of recent pickle, bad salt-meat being too commonly the cause of the disorder. (Dr. A. Farr, p. 40)

STRUMA.-Peroxide of Hydrogen. The author has administered peroxide of hydrogen in various diseases, such as diabetes, rheumatism, cardiac diseases, and struma. The results in the two cases of struma related were encouraging. In both cases there was great enlargement of the cervical glands, and in both, the swelling rapidly disappeared. A third case had suppurating glands in the neck, and purulent discharge from abscesses in six other parts of the body. This case, also, rapidly recovered. (Dr. B. W. Richardson, p. 234.)

AFFECTIONS OF THE NERVOUS SYSTEM.

CHOREA.-The red oxide of iron is one of our best remedies in chorea. It was first given by Dr. Elliotson many years ago, and he acquired great fame by his success. An equally favourite remedy at Guy's Hospital is sulphate of zinc, beginning with grain doses, and increasing gradually. A favourite remedy of the late Dr. Hughes was rhubarb steeped in port wine; the children were thus well kept up at the same time that the stomach and bowels were improved in condition. (Dr. S. Wilks, p. 65.)

Indian Hemp.-Indian hemp has a peculiar value and power in controlling the irregular movements of chorea. Small doses frequently repeated are more suitable than larger ones at longer intervals. Six minims every hour was given in the case of a child thirteen years of age. (Dr. Douglas, p. 67.) CRUVEILHIER'S PARALYSIS.-Electricity.--Cruveilhier's paralysis is only another name for "progressive muscular atrophy" and "wasting palsy." It occurs always in the muscles of the upper extremity. It may be diagnosed from paralysis produced by lead in the system by the fact that in the latter the muscles do not respond to the stimulus of electricity, whereas in progressive muscular atrophy they do. There can be no doubt that the best and

perhaps only treatment for this disease is electricity. Remak's method, although quite empirical, is perhaps the best. This consists in the employment of a "constant" battery, having 100 cells, of which a variable number are used according to circumstances. The positive pole is applied to the back of the head or neck, the other or negative pole is placed over the spine, below the fifth cervical vertebra. (Dr. C. H. Fagge, p. 72.)

INSOMNIA.-If sleeplessness arises from pain, opium is our remedy; if, however, from mental rather than from physical pain, or from trifling causes exciting a morbidly sensitive nervous system, bromide of potassium or ammonium is more appropriate. In the latter class of cases opium will frequently aggravate the insomnolency. To adults a dose of thirty grains of bromide should be given a quarter of an hour before the last meal, and a second dose of from twenty to fifty at bed-time. In cases in which, without any nervous complaint, there is sleeplessness owing to some cause of cerebral excitement, sleep is almost always induced by that remedy. (Dr. James Turnbull, p. 53.)

MIGRAINE AND CLAVUS HYSTERICUS.-Muriate of Ammonia.—Migraine is one-sided headache, which if it lasts long enough ends in vomiting. Both this affection and clavus hystericus are primary neuralgias of the fifth cranial nerve. Salts of ammonia, as being diffusible stimuli, naturally suggest themselves as likely to cut short attacks of these kinds. The muriate of ammonia in doses of ten to twenty grains is very effective, and if given early enough seldom fails to cut short or greatly mitigate an attack. (Dr. Anstie, p. 49.)

MYALGIA.-Muriate of Ammonia.-The general type of cases of myalgia (so named by Dr. Inman of Liverpool) is that of aching pains felt in muscles which are habitually overworked in proportion to their nutrition; such pains are naturally commonest in laborious and ill-fed persons. Theoretically rest is the one all-paramount indication of treatment; but practically this is often found to be impossible. Dr. Anstie, from whose paper these remarks are abstracted, observes of the action of muriate of ammonia in these cases, "I give it in doses varying from ten to twenty grains, and can say that not even quinine in ague is a more reliable agent than the muriate in myalgia." (Dr. F. E. Anstie, p. 48.)

NEURALGIA. Sulphate of Nickel.-A case of obstinate neuralgia is related which was cured by sulphate of nickel in doses of half a grain, three times a day. At the end of a week, a dose of one grain was given. "Its sedative action was speedily manifested in reducing the pulse and procuring sleep. All symptoms of the paroxysm disappeared." The remedy seems worth a trial. (p. 58)

Intercostal Neuralgia.—Intercostal neuralgias and myalgias which are so common in suckling women, are generally much benefitted by the administration of muriate of ammonia. (Dr. F. E. Anstie, p. 50.)

Neuralgias of the Viscera.--There can be no doubt that neuralgia attacks internal organs-such as the heart, the liver, the stomach, and the ovary. Hepatic neuralgia is not uncommon. The pain complained of is severe and intermittent, and unaccompanied with symptoms indicating inflammatory action or any organic change. Nothing is more obstinate than such a case. Quinine and arsenic are useless, or even ill borne. But here the muriate of ammonia, in ten or fifteen grain doses acts like a charm," cutting short the attack promptly, and also seeming to dissipate the tendency to neuralgia. (Dr. Austie, p. 51.)

Facial Neuralgia.-Spasmodic or "Epileptiform."-There is a form of facial neuralgia, which, when it occurs, does so in persons past the prime of life. It is characterised by intense severity in its onset, which is also sudden. It is to some extent hereditary. Our best treatment consists in: 1. The use of counter-irritation of a peculiar kind. 2. Nutritive tonics. 3. Subcutaneous injection of morphia, or of atropia according to circumstances. The counter-irritation must not be applied to the branches of the fifth nerve, but to those of the occipital nerve. A blister at the nape of the neck is often strikingly effective in gaining a short respite. The assiduous use of