cases, however severe, will be most beneficial and cause a complete change in a short time. The secretions from the liver, as a rule, are scant and extremely vitiated, the belly is often distended with gas, the discharges are frequent, thin, light-colored and very offensive, and the child becomes emaciated, stupid and restless. The treatment above will stimulate the secretions, but if diarrhea continues it can be controlled by the use of chalk mixture. Ice water should never be given to the child, for it is not only injurious on account of its low temperature, but also its extreme impurity. The water should be boiled and then cooled by placing ice about the receptacle containing it, but never should be placed in the water. If the child is artificially fed the milk should be cared for in the same manner as the water. All food except barley water should be forbidden for a day or two. In case the stools are putrid and the abdomen is retracted instead of distended, I administer no albuminous food, but irrigate the bowels thoroughly with a salt solution and push my antiseptics, and where the bowels are running off almost incessantly, causing rawness to the parts, I have found salol in 1-10 grain doses to be very efficacious. The principal methods of checking this disease are: During the first three to eight hours no food or drink should be given, in order to secure rest for the irritated stomach, for vomiting will cease on this condition only; then give one teaspoonful of iced water (the water prepared as previously stated) with a few drops of brandy every 10 minutes as long as the tendency to vomiting persists. Strained barley water with a little whisky and the white of an egg, a teaspoonful at short intervals, is well borne and easily digested. When food can be resumed milk should be avoided, except breast milk. Many cases will entirely recover with this dietical treatment. The air should be kept as fresh and cool as possible, at night as well as day. The extremities must be maintained in a warm state, and flannel cloths wrung out of hot mustard water and placed over the abdomen will be found very beneficial. The little sufferer must be vigilantly watched during the convalescent period, for one attack increases the predisposition to another. Cholera infantum possesses characteristics distinctly individual and debars all impossibility of error. These characteristics are the severe serous vomiting and purging (Smith says there is no disease of infancy in which the temperature of the blood is higher.) and the rapid wasting and exhaustion. I have used these two prescriptions in this disorder with the most gratifying results: B. Bismuth subnit........ gr. x-xij .gr. iij For excessive vomiting, carbolic acid, 1-4 to 1-2 drop in lime water or chalk mixture, combined with bismuth, are effectual. Again, I cannot speak too highly of stimulants, either good brandy or whisky, for they assuage the thirst and lessen the vomiting, and hence combat exhaustion. Three or four drops of laudanum in a tablespoonful of thin starch water, thrown up into the bowels three or four times during the day, is most helpful. This dread infantile disorder could be prevented if careful attention was given to the following methods and prophylactic treatment, and thousands of lives, especially in our large cities, would be spared: The contents of the child's stomach, also its size and weight; the quantity of food to be given at each meal, the number of meals and their regularity; the choice of a good succedaneum for mother's milk, and the proper method of preparing it; the temperature of the food, and the manner and frequency of administering it; the condition of the food, whether well or illy preserved; cleanliness of the vessels in which prepared and administered, the purity of milk and the sanitary conditions of the environments. Cor. Barrett & N. Grand Ave., St. Louis, Mo. TO SUBSCRIBERS.-Please examine the wrapper in which your SUMMARY comes, and see the date to which your subscription is paid. If your time is out, a remittance is in order! TREATMENT OF ERYSIPELAS.-REPORT OF A CASE. BY CHAS. E. TUCKER, M. D. HE following method of treating erysipelas has given me such universal success that I venture to offer it for publication, hoping it may be useful: Upon examination of the patient, if I find a vitiated condition of the system, manifested by a sallow skin, foetid breath, coated tongue, anorexia, constipation and other symptoms indicating eliminative treatment, I make use of the following, modified to suit age and condition: B. Hydrarg. chlor. mit......gr. iij Podophillin, Pulv. ipecac... Ext. hyoscyami. Sodii bicarb. .aa gr. j .gr. iij .gr. xij M. ft. caps. No. xij. Sig,-One capsule every two hours until bowels respond freely. Usually after administering a few doses there is a copious, painless and bilious action of the bowels. It will not always be necessary to give the number of doses above mentioned, then again the prescription may have to be repeated, the idea being to get a thorough eliminative action of all the excretory organs. Very often the result