■ 
 
 ■ 1 1 
 
 »"»■»' 
 
 I 
 
 
 RM 671 
 
 .113 
 1898 
 Copy 1 
 
 
 91 
 
 9 
 
 n 
 
« c: 
 
 cc XL 
 
 Cc - 
 Cc 
 
 c < 
 
 C i 
 
 c;c - 
 
 c c 
 
 C o< 
 
 c c_ 
 c c 
 c c 
 C C 
 
 v c cc c 
 
 ' -^ C 
 
 > c a •■ • 
 
 £; v <: Cc<.c<7 
 
 V < Ccrcc 
 
 vS C S vC 
 
 - ( cc c«c 
 
 >£ COCj 
 
 CC v ccc 
 CC C cc<c 
 
 < CCC 
 
 - < C ( K 
 C'c cC 
 C c c< 
 
 -^ C Ccc 
 : cc c c c cc 
 
 ( ,C(. C C CC 
 \ CC( C C <&C 
 
 - c c c c cc.c 
 CC-. c c C< 
 
 - CC c < cc<C 
 CC C C CCC 
 
 B C C c C G.<C 
 
 - CCic c <C<3C 
 
 cc: c c crcC 
 c cc cc c <x cc 
 
 ; * C«.XC cc « «T 
 
 - CC cc C " CCcC 
 P, CC c cccC 
 c < K c. cc c: 
 
 Cc c cccC 
 
 - cc .. c: cccc 
 
 C c CCcc 
 
 Xc Cc 
 CC C C cc c 
 
 <CC c C c 
 
 ,c >c 
 
 CC C*L 
 
 Cc CT 
 
 cc CC 
 
 cc c «c 
 
 '<■ CC < «L 
 
 cc c«c 
 
 «rc <^ 
 
 CC C <c 
 
 c.c.m^ 
 
 etc 
 
 - c« C c 
 
 *. << c c 
 
 . 'CCC 
 
 -*J* c c 
 
 C C Cc 
 
 C< C C c 
 
 ,Cc c v 
 
 ' C C 
 
 < c c 
 
 -C c C 
 
 : c <: 
 
 c^ ^ 
 
 c 
 
 CC 
 Cc 
 
 CC 
 
 CC 
 
 CC 
 
 cc 
 cc 
 
 CC 
 
 cc 
 
 cc 
 cc 
 
 cc 
 cc 
 
 cc 
 cc 
 cc 
 
 cc 
 
 CC 
 
 CC 
 
 cc 
 
 < cc 
 
 c c 
 
 c c 
 c c 
 
 c c 
 
 Cc 
 
 £C 
 
 ^c 
 
 
 cc 
 
 <<c 
 
 
 c c 
 
 
 '■ 
 
 <cc: 
 
 
 CC' 
 
 <C C 
 
 
 C t 
 
 «: <* 
 
 
 c 
 
 CC C 
 
 
 cc< 
 
 C«c «C 
 
 
 C( 
 
 cC «C 
 
 
 Ccc 
 
 CC1 €^ 
 
 
 CC 
 
 cc *c 
 
 
 c 
 
 cc cc 
 
 
 c 
 
 cc cc 
 
 
 c^ 
 
 cc cc 
 
 
 c < 
 
 CCS cv 
 
 
 c < 
 
 c c <c 
 
 > 
 
 c 
 
 CC cc 
 
 CC 
 
 c C < ( 
 Cd cc 
 
 C 
 
 Cc 
 
 <:c 
 c 
 C 
 
 LIBRARY OF CONGRESS. 
 
 ^ Chap Copyright So 
 
 Shelf -..^ -(A. $ 
 
 UNITED STATES OF AMERICA. 
 
 c c 
 
 ^_ C C 
 
 ( c 
 c c 
 c c 
 
 C( 
 C ( 
 c c 
 
 c c 
 
 o c 
 
 d c 
 
 CC 
 
 c< 
 
 L <«' CC C C CC 
 
 C X. CO "Cc c < CC ' 
 
 C C Ccc Ccc c C CC < 
 
 • C-- <C C C< (( < c < c 
 
 c c Cc < c c c c (Ci 
 
 c C Cc< v cc < c cc 
 
 c c Ccc CC c c < c/ 
 
 c c ccc ccc < c cc\ 
 
 . fcCCCcCCC c C CCc 
 
 : « ^ CCC C C<_ c c ccc 
 
 «T<:ccc< c^ ( c< 
 
 C C r C CC. CCCC C 
 
 C CCc ; cr c ^ <C c 
 
 C Cc c Cc c t <C ^ _ 
 
 -- • ' c ■ C C Cc cr < ^ c C < 
 
 > CCC C cc c c cC 
 
 C- Cc c C cc , cc c 
 
 ^C c c c c cc c«c c 
 
 C c c <: c < <c . t cC 
 
 c CCC C c 
 
 cc c 
 
 c c C 
 
 CC ^C ^Jt C ct 
 < c c c CC c c< 
 c C i c C CC C Cc 
 CC C CC C cc 
 < C C CC c CC 
 cO cC CC c cc 
 CCc cC CC ( CC 
 cCc ■ C <LC c CC 
 c C < c C CC ' CC C< 
 
 cC c Ccc cc * 
 <C c cC cc cc c 
 
 X'CCCCC < c 
 
 r r- ■ ^ C( tC CC '<■ 
 
 _cc ccc 
 
 c c. - c 
 
 ^< .^C 
 
 CC C CC C 
 Cc c <~ c c 
 CC C CC c 
 CC CC C 'C 
 
 CC ,CC C C 
 
 cc cc cr c 
 
 CC c.CC- ;C 
 
 CCCCCT (C 
 cc CCCc cC 
 
 cCCc: cc 
 CC CC 
 C CC 
 
 c 
 
 jp c «C 
 
 ,C C 4C 
 C «T" 
 
 c 
 
 re 
 
 < 
 c 
 c c 
 
 C C < 
 c c 
 C C 
 
 c c 
 
 c i c C 
 
 c c 
 
 C C Cc 
 
 cc 
 
 C C c: 
 
 C C Cc 
 
 c c^ 
 
 c 
 
 c 
 
 
 CtcC 
 
 c ^c 
 c < 
 
 <l 
 
 K_jC'( c 
 
 < 
 
 dCC- 
 
 c. 
 
 dece 
 
 c 
 r 
 
 ar c", 
 
 Ci <x 
 
 «TCv c C 
 
 Ci cc 
 
 .Cc CC 
 
 Cc C C. 
 
 c i 
 
 c c 
 
 <c C C 
 
 C CCC 
 
 C CC c 
 
 cccc 
 
 c CCC 
 c c cc 
 
 cc 
 
 c c 
 
 CC 
 
 c C Cc 
 c c C 
 c c 
 
c (. 
 
 c < 
 c < 
 c C 
 
 c C cc 
 
 , c < 
 
 c c c 
 
 X 
 
 a 
 
 C* 
 
 c c 
 
 <r 
 
 ((. 
 
 <L 
 
 
 < 
 "C 
 
 c c 
 
 C 
 
 c c 
 
 Cl 
 
 cc 
 
 CC 
 cC 
 
 c c <* 
 
 cc 
 
 cc 
 
 c~ <^ 
 
 c c 
 
 c 
 
 rc<c.tcxc( 
 
 c ■ C C <L C 
 
 cC 
 
 CC 
 
 c «: 
 
 c c 
 
 C C 
 
 c «L 
 c C 
 
 : c c 
 c c 
 c c 
 
 cc c 
 
 c 
 
 c «. c 
 C < c 
 c < C 
 
 c 
 
 C* 
 
 c C C( 
 l C C< 'c 
 c C C < < c 
 c C CC 
 
 tec 
 
 c c c 
 
 c c cc 
 
 cc o ^ 
 
 CC CC cc 
 
 c c c c 
 
 cc cc cc 
 c c cc 
 
 CC cc 
 
 C C < 
 
 <c c • 
 
 cc c 
 v ecu 
 . ccc a C 
 
 ( C C tt c 
 
 c< 
 cc 
 
 - Cc 
 
 ' c 
 c 
 c 
 C C 
 C C 
 C C ' 
 
 c c 
 
 cc 
 
 c c 
 
 c c 
 
 re 
 
 *c_ C 
 
 cc r 
 
 c c 
 
 cr c 
 
 c c 
 
 c c 
 
 c c 
 
 <c 
 cc 
 
 cc 
 
 c c c 
 
 c c c 
 
 c c c 
 
 c cc 
 
 C CC 
 
 C V v. 
 
 C c C 
 
 c <^c 
 1 C cc 
 c C cC 
 ^ C c C 
 c C CC 
 
 '- 
 
 < 
 
 C cc 
 
 CCC 
 
 c CC 
 
 ccc 
 c cc 
 
 CCC 
 
 c cc 
 
 cc CC 
 
 CCC 
 
 CCC 
 
 CCC 
 
 c c c C < C CC 
 
 < C'cC C Ck' 
 cc c c < 
 
 ' C« CvC 
 
 Ci c c < C 
 
 c < c C (< C 
 
 C< c c - c 
 
 c C < C 
 
 : c c c< 
 
 ~ c C C « * 
 
 c 
 
 : c -c c 
 
 - r" <c c 
 
 C_ C 
 
 c 
 
 ■c-c 
 
 C «x c 
 
 < «:« .c 
 
 r cc c 
 
 c cccc 
 
 c C 
 
 CCCc<I 
 
 cc 
 
 rccc 
 
 cc 
 cccc 
 
 CCU 
 
 cccc 
 
 CC. C C 
 
 cccc 
 
 C cc c C 
 
 CC'Cc 
 
 C cs. C \ 
 
 exec 
 
 c< c< 
 
 C^ c C 
 
 cr c^ 
 
 cccc * 
 
 >-c 
 
 C 
 
 : d(C 
 
 c <C 
 
 r<c 
 
 \ cc 
 
 cc 
 
 * cc 
 
 c CC C( 
 
 CC C'( 
 "< cc 
 
 cc; 
 
 c cc c 
 
 c C' 1 
 
 cC 
 c C - 
 
 C 4C 
 
 C C 
 
 cc cc est 
 
 cc cc 
 CC cC CC 
 
 cc c c 
 
 cc c c 
 
 cc c c 
 
 <c cc 
 
 cc cc 
 
 C<r 
 
 CC C 4 
 
 Cc re 
 
 Cc c C 
 
 Cc c C 
 CC CC 
 CC c C i 
 
 CC c 
 
 ^c cc c 
 
 cc « 
 
 c 
 c 
 
 Cc c CC 
 
 cc CCC 
 
 c^ cCC 
 
 <c CC 
 
 CC CCCrc 
 
 c c c 
 
 c C 
 c C 
 
 
 
 c c 
 
 C( < 
 
 c C 
 
 CC i 
 
 c c 
 
 CC 4 
 
 C C CC 4 
 
 c 
 
 CCC 
 
 c 
 
 
 c < < c 
 CC ' < C. C 
 
 ccc < c 
 
 CCC <~ c« 
 CCC C C 
 
 CCC 
 
 *Ccr ^ 
 
 «i C c 
 
 -: C c < 
 CCCC 
 c C C CCvj c 
 c CC c< cc 
 
 c: c c 
 
 c C('(\c c: 
 
 . < C C cc cC 
 c - <: <: c^ 
 c. CO c 
 
 C CC Cc CC 
 C C r c 
 
 : Cc :c 
 
 C"c < c 
 
 C cc c 
 
 C" c 
 c 
 c< 
 
 CC CC 
 
 cc c c «c 
 
 C c cc 
 
 cc < 
 cc CC C 
 
 cC C C C^C 
 
 c< c C % 
 
 cc" c < 
 
 cc c c 
 
 c c c 
 
 cc c C 
 
 c c c 
 
 c <r 
 <^ c 
 
 CC 
 
 c c< 
 
 c CC 
 
 Ci 
 
 CCa 
 
 CC Cc 
 
 «C CC.cc 
 
 cc <x 
 
 CiC Cw 
 
 CiC.C 
 CCC 
 
/ 
 
 The Therapeutical Applications ^ ( ^ 
 
 OF 
 
 Hydrozone 
 
 30 VOL. PRESERVED AQUEOUS HgOgSOfcUTION. 
 
 AND 
 
 Glycozone I 
 
 BY 
 CHARLES MARCHAND, Chemist, 
 
 GRADUATE OF THE "ECOLE CBNTRALE DES ARTS ET MANUFACTURES DE PARIS" (FRANCE). 
 
 RATIONAL TREATMENT OF DISEASES 
 
 CHARACTERIZED BY THE PRESENCE OF PATHOGENIC GERMS. 
 
 THIRTEENTH EDITION. 
 
 NEW YORK. 
 1898 
 
** 
 
 MAR 7 w' 
 
 The Therapeutical Applications 
 
 Hydrozone 
 
 30 VOL. PRESERVED AQUEOUS HgOoSOLUTION. 
 
 AND 
 
 Glycozone 
 
 BY 
 CHARLES MARCHAND, Chemist, 
 
 GRADUATE OF THE ll ECOLE CENTRALE DES ARTS ET MANUFACTURES DE PARIS" (FRANCE). 
 
 RATIONAL TREATMENT OF DISEASES 
 
 CHARACTERIZED BY THE PRESENCE OF PATHOGENIC GERMS. 
 
 THIRTEENTH EDITION. 
 
 NEW YORK. 
 
 1898 
 
 
 ^t>U>o 
 
<$> 
 
 b 
 
 
 2544 A ^.« 
 
 Copyright 1898, by Charles Marchand. 
 

 ix. 
 
 TO THE MEDICAL PROFESSION 
 
 I respectfully call your attention to the fact that I manufacture 
 Hydrozone at the request of the leading Medical Profession, whom 
 experience has taught, that in the treatment of many diseases caused 
 by pathogenic germs, the bactericide power of my Peroxide of Hydro- 
 gen (medicinal), (fifteen volumes,) is not always sufficient to thor- 
 oughly destroy quick enough the microbian element, which frequently 
 develops with such prodigious rapidity, that it is urgent to check and 
 overcome its virulence in the shortest possible time, so as to prevent 
 the whole system of economy from being invaded by poisonous 
 ptomaines. 
 
 Hydrozone yields thirty times its own volume of '^Nascent 
 Oxygen" (near to the condition of Ozone) and it is far superior to my 
 Peroxide of Hydrogen (medicinal), in healing properties. 
 
 Hydrozone retains its germicide and curative power for any 
 length of time when kept with ordinary care. 
 
 It is slightly acid to the taste, and it should never be made neu- 
 tral before using, even in the treatment of diseases of the most deli- 
 cate mucous membrane. 
 
 A host of imitators and substitutors of drugs are filling prescrip- 
 tions with commercial Peroxide of Hydrogen, which is good enough 
 for bleaching purposes, but totally unfit, unsafe and always worthless 
 as a remedy. 
 
 They claim that it is "just as good" as the genuine article, but they 
 take great care not to say, that this cheap article which I sell in 
 bulk at four cents per pound leaves them a profit varying from 500 to 
 1,000 per cent. 
 
 By so doing, substitutors of drugs place the physician's reputa- 
 tion as well as his patient's life in jeopardy, and the only effective 
 manner to check this fraudulent business is to expose these criminals 
 through Medical Journals and Daily Papers. 
 
This course, which is already followed by several manufacturers 
 of legitimate preparations will benefit the honest druggists, the phy- 
 sicians and their patients. 
 
 In order to protect the Profession against fraud, my medicinal 
 preparations are put up only as follows: 
 
 Hydrozone. — (thirty volumes preserved H2O2 solution): Extra 
 small size (for Dentists), small, medium and large size bottles, bear- 
 ing a red label, white letters, blue and gold border, with my signature. 
 
 Charles Marchand's Peroxide of Hydrogen (Medicinal) 
 (fifteen Vol. H2O2): — ^ lb., % lb., l / 2 lb., 1 lb. bottles, bearing a blue 
 label, white letters, red and gold border with my signature. 
 
 Glycozone. — %. lb., % lb. , 1 lb. bottles, bearing a dark yellow 
 label, white and black letters, red and gold border with my signature. 
 
 Marchand's Eye Balsam: — One size bottle packed in a box, 
 sealed with my signature. 
 
 Please prescribe in original, unbroken packages, to avoid imita- 
 tions and disappointment. 
 
 Yours respectfully, 
 
 Chemist and Graduate of the "Eco/e Cent rale des Arts et 
 Manufactures de Paris" (Frame). 
 
 NOTE. — All bottles of Hydrozone and Marchand's Peroxide of Hydrogen 
 (medicinal) are filled ONLY to horizontal line blown in glass, thereby 
 allowing space for expansion of gas which may liberate during transit, or 
 when kept long-in stock at a temperature exceeding 70 degrees F. 
 
 Although the bottles are tightly corked, if kept at a low temperature, 
 there is little or no popping when opened, viz.: no loss. Loud popping indi- 
 cates a loss of about one volume of nascent oxygen gas. 
 
TO THE MEDICAL PROFESSION. 
 
 The Thirteenth edition of this book contains the directions for using 
 Hydrozone, Glycozone and Eye Balsam. 
 
 Hydrozone being a30 volume H2 O2 aqueous solution, is twice as strong 
 as my medicinal H2 O2 (15 volumes). Therefore, when my medicinal Per- 
 oxide is prescribed, the dose should be at least double in order to obtain 
 satisfactory results. 
 
 I earnestly request Physicians to use Hydrozone in preference to my 
 medicinal Peroxide, not only on account of its wonderful bactericide proper- 
 ties, but also owing to its being far superior in stimulating and healing 
 action upon diseased tissues. 
 
 It will afford me great pleasure to embody in the Fourteenth edition of 
 this book, all scientific reports, which may appear in the Medical Press, 
 between now and the first of September, 1898. Full credit will be given to 
 both the writer and medical journal. 
 
 CONTENTS. 
 
 PART I. 
 
 Page, 
 
 Report on II2 O2, by Prof. L. D. 
 Kastenbine, A. M., M. D 1— 1 54 
 
 Real Value of 1 1 2 O2 Brands in the 
 Market, by Dr. H. Kndemann, Ph. 
 
