longer than their more fortunate sisters possessing a good liver-one that has not been abused by the injudicious use of mercurials, arsenic and phosphorus, remedies which are known to destroy the hepatic functions.

It seems almost incredible that all such manifestations should be charged to the nervous system, when the facts point unmistakably to the constant poisoning of the blood from the presence of morbid materials, which are retained in the system upon the cessation of menstruation. The successful use of drop doses of the wine of ipecac points to the employment of strychnine, but in some cases, more obstinate than others, the addition of ipecac in the form of powder will be found available.

The objects to be attained are as follows: First, a general nervine tonic is demanded, second, a stomach tonic; third, a remedy which will act as a hepatic stimulant; and fourth. an intestinal stimulant. Nux vomica, or its alkaloid, strychnine, answers all of these demands, but as suggested, in extreme cases of hepatic torpor, the ipecac will prove a valuable aid. In women who have become debilitated from lack of proper exercise and nutrition, and suffer from obstinate constipation, strychnine, 1-60 of a grain, every four hours, will act as a brisk cathartic, and although such action is rather inconvenient, the patients will assert that they improve daily.

We may take advantage of this principle in the treatment of vomiting of pregnancy by administering small doses of the drug at short intervals during the day.

Ten to twenty drops of the tincture may be placed in a glass of water in the morning and the patient directed to sip a small portion every half-hour until the whole is taken and the treatment repeated on the following day.

THE DANGER FROM HYPNOTICS.

It has been more than two decades since chloral fell into the hands of the writer. Then its use as a hypnotic was confined to comparatively narrow limits, since it has come to be regarded as the ideal sleep producer.

It merits its place, because the sleep induced counterfeits nature so perfectly that it cannot be distinguished from the original. Though 26 years ago the writer well remembers how it relieved him of an insomnia of severad days' duration.

It seems deplorable that this restorer of tired nature should have fallen under the ban of suspicion, but so it is. Cases of fatal poisoning by the drug began to appear in print, and the physician found it necessary to scrutinize his cases of sleeplessness for signs of cardiac failure. Our idol was broken. Sulphonal and Trional bid for the place, and with all the "pomp and circumstances" of modern advertising by commercial pharmacists they too only partially succeeded.

The claims set up for each have been extravagant-experimental research has proved both inferior to chloral. The crucial test, clinical experience, has catalogued them along with chloral as poisons.

Thus another dream was shattered. The last name of a hypnotic to make its appearance in current prints is Chloretone, for which it is alleged that it exercises no depressing influence on the heart. So it was claimed for Sulphonal and Trional.

It is hoped that the claims made for Chloretone may be realized.

A safe and efficient hypnotic is a desideratum. Skill and enterprise by eliminating and combining may yet solve the equation of equal safety and efficiency.

One dollar for the SUMMARY one year.

IN

N a complete and comprehensive study of the cutaneous affections which commonly attack the ears, we must necessarily remember the fact that not alone do we find this class of diseases on the external ear, but alike attacking those portions of the internal canal which are in close contact with the outer structures, as well as its proximity to those delicate structures within the cranial cavity. As errors of diagnosis may intervene upon the most careful observation, it is the purpose of the writer to assist in the elimination of at least some causes that may arise in this particular.

Of the diseases which attack the cartilaginous or soft parts of the ear, there is no doubt but that eczema is the most frequent, forming, as it does, about 35%, or a little over one-third, of all the dermal affections which visit our clinical services.

The vesicular variety of eczema is most prone to be exhibited in this region, while many cases of the squamous manifestation are likely to be presented, and yet many cases are shown where, from the extension of this disease from the surrounding areas, we observe some maceration and fissuring at the junction of the external ear to the head, either from behind or below.

Upon the cartilaginous portion we find that the vesicles are usually flat and well distended with fluid, while the reverse is the rule when this lesion is detected upon the more soft parts, such as the helix. The lesions of the cartilaginous parts are likely to show pus contents intermixed with serum, which is retained for sometime, while those upon the helix rarely contain pus and usually rupture

into a crust.

Upon both the cartilaginous and soft parts the squamous manifestation is encountered, and while it may be the remains of a former extensive irritation, it is often the only lesion that has been present.

It is seen in abundant or small quantity and may be observed on the rim of the ear, in the grooves or upon the outer or inner side of the helix.

At the junction of the external ear to the head upon the posterior portion we are likely to observe considerable maceration and consequent fissuring in old or long standing cases. In old cases, either of long standing or where acute outbreaks frequently intervene, we are likely to observe extension of the condition into the auditory canal, and thus matters are disagreeable indeed.