of the treatment will be a decline of the fever and other indications of amelioration in the course of the disease. After the bowels have acted freely and the treatment given above seems to have accomplished the desired result, I give from 10 to 30 minims of muriated tincture of iron and from one to five grains of quinine sulphate, according to age and indication, every three hours, alternately; also opium, when indicated, for nervous symptoms. The local infammatory process is treated in the following manner: Wash the inflamed area and the surrounding healthy skin thoroughly with a carbolic acid solution of medium strength, then apply a heavy coating of the following ointment: B. Carbolic acid.. MXXV 3 ss 3 j Tannic acid. Boric acid.. Vaselin ... ..... ... 3j M. Sig.-Fresh applications may be made when necessary. This method of treatment has cured every case in which I have tried it. I do not think that too much stress can be placed upon thorough local antiseptic treatment, which, when properly carried out, undoubtedly checks the spread of the inflammatory process. The following case is cited in order to demonstrate the difficulty sometimes met in differentiating between erysipelas and other inflammatory skin affections: I was called to a gentleman about 60 years of age, and learned, upon inquiry, that he had been sick about three days. His illness began with a rigor, followed by fever; no recurrence of the rigor, fever continued, ranging from 10 to 103 degrees Fahr; headache, restless, copious sweats, coated tongue, fœtid breath, constipation, anorexia. There was an inflammation of the integument of the forehead and temples. This extended from the mastoid process on the right side, over the side of the head and temple to the forehead, as above stated. The skin covering this area was dark, and tongues of inflammatory exudation were extending beneath the skin, elevating it and exactly resembling erysipelas. Before I finished my examination the old gentleman asked me what his disease was. It being my first visit to the family, I was very anxious to avoid any error and make the best possible expression, so, in order to gain time, I remarked that the disease resembled erysipelas very much and proceeded with my examination. Upon further inquiry I learned that he was a sufferer from chronic rheumatism. The first phalangeal joint of one little finger was swollen, red and tender. These symptoms, coupled with the copious sour sweats, warranted me in telling him that his disease was acute articular rheumatism. This was verified by the promptness with which it yielded to alteratives and salol. The inflammatory condition of the skin of the forehead was a part of the same process, the inflammation having commenced in the masto-parietal articulation on the right side, and extending along the sutures of the skull to the forehead, had involved the overlaying integument. This case resembling erysipelas so much, and as rheumatic inflammation of the cranial articulations is so rare in my practic, I am sure that this case is worthy of record, hence my excuse for occupying so much space. Joppa, Ill. DOES TOBAcco cause AMBLYOPIA? THE BY WILLARD H. MORSE, M. D. HE term amblyopia is limited, strictly speaking, to those cases of imperfect vision in which the affected eye presents no recognizable objective symptoms whatever, with or without the ophthalmoscope, and in which the impaired vision is not due to anomalous refraction, as in myopia, hypermetropia or astigmatism. In a general way the term is employed to express impaired sight from almost any and every cause except that of actual optical defect. Thus, if we find that no glasses improve the acuteness of vision, we say that the patient is amblyopic, meaning, of course, nothing more definite than that the blindness is not to be attributed wholly to any abnormal refractive power, and that there is some disease in the fundus of the globe. It The diagnosis is very simple, and at the same time reliable and practical. consists in the easy device of permitting a patient to look through a pin-hole in a black card. If this improves vision there is no amblyopia; if not, an ophthalmoscope examination is necessary. The fact that the ophthalmoscope examination frequently yields but negative results is, of itself, a favorable omen in the prognosis. The practiced observer has no difficulty in making out any change in the fundus of the globe, which may consist in atrophy or atrophic changes of the optic nerve, or an optic neuritis with considerable effusion into the retina. Obviously there can but be a limitation of vision, which is always other than that due to an error in refraction. The etiology has nothing radically obscure about it. Temporary congestion of the brain and nervous structure of the eye may be occasioned by the suppression of exhalations of the skin through exposure to the cold or wet, by amenorrhea and menorrhagia, by severe illness, by pregnancy, by excessive drains on the system from hemorrhage and overprolonged gestation, by septicemia, by dental neuralgia, by fright, disorders of digestion