 D., Chemist I 
 
 H2 O2, by J. P. Parker, Ph. G., 
 
 M. I) iv 
 
 List of Contributors to Medical Lit- 
 erature V 
 
 Relations of Bacteria to Disease 1 
 
 Modifications in the Cerm Theory.. .. 3 
 
 Predisposition to Disease 5 
 
 Requirements of an Antiseptic 7 
 
 Rational Treatment of Diseases — 
 
 Action of Ozone - upon Virus 8 
 
 Comparative Chemical Reactions Be- 
 tween Hydrozone and Ozone 10 
 
 Important Information on II2 O2 and 
 
 Hydrozone 1 1 
 
 Action of Hydrozone (30 Vol. Aque- 
 ous H2 O2 Solution) upon Animal 
 
 ( ells and Vegetable Cells 12 
 
 Action of Hydrozone upon Open Dis- 
 eased Surfaces — Its Use as a 
 Hemostatic 12-225 
 
 Page. 
 
 Nasal Hemorrhage 13 
 
 Respective Bactericide Power of Dif- 
 ferent Chemicals 14 
 
 Compound Oxygen Treatment (foot 
 
 note ) 14 
 
 Glycozone — Important Information.. 15 
 The Therapeutics of Glycozone — Com- 
 position and Characteristics 16 
 
 PART II. 
 
 Diseases of the Nose, Throat and 
 Chest. 
 
 General Directions for- Using and 
 Applying Hydrozone and Glyco- 
 zone in Diseases Characterized by 
 the Presence of Pathogenic Germs, 18 
 
 Catarrh of the Nose and Throat — 
 
 Treatment 18 
 
 See also pages, 72, 145, 176, 207, 
 212, 224 
 
 Ozcena or Putrid Catarrh of the Nose, 20 
 
 Hay Fever — Rose Cold — Coryza-- 
 Causes and Treatment 21 
 
 Influenza — La Grippe — Causes and 
 Treatment of the Local Symptoms, 24 
 
CONTENTS 
 
 Page. 
 
 Asthma 25 
 
 Bronchitis 26 
 
 Laryngitis — Hoarseness — Pharyngitis , 2 7 
 
 Croup — Membranous Croup. 27 
 
 Whooping Cough — Causes and Treat- 
 ment 28 
 
 Consumption — Phthisis — Tuberculosis 
 of the Lungs — Causes and Treat- 
 ment 29 
 
 Sore Throat — Angina — Tonsilitis, 
 
 Quinsy, etc 31 
 
 Diphtheria — Causes and Treatment. . . 32 
 See also pages 65, 67, 68, 70, 75, 81, 
 82, 96, 97, 104, 144, 188, 202, 210, 
 
 219, 224, 228, 247 
 
 Scarlet Fever — Causes and Treatment, 33 
 Hand Atomizer and Ozonizer — 
 
 Description $ 34 
 
 Illustrations 35~36 
 
 PART III. 
 
 Inflammatory and Contagious 
 
 Diseases of the Alimentary 
 
 Tract. 
 
 The Rational Treatment of Gastric and 
 Intestinal Disorders. 37 
 
 Dyspepsia, Gastritis Predisposing 
 
 and Exciting Causes 37 
 
 See also Scientific Reports, pages 
 156, 214, 216, 217, 236, 237, 241, 
 248, 250, 251 
 
 Directions for Using Hydrozorie and 
 Glycozone in Chronic Dyspepsia, 
 Gastritis 40 
 
 Gastric Ulcer 42 
 
 Indigestion — Vomiting in Pregnancy, 42 
 
 Inflammatory Diseases of the Intes- 
 tines — Chronic Constipation — Diar- 
 rhoea. 43 
 
 Typhoid Fever — Causes and Treat- 
 ment 43 
 
 Treatment of Typhoid Fever, by Dr. 
 
 Elmer Lee 44 
 
 See also pages 92, 150, 156, 247 
 
 (Continued.) 
 
 Page. 
 H2O2 in Contagious Diseases of the 
 Alimentary Tract — Cholera — Yellow 
 Fever — Typhus — Typhoid Fever. . . 46 
 
 Yellow Fever — Treatment 48 
 
 Cholera Infantum — Dysentery — Treat- 
 ment 49 
 
 PART IV. 
 
 Hydrozone and Marchand's Eye 
 
 Balsam in Inflammatory and 
 
 Contagious Diseases 
 
 of the Eye. 
 
 Catarrhal Conjunctivitis or Ophthal- 
 mia 49 
 
 Causes 49 
 
 Treatment 50 
 
 Blepharitis 51 
 
 Purulent Conjunctivitis — Ophthalmia 
 Neonatorum or Ophthalmia in 
 Children 51 
 
 Granular Eyelids 51 
 
 PART V. 
 
 Inflammatory and Purulent Diseases 
 of the Ear. 
 
 Treatment 52 
 
 See also pages 108, 91, 211, 215, 
 224, 249, 252 
 
 PART VI. 
 
 Hydrozone in Dental Surgery. 
 
 See also pages 53, 94, 180 
 
 Alveolar Abscess and Abscess of the 
 
 Inferior Maxilla — Treatment 53 
 
 Laceration — Inflammation and Ulcera- 
 tion of the Gums — Stomatitis — 
 
 Treatment 54 
 
 Necrosis and Caries of the Teeth. ... 55 
 How to Use Hydrozone for Bleaching 
 Discolored or Devitalized Teeth. . . 55 
 
 Rigg's Disease 55 
 
 Hydrozone as a Mouth and Tooth 
 
 Wash 56 
 
 Teething, Dentition 56 
 
CONTENTS 
 
 Page. 
 PART VII. 
 
 Hydrozone and Glycozone 
 in Chronic and Acute Ulcers. 
 
 See also pages 56, 72, 81, 84, 94, 98, 
 99, 106, no, in, 235, 238, 246, 
 
 247, 249,252, 254 
 
 Boils — Abscesses Buboes, and all 
 
 Open Sores — Treatment 57 
 
 Anthrax-Carbuncle — Treatment 58 
 
 See also. . ., .110, 246 
 
 Cancerous Sores, Gangrenous Sores — 
 
 Lupus — Treatment 59 
 
 Empyema 59 
 
 Ulceration of the Rectum 60 
 
 Phagedenic Ulcer of the Rectum 60 
 
 Fistula-in-Ano 61 
 
 Piles (External or Internal) 61 
 
 PART VIII. 
 
 The Rational Treatment of Acute 
 
 and Chronic Diseases of the 
 
 Genito-Urinary Tract. 
 
 Gonorrhoea — Gleet — Urethritis — 
 
 Treatment 63 
 
 See also pages 69, 79, 100, 101, 125, 
 229, 247, 256 
 
 Women's Weaknesses Whites 
 
 Leucorrhoea 64 
 
 Clitoritis Vaginitis Metritis 
 
 Endometritis Ulceration of the 
 
 Cervix Uteri 64A 
 
 (Continued.) 
 
 Page. 
 Cancer and Gangrene of the Uterus. .64B 
 See also pages 79, 126, 163, 167, 220, 
 
 229, 247 \ 
 
 Pelvic Abscess — Abscess of the Vagina, 64c 
 
 Recto-Vaginal Fistula 64D 
 
 Inflammatory and Suppurative 
 Diseases of the Bladder — Purulent 
 
 Cystitis 64D 
 
 See also pages . .72, 79, 229, 247 
 
 Nephritis Diabetes 64E 
 
 See also Report of a case on Suppur- 
 ative Nephritis 256 
 
 PART IX. 
 
 Hydrozone and Glycozone in Skin 
 Diseases. 
 
 Eczema — Psoriasis — Salt Rheum — 
 Lupus — Itch — Barber's Itch — Ery- 
 sipelas — Sun Burn — Poisoning Ivy- 
 Acne— Mosquito Bite, Etc 64E 
 
 See also pages 102, 192, 246 
 
 Herpes Zoster or Zona 64G 
 
 Acne — Pimples on the Face 64G 
 
 Freckles and Moth Patches 64G 
 
 Chapped Hands 64H 
 
 Dandruff 64H 
 
 PART X. 
 Opinion of the Medical Profession. 
 
 Reprints of Scientific Articles, which 
 appeared in the Medical Press, up to 
 September, 1897 65-257 
 
STANDARD 
 
 FOR 
 
 CHARLES MARCHAND'S 
 
 Peroxide of Hydrogen, 
 
 (MEDICINAL) 
 
 AND 
 
 Hydrozone. 
 
 First — Free from soluble salts. 
 
 Second — Free acid contained in ioo cubic centimetres requires 
 not less than one c. c. and not more than three c. c. of normal volumetric 
 soda solution, to be neutralized. 
 
 Third — Peroxide of Hydrogen yields not less than fifteen volumes 
 of available nascent oxygen, which corresponds to 4.5$ of anhydrous 
 H2O2. Hydrozone yields not less than thirty volumes of available 
 nascent oxygen, corresponding to 9$ of anhydrous H2O2. 
 
 Test. — One cubic centimetre of Peroxide of Hydrogen diluted 
 with 150 c. c. of distilled water, containing two c. c. of C. P. sulphuric 
 acid decolorizes at least fifteen cubic centimetres of a solution con- 
 taining 5,665 grammes of C. P. permanganate of potash, per liter of dis- 
 tilled water. 
 
 One c. c. of Hydrozone being submitted to the above test decolor- 
 izes at least thirty c. c. of the same solution of permanganate of potash. 
 
 Marchand's H2O2 (medicinal) and Hydrozone retain their 
 strength for any length of time, when kept in stock with ordinary care 
 at a temperature not exceeding 70° F. 
 
 Prepared only by 
 
 Chemist and Graduate ofthe li Ecole Centrale des Arts et Manufactures dc Paris" {France.) 
 
 NOTE.— One cubic centimetre of "Hydrozone" is not 
 only equivalent in bactericide power, to two cubic centimetres 
 of my H2O2 (medicinal) but it is far superior as a healing 
 agent. See p. 11: Important information on H2O2 (medicinal) 
 and Hydrozone. 
 
 
L. D. KASTENBINE, A. M., M. D. 
 
 Professor of Chemistry, Urinology and Medical Jurisprudence, Louisville Medical 
 College; Professor of Chemistry, Louisville College of Pharmacy, 
 
 Reports as follows in the Louisville Medical Monthly for July, 1894: 
 
 (See article headed "Hydrogen Dioxide," H2 O2, page 154.) 
 
 Of the various brands of Hydrogen Dioxides, I have examined, 
 I find Marchand's to be the one which yields the largest amount of 
 available oxygen under all conditions of exposure, about fifteen vol- 
 umes, and the one which contains the minimum percentage of free 
 acid. All the marketable articles I have seen are free from barium 
 compounds, but the majority do not come up to the fifteen volume 
 standard, but are six, eight, ten and twelve volume solutions. * * * 
 
 The above statement is strongly confirmed by the following 
 report : 
 
 THE REAL VALUE OF THE MEDICINAL PEROXIDE OF HYDROGEN 
 PREPARATIONS FOUND IN THE MARKET. 
 
 By H. ENDEMANN, Ph. D., Chemist, of New York. 
 
 Formerly Associate Chemist to the New York City Board of Health. 
 
 Published by the Times and Register, of Philadelphia, Pa., Dec. 15, 1894. 
 
 My attention having repeatedly been called to several reports 
 and analyses made "by chemists and published by some medical jour- 
 nals, I concluded to examine all the brands of Peroxide of Hydrogen 
 that I could find on the market, in order to ascertain the real value 
 of each when intended to be used as an antiseptic remedy, both inter- 
 nally and externally. 
 
 The reports on the subject which have come to my knowledge 
 are quite contradictory, and my object is to impart to the medical 
 profession the results of my experiments, which have been made on 
 fourteen fresh samples, purchased by me in duplicate, directly from 
 the manufacturers or their selling agents. 
 
 These brands have been tested for the volume of available oxy- 
 gen, the amount of residue, the degree of acidity, and the amount of 
 soluble barium salts contained therein, as per following table: 
 
II 
 
 
 P.RANDS OF 
 H 2 O s SOLUTIONS. 
 
 
 lume of Available ( )xygen| 
 ermined by means of a 
 ution containing 5.665 
 ammes of Permanganate 
 Potash per liter of dis- 
 ed water. 
 
 esidue obtained from 100 
 . C. of Peroxide of Hydro- 
 :n dried at 120 degrees C. 
 
 idity expressed in Cubic 
 itimetres of Normal Volu- 
 tric Soda Solution for 100 
 C. of Peroxide. 
 
 ryta found in Soluble 
 ryum Salts contained in 
 1 C. C. of Peroxide. 
 
 
 
 
 0^- v. a 
 
 O « V . 
 
 c« <fl V 
 PQOQ 2 
 
 
 
 
 
 <*o So 
 
 < 8 £U 
 
 No. i. 
 
 John Bene's Hj 
 
 ) 2 (medicinal) 
 
 10.50 
 
 0.1886 
 
 2.19 
 
 None 
 
 No. 2 
 
 .Hydrozone 
 
 
 27-35 
 9-65 
 
 0.2I 80 
 
 3-11 
 
 6.75 
 
 « 
 
 No. 3. 
 
 Larkin & Scheffer's H 2 < 
 
 J 2 (medicinal) 
 
 0.1206 
 
 ii 
 
 No. 4. 
 
 Mallinckrodt's ' 
 
 i it 
 
 9-55 
 
 0.1408 
 
 1.43 
 
 . 1 
 
 No. 5 
 
 Marchand's ' 
 
 i 1 1 
 
 '6-55 
 
 O.0564 
 
 I.29 
 
 < < 
 
 No. 6. 
 
 McKesson & Robbins' ' 
 
 1 it 
 
 10.95 
 
 0.0540 
 
 0.44 
 
 ii 
 
 No. 7. 
 
 Merck & Co.'s 
 
 i ii 
 
 0.50 
 
 0.241& 
 
 4-57 
 
 ii 
 
 No. 8. 
 
 Oakland Chemical Co.'s 
 
 i ii 
 
 10.50 
 
 0.0382 
 
 0.34 
 
 0.0017 
 
 No. 9. 
 
 Peuchot's ' 
 
 » it 
 
 10.60 
 
 0.4674 
 
 1.77 
 
 0.0018 
 
 No. 10. 
 
 Powers & Weightman's ' 
 
 i it 
 
 8.40 
 
 0.0830 
 
 2.08 
 
 None 
 
 No. 11. 
 
 Pyrozone, 3 per cent. 
 
 1 it 
 
 11.20 
 
 0.0534 
 
 0.76 
 
 ii 
 
 No. 12. 
 
 Rosengarten & Son's ' 
 
 i it 
 
 3.10 
 
 0.1002 
 
 0.25 
 
 11 
 
 No. 13. 
 
 Smith, Kline & French Co.'s ' 
 
 . it 
 
 6.15 
 
 0.0880 
 
 2.6 
 
 " 
 
 No. 14. 
 
 E. R. Squibb's 
 
 1 it 
 
 12.40 
 
 1.004 
 
 12.04 
 
 ii 
 
 By referring to this table it is easily understood that sample No. 
 2, "Hydrozone" is far superior to any other brand which I have ever 
 examined. 
 
 When Hydrozone is diluted with distilled water, in the propor- 
 tion of half and half, the resulting mixture contains about 13.5 vol- 
 umes of available oxygen. 
 
 Sample No. 14 comes next to sample No. 5, but it is readily seen 
 that the degree of acidity is entirely too large for a preparation 
 which is to be applied to the most sensitive diseased mucous mem- 
 branes. 
 
 Acidity. — The fourteen brands which I have examined contain free 
 acids (phosphoric, sulphuric, muriatic); and I must say that Peroxide 
 of Hydrogen (medicinal) should never be made neutral before using, 
 even in the most delicate cases: Neutral Peroxide of Hydrogen 
 rapidly decomposes under all conditions of exposure. 
 
Ill 
 
 The keeping properties of H2 O2 solutions vary a great deal with 
 the degree of purity and the percentage of free acids contained 
 therein. 
 
 If the proportion of acid is too large, it acts as an irritant upon 
 diseased surfaces. If it is too small the solution don't keep well. 
 
 My opinion is, that a standard solution of medicinal H2 O2 must 
 answer the following tests: 
 
 First. — It should contain at least fifteen volumes of available 
 oxygen. 
 
 Second. — The quantity of free acids contained in 100 cubic 
 centimetres should require not less than one c. c. and not more than 
 three c. c. of normal volumetric soda solution, to be made neutral. 
 Such a small quantity of free acid is not objectionable. 
 
 Third. — It should not contain any soluble baryta salts. 
 
 Fourth. — It must be free from sediment. 
 
 It is to be noticed that brands No. 7 and No. 12 are valueless. 
 The brands No. 8 and No. 9 are not fit for medicinal uses, owing to the 
 fact that they contain soluble baryta salts. 
 
 The brand No. 3 has a heavy sediment of sulphate of baryta, 
 which may be considered inert towards the system, but it is certainly 
 detrimental to the keeping qualities of this preparation. 
 
 Brand No. 14 which is sold as a ten volume solution, is really 
 twelve volumes, but it is too acid. 
 
 Brand No. 5 which is sold as a fifteen volume solution, is really 16.55 vol- 
 umes, viz.: About 10 per cent, above the standard. 
 
 The brand No. 2, "Hydrozone," which is sold without any mention of 
 volume, is really a 27.35 volume solution, viz.: 90 per cent, above the 
 standard. 
 
 None of the other brands come up to the standard, but on the contrary 
 they run from 35 to 55 per cent, below. 
 
 Note. — Dr. H. Endemann in his subsequent report headed: "The Keeping 
 Qualities of the Various Brands of Peroxide of Hydrogen," published by the Phila- 
 delphia Medical Times and Register, March 2, 1895, writes: 
 
 "All the above samples having been kept for three months in the dark at a temper- 
 ature ranging between 63 ° and 5 2° F., the only brand which still answers to the 
 standard is the No. 5 (14.90 volumes). 
 
 Brand No. 2, "Hydrozone," which was 27.35 volumes in November, (90 per cent, 
 above the standard) showed 25.90 volumes when retested in February, 1895 (about 
 three times as strong as brands Nos. 1, 3, 4, 8, 9, 11, 14), consequently its high 
 degree of strength as well as its keeping properties are thoroughly reliable. 
 