The itching and distress occasioned at this part are intolerable, and complications are likely to be observed after the frequent attempts at relief. If the lesions are ruptured by traumatic influences there is likely to be seen much bleeding in addition to the exuding serum, and thus much more disagreeable sights are encountered. In children, the condition is more often noticed, especially in those below the age of two years, and then between the ages of seven and 10 years; in adults the complications are not usually so pronounced.

The diagnosis of this disease is usually not a difficult matter, if the character of the lesion is given just study; if the character of the irritation is strictly observed and the tendency of relapse is considered with the rapidity of the formation of crusts, with the consequent itching, and there being only a few resemblances to other affections of the skin.

Lupus erythematosus, while forming only a small percentage of all cutaneous diseases which come under the attention of the clinician, is yet observed in sufficient frequency to cause much discomfort to the sufferer and, alike, many misgivings in the mind of the practitioner. Being observed in the frequency of one in every thousand cases, it is necessary that the physician should be upon the

alert not to allow himself to make any rash statements as to the time required for a cure.

It appears upon the rim of the ear, upon the grooves and upon the helix in about equal proportions; in fact, it never limits itself to any particular portion of this member. It presents a slightly inflamed area which is usually superficial, although at times the maceration may become marked, especially in aggravated or long standing cases. The patch, usually being of a darkish tint, is covered with thin fine, or rather branny scales, although usually much heavier at times than those observed in squamous eczema. We are not likely to find the circumscribed areas, with their raised border and apparently unaffected or rather atrophic centers, as observed upon other portions of the face. Its progress is either slow or exceedingly rapid, and as this procession is noticed its character soon becomes manifest to the careful observer, and as it shows its manifestations they will, with care, be sufficient to prevent its identity being lost. We can always with safety know that an affection which spreads as this does that some grave condition affronts us, and if we are unable to cope with its maneuvers we should call upon our well informed friends.

Leprosy, fortunately, is of very infrequent occurrence in this country, and is very unlikely to attack the ear as an initial point. It is an affection that is likely to have first shown erythematous patches at some remote portion, as well as to give other general symptoms, such as pains resembling arthritis deformans, anesthetic zones and certain other manifestations. It is certain that only a few cases have originated de novo in our clime, and these may cause some difficulty in their possible elucidation. It is an affection that so materially differs from other dermatologic conditions that little difficulty of diagnosis should occur. The nodules of leprosy may occasionally be mistaken for syphilis, but in the latter affection we usually have some point that will lead to a proper recognition of the case presented. Vitiligo, morphoea, sarcoma, etc., usually present some distinct marks of identification.

Furunculosis is observed for the greater part within the auditory meatus, and is a very persistent condition. Many of the so-called running ears or abscesses of this organ are nothing more than ordinary furuncles. From the character of lesion we should not mistake this condition, because they differ only in size from those observed on the general surface.

315 S. 18th St, Philadelphia.

MISCHIEVOUS MUTILATION OF WOMEN.

BY S. L. KILMER, M. D.

HE frequency with which one reads of the removal of the tubes and ovaries of both sides when those of one side only (if any) are diseased at the time, and on the flimsy pretext of doing so to prevent them from becoming diseased in the future, is appalling and abhorrent, and such mutilation is wholly unjustifiable. It would be just as logical, just as sensible, just as right, in case of a single diseased testical requiring removal to remove also the other and healthy testicle to prevent it from becoming diseased.

Let the thoughtless operators who have such a penchant for removing ovaries, whether diseased or not, and to remove two when only one is diseased, put themselves into their patients' places and consider whether they would consent to the removal of both their sexual glands because one was diseased.

It is impossible to refrain from the belief that many operators are more imbued with the desire of making a record in the number of operations performed, and the number of ovaries removed, than they are with a desire to be of benefit to womankind. They appear so steeped in selfishness as to consider their own interests from the standpoint of reputation rather than the patients' welfare. It matters not that a woman's consent is usually easily obtained for the removal of both ovaries when only one requires it, because the vast majority of women have only a very vague and indistinct idea of the functions until it is well axplained to them

Various instances have occurred in my practice in which when I suggested the

possibility of removal of the ovaries being required, the prompt consent was given for its performance, but when I had explained the functions of the ovaries the consent was as promptly withdrawn, and would only be granted as a dernier resort after everything else should fail, and I contend that it is the solemn duty of a surgeon to thus enlighten his patient before proceeding to an operation for partially or wholly unsexing her.

Not to mention the frequent unjustifiably hasty resort to ovariotomy in a vast number of cases of inflamed ovaries,

which inflammation with a little patience and proper treatment can be cured in reasonable time, and without jeopardizing the life of the patient, and the vast number of ovaries which after laparotomy are found free from disease (mistakes in diagnosis), or so slightly diseased as not to require operation, which are removed after all, apparently on the principle (?) that the patient and the ovaries must suffer rather than the reputation! of the doctor as a diagnostician, the practice of totally unsexing a woman by removing the adnexa on both sides because those of one side only are diseased, cannot be too strongly condemned.