and drug poisoning. It is the last-mentioned item that deserves of attention, for the reason that it is made to include tobacco. Undeniably there are drugs which, in an overdose or by prolonged continuance, occasion amblyopia and amaurosis. One of these is lead; and the impaired vision is a notable symptom in lead poisoning. Another is quinine, which, in large doses, is a factor of importance. Vile alcoholic beverages -that is, those abundant in fusel oilalso act to poison the brain. In fact, any drug that occasions a temporary cerebral congestion on the one hand, or a diminished supply of blood to the brain, is liable to cause the disorder. It is scarcely necessary to make up the list, as it is one that will occur to any practitioner. Again, and finally, amblyopia may be due to drugs that act to atrophy the nerve cells. We are accustomed to hear the expression "tobacco amblyopia," "tobacco amaurosis," and to the lay mind tobacco is noted as one of the drugs that cause the disorder. Is this veritable? That is, does the use of tobacco cause a disorder of the eye which is expressed by a disturbance of vision ? Tobacco is a narcotic. But narcosis— that is privation of sense or consciousness -induced by tobacco, opium, conium or any drug of the class, does not, of itself, occasion any optical defect or deficiency. All authorities agree on this, although we group the mydriatics, because they may cause confusion or dimness of vision, but by disordering the mechanism of focusing the eye. Tobacco, however, is not a mydriatic, as are belladonna, henbane, Indian hemp and stramonium. As a narcotic tobacco does not cause amblyopia or amaurosis—which ever way we may define it. As a narcotic it cannot. But as a narcotic it is inveighed against for this fault, and the charge is made. It is a disproved charge. Any student who knows the physiological action of the drug (for, out of courtesy, we are writing of tobacco just now as a drug) knows that it absolutely declines intraocular effect. Tobacco, the narcotic, acting as a narcotic may occasion narcosis, but that narcosis is insufficient to cause that dimness or disorganization of vision that takes the name of amblyopia. Remembering the true pathology of the disease or preferably speaking, disorder -it should be plain that a narcotic like tobacco cannot occasion the complaint. Tobacco is also a drug that acts contrary to amblyopia; mark this. In order to occasion the amblyopic condition it must have the hyperemic, the anemic or the narcotic effect on the brain, and it has none of these. Give an animal a lethal dose of nicotine and paresis ensues. Death is due to the paralyzing effect on the muscles of respiration. The nerves lose their excitability, but the brain is not affected in the least. In a person poisoned by nicotine there is, it is true, giddiness and delirium, but these symptoms, as well as the insensibility that immediately precedes death, are due to the accumulation of carbonic acid in the blood. Oxygenation is arrested and the blood has a peculiar blackness to it. It is notable that even after respiration ceases the heart continues to beat, and after death its cavities are usually found empty. Tobacco is not, therefore, a cardiac poison any more than it is a cerebral poison, and the depression or circulation is due to the interference with the pulmonary functions. If this interference was efficient to directly affect the brain, then we might look for the amblyopic mischief, but it isn't. Tobacco has another distinctive effect, It is a diuretic, by virtue of the direct action of the drug on the Malpighian tufts and the tubules of the kidneys. The assertion has been made that therefore it occasions uremia, and that the particular form of blood poisoning is efficient in causing the amblyopic condition. Nothing can be more silly. Flint says: "The therapeutical indications pertaining to uremia are to endeavor to promote the excretion of urea by the kidneys by the use of diuretic remedies." Corollary to this, it should be evident, and is manifest, that where an active diuretic acts as it should-and as tobacco does-uremia will not occur. Uremia causes amblyopia; tobacco never does. On the contrary, it prevents and cures it. Again, tobacco is a depressing nauseant. It has, in a person not habited to its use, an irritating effect on the gastric mucous membrane. Now temporary, and sometimes persistent amblyopia may be due to disorders of digestion from impaired functional disorder of the stomach. Such an affection causes, through the medium of the sympathetic nerve, a disturbance in the nervous structure of the eye, whereby vision is impaired. Tobacco may cause this condition of things. In this way, then, tobacco induces amblyopia, or rather an amblyopic condition. But, mind you, any drug or any food that disorders the stomach is liable to do the same. The canned beef in Porto Rico did this, and soggy bread, saleratus biscuit, Welsh rarebit, boiled cabbage and buckwheat cakes do the same; that is, these may do so, but do not in all cases. The disordered stomach is apt to mean a disordered