IV 
 
 My opinion concerning Peroxide of Hydrogen for medicinal purpose is, that strong 
 solutions will soon be exclusively in use, as I consider that even a fifteen volume solution 
 is not always powerful enough. Should this strength be sufficient in many cases, the 
 twenty-seven or thirty volume solution can easily be reduced to fifteen volumes, so that 
 the strong solution will answer all requirements." 
 
 The above reports were confirmed by a letter from Dr. Endemann, which 
 appeared in the "Times and Register," for July 13, 1895. 
 
 PEROXIDE of HYDROGEN. 
 
 By J. P. Parker, Ph. G., M. D., of St. Louis, Mo. 
 
 (Published by the Annals of Ophthalmology and Otology, of St. Louis, Mo., for 
 
 April, 1895). 
 
 (Abstract from the Times and Register, June 8, 1895.) 
 
 I have used Peroxide of Hydrogen quite extensively for cleansing 
 discharging ear*, the nasal and accessory cavities, and have tried all 
 the brands of the preparation in the market, and once thought one 
 manufacturer's make as good as that of another, and bought the cheap- 
 est as a matter of economy, but recent experience has taught me that 
 the difference in quality is greater than the difference in price. After 
 an unpleasant experience with a solution of Peroxide of Hydrogen 
 which severely injured the mucous membrane, I bought and examined, 
 chemically, a bottle of each preparation of H2 O2 in the market and 
 was surprised to find so much difference. Some are useless, and 
 others worse than useless because they contain too little available 
 oxygen and too much free acids (phosphoric, sulphuric, hydrochloric). 
 I now order Marchand's (medicinal) exclusively because I find it con- 
 tains the desired quantity of available oxygen and not enough free 
 acid to be objectionable, and its keeping properties are all that could 
 be desired. 
 
 By inquiry I learn that Marchand's is the preparation that is used 
 by almost all surgeons, and it is considered by them the standard. 
 
 My personal experience with Peroxide of Hydrogen confirms entirely the state- 
 ment of Dr. J. P. Parker. I have used exclusively Marchand's brand until lately, when I 
 experimented with Hydrozone. Then I gave up entirely the use of Peroxide of 
 Hydrogen giving the preference to Hydrozone on account of its strength, which cannot 
 be compared with any other brand, even Marchand's. I must say that the results 
 which I obtained with Hydrozone are most gratifying. — Ed. 
 
LIST OF CONTRIBUTORS 
 
 TO 
 
 MEDICAL LITERATURE. 
 
 G. F. Adams, M. D., of Pulaski, N. Y., "H2O2 in Diphtheria" 82 
 
 Lewis H. Adler, Jr., M. D., of Philadelphia, Pa., "The Operative Treatment of 
 
 Fistula-in-Ano" 109 
 
 Charles W. Aitkin, M. D., of Flemingsburg, Ky., "Wound Closure After the 
 
 Empyema Operation" 98 
 
 American Text Book of Gynecology, "Treatment of Neuralgic Variety of 
 
 Dysmenorrhoea" (abstract) 207 
 
 John Aulde, M. D., of Philadelphia, Pa., "H2O2; a Resume" 76 
 
 "Substitution and Its Attendant Evils" .- 93 
 
 "Hydrozone in Gastric and Intestinal Disorders" 216 
 
 "Hydrozone for Disorders of the Genito-Urinary Tract" 229 
 
 Bacteriological World (editorial,) Battle Creek, Mich., "H2O2 in Pelvic 
 
 Abscess" 94 
 
 Edw. J. Bernstein, M. D., of Baltimore, Md., "Diphtheria and the Use of 
 
 H2O2 in its Treatment" 81 
 
 S. S. Bishop, M. D., of Chicago, 111., "Treatment of Chronic Suppuration of the 
 
 Middle Ear" 249 
 
 Gustavus Blech, M. D., of Detroit, Mich., "Rational Therapeutics of Cholera 
 
 Infantum" 185 
 
 "Medicinal Treatment of Typhoid Fever" 199 
 
 "Can Antitoxin Statistics be Relied Upon ? " 210 
 
 "Treatment of Inflammatory Diseases of the Stomach" 217 
 
 J. Mount Bleyer, M. D., of New York, "Some Practical Hints in Connection 
 
 with Intubation of the Larynx, and a Resume of 206 Cases of Diphtheria Oper- 
 ated on from 1886 to 1888" , 67 
 
 Wm. C. Boteler, M. D., of Kansas City, Mo., "Hydrozone in Purulent Otitis 
 
 Media" 211 
 
 Wm. Ellery Briggs, M. D., of Sacramento, Cal., "Diagnosis and Treatment of 
 
 the Diseases of the Accessory Sinuses of the Nose" 207 
 
 F. H. Brobst, M. D., of Reading, Pa., "Report of a Case of Extensive Gunshot 
 
 Wound" 175 
 
 Mortimer H. Brown, M. D., of Holcomb, 111., "Acute Glossitis" 191 
 
 Warren Brown, M. D., of Tacoma, Wash., "H2O2" .212 
 
 H. F. Brownlee, M. D., of Danbury, Conn., "An Interesting Case of Empyema 
 
 with Special Reference to the Use of H2O2" 99 
 
 Albert H. Buck, M. D., of New York City, "Diseases of the Ear," (Abstract from 
 
 'Twentieth Century Practice of Medicine") 215 
 
 A. G. Caldwell, M. D., of Ballardville, Ky., "Scarlet Fever" 189 
 
 ' ' Mammary Abscess" 227 
 
VI 
 
 J. M. G. Carter, M. D., Sc. D., Ph. D., of Chicago, 111., "Local Treatment of 
 
 Chronic Gastric Catarrh.— A Clinical Lecture" 236 
 
 R. Charest, M. D., of St. Cloud, Minn., "H2O2 for Gonorrhea" 69 
 
 R. M. Chase, D. D. S., M. D., of Bethel, Vt., "Dental Medicine" 94 
 
 M. A. Clark, A. M., M. D., of Macon, Ga., "The Treatment of Typhoid 
 
 Fever" 150 
 
 1 'Entero-Colitis of Infancy" 250 
 
 R. M. Clark, M. D., of Ada, Kan., "Poison Ivy" 192 
 
 A. B. Clay, M. D., of Rutherford, Tenn., "H2O2 in Diphtheria" 22S 
 
 Henry W. Coe, M. D., of Portland, Ore., "Thiersch's Grafts in Extensive De- 
 struction of Soft Parts About Large Joints" 169 
 
 "The Care of the Insane in Private Practice" 250 
 
 Hermann L. Collyer, M. D., of New York, "Treatment of Vaginitis by H2O2 
 
 (medicinal) 126 
 
 M. F. Coomes, A. M., M. D., of Louisville, Ky., "H2O2 as a Haemostatic" 225 
 Geo. A. Curriden, M. D., of Chambersburg, Pa., "Chronic Gastritis of Long 
 
 Standing, with Periodic Attacks of Migraine". 214 
 
 H. C. Dalton, M. D., of St. Louis, Mo., "A Case of Traumatic Synovitis of the 
 
 Knee" 238 
 
 Warren E. Day, M. D., of Prescott, Ariz., "Hydrozone and Glycozone in Gas- 
 tric Catarrh with Nervous Symptoms" 251 
 
 "Hydrozone and Glycozone in Gonorrhoea" 256 
 
 J. O. DeCourcy, A. M., M. D., of St. Libory, 111., "Diseases of the Alimentary 
 
 Canal; Treatment. Internal and External Hydrotherapy. Medication" 156 
 
 ' 'Treatment of Acute and Chronic Ulcers" • 147 
 
 "Malignant Sore Throat and Its Treatment" 202 
 
 "Ulcer Resulting from Anthrax, and Its Treatment" 254 
 
 B. H. Detwiller, M. D., of Williamsport, Pa., "Letter to the N. Y. State Medical * 
 Reporter" 199 
 
 W. B. Dewees, M. D., of Salina, Kan., "Medicinal vs. Commercial H2O2". . .102 
 J. H. DeWolf, M. D., of Baltimore, Md., "Medicinal H202and Glycozone". . . 87 
 S. Potts Eagleton, M. D., of Philadelphia, Pa., "A Resume of the History and 
 
 Practical Application of H2O2 in Surgical Affections" 84 
 
 Cyrus Edson, M. D., formerly Health Commissioner, Board of Health, N. Y., 
 
 "The Therapeutics of Glycozone, Composition and Characteristics" 16 
 
 "H2O2 in Contagious Diseases — Cholera, Yellow Fever, Typhus, Typhoid Fever" 46 
 Landon B. Edwards, M. D., of Richmond, Va., "Vaginal Douche of Hydrozone"223 
 H. Endemann, Ph. D., Chemist, "The Real Value of the Medicinal H2O2 
 
 Preparations Found in the Market" 1 
 
 Francis T. B. Fest, M. D., of Plank Road, Mich., "Rational Treatment of Per- 
 tussis" 1 197 
 
 J. A. Fort, M. D., of Paris, France, "Electrolysis for the Treatment of Strictures"2o8 
 Paul Gibier, M. D., of New York, "H2O2 and Ozone; Their Antiseptic 
 
 Properties" 73 
 
 Egbert H. Grandin, M. D., of New York, "H2O2 in Gynecology and in 
 
 Obstetrics" 79 
 
 N. H. Haight, M. D., of Oakland, Cal., "H2O2 as a Local Application in Rhus 
 
 Tox Poisoning" , 102 
 
 George B. Hope, M. D., of New York, "Some Clinical Features of Diphtheria 
 
 and the Treatment by H2O2" 65 
 
 Frank C. Hoyt, M. D., of Clarinda, la., "Mechanical Feeding in the Insane". .237 
 Walter B. Johnson, M. D., of Paterson, N. J., "H2O2 and Its Use in Ear 
 
 Diseases" 108 
 
 George W. Kaan, M. D., of Boston, Mass., "H262 as a Deodorizer in Cancer 
 
 of the Uterus" 10 1 
 
VII 
 
 L. D. Kastenbine, A. M., M. D., of Louisville, Ky., "H2O2" 154 
 
 James S. Kennedy, M. D., of Chambersburg, Pa., "Scarlet Fever" 173 
 
 Robert C. Kenner, A. M., M. D., of Louisville, Ky., "Essential Requirements 
 
 of a Modern Antiseptic" 247 
 
 R. M. Kirley, M. D., Superintendent Female Hospital of St. Louis, "Tubercular 
 
 Adenitis of the Neck" 168 
 
 Percival Lantz, M. D., of Alaska, W. Va., "Diphtheria; False Membrane Ex- 
 pelled; Recovery" 144 
 
 John A. Larrabee, M. D., of Louisville, Ky., "Some Practical Points in Thera- 
 peutics" 91 
 
 Elmer Lee, A. M., M. D.,of New York, "The Treatment of Typhoid Fever," 44 
 
 "Cholera; Prevention and Treatment" 160 
 
 "Treatment of Asiatic Cholera" 193 
 
 "Syphilis Successfully Treated by Hydriatics" 231 
 
 F. P. Lefferts, M. D., of Belvidere, N. J., "Pelvic Peritonitis with Resulting 
 Abscess" 178 
 
 H. E. Lewis, M. D., of Burlington, Vt., "The Successful Treatment of Riggs' 
 
 Disease" 180 
 
 E. Lawrence Linder, M. D., of Blackfoot, Tex., "Treatment in Diphtheria". .219 
 
 A. Livezey, M. D., of Yardley, Pa., "H2O2" 76 
 
 I. N. Love, M. D., of St. Louis, Mo., "Diphtheria, Local Treatment" 97 
 
 "Cholera Infantum" 190 
 
 Thomas H. Manley, M. D., of New York, "Some of the Uses of H2O2 in Gen- 
 eral Surgery" m no 
 
 "Surgical Measures of Relief in Stenosis of the Upper Air Passages" 113 
 
 Discussion on Dr. Manley's paper 116 
 
 Joseph M. Mathews, M. D., of Louisville, Ky., "Abstract from a Treatise on 
 
 Diseases of the Rectum, Anus and Sigmoid Flexure" no 
 
 "The Etiology, Diagnosis and Treatment of Ulceration of the Rectum" 141 
 
 Medical Fortnightly, (editorial,) St. Louis, Mo., "H2O2 in Conjunctivitis". . . .154 
 
 Robert T. Morris, A. M., M. D., of New York, "The Necessary H2O2" 72 
 
 "Appendicitis" „ -. 117 
 
 W. S. Mullins, M. D., of Henderson, Ky., "H2O2 in Diseases of the Mucous 
 
 and Serous Membranes" 88 
 
 New York Medical Record, (editorial,) New York, "Medicinal Use of H2O2". . 70 
 Charles P. Noble, M. D., of Philadelphia, Pa., "H2O2— Its Uses in Abdominal 
 
 Surgery" 83 
 
 Oliver D. Nostrand, M. D., of Cincinnati, O., "Glycozone in the Treatment of 
 
 Gastric Trouble" 107 
 
 J. P. Parker, Ph. G., M. D., of St. Louis, Mo., "H2O2" iv 
 
 Frank S. Parsons, M. D.,of Boston, Mass., "A Practical Theory and Treatment 
 
 of Pulmonary Tuberculosis," (abstract) 179 
 
 C. E. Perkins, M. D., of Sandusky, O., "Retained Nasal Secretion of Syphilitic 
 
 Rhinitis" 103 
 
 Wilson Peterson, M. D., of New York, "Suppurative Nephritis, Report of a 
 
 Case" 256 
 
 Mark W. Peyser, M. D., of Richmond, Va., "Horse-shoe Fistula Successfully 
 
 Treated with Hydrozone" 223 
 
 A. M. Phelps, M. D., of New York, "The Plaster of Paris, Wood, Aluminum, 
 
 Paper, Leather and Steel Spinal Supports" 181 
 
 "Etiojogy of the Various Deformities of Hip-Joint Disease" 127 
 
 G. W. Pickerill, M. D., of Indianapolis, Ind., "H2O2 (medicinal)" 152 
 
 George H. Pierce, M. D., of Brooklyn, N. Y., "H2O2 (medicinal); an Indispen- 
 sable Wound Sterilizer" 106 
 
 David Phillips, M. D., of New York, "H2O2 in Diphtheria". . 75 
 
VIII 
 
 Practice, (editorial), Richmond, Va., "Sinus Treated with H2O2" 81 
 
 C. A. Phillips, M. D., of Boston, Mass., "Extract from Paper on 'Adjuvants or 
 
 Aids to Gynaecology — Neither Medical nor Surgical' " 87 
 
 Clarence C. Rice, M. D., of New York, "Fracture of the Septum Narium — Irri- 
 tative Congestion of the Turbinates" 145 
 
 M. F. Richards, M. D., of Toledo, O., "Watery Ulcer" 196 
 
 Phillippe Ricord, M. D.,of Newark, N. J., "H2O2 for the Relief of Bites from 
 
 Venomous Insects" 7 1 
 
 Alexander Rixa, M. D., of New York, "New Therapeutics in Hay Fever". . . .176 
 William Roberts, Hospital Steward, U. S. A., of Plattsburgh Barracks, N. Y., 
 
 "The Value of H2O2 in Chronic Gonorrhoea, Illustrated by a Case" 10a 
 
 P. N. Russell, M. D., of Fresno, Cal., "Pathology and Treatment of Indolent 
 
 Ulcers," (abstract) 235 
 
 W. Scheppegrell, A. M., M. D., of New Orleans, La., "The Uses of H202in 
 
 Diseases of the Nose, Throat and Ear" 224 
 
 L. C. Schutt, M. D., of Toledo, O., "H2O2" 112 
 
 Truman Sexsmith, M. D., of Yuma, A. T., "A Case of Lupus of Six Years' 
 
 Standing" 246 
 
 S. H. Sherman, M. D., of Boston, Mass., "Treatment of Diphtheria" 104 
 
 John V. Shoemaker, M. D., of Philadelphia, Pa., "H2O2, Materia Medica and 
 
 Therapeutics" 88 
 
 J. Lewis Smith, M. D., of New York, "Recent Investigations Relating to the 
 
 Prevention of Diphtheria and Scarlet Fever" 96 
 
 E. R. Squibb, M. D., of Brooklyn, N. Y., "On the Medicinal Uses of H2O2". . 68 
 J. W. Starr, M. D., of Chariton, la., "Glycozone in Chronic Catarrh of the 
 
 Stomach" 248 
 
 Douglas H. Stewart, M. D., of New York, "A Glance at the Management of 
 
 Capillary Bronchitis in Infants" 186 
 
 John J. Sullivan, M. D.,of New York, "H202inthe Treatment of Gonorrhoea — 
 
 With Report of a Case" 125 
 
 A. S. Tuckler, '92, C. M. C, S. F., of San Francisco, Cal., "Wax in the Ears" 91 
 
 J. N. Upshur, M. D., of Richmond, Va., "A Case of Protracted Labor'' 220 
 
 Charles P.Wagar, M. D., of Toledo, Ohio, "The Therapeutics of Specific 
 
 Urethritis" 206 
 
 Wm. F. Waugh, M. D., of Chicago, 111., "Scarlatinal Diphtheria" 82 
 
 Arthur Weber, M. D., of New Orleans, La., "Notes on the Treatment of Diph- 
 theria" 188 
 
 Prof. H. T. Webster, M. D., of San Francisco, Cal., "Chronic Gastritis" 241 
 
 Walter S. Wells, M. D., of New York, "Chronic Cervical Endometritis.— 
 
 Osmotic Treatment" 163 
 
 M. F. Weymann, M. D., of St. Joseph, Mo., "H2O2 in Mastoid Complications".. 25 2 
 
 F. H. Wiggin, M. D., of New York, "H2O2 in Typhoid Fever" 92 
 
 "Intestinal Obstructions. Diagnosis and Treatment" in 
 
 "Notes on the Treatment of Faecal Fistulae" (abstract) 226 
 
 W. C. Wile, A. M., M. D., LL. D., of Danbury, Conn., "Hydrozone" 153 
 
 "Local Treatment of Uterine and Vaginal Diseases" 167 
 
 Robert T. Wilson, M. D., of Baltimore, Md., "Some Notes on the Value of 
 
 H2O2" 97 
 
 S. J. Wimmer, M. D., and F. S. Parsons, M. D., "Notes on the Value of 
 
 Hydrozone in Various Diseases (Abstract from The Physician's Vade Mecum)" . . 197 
 C. W. Woodward, Surg.-General, M. S. T., of Tecumsch, Mich., Medical De- 
 partment of Surgeon-General's Office *« • . 106 
 
 Willard Parker Worster, M. P., of New York, "The Treatment and Cure of 
 Chancre with H2O2 (medicinal)" 149 
 
RELATIONS OF BACTERIA TO DISEASE. 
 