Opening the belly on the slightest pretext is, and has been, much too prevalent, whether because there was a pain in the region of the ovaries or in the region of the appendix. Vast numbers of lives have been sacrificed on the operating table that might and could have been spared by a manifestation of a little patience and a little persistent proper treatment. Fortunately the pendulum which swung too far in one direction is now on its return, and if it can be stopped at the proper place there will be a vast gain for humanity in general.

Gentlemen may say that the case cited above regarding the removal of the male sexual organs is not a parallel one, as in such case the abdomen is not opened. But what! is the opening of the abdomen such a dangerous procedure? If so, why resort to it so frequently in haste instead of allowing proper time for a proper diagnosis, to say the least, and during which time Nature will very often, with a little aid from the doctor, produce a perfect cure.

I repeat, that the unnecessary unsexing of a woman, because the doctor has made a mistake in diagnosis, or by removing the uterine adnexa on both sides when those on one side only are diseased, especially during the fruitful period of a woman's life, is wholly inexcusable and unjustifiable. Such practice is malpractice of the worst sort, and should be punished accordingly. South Bend, Ind.

REPORT Of a case oF NECROTIC SORE OF THE FACE.

BY JAS. S. COBB, M. D.

ECROTIC sores of the face and noma

of the female genitals may not be so very uncommon among sickly children in crowded city tenements, in damp low-lying situations, but they are the rarest of the rare diseases in healthy country localities.

The case of the former of the two above mentioned varieties of gangrene, which I am about to describe, was of so severe a type, and the child's recovery from its ravages was so unexpected and so satisfactory, that I do not feel called upon to apologize for presenting the history of so well known a disease for professional consideration.

I was called several miles out of town on the 21st of July last, to see a little colored girl, Beulah S., living on her father's farm. I was told that the child had the whooping cough and that her face was swollen, the latter caused, presumably, from a decayed tooth. On reaching their home I found that the little girl, a child of seven years, had considerable fever, her temperature being 103° and her pulse 120. The left cheek was tense and swollen, and inspection of the interior of the mouth showed a large, greyish ulcer, involving about one-half of the inside of the left cheek. I at once, of course, made a diagnosis of gangrenous stomatitis, and proceeded to remove, with dressing forceps and scissors, as much of the dead tissue as I could, and succeeded in riding the child of a large portion of it. On the following day I noticed a slight darkening of the skin in the center of the cheek,

over an area the size of a 25 cent piece. This gave way during the next 24 hours to a dry blister of the diameter of a halfdollar, and beneath this I found a dry, grey slough. All along, the fetidity of the breath and of the slough was extreme, but the temperature and pulse had fallen somewhat after I cut away the necrosed surface, the former 102° and the latter 115. Up to this time the disease had been confined to the cheek and had shown no tendency to attack the gum. Soon, however, the upper gum was involved and became necrosed and the sur

keeping the edges of the wound cleansed with a saturated solution of boracic acid, to prevent as much as possible the formation of cicatricial tissue and promote granulation. I had the edges well rubbed twice daily with the saturated solution of boracic acid, and on this measure I wish to lay especial stress, as to it I ascribe, in a large measure, the fortunate closing of the immense gap the lesion had made. The internal treatment was tonics and cod-liver oil, supplemented with all the food (milk, beef extract, oysters, etc.) which the child could take. I directed that the child should be kept out of doors all day whenever the weather would permit.

After the removal of the slough the child's improvement was marked and the fever gradually disappeared. The chlorinated lotion was kept up throughout the entire process of cicatrization. The extension of the gangrene did not at once

face of the aveolar process of the superior maxilla separated. As soon as this was detected I detached and removed the dead shell, continuing backward until I reached sound bone. The underlying bone I treated with the compound tincture of benzoin, irrigating the whole sloughing surface with a chlorinated solution.

On the 29th I asked my friend, Dr. E. S. Dwight, of Smyrna, Del., to see the case with me, and to him I am indebted for the photographs which, through his kindness, I am able to reproduce here. Portrait No. I was taken on our arrival. I then cut out the gangrenous mass, and No. 2 represents the child as she appeared directly afterward. I regret that these pictures are not more distinct, but it was raining at the time they were taken; the sick room was poorly lighted and the child peevish and very restless.

My subsequent treatment consisted in

close, however, but it advanced upward and inward until under the internal angle of the eye. Here one day I found the remains of the upper part of the levator labii superioris alæque nasi muscle hanging as a necrotic pyramidal stump, which I removed, and which proved to be the last effort made by the disease.

At the time I resected the greater part of the cheek the molar teeth were all loose and almost ready to drop out, but after cutting away the necrosed portion of the bone and treating it. As the case improved the teeth became firm and again