vision; an amblyopic vision, if you please. The condition, then, may be due to a primary hyperplasia of the optic nerve because of the gastric disorder. It is but a mild disorder, a mere derangement. The lesion is not due to the direct action of the tobacco on the central inhibiting center. It does not produce a bilateral, retrobulbar neuritis of the optic nerve with central color scotoma, such as characterizes severe amblyopia. Tobacco amblyopia is, therefore, a mild form, especially liable to occur in youth and early manhood, and is readily cured. It is rather a disorder of those not habited to the use of tobacco than to excessive addiction. I have made this matter the subject of extensive and long-continued research, undertaking to present an indictment against tobacco, and it is to be admitted that full Justice requires that I dismiss the I have called witnesses by the hundred, in this country, Europe and Australia, and, whether tobacco is used for smoking or chewing or as a drug, the case. charge goes unsupported, except, of course, as indicated in producing a mere condition-a simulative condition. Tobacco, the narcotic, and tobacco, the diuretic, do not, cannot cause amblyopia. Tobacco, as a nauseant, may cause an amblyopic condition. Westfield, N. J. THERMIC CONVULSIONS OF CHILDREN. THE BY A. J. MANN, M. D. HE object of this paper will, if its aims can be clearly set forth, show the history, symptoms and treatment of thermic convulsions. Convulsion is derived from the Latin word "convulsio," or the French word "convellere,' meaning to pull together; definition, tonic or clonic spasm of the limbs or body, producing violent agitation. There are several varieties of convulsions, or inward fits," viz: Thermic, those excited by reflex irritation, caused by a rise of temperature to 104 degrees Fahr.; toxic, those excited by narcotic poisons, alcohol, leucomaines, etc.; symptomotic, when incomplete or as a symptom of indigestion, irritation by worms, colic and flatulence; the reflex are those caused by pain, continued at any point, such as griping and tenesmus. Causes: The most prevalent causes of thermic convulsions are such as will raise the temperature to 104 degrees Fahr., cold, diarrhea, septic or toxic matter in the bowels or stomach and overheating; the toxic will generally produce the thermic; intense griping and straining will cause the reflex. Acute intestinal catarrh is a condition in which convulsions are most apt to occur. They are also the result of an overloaded stomach, but as they occur mostly in summer diseases of infants I shall give my attention to them in that line. Symptoms: Tonic or clonic spasm, drawing to one side of the eyes, quivering or muscular twitching, the thumbs are flexed in the palms, the toes drawn downward, the muscles are generally rigid and the jaws remain set for sometime after the other muscles have relaxed. Spasm and contraction of the muscles of the neck, re sembling meningeal spasm, is probably produced by reflex excitement of the meninges or irritation thereof. The convulsions usually consist of several paroxysms, either increasing in severity or diminishing into milder forms, with intervals of unconsciousness and insensibility. The patient is bathed in a profuse perspiration, foam runs from the mouth, respiration is quickened and becomes irregular, the pupils are dilated and contracted at intervals, the urine and feces are passed involuntarily during an attack. Implication of the glottis is certain to occur, which causes intervals between the inspirations and the expiration to lengthen, but death is not likely to occur from this, as relaxation generally occurs from an accumulation of carbon dioxide in the blood. The fevers are of a remittent type generally, and occur during the latter part of the day, which excites the nervous and muscular symptoms. Sleep or coma follows an attack, but is sometimes interrupted by slight jerkings and nervous sensations with feeble groans. One Prognosis: It is said that the younger the child the more unfavorable the prognosis, which is, no doubt, correct, owing to the delicate structure of the child. The writer has known 50 per cent. of all cases under his observation to recover. case recovered with hydrocephalus and enlargement of the cranium. It is probable that most of the recoveries of the severe forms of the disease will result in idiocy, etc. Treatment: This should be rational and dependent upon the conditions. The alimentary canal should be cleansed of its toxic contents. For this I use a combination of podophillum, leptandria, natrium bicarbonate and capsicum, but this should not be given in purgative doses, as such will excite the spasm. This not only re lieves the bowels of their contents, but has a carminative effect, relieving colic, flatus, tenesmus and griping. If the tongue is broad, pallid, light and pasty, sulphite of natrium should be used instead of the bicarbonate. However, attention to the bowels is of secondary importance. When a child is seized with a convulsion attention should be directed to the relaxation of the mus |