 The branch of science named bacteriology was opened to the 
 medical profession by the classic researches of Prof. Pasteur in the 
 settlement of the question of spontaneous generation, and in his sub- 
 sequent studies of the process of fermentation. With the investiga- 
 tions of that distinguished French savant began our first positive 
 knowledge of the definite relations of bacteria to disease in the animal 
 kingdom. 
 
 Prof. Robert Koch, of Berlin, has contributed widely by his 
 experiments to the progress in knowledge of etiology of infectious 
 and contagious diseases. 
 
 Owing to the methods which he has devised in order to practically 
 and easily isolate different species of bacteria, we are now enabled to 
 follow the phases of their development in pure cultures under varying 
 circumstances. 
 
 Microscopic examinations show that, during the various stages 
 of their life, bacteria present different forms and dimensions; but it 
 is also demonstrated that one species of bacteria, placed under the 
 same circumstances, always present the same forms, and produce the 
 same effects. 
 
 Bacteria belong to the vegetable kingdom; they are vegetable 
 cells which can be cultivated in a suitable medium under favorable 
 conditions of temperature. The nutrient material must be free 
 from pre-existing micro-organisms, called microproteine. 
 
 The pathogenic bacteria only are of the greatest interest to the 
 physician, as they are supposed to be a cause of infectious diseases in 
 human beings, and, according to the definition given by Prof. Koch, 
 a micro-organism is pathogenic when it presents the following char- 
 acteristics: 
 
 First. — It must be found in the excretions, secretions, or tissues 
 of the animal suffering or dead from the disease. 
 
Second. — The micro-organism must be cultivated out from the 
 organism. 
 
 Third. — A pure culture inoculated in an animal should reproduce 
 the disease. 
 
 Fourth. — The bacteria should be found in the humors or tissues 
 of the animal after death. 
 
 Pathogenic bacteria produce poisonous ptomaines, which consti- 
 tute a transition stage between an organic and an inorganic condition 
 of matter in process of putrefaction. 
 
 Some ptomaines are poisonous and toxic while others are non- 
 poisonous. 
 
 Pathogenic bacteria are differently affected in their infective 
 power by the soil in which they grow; some of them have merely a 
 local action, while others produce the infection of the whole system 
 with prodigious rapidity. 
 
 These fact? have been demonstrated from microscopic exami- 
 nations: for example the autopsy shows that the blood of a patient 
 who died from diphtheria is invaded with a large number of Klebs- 
 Lcefler bacilli and toxines, the same germs being also present in 
 diphtheritic membranes, although the disease was at first a local 
 affection. 
 
 The blood of a patient who died from anthrax contained a large 
 number of anthracis bacilli, which were at first found only in the 
 excretions or pus coming from the infected surface. 
 
 Therefore the infection does not always invade the system 
 immediately, and it is previous to the period of incubation, or infec- 
 tion, that the microbian element should be either eliminated or 
 neutralized by antiseptic remedies. 
 
 Micro-organisms (vegetable cells) in the atmosphere have been 
 shown by Ehrenburg to exist in masses or clouds, so that, in a room 
 containing infection, a portion of the air may be loaded, while other 
 portions are free, which would seem to explain cases of escape from 
 septic or zymotic influences. 
 
 It is owing to the existence of these micro-organisms, that Profs. 
 Pasteur, Koch, Tyndall and other scientists have been able to estab- 
 lish the germ theory, and the etiology of diseases. 
 
 Recent investigations, made by bacteriologists, lead them to 
 introduce some modifications in the germ theory and I will quote 
 
here an article which appeared in the Medicine and Science of Portland, 
 Me., for May, 1897, which reads as follows: 
 
 MODIFICATIONS IN THE GERM THEORY. 
 
 When the bacteriologists Roux and Yersin, after careful investi- 
 gations and experiments extending through several months, declared 
 that the Klebs-Lcefler bacillus was to be found in a large number of 
 normal throats, and that too in parts of the country where diphtheria 
 has not been epidemic for years, scientists were driven to conclude 
 that either the germ was not the cause of the disease or else that some 
 other factor other than the bacillus entered, to quite a large extent, 
 into the problem. See article headed ' 'Predisposition to Disease," 
 
 P- 5- 
 
 The germ theory as first promulgated, was delightfully simple. 
 
 It amounted to this: Every contagious disease is due to a specific 
 
 germ; no microbe, no disease; eliminate the microbe, cure the disease. 
 
 This was a plain statement which all could understand, but further 
 
 experience proved that exceptions were continually cropping out, and 
 
 the conditions upon which these exceptions depended were found to 
 
 be more and more complex and perplexing. 
 
 Of late Drs. Roux and Metschnikoff, and the Chemist Duclaux, 
 successor to Pasteur, as director to the "Institut Pasteur, "each work- 
 ing separately, after many experiments and much study, have all come 
 to about the same conclusion, which they have formulated as follows: 
 "Cases in which the microbe is found but not the disease are especially 
 frequent, so that bacteriologists have come reluctantly to recognize, 
 that not the presence of the germ but some peculiar virulent condi- 
 tion of the microbe causes the disease. In other words, the diseased 
 condition seems to be common to both the germ and the patient, — 
 the germ does not cause the malady until it itself first becomes dis- 
 eased, and the problem which really confronts us is to find out what 
 ails the microbe." 
 
 For a long time investigators found it a difficult task to differen- 
 tiate the bacillus of typhoid fever, and also the spirillum of cholera, 
 from a host of apparently similar bacteria found widely spread in 
 nature, and which latter were to all appearances harmless. In attempt- 
 ing to solve this problem, more and more delicate and intricate, 
 
technical methods were invented in order to enable the bacteriologists 
 to decide with certainty, which, of the many germs present, were the 
 true pathogenic germs which caused these two diseases. Dr. Roux 
 has declared his conclusion to be that the changes in virulence in 
 microbes are the rule rather than the exception; and Dr. Metschnikoff 
 says that cholera bacillus is widely disseminated in water in many 
 places, practically all over the world, and that its power as a specific 
 agent in causing cholera is due to extrinsic circumstances which have 
 modified its virulence. Duclaux has devoted his attention to the 
 study of typhoid fever, and he is positive that in this disease we have 
 to deal with a family of bacilli, some individuals of which, under cer- 
 tain circumstances not well understood, are pathogenic and will cause 
 the disease, and that the others, belonging to the same family but in 
 different conditions of life or of environment, are harmless. 
 
 The conclusions accepted by many of the leading scientists may 
 be summed up as follows: In every germ disease one has to deal 
 with a family of microbes in which some of the members of each 
 family are specially pathogenic and some are not. These last may 
 become virulent under certain conditions not well understood, but the 
 main factor seems to be the passage of the bacillus through one or 
 more individuals whose lowered resistive vitality make them subject 
 even to the originally attenuated virulence of the bacilli. 
 
 It is, perhaps, to be deplored that all later investigations seem to 
 have thrown some doubt on the value of positive testimony in bacteri- 
 ology. Most physicians had come to accept the conclusion that if, 
 after making a proper culture, the germs were found, that this fact 
 alone was positive proof of the presence of the disease, but that on 
 the other hand, so much reliance could not be placed upon negative 
 evidence, for sometimes the disease existed when no germs could be 
 found. The present status of the question seems to be that neither 
 the positive nor negative evidence is entirely reliable, but that in 
 order to produce a disease the germ must be found occupying a cer- 
 tain environment, or itself presenting certain abnormal conditions, or 
 undergoing certain diseased transformations. 
 
 Professor Duclaux has also pointed out that if the recent conclu- 
 sions are correct it will be found that the hygienic precautions looking 
 to the prevention of the contamination of water supplies which we 
 
have heretofore considered trustworthy, will now be found to be unre- 
 liable. For the bacilli of the disease are so widespread in nature 
 and so liable to become pathogenic, though they may not before have 
 been virulent, that the simple precaution of protecting the water supply 
 from contamination by human excreta may prove to be illusionary. 
 
 Anyway, if we are candid, we must acknowledge that those who 
 know the most about the germ theory of disease have still very 
 many things to learn and some problems yet to solve. 
 
 PREDISPOSITION TO DISEASE. 
 
 The above statement leads to the following logical explanation 
 of "Predisposition to Disease." 
 
 Assuming that all human beings are exposed, during their life, 
 to absorb millions of pathogenic germs (vegetable cells), why is it, 
 that some individuals, are more liable than others, to be the victims 
 of their destructive and infectious action? 
 
 Why is it that some individuals catch disease, while others, who 
 are exposed to the action of the same germs, remain free from it? 
 
 Is it due to the peculiar virulent condition of the microbe at the 
 time it is absorbed by an individual, or else, is it due to the impaired 
 vitality of the animal cells, with which the microbian element comes 
 in contact? 
 
 Disease may be due to the peculiar virulence of germs, but it is 
 quite logical to admit that even in case the virulence of germs is 
 relatively feeble, disease may develop just the same, when the vitality 
 of our animal cells with which they come in contact is more or less 
 impaired. 
 
 Infectious diseases are undoubtedly the consequence of a chemi- 
 cal reaction, that takes place (under favorable conditions of tempera- 
 ture and moisture) when putrefactive alkaloids, or poisonous ptomaines 
 (formed by action of bacteria on organic matter) come in contact 
 with weakened animal cells, and remain there for a certain length of 
 time. 
 
 Every physician knows, that some harmful atoms of different 
 character, may remain in contact forever, without entering into chem- 
 ical combination. 
 
For instance, the main constituents of the air, oxygen 20.61 vol., 
 and nitrogen 77.95 vol. which are mixed together, never enter into 
 chemical combination, unless the atoms of oxygen and nitrogen are in 
 a state of peculiar affinity; then they may combine, in various propor- 
 tions, forming nitrogenous compounds, which are more or less poison- 
 ous to human beings. 
 
 The same laws apply to both "organic chemistry and inorganic 
 chemistry." Therefore, it is not strange that germs (which we con- 
 stantly absorb) may remain in contact with our animal cells, without 
 entering into organic chemical combination, until an abnormal con- 
 dition of either one or the other elements in presence helps this 
 chemical reaction to take place. 
 
 Then the resulting compound may be either poisonous or harm- 
 ful to the system. 
 
 The conditions of life are such, that this chemical combination 
 may take place at any time, since both elements, "Germs and our 
 Animal cells" are constantly in contact. 
 
 For instance, exposure to a sudden change in the temperature 
 may promote the chemical combination to take place. Therefore 
 although it is true, that pathogenic germs are present, when disease 
 sets in, it does not imply that they are the only factors causing dis- 
 ease, since they are also present when disease does not exist. 
 
 Improper nutrition, insufficient supply of air, overwork, etc., 
 may also help this organic chemical reaction to take place. 
 
 The whole organized body may be regarded as a congeries of 
 cells, having different endowments, each set being concerned in 
 special acts connected with absorption, nutrition and secretion, wher- 
 ever action of selection or elaboration has to be effected. (Dung- 
 lisons Med. Diet. ) 
 
 Our blood, entering every organ through the circulation, dis- 
 tributes nutritive principles to every set of cells. 
 
 When blood is normal, that is to say, when its constitutive ele- 
 ments are in their normal proportions, all our cells receive a proper 
 nutrition and therefore, they remain strong and healthy. 
 
 Hence, they may resist the destructive action of the toxines, 
 which they either neutralize or else eliminate from the system. Dis- 
 ease cannot develop. 
 
7 
 
 On the contrary, when blood is abnormal, that is to say, when 
 some of its constituents are in deficiency while others are in excess, 
 some of our animal cells may be deprived from receiving the neces- 
 sary amount of the nutritive principles which are indispensable to 
 their existence. Therefore, their strength and vitality being im- 
 paired, they cease to accomplish their functions and become liable to 
 enter into chemical combination with the micro-organisms which con- 
 stantly surround them. . 
 
 From that time, pathogenic germs may cause disease, because 
 the animal cells are too weak to either neutralize or else eliminate 
 them from the system. 
 
 In fact, disease develops only when either the neutralizing or 
 eliminating power of our animal cells are in deficiency, towards their 
 absorbing power. 
 
 The equilibrium being upset, micro-organisms develop, and pro- 
 duce toxines, which cause either a local or general infection resulting 
 from the above mentioned chemical reaction. 
 
 Therefore, pathogenic germs should not be allowed to remain in 
 the system long enough for the toxines to invade the system. 
 
 We absorb most all germs through the mouth, while we eliminate 
 them through the skin, the intestines and the urinary tract. 
 
 When our animal cells are powerless to prevent the above men- 
 tioned chemical combination from taking place, by either neutraliz- 
 ing or else driving away from the system the microbian element, anti- 
 septic remedies must be resorted to, so as to help nature in its work. 
 
 Requirements of an Antiseptic. — (See article headed ' 'Essen- 
 tial Requirements of a Modern Antiseptic" by Dr. R. C. Kenner, 
 p. 247.) An antiseptic should possess the following properties: 
 
 First. — It must be most powerful, not only as a destructive agent 
 of pathogenic germs, but also as a neutralizing and oxidizing agent 
 of toxines. 
 
 Second. — It should have no injurious action upon animal cells, 
 neither toxic nor corrosive. 
 
 Third.— It should ' 'stimulate" healthy granulations and strengthen 
 the surrounding tissues of any diseased surface. 
 
 Fourth. — It should destroy the unhealthy secretions and excre- 
 tions such as pus, etc., so as to leave a clean surface. 
 
8 
 
 Among antiseptics which are used in medicine I find: Bichloride 
 of mercury, sulphate of zinc, chloride of zinc, sulphate of copper, 
 nitrate of silver, carbolic acid, salicylic acid, iodoform, iodine, chlor- 
 ine, chloride of lime, hypochlorite of soda, permanganate of potash, 
 chromic acid, sulphurous acid, eucalyptus, sulphide of calcium, etc. 
 
 The above mentioned drugs being injurious to healthy tissues, 
 destroy both the pathogenic germs and the animal cells. 
 
 Other drugs, such as borax, boracic acid, tannin, etc., are harm- 
 less to healthy tissues, but being powerless to interfere with the chem- 
 ical reaction referred to, article headed "Predisposition to Disease," 
 p. 5, they are worthless and deceiving remedies. 
 
 Poisonous drugs may aggravate the disease by weakening and 
 irritating slowly but constantly, the surrounding healthy tissues. In 
 fact, they do fully as much harm as the microbian element itself. 
 
 Whenever a patient has recovered under the action of poisonous 
 drugs, "Nature has surely accomplished wonders," since it has 
 been powerful enough to either eliminate or else neutralize both 
 poisons, viz: the toxines and the injurious drug. 
 
 Physicians understand organic chemistry, therefore they will surely 
 agree with me when I emphatically state here "that empiric treat- 
 ment of diseases by means of poisonous drugs does more harm than 
 good." Hence, it should be discarded for the benefit of mankind 
 and the honor of the medical profession. 
 
 RATIONAL TREATMENT OF DISEASES. 
 
 Action of Ozone Upon Virus. — The rational treatment of dis- 
 eases is based upon the use of powerful antiseptics which are at the 
 same time harmless to healthy tissues. See articles headed, "Require- 
 ments of an Antiseptic," p. 7, — "Essential Requirements of a Modern 
 Antiseptic," by Dr. R. C. Kenner, p. 247. 
 
 Bacteriologists and chemists have demonstrated that all virus is 
 albuminoid, whether propagative or not; it is destroyed or by coagu- 
 lation rendered inert, by the oxidizing action of Ozone saturated with 
 water. Dry Ozone is irritating to both healthy and diseased animal 
 
tissues. An aqueous solution of Ozone is readily transformed into an 
 aqueous solution of H2O2: H20-|-03=H202-|-02, 
 
 Ozone formula 3 , or condensed oxygen O2+O, is nature's 
 disinfectant "par excellence." It is the most powerful destroyer of 
 germs, and yet it is the "life giving element" to human beings. 
 
 Houzeau found the air of the country at the height of six feet 
 above the ground to contain ^yVro" of its weight of Ozone, or ^ 0^ 6 6 
 of its volume. 
 
 This very small quantity of Ozone (which is always damp) is 
 sufficient, owing to its wonderful oxidizing power to destroy germs. 
 
 Ozone is a normal constituent of fresh air; its proportion 
 varies with temperature and electric conditions of the atmosphere. 
 
 Billard, Wolfe, Boeckel and Strambes agreed that the cholera, 
 when it raged in Strasbourg, Berlin and Milan, coincided with the 
 absence of Ozone in the atmosphere, and that Ozone reappeared at the 
 end of the epidemy. 
 
 These observations are in perfect accord' with those obtained by 
 Dr. F. H. Hammond. Drs. Moffat, Romain, Vigouroux, Uhle, and 
 other scientists also attribute the prevalence at a time of cholera, 
 malarious fever, to the absence of Ozone in the air. 
 
 Is it due to an excessive production of miasms relatively to the 
 normal proportion of Ozone, or is it because Ozone is in deficiency 
 to destroy the germs? 
 
 No one could answer this question, but a positive fact is, that: 
 "If Ozone is in excess there is no epidemy." 
 
 The wonderful antiseptic value of Ozone has attracted the 
 attention of all scientists, and a number of chemists have devised 
 different methods of its production; but none of these processes 
 could be used to manufacture Ozone industrially. 
 
 Therefore, Hydrozone, (30 vol. aqueous solution of H2O2) which 
 is always on a strain to break up into water and "Nascent Oxygen" 
 near to the condition of Ozone, is bound to fill all the requirements 
 of a powerful and at the same time harmless antiseptic. 
 
 Hydrozone yields thirty times its own volume of "Nascent 
 Oxygen" near to the condition of Ozone. 
 
 The following synopsis shows the similarity which exists between 
 the oxidizing power of both "Hydrozone" and "Ozone." 
 
IO 
 
 COMPARATIVE CHEMICAL REACTIONS BETWEEN 
 HYDROZONE AND OZONE. 
 
 I 
 
 Iodide of Potassium So- 
 lution in presence of 
 
 H O, ,30 vol Sol. Result ( p d ^. 
 
 (Hydrozone.) of reaction { 
 
 Permanganate of Potash 
 Purple Solution in pres- 
 ence of 
 
 Ozone, dissolved 
 in water. 
 
 H 2 O a 30 vol. 
 Acidulated Solu- 
 tion (Hydrozone.) 
 
 Result 
 of reaction 1 1 
 
 Result 
 of reaction. 
 
 Potash and Iodine. 
 
 Peroxide of Iron Salt So- 
 lution and Ferrigya- 
 nide of Potassium So- } 
 lution mixed together | 
 in presence of 
 
 Tincture of Indigo in 
 presence of 
 
 K 2 Mn 2 8 -f-4 
 Ozone, dissolved in water 
 
 Immediate discoloration. 
 Escaping of Oxygen 
 -< (las and formation of 
 brown Oxide of Man- 
 ganese. 
 Ho 2 =2 KHO-f Mn„ H O +4 8 
 
 Nitrous Acid in presence 
 of 
 
 Arsenious Acid in 
 ence of 
 
 pres- 
 
 Tincture of Guaiacum 
 mixed with either 
 Blood or Extract of 
 
 Malt. ' I 
 
 Organic substances such"] 
 as Cotton, Woolen, | 
 Silk, Feathers, Hair, 
 Bones, Ivory, etc., in 
 presence of 
 
 H 2 O a 30 vol. Sol. 
 (Hydrozone.) 
 
 Ozone, dissolved 
 
 in water. 
 II 2 3 30 vol. Sol. 
 
 (Hydrozone.) 
 Ozone, dissolved 
 
 in water. 
 H 2 2 30 vol. Sol. 
 
 (Hydrozone.) 
 Ozone, dissolved 
 
 in water. 
 H 2 2 30 vol. Sol. 
 
 (Hydrozone.) 
 Ozone, dissolved 
 (Hydrozone.) 
 
 H 2 2 30 vol. Sol. 
 
 (Hydrozone.) 
 Ozone, dissolved 
 
 in water. 
 II 2 () 2 30 volume 
 
 Alkaline Sol. 
 
 (Hydrozone.) 
 Ozone, dissolved in 
 
 Alkaline. 
 
 Result 
 of reaction. 
 
 Result ( 
 of reaction. ( 
 
 \ 
 
 Result ( 
 of reaction. { 
 
 Result 
 of reaction. 
 
 Same result. 
 
 Ferricyanide is trans- 
 formed into Ferrocya 
 nide of Potassium, giv- 
 ing a blue coloration. 
 
 Same result. 
 Decoloration. 
 Decoloration. 
 Formation of Nitric Acid. 
 Same Result. 
 
 Formation 
 Acid. 
 
 Same result. 
 
 of Arsenic 
 
 Result 
 of reaction. 
 
 Result 
 of reaction. 
 
 Result 
 
 {Blue coloration, with ef- 
 fervescence and coagu- 
 lation of albumen. 
 
 -] Same reaction. 
 
 { Oxidizing and Bleaching 
 
 of reaction. ( Action. 
 
 water, \ Same result but slower 
 
 I Action. 
 
II 
 
 IMPORTANT INFORMATION ON H2O2 AND HYDROZONE. 
 
 Anhydrous Peroxide of Hydrogen formula H2 O2 is a syrupy 
 liquid which contains 475 times its volume of Oxygen, Density, 1.452. 
 
 It is a very unstable compound with slight acid reaction to the 
 litmus paper. Its. decomposition into water and nascent oxygen takes 
 place under the most enigmatical circumstances, hence it is not an 
 article of commerce. 
 
 According to the U. S. Pharmacopoeia, a 3 per cent, aqueous 
 solution of Peroxide of Hydrogen yields about ten times its own vol- 
 ume of oxygen. (Careful practitioners know that in many cases such 
 a weak solution of H2 O2 is deceiving on account of being powerless 
 to destroy germs.) 
 
 Charles Marchand's H2O2 (medicinal) yields fifteen times its 
 own volume of nascent oxygen, which corresponds to a 4. 5 per cent, 
 aqueous solution, of anhydrous H2O2. 
 
 Hydrozone yields thirty times its own volume of nascent oxygen, 
 corresponding therefore to a 9 per cent, aqueous solution of anhydrous 
 H2 O2. It is a preserved aqueous solution which retains its strength 
 for any length of time, when kept at a temperature not exceeding 
 70 F. 
 
 Both Hydrozone and my medicinal H2O2 are slightly acid in 
 taste. 
 
 Hydrozone is not only twice the strength of my medicinal H2O2, 
 but it is far superior as a healing agent. 
 
 In no instance should Hydrozone be made either alkaline or 
 neutral before using, even when it is applied to the most delicate 
 diseased mucous membranes. 
 
 Bacteriological experiments made upon cultures of pathogenic germs 
 demonstrate that: 
 
 One cubic centimetre of Hydrozone which contains traces of acid, is 
 equivalent for its bactericide power to: 
 
 Two cubic centimetres of the same preparation after it has been made 
 neutral by the addition of either lime water, bicarbonate of Soda, Ammonia, 
 etc. 
 
 And to three cubic centimetres of the same preparation after it has been 
 made slightly alkaline by the addition of a small excess of alkali. 
 
 My medicinal H2O2 freezes at 8° to io° F. Hydrozone freezes 
 at about 5 F. When such is the case, thaw them out slowly at a 
 
12 
 
 temperature not exceeding 65 to 70 F., so as to prevent deteriora- 
 tion. 
 
 Action of Hydrozone (thirty vol. aqueous solution of H2 O2) upon 
 Animal Cells and Vegetable Cells. — See report by Dr. Paul 
 Gibier, p. 73; also report by Dr. S. Potts Eagleton, p. 84. The 
 Requirements of a Modern Antiseptic, by Dr Kenner, p. 247. 
 
 Experiments made by bacteriologists prove beyond doubt that: 
 
 First. — Hydrozone has no injurious effects upon animal cells. 
 
 Second. — It has a very energetic destructive action upon vegetable 
 cells — microbes. 
 
 Third. — It has no toxic properties; five cubic centimetres 
 injected beneath the skin of a guinea-pig do not produce any serious 
 result, and it is also harmless when administered internally. 
 
 Fourth. — It is a stimulant to granulating tissues. 
 
 Fifth. — It has no corrosive action whatever upon the healthy 
 mucous membrane's when used in diseases caused by germs, such as 
 Diphtheria, Scarlet Fever, Whooping-cough, etc. 
 
 Sixth. — It is the pus destroyer ' ; par excellence," See article 
 headed The Necessary Peroxide of Hydrogen, by Dr. Robert T. 
 Morris, p. 72. 
 
 Note. — Although Hydrozone has no toxic properties, it should never be 
 injected into the circulation of the blood on account of its coagulating the 
 albumen. One cubic centimetre of Hydrozone being injected into the femoral 
 vein of a dog kills the animal almost instantly, when the free egress of oxygen 
 gas (which is generated in the circulation), is prevented by external pressure 
 of the vein. It stops the circulation at once. 
 
 Action of Hydrozone upon Open Diseased Surfaces. Its 
 Use as a Hemostatic. — When Hydrozone is brought into contact 
 with any open diseased surface, either of the skin or of the mucous 
 membranes, its decomposition takes place immediately; nascent 
 oxygen (near to the condition of Ozone) is set free, the albuminoid 
 element of the unhealthy secretions is coagulated, pus corpuscles are 
 destroyed and the pus process is checked, the bacteria as well as 
 their spores being annihilated. 
 
 Nascent oxygen after oxidizing and cleansing the infected sur- 
 face is readily transformed into ordinary oxygen. 
 
 Owing to the fact, that Hydrozone coagulates albumen, it is a 
 hemostatic "par excellence." (See article headed Peroxide of 
 
*3 
 
 Hydrogen as a Hemostatic, by Dr. F. M. Coomes, p. 225.) The fol- 
 lowing article appeared as an editorial in the Alkaloidal Clinic, for 
 October, 1897, under the heading, "Nasal Hemorrhage:" 
 
 "The treatment of this condition is often troublesome and 
 exasperating in the extreme. While it is usually a self-limited con- 
 dition it may go on to syncope and death. Most of the older and 
 recognized methods are disagreeable and many of them inefficient. 
 It has been our pleasure to find in Hydrozone a remedy par 
 €xcelle?ice. The nose should be syringed out with a full-strength 
 solution, and while the foam is still bubbling out, pack the nostril 
 tightly with cotton saturated with the same remedy. The result is 
 magical, without pain or unpleasant after-effects. Some hours later 
 the cotton may be removed and there are none of the disagreeable 
 clots that accompany the application of astringent tampons, the 
 detachment of which so often occasions a recurrence of the condition. " 
 
 It is of great importance to notice that water charged with thirty 
 times its own volume of ordinary oxygen gas under pressure, has no 
 similar action whatever on the albuminoid substances, as there is 
 neither coagulation, nor cleansing effect upon unhealthy secretions. 
 In fact it does not destroy pathogenic germs, and it has no healing 
 action whatever. 
 
 This remark plainly establishes the difference between the thera- 
 peutical value of Hydrozone and the "Oxygen" or so-called "Com- 
 pound Oxygen treatment." 
 
 Hydrozone is recognized by leading physicians (see the opinion 
 of the medical profession on pp. 65 to 257) as being the most power- 
 ful and reliable bactericide known. It has no equal as a pus destroyer. 
 I now submit to the profession the results of comparative tests which 
 I have made, in order to establish experimentally the respective bac- 
 tericide potency of the following chemicals: 
 
1 I 
 
 QUANTITY OF nn MIXTURE 08 .> % SOLUTION OF THE FOLLOWING 
 CHEMICALS REQUIRED rO ANNIHILATE rHE SAME GIVEN AMOUNT 
 
 OF KLEBS-LCEFLEK B ICILLI. 
 
 Cubit ( 'cnliinelies. 
 
 Hydrozone (harmless) 30 volumes aqueoui solution of ll a o a i.oo 
 
 Biniodlde of mercury 1,00 
 
 Biniodide °f silver 1,33 
 
 Marc-hand's Peroxide of Hydrogen, ineilii inal (harmless) 
 
 15 volumes aqueous solution of 1 1 o O a 9.00 
 
 Bichloride of mercury \ 1 >• > 
 
 Nitrate of silver 5.00 
 
 Hypochlorite of soda 9.00 
 
 Chlorine gas (freshly prepared aqueous solution) 10.00 
 
 Iodine [9.00 
 
 Hromine 1 1 1 K » 
 
 Iodoform (when fresh) <k> 
 
 Salicylic acid. . |0,oo 
 
 Muriatic add [00.00 
 
 irboUc acid ts8 00 
 
 Permanganate of Potash r.40. <><> 
 
 t Ihlorate of Potash 158.00 
 
 Alum 1 So. 00 
 
 Tannin 100.00 
 
 Common salt [96.OO 
 
 Sulphide of calcium 201 ,00 
 
 Boraclc acid 300.00 
 
 Sulphurous acid 325.00 
 
 Lactic acid 300.< « I 
 
 1'erchloridc of Iron. 37' "" 
 
 Concenu^g the so<alled "Compound Oxygen treatment," 1 refei the profession to a report on: 
 The Manngement ol Pulmonary Diseases, by Karl von Ruck, B. S., M. i». Director of the 
 
 Winyah Sanitarium for Disease-, of thcTlno.it .mil I .tini^s, Ashevillc, N. (.'., 1880. < >n pp. 8 and o 
 of this publication, the author writes as follows: 
 
 "inhalation g/ Oxygtn, Undoubtedly tome benefit has been derived from mch Inhalatloni in 
 anaemia and digestive derangements, also in certain (onus of dyspnoea l nave teen patients made much 
 more comfortable after rath inhalation, especially when a small quantity ol nitrous oxide was added. 
 1 have also st-en an occasional but undoubted Increase in the number ol red blood corpusclei undei its 
 sdministration, both in essential and symptomatic snsemia, especially when Iron preparations which 
 
 alone had proved inefficacious, could be administered at the same time. Ii of usefulness in 
 
 umption is second many other means, and it is only occasionally that anything 
 
 more than temporary relief can thereby be riven, and, DO matter how plausible the theory as to its 
 
 influence upon nutrition, practical experience shows that its use is always experimental, and frequently 
 
 without result, the same as is the case in its employment in Other diseases. Its mixture with 
 nitrous oxide in the lunn of the BO-called ' < 01 u pound oxygen,' by the temporary stimulating or mtoM 
 
 eating effect of the laughing gas, has no effect whatever, except in dyspnoea, but it makes the patients 
 
 w ho become the victims ol 1 hai latans feel that 'something powerful' is present in such inhalations, and 
 inducts them to believe in it more readily, This * compound oxygen cure for consumption ' still flour- 
 ishes in many localities, the same as do the t|uack remedies for the same object noon the shelves and 
 Counters Of our druggists, anil I have DO dOUbt the venders of such with their advertisement^ Sit 
 injurious parasites upon the consumptives as are the tubcicle bacilli themselves; ami while we must 
 acknowledge that our ellorts in phthiso lb, oust the latter have thus lar been Unavailing, many 
 
 lives could undoubtedly be saved if the former could be extinguished by the enactment ol a 
 
 which would oblige them to derive their means of livelihood otherwise than by tiillitiK with human 
 life/' 
 
 Permanganate of potash, hypochlorite of soda, bichloride of mer- 
 cury, the aqueous solution of chlorine ^\ Carbolic acid, nitrate of 
 
 
J 5 
 
 silver, etc., destroy microbes, but, being toxic, corrosive and poison- 
 ous, they are dangerous to the patient's life. 
 
 It is worthy of note that 1 [ydrozone is absolutely harmless, and yet 
 it is more powerful as a bactericide than all other poisonous antiseptics, 
 as it is proved by chemical and clinical tests. Jn addition to its 
 powerful germicide properties, Hydrozone acts as a stimulant to healthy 
 granulations, while other antiseptics constantly impairandeven destroy 
 our animal cells. 
 
 The comparative tests published on p. 14, show that Hydro- 
 zone is twice as strong as Marc hand's H2O2 (medicinal), three times 
 as powerful as bichloride of mercury, five times as powerful as nitrate 
 of silver, ten times as powerful as iodine, twenty-eight times as power- 
 ful as iodoform, forty times as powerful as salicylic acid, 128 times as 
 powerful as carbolic acid. 
 
 glycozone: 
 
 IMPORTANT INFORMATION. 
 
 Glycozone is a stable compound resulting from the chemical 
 reaction that takes place when c. p. glycerine is submitted under 
 special conditions, to the action of fifteen times its own volume of 
 Ozone, under normal atmospheric pressure at a temperature of O C. 
 Its density is 1260 grammes. 
 
 The presence of water (and other impurities) in the glycerine, 
 changes the nature of this reaction, so that instead of producing 
 Glycozone, formic acid, and other secondary compounds having dele- 
 terious effects upon animal cells, are obtained. 
 
 Glycozone being hydroscopic, must be tightly corked, so as to 
 avoid being deteriorated by the moisture contained in the atmosphere. 
 
 Although Glycozone absorbs water readily, it does not deteriorate 
 when kept at a temperature below 110 degrees l\ As long as it 
 retains its proper anhydrous condition, its healing properties increase 
 with age. 
 
 The therapeutic properties of Glycozone and Hydrozone, differ 
 in the following particulars: 
 
i6 
 
 Hydrozone instantly destroys the morbid element of diseased 
 surfaces of the skin or of the mucous membrane with which it comes 
 in contact, leaving the tissues beneath in a healthy condition. 
 
 Glycozone acts more slowly, but not less certain as a stimulant 
 to healthy granulations. Its healing action upon diseased mucous 
 membrane of the stomach is powerful and harmless in gastric and 
 intestinal disorders. 
 
 Glycozone has a pleasant, sweet and acidulated taste, similar to 
 the taste of lemonade. 
 
 Caution. — Glycozone is a peculiar chemical compound, and not a mixture 
 of Peroxide of Hydrogen (medicinal) with Glycerine. 
 
 These two liquids when mixed do not form a stable product, but develop 
 substances which are injurious to animal cells. 
 
 Such a mixture when freshly made has no healing properties similar to 
 Glycozone. On the contrary, Glycozone is stable, harmless and always 
 effective. 
 
 THE THERAPEUTICS OF GLYCOZONE. 
 COMPOSITION AND CHARACTERISTICS. 
 
 KY CYRUS EDSON, M. 1). 
 Formerly Health Commissioner , Board of Health, New York City. 
 
 (Abstract from the Times and Register, Philadelphia, Pa., April 22, 1893.) 
 
 The writer states that Glycozone, like H2O2, is a powerful Oxi- 
 dizing agent, although its action is not as rapid or as energetic in this 
 respect as the latter compound. 
 
 When taken into the mouth and stomach, Glycozone causes a 
 feeling of warmth. It is harmless; in large doses, (one or two ounces) 
 it causes a feeling of distress in the epigastrium; loose, copious, 
 watery stools, with cramps may follow the administration of very large 
 doses. 
 
 It has no ill effect on the kidneys, the liver or heart. 
 
 Dr. Edson states, that Glycozone is, in his opinion the best 
 known agent for the treatment of gastric ulcer, and all inflammatory 
 conditions of the alimentary canal. 
 
 He recommends the use of Glycozone diluted with water, as a 
 beverage in diphtheria and membranous croup, depending upon the 
 medicinal H2O2 as a local antiseptic treatment. 
 
 He further states, that remarkable benefit may be derived in 
 ulceration and inflammation of the rectum and lower gut, by enemata 
 
i7 
 
 containing one ounce of Glycozone diluted with twelve ounces of 
 warm water. 
 
 In cases of fistula-in-ano and of rectal ulcerations low down, it 
 may be applied undiluted with the best results. 
 
 As a rule, Glycozone acts to better advantage, as a stimulant to 
 healthy granulations, when it is applied to a diseased surface which 
 has previously been cleansed and made aseptic by means of H2O2 
 (medicinal) or better still, by means of Hydrozone. 
 
 Follicular Pharyngitis, chronic coryza, and ulcerated stomatitis 
 are all benefited by frequent applications of Glycozone. As an appli- 
 cation to ulcerated cervix-uteri and in tumefied conditions of the cer- 
 vix and uteri it is far superior to pure glycerine. 
 
 In these cases, and for the cure of leucorrhoea, the remedy should 
 be applied on small rolls of lint, or absorbent cotton, the vagina 
 having first been thoroughly washed with an injection of H2O2 
 (medicinal) one part, water four parts. Better results are obtained 
 with Hydrozone one part, water eight parts. - This procedure should 
 be repeated twice daily. 
 
i8 
 
 GENERAL DIRECTIONS FOR USING AND APPLYING 
 
 HYDROZONE and GLYCOZONE 
 
 IN DISEASES CHARACTERIZED HY THE PRESENCE OF 
 PATHOGENIC GERMS. 
 
 NOSE, THROAT AND CHEST DISEASES. 
 
 Catarrh of the Nose and Throat.— Causes. — Micro-organ- 
 isms, principally of the micrococcus species have been detected by 
 microscopic examinations, in the mucous discharges from the nos- 
 trils of persons afflicted with this disease. Hydrozone, by its oxidiz- 
 ing action restores the diseased tissues to their normal condition 
 See article headed ' 'Predisposition to Disease," p. 5, also article 
 headed, "Requirements of an Antiseptic," p. 7. 
 
 Treatment. — By means of an atomizer made of glass and hard 
 rubber, spray the nose and the throat copiously and repeatedly twice 
 or three times ev«ery day with a mixture made of: 
 1 tablespoonful of Hydrozone 
 with 8 to 20 tablespoonfuls of water (lukewarm), 
 taking great care that the remedy should always pass through the 
 post nasal tubes and reach the throat. Dilute Hydrozone with luke- 
 warm water, according to the degree of sensitiveness of the patient. 
 Some patients may stand a mixture of one part Hydrozone to four 
 parts of water while others cannot use the remedy unless it is diluted 
 in the proportion of one part of Hydrozone to thirty parts of luke- 
 warm water. The strength of the above mixture should be regulated 
 so as to suit each case. 
 
 In the absence of an atomizer, apply the remedy to the nose by 
 sniffing the liquid from the hand through the nostrils repeatedly and 
 gargle the throat. It is always beneficial to swallow the remedy. 
 
 Do not blow the nose too hard, as it might cause a temporary 
 bleeding. Remain indoors for fifteen minutes after spraying the 
 nostrils. 
 
 Jn chronic cases of longstanding (especially when injurious drugs 
 have been used) at the beginning of the treatment, the tenderness of 
 the mucous membrane is so great, that the patient may feel during 
 one hour or so after each spraying of the nose, a partial obstruction 
 of either one of the nostrils. 
 
 This rather unpleasant feeling is often accompanied by frequent 
 sneezing, which is due to the tickling sensation produced in the 
 
1( ; 
 
 nasal cavities by the presence of a great quantity of minute bubbles- 
 of Ozone, being set free from the decomposition of Hydrozone 
 coming in contact with the infected surface. The unhealthy secre- 
 tions are destroyed, and the cleansing of the nostrils is made perfect. 
 
 In chronic cases, when the middle ear is involved, deafness may 
 result from this disease. Then Ozonized vapor inhalations should 
 follow immediately the spraying of the nose and the throat, and 
 should be administered by means of Charles Marchand's Hand Atom- 
 izer and Ozonizer, with a mixture thoroughly made of: 
 i tablespoonful of Hydrozone, 
 i " of water, 
 
 2 li of pure glycerine. 
 
 1» many cases better results will be obtained by using a mixture 
 made of equal parts of Hydrozone and glycerine. 
 
 Shake well and renew the mixture every three days. 'The above 
 mixture must be made perfect, before connecting the parts of the 
 apparatus, otherwise the spray tube might -clog on account of the 
 syrupy nature of the glycerine. 
 
 A permanent cure may be accomplished in a very short time. 
 
 When chronic catarrh of the nose is tenacious and painful, (espec- 
 ially, when the patient is troubled with a persistent dryness of the 
 mucous membrane,) apply at night before retiring a few drops of 
 (ilycozone to the nostrils by means of a soft camel's hair brush. Sniff 
 it gently, so as to force it through the post nasal cavities. The patient 
 should not mind the temporary pain following the application of 
 (llycozone, as it will accelerate the cure. At the same time it relieves 
 the sensation of fullness, and owing to its osmotic properties,, 
 (ilycozone subdues the dryness of the mucous membrane. 
 
 The incurability of chronic catarrh of the nose is frequently due 
 to partial or even complete obstruction of the nasal cavities, caused 
 by the presence of some abnormal growth. 
 
 When such is the case, use Hydrozone, as heretofore explained r 
 morning and evening, following by an application of Glycozone. 
 After ten or fifteen days if the excrescence does not disappear, it may 
 be advisable to have it removed by means of the thermo-cautery or 
 otherwise. (No caustic should be used as it would destroy both taste 
 and smell.) Then, an absolute cure will be accomplished if the above 
 treatment is earnestly followed. 
 
20 
 
 On p. 7, article headed ' 'Requirements of an Antiseptic," the 
 list of injurious drugs which are daily prescribed in catarrh is given. 
 
 These injurious drugs having a deadly action upon both the 
 healthy tissues and the morbid element, should be condemned as they 
 -do more harm than good. 
 
 On the contrary Hydrozone destroys the morbid element and 
 restores the diseased tissues to a healthy condition. It stimulates 
 healthy granulations. 
 
 Note. — In case of excessive tenderness of the mucous membrane 
 of the nostrils, spraying the nose with a cold mixture of Hydrozone 
 with water, may cause a severe pain and even irritate the membrane; 
 therefore the mixture should always be used lukewarm. 
 
 Dr. Robert T. Morris recommends the use of a 3 per cent, solu- 
 tion of cocaine before spraying the nostrils with diluted H2O2 
 (medicinal) or Hydrozone, in order to quiet the smarting sensation. 
 (See pp. 72,— 145,— 176,— 207,— 212,— 224). 
 
 OZ.ENA, OR PUTRID CATARRH OF THE NOSE. 
 
 Ozaena is frequently the consequence of Catarrh having been 
 treated for a long time by means of poisonous remedies. See article 
 headed "Requirements of an Antiseptic," p. 7. It is characterized 
 by ulceration of the nasal cavities with fetid discharge, symptom of 
 atrophic rhinitis. It should be treated as follows: 
 
 Spray copiously the nostrils and the throat, morning and evening 
 with a mixture made of: 
 
 1 tablespoonful of Hydrozone 
 
 with 6 to 10 tablespoonfuls of water (lukewarm). 
 
 It is onlv in case of extreme tenderness of the mucous membrane 
 that a weaker solution should be used as follows: 
 1 tablespoonful of Hydrozone 
 with 12 to 20 tablespoonfuls of water (lukewarm). 
 
 In the absence of an atomizer, apply the remedy to the nose by 
 sniffing the liquid from the hand through the nostrils repeatedly, and 
 gargle the throat, taking great care that it should always pass through 
 the post-nasal cavities. 
 
 In case of necrosis, a small quantity of Hydrozone full strength 
 should be applied, morning and evening to each nostril, by means of 
 a camel's hair brush (free from metallic parts), until the vitality of the 
 animal cells is restored. 
 
21 
 
 In all cases of ozaena, by means of a camel's hair brush, apply 
 Glycozone to the nostrils, morning and evening, after spraying; sniff 
 it gently. It will accelerate a cure, and it will prevent the dryness of 
 the mucous membrane from being so troublesome. The patient 
 should always remain indoors for fifteen minutes after each spraying. 
 
 The above treatment is so powerful, that the most offensive or 
 rather repulsive odor which characterizes this peculiar disease, dis- 
 appears three or four days after the first applications. 
 
 A cure may be accomplished in three months. When the case is 
 of a very long standing it requires more time to effect an absolute 
 cure. 
 
 Sneezing and obstruction of the nostrils following each application 
 of the remedy, may be subdued by applying Glycozone. See p. 18, 
 article headed "Catarrh of the Nose." « 
 
 HAY FEVER —ROSE COLD.— CORYZA. 
 
 The microscopic examination of the unhealthy mucous secre- 
 tions and excretions from the nostrils of Hay Fever sufferers demon- 
 strates the presence of small ovoid micro-organisms, which are 
 instantly annihilated when brought in contact with Hydrozone. See 
 p. 5, "Predisposition to Disease," — p. 8, "Rational Treatment of Dis- 
 eases," — and p. 176, "New Therapeutics in Hay Fever," by Dr. A. 
 Rixa. 
 
 It is worthy of notice that the degree of susceptibility to the 
 infectious action of these germs differs with each individual. The 
 spores of germs which cause this disease do not always find a proper 
 soil for development in the mucous secretions. Therefore they can- 
 not enter into organic chemical combination which causes disease. 
 This explains why all human beings are not troubled with Hay Fever.. 
 
 The peculiarity of this disease is, that any one afflicted with Hay 
 Fever, can foretell every year, almost to a certainty, the day upon 
 which it will begin, and also the day upon which they will get rid of it. 
 
 The logical explanation of this is, that the conditions of life of 
 Hay Fever sufferers are always the same;" that is, the circumstances 
 and surroundings of their existence are alike from year to year." 
 Thus the microbian causes of the trouble develop under the same 
 influences every year, at about the same time, and, consequently, the 
 disease begins as soon as the atmospheric conditions become favor- 
 
22 
 
 able for the development of the spores I have mentioned. These 
 spores grow, under proper conditions of temperature and dampness, 
 in the secretions of the mucous membranes of the nostrils, and the 
 microbian infection takes place, to the detriment of the animal cells 
 which are involved, producing inflammation and ulceration. 
 
 These micro-organisms continue their growth as long as these 
 favorable atmospheric conditions exist, and they disappear as soon 
 as the temperature falls and remains at a lower degree. Then the 
 effects disappear with their causes, and the patient gets rid of his 
 trouble. 
 
 Treatment. — The causes of Hay Fever being now well established, 
 it is easy to understand that any remedy having the property to 
 restore the diseased tissues to their normal condition will interfere 
 with the above mentioned chemical reaction and cure, or at least pre- 
 vent the disease, providing this remedy has no injurious effects upon 
 the surrounding healthy tissues. See p. 7, "The Requirements of an 
 Antiseptic." 
 
 In case of Hay Fever, Hydrozone should be applied locally to 
 the nostrils as a spray, and also by inhalations of ozonized vapor in 
 order to subdue the asthmatic attacks which often accompany this 
 troublesome complaint. 
 
 The Hydrozone treatment is based upon the indisputable results 
 which are obtained when a Hay Fever patient goes to the White Moun- 
 tains, where the atmospheric conditions are such that the air contains 
 always a small quantity of damp Ozone. The constant breathing of this 
 ozonized atmosphere accomplishes the cure, or at least relieves the 
 sufferer in a very short time as it prevents the germs from entering 
 into organic chemical combination with the animal cells. 
 
 Hay Fever may always be prevented by an early application of 
 Hydrozone, (two weeks before the disease is expected), in those cases 
 which occur regularly at known periods of the summer. 
 
 When the disease has developed, the same treatment will check 
 it within three or four days, the patient being made comfortable, but 
 he could not expect to be entirely free from his trouble. In all cases 
 it is urgent to continue the treatment during the whole Hay Fever 
 season, otherwise the sufferer will surely be troubled, even if he stops 
 it for only twenty-four hours. 
 
 The remedy should be applied as follows: 
 
2 3 
 
 First. — Spray the nostrils and throat copiously and repeatedly 
 twice or three times every day with a mixture made of: 
 i tablespoonful of Hydrozone 
 with 8 to 30 tablespoonfuls of water (lukewarm), 
 according to the degree of inflammation. 
 
 Some patients can use the remedy diluted in the proportion of 
 one to four, without discomfort, while others could not use it, unless 
 it is diluted with lukewarm water in the proportion of one to thirty. 
 The strength of the mixture should be regulated, according to the 
 degree of tenderness. 
 
 In all cases, the patient must take great care, that the remedy 
 is forced through the post-nasal cavities, and reaches the throat, at 
 each spraying. 
 
 Swallowing the remedy will do a great deal of good. 
 
 The unpleasant sensation of fullness (sometimes dryness) in the 
 nostrils, which often follows each spraying, can be relieved by apply- 
 ing Glycozone, as explained in the article headed Catarrh of the Nose, 
 p. 18. 
 
 Second. — By means of Charles Marchand's Hand Atomizer and 
 Ozonizer, inhalations of Ozonized vapor should be administered with 
 a mixture thoroughly made of: 
 
 1 tablespoonful of Hydrozone, 
 
 1 " of water, 
 
 2 "- of chemically pure glycerine. 
 
 Shake well and renew the above mixture every three days. 
 
 The duration of each inhalation should not exceed ten minutes 
 and should be taken three to six times daily. Inspirations should be 
 as deep and prolonged as possible. 
 
 Note that I claim to prevent Hay Fever, but I don't claim to cure 
 it. Therefore Hay Fever sufferers must resume the treatment 
 every year, beginning at least two weeks before they expect the 
 first attack. In this way the animal cells of the mucous membrane 
 of the nostrils are made strong enough to resist the infection of the 
 germs which will be either eliminated or neutralized at the time they 
 make their appearance. (See article headed "Predisposition to Dis- 
 ease," p. 5.) 
 
 When a Hay Fever patient has been fortunate enough to have used 
 only harmless remedies to relieve the trouble, he will find immediate 
 relief by following the above treatment. If he has used injurious 
 
24 
 
 drugs (for years) which have impaired or even destroyed the vitality of 
 the animal cells, it may require one week or ten days before he feels 
 relieved. 
 
 In all cases a few drops of Glycozone being repeatedly applied 
 to each nostril morning and evening helps to quickly relieve the 
 patient. Sniff it gently. 
 
 The Ozonized vapor inhalations should be administered only incase 
 of- Asthma, which so often accompanies this troublesome affection. 
 
 Itching and Inflammation of the Eyes. — Bathe the eyes copi- 
 ously and repeatedly with a warm mixture made of one ounce of 
 Hydrozone with two pints of water. This treatment gives immediate 
 relief. 
 
 See p. 49 article headed Hydrozone and Eye Balsam in Inflam- 
 matory and Contagious Diseases of the Eyes. 
 
 Note. — In addition to the above local treatment of the air pas- 
 sages, it is urgent to subdue the inflammatory condition of the stom- 
 ach, which may result from either the constant dropping of unhealthy 
 secretions from the throat, or else from the action of injurious drugs, 
 which have been used by the patient for years previous. 
 
 Therefore, in case of gastric disorders, Hay Fever sufferers should 
 follow the Hydrozone and Glycozone treatment as explained p. 
 37 article headed The Rational Treatment of Gastric and Intestinal 
 Disorders. 
 
 INFLUENZA.— LA GRIPPE. 
 
 Causes. — This disease is supposed to be characterized by the 
 presence of pathogenic germs which affect the respiratory organs and 
 have a reflex action upon the nervous system. 
 
 The local symptoms are a severe naso-pharyngeal . Catarrh with 
 Headache, Sore Throat and Bronchitis. 
 
 The general symptoms are a feeling of lassitude, with acute pains 
 in the limbs and back, accompanied with fever and profuse perspira- 
 tion. 
 
 The stomach is also greatly congested and should be taken care 
 of as explained on p. 37, Rational Treatment of Gastric and Intes- 
 tinal Disorders. 
 
 The internal medication with an appropriate diet may soon 
 relieve the patient from the general symptoms, but the danger lies 
 
25 
 
 with the complications which either accompany or follow the Influenza, 
 such as Laryngitis, Bronchitis, acute lobar Pneumonia, Pleurisy, etc. 
 
 In fact, the local symptoms, viz.: The inflammatory condition 
 of the respiratory tract must be promptly checked in order to pre- 
 vent the microbian infection from producing dangerous complications. 
 
 Hydrozone will always subdue the inflammatory condition of the 
 respiratory organs, by strengthening the involved tissues. 
 
 Treatment of the Local Symptoms. — First. — Spray the nos- 
 trils copiously and repeatedly every three hours with a mixture made of: 
 i tablespoonful of Hydrozone 
 with 8 to 10 tablespoonfuls of lukewarm water, 
 according to the sensitiveness of the mucous membrane. 
 
 Second. — In order to reach the seat of the disease, deeply located 
 in the bronchial tubes, by means of the Hand Atomizer and Ozonizer 
 (see pp. 35 and 36) administer Ozonized vapor inhalations three to six 
 times every day with a mixture thoroughly made of: 
 1 tablespoonful of Hydrozone, 
 1 " of chemically pure glycerine. 
 
 Shake well and renew every three days. 
 
 The above treatment will not only check the local symptoms, 
 but it will also prevent the patient from being subsequently troubled 
 with chronic Bronchitis. 
 
 Treatment of Asthma. — By means of Ch. Marchand's Hand 
 Atomizer and Ozonizer, inhalations of Ozonized vapor should be 
 administered three to six times daily. 
 
 The action of Ozonized vapor upon the diseased surface of the 
 bronchial tubes or the cells of the lungs is similar to the action of 
 Hydrozone upon any open sore or ulcer. The morbid element is 
 destroyed or rendered inert by the ."nascent oxygen" near to 
 the condition of Ozone, which is set free; the diseased tissues are 
 disinfected and restored to a healthy condition. 
 
 The bronchial trouble can easily be relieved, but unfortunately 
 the remedy is powerless to subdue the nervous symptoms. 
 
 Therefore, although the patient may be much relieved, a perma- 
 nent cure cannot be accomplished, on account of the nervous symp- 
 toms which are uncontrollable. 
 
 The mixture for inhalations, that gives the most satisfactory 
 results is made of: 
 
26 
 
 i tablespoonful of Hydrozone, 
 
 i " of chemically pure glycerine. 
 
 Mix well together by shaking the bottle, and renew the mixture 
 every three days. 
 
 The duration of each inhalation should not exceed ten minutes, 
 and after each inhalation, especially during the winter, the patient 
 should remain indoors for fifteen or twenty minutes. 
 
 Owing to the fact that all asthmatic patients are more or less 
 troubled with gastric disorders, it is of great benefit to prescribe half 
 an hour before meals, half a tumblerful of Ozonized water made of: 
 i ounce of Hydrozone 
 with 2 quarts of water. 
 
 This cleanses the stomach and regulates the bowels. The above 
 treatment being* earnestly followed will keep the patient free from 
 Asthma, but the disease will reappear soon after he discontinues tak- 
 ing the Ozonized vapor inhalations. 
 
 See article headed The Rational Treatment of Gastric and Intes- 
 tinal Disorders, p. 37. 
 
 Bronchitis. — Treatment. — By means of Charles Marchand's 
 Hand Atomizer and Ozonizer three inhalations of Ozonized vapor 
 should be administered daily. 
 
 It is the most efficacious local treatment which can be prescribed 
 to subdue this disease, on account of the harmless, although very 
 powerful, antiseptic and healing properties of Hydrozone. 
 
 It quickly checks profuse bronchial secretions, and by its stimu- 
 lating action upon the diseased tissues of the bronchial tubes, an abso- 
 lute cure may be accomplished in a very short time, especially if the 
 patient has never used before, any poisonous drugs. See p. 7, The 
 Requirements of an Antiseptic. 
 
 Mixture for inhalations: 
 
 1 tablespoonful of Hydrozone, 
 
 1 " of water, 
 
 2 ,, of pure glycerine 
 
 This mixture should be made perfect by shaking the bottle, and 
 renewed every three days. In chronic cases it should be made of 
 equal parts of Hydrozone and pure glycerine. 
 
 As a beverage, take half an hour before meals, half a tumblerful 
 of Ozonized water made of: 
 
27 
 
 i ounce of Hydrozone 
 mixed with 2 quarts of water. 
 
 This will have the most beneficial effect upon the stomach, which 
 is always affected by constant droppings of unhealthy excretions from 
 the throat. See article headed The Rational Treatment of Gastric and 
 Intestinal Disorders, p. 37. 
 
 In the majority of cases it is necessary to administer immediately 
 after each meal 1 teaspoonful of Glycozone diluted with a wineglassful 
 of water, in order to heal the local inflammation of the stomach. 
 
 Laryngitis. — Hydrozone is the safest and most powerful remedy 
 to use in order to subdue this disease. 
 
 Spray the larynx or gargle three times every day with a mixture of: 
 1 tablespoonful of Hydrozone 
 with 4 to 12 tablespoonfuls of water (lukewarm). 
 
 Swallow a portion of the remedy. 
 
 Hoarseness which often follows or accompanies Laryngitis is 
 promptly subdued by the same above treatment. 
 
 In many cases, Ozonized vapor inhalations will accelerate the 
 cure. 
 
 Pharyngitis. — Spray or irrigate copiously the pharynx morning 
 and evening every day with a mixture of: 
 1 tablespoonful of Hydrozone 
 with 6 to 14 tablespoonfuls of water (lukewarm). 
 
 Swallow a portion of the remedy and administer Ozonized vapor 
 inhalations morning and evening, (See article headed Bronchitis, 
 p. 26). 
 
 Appropriate internal medication may accelerate the cure. 
 
 Croup, Membranous Croup. — This disease seems to be 
 caused by the same specific virus as Diphtheria, but it shows a milder 
 degree of virulence. 
 
 When fully developed, whitish spots or membranous exudations 
 are observed in the larynx. After the membrane is once formed, if 
 left alone it may be cast off in the form of a cylinder, in bands or 
 shreds^ Recent experiments have proved that Hydrozone destroys 
 these membranes after a short contact, and restores the diseased 
 tissues to a healthy condition. 
 
 In case of Membranous Croup, the nose, throat, mouth, pharynx 
 and larynx, should be flooded every two hours with a mixture of: 
 
28 
 
 i tablespoonful of Hydrozone 
 
 with 8 to 12 tablespoonfuls of water (lukewarm). 
 
 The membranes are destroyed, and their production is checked. 
 From that time there is no danger of the patient being troubled 
 with suffocation resulting from the development of these infected 
 membranes. As an internal treatment, one teaspoonful of Glycozone 
 diluted in a wineglassful of water, taken three times a day will pre- 
 vent any disorder of the stomach and regulate the bowels. When 
 the patient's stomach is seriously disturbed, alternate with Ozonized 
 water as a beverage. See Catarrh of the Stomach, p. 37. 
 
 Whooping-cough. — Causes. — Dr. Burger, of Bonn, Germany, 
 and Dr. Affanassieff, of Russia, have shown the presence of micro- 
 organisms in Whooping-cough sputum. Dr. Affanassieff has pre- 
 pared, with all the precautions, for microscopical experimentation, a 
 small portion of the expectoration of a Whooping-cough patient, which 
 showed large numbers of short rod bacteria, partly singly, partly in 
 two and of larger chains. 
 
 With pure cultures of these rod bacteria the investigator has 
 made several inoculations upon animals. A solution of this culture 
 upon agar-agar, at least eight days old, in one-half a cubic centimetre 
 of common salt, was made and injected into the windpipe or lungs of 
 dogs and rabbits, under antiseptic precautions. 
 
 The animals all contracted a disease similar to Whooping-cough^ 
 often complicated with Broncho-pneumonia. 
 
 Several died, and the autopsy showed that the mucous mem- 
 branes of the bronchi, of the trachea, and even of the nose, are the 
 chief seats of the injected bacteria. 
 
 The same bacteria were found in the lungs and the respiratory 
 mucous membranes of children who died of Whooping-cough. 
 
 Dr. Affanassieff considers it to be a cause of W T hooping-coughr 
 and names it the "bacillus tussis convulsivce" 
 
 Hydrozone not only destroys these germs instantaneously, but it 
 strengthens the tissues. Therefore it interferes with the organic 
 chemical reaction mentioned, p. 5, "Predisposition to Disease." 
 
 Dr. Schwenker (London Lancet, January 7, 1888) and Dr. Wenat 
 {Medical News, June 2, 1888) have confirmed Dr. AffanassiefFs obser- 
 vations. 
 
2 9 
 
 Treatment. — First. — Spray frequently and copiously the nose, 
 throat, pharynx and larynx with a mixture made of: 
 i tablespoonful of Hydrozone 
 with 8 to 20 tablespoonfuls of water (lukewarm). 
 The patient may swallow the remedy without discomfort, as it 
 is beneficial and perfectly harmless. Three or four applications every 
 day will be sufficient in most all cases. 
 
 Second. — By means of the Hand Atomizer and Ozonizer, admin- 
 ister Ozonized vapor inhalations three to six times daily, in order to 
 insure the complete destruction of the morbid element in the respira- 
 tory organs. 
 
 The mixture for inhalations should be made of: 
 1 tablespoonful of Hydrozone, 
 
 1 " of water, 
 
 2 " of pure glycerine. 
 
 Mix well together and renew every three days. 
 
 The gastric disorder which always accompanies this disease may 
 be subdued by administering half a tumblerful of Ozonized water, 
 made of one ounce of Hydrozone with two quarts of water morning 
 and evening. (See article headed ' 'The Rational Treatment of Gastric 
 and Intestinal Disorders," p. 37.) 
 
 In addition to the Ozonized water it will be found beneficial to 
 administer as a beverage, one teaspoonful of Glycozone diluted with 
 water, whenever the patient feels thirsty. 
 
 Consumption, Phthisis, Tuberculosis of the Lungs. — 
 Causes. — It is a well demonstrated fact that Consumption or Phthisis 
 is characterized by the presence into the lungs of the Bacillus Tuber- 
 culosis of Koch. 
 
 With pure cultures of this bacillus, Dr. Koch and other bacteri- 
 ologists have made experimental inoculations upon animals. A solu- 
 tion of this culture upon agar-agar was made and injected into the 
 windpipe or lungs of dogs. The animals all contracted Tuberculosis 
 of the lungs or Consumption. The bacillus locates itself in tubercles, 
 producing ulcerated cavities of the lungs. 
 
 The bacillus tuberculosis is readily destroyed by antiseptic rem- 
 edies; but although the annihilation of the microbial! element is 
 accomplished almost instantaneously by Hydrozone, this remedy could 
 not cure consumption when the disease has reached such a degree of 
 
3° 
 
 development that the lung tissue has broken down. In fact, if it 
 should be possible to bring the remedy in contact with all parts of 
 the lungs, which are invaded by the bacilli, undoubtedly the cure of 
 consumption might be accomplished by the Ozonized vapor inhalations. 
 
 Unfortunately, it is rather difficult, and often impossible to reach 
 the seat of the disease, so as to prevent a chemical reaction from tak- 
 ing place when the germs and weakened animal cells remain in con- 
 tact. See article headed "Predisposition to Disease," p. 5. There- 
 fore, in the majority of cases, the patient could only expect to check 
 the disease, preventing the microbian element from invading a new 
 portion of the lungs, which is yet in a healthy condition. 
 
 The Ozonized vapor treatment will, in all cases, strengthen the 
 animal cells of the lungs, and restore their vitality to its normal con- 
 dition, so that they may become strong enough to either neutralize or 
 eliminate the vegetable cells (bacilli tuberculosis). At the same time 
 it will supply the circulation with the necessary amount of nascent 
 oxygen, in its most active condition. 
 
 Treatment. — Frequent and deep inhalations of Ozonized vapor 
 should be administered three to six times daily with a mixture made of: 
 1 ounce of Hydrozone 
 with 1 ounce of chemically pure glycerine. 
 
 Shake well and renew the mixture every three days. 
 
 The duration of each inhalation should not exceed ten minutes, 
 and inspirations should be as deep and prolonged as possible. The 
 remedy will reach the lungs if administered either through the nose 
 or mouth, by means of Charles Marchand's Hand Atomizer and 
 Ozonizer (See pp. 34, 35, 36) or any other vaporizer made entirely 
 of glass and hard rubber, such as the Globe nebulizer of Dr. Dunlap. 
 
 The vaporizer being connected with an air cylinder compressor 
 gives much better results. 
 
 Remain indoors for twenty minutes after each inhalation, espe- 
 cially during the cold weather. 
 
 It is easy to understand that, the Ozonized vapor coming into 
 contact with the ulcerated cavities of the lungs, the nascent oxygen 
 near to the condition of Ozone, which is set free, immediately oxidizes 
 and neutralizes the morbid element leaving the surrounding tissues in a 
 healthy condition. 
 
3 1 
 
 When Consumption has not developed beyond its first or second 
 stages — that is, when the ulcerated cavities are small and so located 
 that they can be reached by the Ozonized vapor — the above treatment 
 prevents the infection from spreading and a cure may be accom- 
 plished. In all cases of Consumption, no matter at what stage of the 
 disease, the relief of the patient will quickly be obtained by using the 
 Hydrozone treatment. It will stop and prevent hemorrhage. 
 
 Ozonized vapor has no injurious action upon the healthy tissues 
 of the lungs, as it acts as a powerful stimulant to healthy granula- 
 tions. 
 
 Although the above local treatment will always relieve Tubercu- 
 losis of the lungs, the patient may grow weak all the time, on account 
 of his stomach being unable to digest a sufficient amount of substan- 
 tial food. In order to keep up his strength, the stomach should be 
 taken care of as follows: 
 
 Half an hour before meals, administer half a tumblerful (or even 
 a tumblerful) of Ozonized water made of: 
 i ounce of Hydrozone 
 with 2 quarts of water. 
 
 A small quantity of pure honey can be added to the Ozonized 
 water so as to make it more palatable. 
 
 This will cleanse the stomach by destroying the morbid element. 
 
 Immediately after meals, administer two teaspoonfuls of Glyco- 
 zone diluted with a wineglassful of water. The stomach will soon be 
 brought to a healthy condition, and enabled to properly digest and 
 assimilate a sufficient amount of substantial food, thus building up 
 waste tissue. (See p. 37 Rational Treatment of Gastric and Intes- 
 tinal Disorders.) 
 
 INFLAMMATORY AND CONTAGIOUS DISEASES OF THE THROAT 
 
 Sore Throat, Angina, Tonsilitis, Quinsy, etc. — 
 Treatment. — Spray or gargle the throat copiously and frequently 
 with a mixture made of; 
 
 1 tablespoonful of Hydrozone 
 
 with 6 to 12 tablespoonfuls of water (cold or lukewarm). 
 
32 
 
 The patient may swallow the remedy without discomfort, as it is 
 rather beneficial. In case of Tonsilar Abscess gargle more frequently 
 (every two hours,) in order to quickly destroy the pus which might 
 cause both suffocation and general infection. 
 
 Diphtheria. — Causes. — Diphtheria is at first a local disease 
 (See p. 2), which is secondarily propagated to the general organism 
 by a contagious virus located about the tonsils; this virus is an albu- 
 minoid substance invaded by a large number of bacteria called 
 micrococci, (Klebs-Lcefter Bacilli). 
 
 Hydrozone acting upon this virus, both chemically and mechan- 
 ically, changes its nature by coagulating the albumen; the germs are 
 readily neutralized, the soil in which they develop being rendered inert 
 and improper to their growth, their reproduction is checked. The 
 surrounding healthy animal cells of which the vitality had been either 
 weakened or destroyed, recover their strength under the stimulating 
 action of this remedy, so that they can eliminate or at least resist 
 the deadly action of the vegetable cells (germs). 
 
 Infection of the system by poisonous ptomaines is therefore pre- 
 vented and the disease remains local. See article headed * 'Predispo- 
 sition to Disease," p. 5. 
 
 When toxic or corrosive remedies are applied (See p. 7, "The 
 Requirements of an Antiseptic") the germs are readily annihilated, but 
 the surrounding healthy animal cells are also destroyed or at least 
 much weakened, so that the patient may die, not from the disease (since 
 the germs are destroyed) but from the effect of the poisonous drug. 
 
 Treatment. — Spray or gargle copiously, every two hours, the 
 nose, throat, mouth, pharynx, and larynx with a mixture of: 
 1 tablespoonful of Hydrozone 
 with 4 tablespoonfuls of water (lukewarm). 
 
 It is beneficial to swallow the remedy. 
 
 When Diphtheria has developed, spray the child's nostrils, throat, 
 mouth, pharynx and larynx more frequently with a mixture of: 
 1 tablespoonful of Hydrozone 
 with 2 tablespoonfuls of water (lukewarm.) 
 
 Dr. Geo. B. Hope, of the Metropolitan Throat Hospital, of New 
 York, and other leading physicians, recommend the use of Hydrozone 
 full strength, particularly when the disease spreads rapidly. 
 
33 
 
 The remedy may be applied full strength to the diphtheritic 
 membranes by means of a soft camel's hair brush (free from any 
 metallic parts.) 
 
 Any portion of this remedy which finds its way into the larynx 
 or stomach is beneficial rather than harmful. 
 
 Adults and children old enough to gargle and rinse the mouth 
 will get a better effect in this way. 
 
 As an. internal treatment, one teaspoonful of Glycozone diluted 
 in a wineglassful of water, administered every three hours, will pre- 
 vent the microbian infection from causing gastric disturbances. 
 
 See pp. 65, 67, 68, 70, 75, 81, 82, 96, 97, 104, 144, 188, 202, 210, 
 219, 224, 228, 247. 
 
 Scarlet Fever. — Causes. — It is a proven fact that this disease is 
 characterized by the presence of bacteria of the micrococcus species. 
 
 Every physician knows that Scarlet Fever is contagious to the 
 highest degree, and that it may be communicated by anything that has 
 touched the patient, such as air, food, clothing, sheets, furniture, cur- 
 tains, etc. All discharges from bowels, kidneys, nose, mouth, eyes, 
 ears, and skin are dangerous; and the poison may remain active 
 for months or years by means of clothing packed away in drawers. 
 
 The germs which characterize this disease are readily neutralized 
 or rendered inert by Hydrozone. 
 
 Treatment. — Spray or gargle the throat copiously and repeat- 
 edly every two or three hours with a mixture made of: 
 1 tablespoonful of Hydrozone 
 with 6 to 20 tablespoonfuls of water (lukewarm.) 
 
 As a preventive for secondary infection: on the third day of Scar- 
 let Fever, the whole body of the patient should be washed, morning 
 and evening, with equal parts of Hydrozone and tepid water. Use 
 a porcelain dish and a clean soft sponge. 
 
 This local treatment does not preclude the internal medication, 
 which may be deemed necessary by the attending physician. 
 
 As an internal treatment: One teaspoonful of Glycozone diluted 
 in a wineglassful of water, administered every three to four hours will 
 prevent the microbian infection from disturbing the stomach. 
 
 See articles pp. 82, 96, 173. 
 
34 
 
 DIRECTIONS FOR USING THE HAND ATOMIZER AND OZONIZER. 
 
 First. — The proper mixture of Hydrozone with chemically pure 
 glycerine for administering Ozonized vapor inhalations should be thor- 
 oughly made in the bottle Z, as is shown on cuts Nos. 2 and 3; p. 35. 
 
 Then, by quickly and repeatedly pressing the terminal soft rub- 
 ber bulb, Z, the air is forced through the bottle Z, and produces a 
 coarse spray in the vaporizing glass bulb, A. The concussion of the 
 spray against the glass breaks up the mixture, and a large amount of 
 fine Ozonized vapor escapes in a continuous flow through the bent 
 glass tube E, as represented on cut No. 2, or through the straight glass 
 tube, F, as shown on cut No. 3. 
 
 When the condensed liquid in the bulb, A, reaches the lower part 
 of the neck, B, iUshould be emptied into the bottle, Z, by discon- 
 necting the spray- tube, Z>. Then reconnect the parts and the appa- 
 ratus is again ready for use. 
 
 Second. — When the apparatus is needed to spray either the throat 
 or the nose, Hydrozone is mixed with the necessary quantity of water 
 in the graduated bottle, Z, as shown on cuts No. 4 and No. 5, p. 36. 
 
 CAUTION. 
 
 The spray tube should be kept perfectly clean by passing tepid water 
 through it at least twice a week. Should it clog, disconnect the vaporizing 
 glass bulb, A, and the bottle, Z, unscrew the tip G, and blow both ways 
 through the spray tube, or pass a thin wire through it, as you would do for 
 an ordinary spray atomizer. 
 
 The above described apparatus is entirely made of glass and hard rubber, 
 because no metal should come in contact with Hydrozone. Use only silver, 
 hard rubber, glass or porcelain spoons to measure Hydrozone or Glycozone. 
 
 Note* — Some practitioners believe that Hydrozone may be suc- 
 cessfully inhaled by means of an ordinary inhaler, the same being 
 placed in a jacket vessel of water heated to i20°-i4o° Fahr* This 
 method is absolutely wrong, for the following reasons: When Hydro- 
 zone is heated at i2o°-i4o° Fahr., steam, ordinary oxygen, and only t 
 traces of nascent oxygen are inhaled by the patient. (See foot note, p. 14, 
 article headed Compound Oxygen Inhalations). On the contrary, 
 when Hydrozone vapor is mechanically produced by means of the 
 Hand Atomizer and Ozonizer, the vapor which reaches the diseased 
 tissues has the same stimulating andhealing properties as Hydrozone. 
 
 
35 
 
 CHARLES MARCHAND'S - 
 
 COMBINED 
 
 HAND ATOMIZER AND OZONIZER. 
 
 DESCRIPTION: 
 
 Cut No. i. — This cut represents apparatus when unpacked from its original box. 
 
 Cut No. 2. — This cut represents apparatus ready for inhaling vapor through the 
 nose in the treatment of Asthma, Bronchitis and lung diseases. 
 
 c. 
 
 -^<i 
 
 Cut No. 3. — This cut represents apparatus ready for inhaling vapor through the 
 mouth in the treatment of Asthma, Bronchitis and lung diseases. 
 
36 
 
 Cut No. 4. — This cut represents apparatus ready for spraying the throat. 
 
 Cut No. 5. — This cut represents apparatus ready for spraying the nostrils. 
 
 Each separate part of the appara- 
 tus is designated by the following 
 letters: 
 
 -The vaporizing glass bulb, with its 
 two openings, B and C. 
 
 D. — The curved spray-tube (hard rubber). 
 
 E. — The bent glass tube. 
 
 F. — The slightly curved glass tube. 
 
 G. — The straight tip (hard rubber). 
 
 H. — The nasal tip (hard rubber). 
 
 /. /. — The two soft rubber bulbs. 
 
 K. — The soft rubber stopper. 
 
 L. — The glass bottle containing the rem- 
 edy. 
 
 Cut No. 6. — This cut shows the different parts of the Hand Atomizer and Ozonizei 
 when disconnected. 
 
37 
 
 THE RATIONAL TREATMENT " 
 OF 
 GASTRIC AND INTESTINAL DISORDERS. 
 
 INJURIOUS DRUGS SHOULD BE DISCARDED. 
 
 Digestion is a function by means of which, alimentary substances, 
 (nitrogenous, non-nitrogenous and mineral) when introduced into the 
 digestive canal, undergo different alterations, the result of which being 
 to convert them into two parts; the one a reparatory juice, destined 
 to renew the perpetual waste occurring in the economy; the other, 
 deprived of its nutritious properties, to be rejected from the body. 
 
 This function, in man, is composed of eight organic actions, viz. : 
 Prehension of food, mastication, insalivation, deglutition, action of 
 the stomach, action of the small intestine, expulsion of the feces. 
 
 Digestion is really the result of a chemical reaction, which takes 
 place as soon as food is mixed with gastric juice, which is a fluid 
 secreted from the mucous membrane of the stomach. The secretion 
 of gastric juice is accomplished by the peptic glands, which are located 
 in the cardiac end of the stomach. 
 
 Gastric juice, in man, contains, in every 1000 parts: water, 992.60; 
 pepsin, 3.04; free hydrochloric acid, 2.20; alkaline chlorides, 2.00; 
 phosphates of calcium, magnesium and iron, 0.16. 
 
 Dyspepsia. — Gastritis. — Predisposing Causes. — Deficient 
 gastric juice secretion, with resulting fermentation of food, is the 
 most prevalent cause of gastric disorders. 
 
 The two main constituents of gastric juice, namely, acid and pep- 
 sin, may be deficient in quantity or disturbed in their relative pro- 
 portions. A certain amount of acid is essential to the digestive pro- 
 cess, while a small amount of pepsin may be sufficient to digest a 
 large amount of albuminoid food. 
 
 Exciting Causes. — Excess in eating and drinking, imperfect 
 mastication and insalivation, the use of indigestible and unwholesome 
 food, the abuse of alcohol, the imperfect arrangement of meals, over- 
 drugging, or even the moderate use of injurious drugs, are chiefly 
 the exciting causes of gastric disorders, indigestion being the imme- 
 diate consequence. 
 
 Intestinal disorders, such as Constipation or Diarrhoea with 
 Catarrhal Inflammation of the bowels, are almost universal accom- 
 
38 
 
 paniments of deranged digestion, and when persistent for years, are 
 apt to lead to the most serious complications. 
 
 In fact, when the alimentary canal ceases to regularly accomplish 
 its functions, the amount of substantial food which can be digested 
 is insufficient to produce enough of the reparatory juice, which renews 
 the perpetual waste occurring in the economy. Hence, the blood is im- 
 paired, some of its constituents being in deficiency, and the animal 
 cells of the entire body become weak from lack of nutrition. 
 
 From that time the equilibrium is upset, and the individual's pre- 
 disposition to disease increases. See article headed "Predisposition 
 to Disease," p. 5. 
 
 Among the.direct exciting causes of gastric disorders, corrosive 
 and poisonous drugs, as well as the excessive use of alcohol, are 
 recognized as being more prevalent than any others. 
 
 Chronic Catarrh of the nose as well as Bronchitis, may also 
 cause gastric disturbances on account of the large amount of unhealthy 
 secretions, which after developing in the post-nasal cavities, find 
 their way into the stomach. 
 
 These unhealthy secretions produce not only a local irritation of 
 the mucous membrane of the stomach, but they also prevent the 
 peptic glands from accomplishing their work in the secretion of a 
 sufficient quantity of gastric juice. 
 
 In cases of Acute Gastritis, for instance, the autopsy shows that 
 the mucous membrane of the stomach is covered with a thick, tena- 
 cious, stringy mucus, which interferes greatly with the functions 
 of the peptic glands. 
 
 The most prominent of the local symptoms of gastric disorders 
 are: A sense of fullness and distention after eating, discomfort dur- 
 ing digestion, lack of appetite and eructation, heart-burn, flatulence, 
 regurgitation of food, and sometimes, in acute cases, nausea and 
 vomiting. 
 
 Now, that I have briefly resumed the causes of gastric disorders, 
 I will explain what I mean by the Rational Treatment of Gastric and 
 Intestinal Disorders. 
 
 The profession know that the innumerable remedies which are 
 prescribed in stomach and intestinal diseases, may be classified as 
 follows: 
 
39 
 
 First. — Remedies having a stimulating action upon the secretion 
 and muscular coats of the stomach. 
 
 Second. — Introduction into the stomach of a necessary amount of 
 one or several of the constituents of the gastric juice, that may be in 
 deficiency in order to make it normal. 
 
 Third. — Remedies having the property to lessen the abnormal 
 irritability. 
 
 Fourth. — Remedies having the property to digest food, arti- 
 ficially. 
 
 i'V/"/^.— Laxatives and cathartics. 
 
 The above mentioned remedies may temporarily relieve the 
 symptoms, but owing to the fact that they have no healing action 
 upon the inflamed mucous membrane, no cure whatever can be 
 accomplished, unless nature is powerful enough to subdue the local 
 inflammation by neutralizing the morbid element, and at the same 
 time restoring the peptic glands to their normal condition. 
 
 Assuming that a chemical analysis of the gastric juice (taken from 
 the stomach of a patient) shows for instance, that muriatic acid is in defi- 
 ciency, it does not imply by any means, that by introducing into the 
 stomach the amount of acid needed to make the gastric juice normal, 
 the mucous membrane will be restored to a healthy condition. 
 
 In case of stomach disorders, the constituents of the gastric juice 
 varying constantly in their respective proportions, it is rather 
 impossible to always know to any degree of certainty, what amount 
 of acid or alkali should be prescribed in order to make it just 
 right. 
 
 Remedies having a stimulating action upon the peptic glands, 
 may also give temporary relief, but owing to their poisonous prop- 
 erties they always aggravate the trouble. 
 
 Gastric and intestinal disorders being due to an inflammatory 
 condition of the lining of the stomach, must be treated by antiseptic 
 remedies, having both a healing and stimulating action upon the 
 diseased mucous membrane. 
 
 Poisonous drugs having stimulant properties should be dis- 
 carded for the only reason, that they do more harm than good, since 
 they compel the peptic glands to perform their functions while they 
 are in a diseased condition. Strychnine is the worst of all. 
 
40 
 
 Therefore, the rational treatment of gastric and intestinal dis- 
 orders is based upon the use of antiseptic remedies, answering the 
 following requirements: 
 
 First. — Destroy the unhealthy mucus which covers the lining 
 membrane of the stomach, without injuring the surrounding healthy 
 tissues. 
 
 Second. — Heal the diseased surface membrane, by stimulating 
 healthy granulations, so as to restore the functions of the peptic glands 
 to their normal condition. 
 
 By referring to articles headed, ' 'Requirements of an Antiseptic, " p. 
 7, and "Rational Treatment of Diseases," p. 8, it will be readily under- 
 stood, that Hydrozone being administered before meals in the form of 
 Ozonized water, will destroy the morbid element, and at the same time 
 stimulate healthy granulations, but owing to its rapid decomposition 
 into nascent oxygen and water, it merely destroys the morbid element, 
 so as to leave a clean surface. 
 
 Then, Glycozone being administered after meals, will act upon 
 a clean surface, and owing to its wonderful healing and stimu- 
 lating properties, a cure may be accomplished in a very short time. 
 
 See articles headed: "Diseases of the Alimentary Canal," by Dr. 
 J. Osborne DeCourcy, p. 156, — "Chronic Gastritis with Periodic At- 
 tacks of Migraine," by Dr. Geo. A. Curriden, p. 214, — "Hydrozone in 
 Gastric and Intestinal Disorders, " by Dr. JohnAulde, p. 216, — "Treat- 
 ment of Inflammatory Diseases of the Stomach," by Dr. G. M. Blech, 
 p. 217, — "Local Treatment of Chronic Gastric Catarrh," by Dr. J. M. 
 G. Carter, p. 236, — "Mechanical Feeding of the Insane, "by Dr. Frank 
 C. Hoyt, p. 237, — "Chronic Gastritis," by Prof. H. T. Webster, p. 
 241, — "Glycozone in Chronic Catarrh of the Stomach," by Dr. J. W. 
 Starr, p. 248, — "The Care of the Insane in Private Practice," by Dr. 
 Henry W. Coe, p. 250, — "Hydrozone and Glycozone in Gastric Ca- 
 tarrh with Nervous Symptoms," by Dr. Warren E. Day, p. 251. 
 
 Directions for using Hydrozone and Glycozone in 
 Chronic Dyspepsia. — Gastritis, and Gastric Ulcer. — 
 First. — Half an hour before meals, administer half a tumblerful (or 
 more) of Ozonized water made of: 
 1 ounce of Hydrozone 
 with 2 quarts of water. 
 
4i 
 
 The patient may feel a distressing and sometimes very unpleasant 
 sensation in the stomach for a few moments after drinking the above 
 mixture.* 
 
 This is due to the decomposition (into nascent oxygen) of the 
 Ozonized water, that takes place more or less rapidly according to 
 the amount of unhealthy mucus, and degree of inflammation. 
 
 When the inflammation is not acute and the amount of unhealthy 
 secretions is small, nascent oxygen is set free rather slowly, and the 
 patient does not feel any discomfort. 
 
 On the contrary, when a large amount of unhealthy secretions is 
 present, and the mucous membrane is much inflamed, Ozonized water 
 is decomposed almost instantly, and the large amount of nascent 
 oxygen which is then suddenly liberated in the stomach, causes a 
 distressing sensation which may be accompanied with nausea. As 
 
 
 
 soon as the stomach is restored to a more healthy condition Ozonized 
 water is taken without discomfort. 
 
 No matter what discomfort results from drinking Ozonized 
 water, in all chronic cases (particularly when the patient has used 
 injurious drugs, which slowly, but constantly have aggravated his 
 trouble,) it should be taken, not only in view of cleansing and 
 disinfecting the stomach, but also, in order to restore the vitality of 
 the animal cells of the mucous membrane, to its normal condition. 
 
 When the life of the animal cells has been seriously impaired and 
 even totally destroyed by the abuse of injurious drugs, although Hydro- 
 zone is the most powerful life giving and stimulating agent, it may 
 require more or less time (according to the degree of injury caused by 
 previous treatment) before the patient feels relieved. 
 
 Second. — The cleansing of the stomach being accomplished by 
 the Ozonized water, the patient should drink immediately after meals; 
 
 i to 2 teaspoonfuls of Glycozone 
 diluted with i wineglassful of water. 
 
 In this way, the healing action of Glycozone takes place upon a 
 clean surface to better advantage. 
 
 * The addition of a small quantity of pure honey to the Ozonized water does not 
 interfere with the action of the remedy. Therefore when the stomach is exceedingly 
 irritable better results are obtained with this mixture, which is not so objectionable to 
 the patient. 
 
42 
 
 The relief is almost immediate, and an absolute cure is soon 
 obtained if the above treatment is earnestly followed, providing that 
 all other remedies are discarded. 
 
 When Dyspepsia as well as Catarrh of the Stomach is not chronic, 
 Glycozone alone, being taken immediately after meals as above 
 explained, will soon accomplish a cure. 
 
 In all cases of stomach diseases, the patient should be careful in 
 his diet avoiding unwholesome food, such as raw vegetables, pastry, 
 starchy food, etc., and should take his meals regularly; otherwise, it 
 might interfere with the healing properties of both Hydrozone and 
 Glycozone. This treatment, which always prevents fermentation of 
 food in the stomach, may cure the most acute and chronic cases of 
 Dyspepsia and Gastritis, within two to six months, when all other 
 remedies have failed. 
 
 Gastric Ulcer, (acute or chronic) which is characterized by 
 vomiting of food and sometimes hemorrhage, is promptly subdued by 
 following the same above treatment, with the exception, that the 
 patient should drink one tumblerful of Ozonized water made of: 
 
 i ounce of Hydrozone 
 with 2 quarts of water, 
 
 (instead of half a tumblerful) half an hour before meals, and at least 
 two teaspoonfuls of Glycozone diluted in a wineglassful of water 
 immediately after meals. In this way Glycozone will heal Gastric 
 Ulcer much quicker than if it was administered alone, and the patient 
 should not mind the unpleasant distressing sensation which always 
 accompanies the use of Ozonized water, at first, as it will soon pass 
 away when the condition of the stomach has improved. See article 
 headed ''Dyspepsia," p. 37. 
 
 A permanent cure of Gastric Ulcer may be accomplished in less 
 than six months, if the above treatment is earnestly followed. 
 
 Indigestion, Vomiting in Pregnancy. — Treatment. — Take 
 two teaspoonfuls of Glycozone, diluted with one wineglassful of water 
 immediately after eating. 
 
 The relief is immediate and the digestion is accomplished with- 
 out discomfort. 
 
43 
 
 Inflammatory Diseases of the Intestines, Chronic Con- 
 stipation, Diarrhoea, Cholera Infantum, Dysentery. — 
 
 Treatment. — Administer half a tumblerful of Ozonized water 
 (one ounce of Hydrozone with two quarts of water) half an hour before 
 meals, so as to thoroughly cleanse the stomach. 
 
 Then administer immediately after meals: 
 • i teaspoonful of Glycozone 
 
 diluted with i wineglassful of water. 
 
 In addition to this internal treatment prescribe every day an 
 enema with: 
 
 i ounce of Glycozone 
 
 diluted with 12 ounces of water (lukewarm). 
 
 Prepare this immediately before using, and administer it once 
 daily, by means of a hard rubber rectal syringe. Retain the enema as 
 long as comfortable. 
 
 The temporary discomfort which .may follow the drinking of 
 Ozonized water, may be avoided as explained on p. 41. 
 
 Note, that laxatives and cathartics should be used as little as 
 possible because they invariably aggravate Constipation. 
 
 In cases of Cholera Infantum the bowels may be irrigated with 
 Ozonized water made of 2 ounces of Hydrozone for 100 ounces of 
 water, see p. 49. 
 
 CONTAGIOUS DISEASES OF THE ALIMENTARY CANAL. 
 
 TYPHOID FEVER, TYPHUS, YELLOW FEVER, CHOLERA INFANTUM, ASIATIC CHOLERA 
 
 Typhoid Fever.— Causes and Treatment. — It is a well- 
 known fact that contaminated water is a cause of this disease. 
 
 Hydrozone destroys the Typhoid bacillus instantaneously. Con- 
 sequently a beverage made of: 
 
 1 ounce of Hydrozone 
 
 with 2 quarts of water, 
 alternating with a mixture of: 
 
 1 teaspoonful of Glycozone, 
 
 1 wineglassful of water, 
 will prevent the typhoid bacillus from entering into chemical combina- 
 tion with weakened animal cells. See article headed "Predisposition 
 to Disease," p. 5. 
 
44 
 
 It is the safest and most powerful antiseptic treatment, which always 
 prevents septicaemia. Gastric Ulcer which so often follows Typhoid 
 Fever (as a consequence of injurious drugs having been used) need 
 not be feared when Hydrozone and Glycozone are the only prescribed 
 antiseptic remedies. 
 
 This antiseptic medication does not preclude the general treat- 
 ment. 
 
 The treatment of Yellow Fever, Cholera Infantum, and Asiatic 
 Cholera is the same as above. 
 
 The following abstract of article by Dr. Elmer Lee contains full 
 information in reference to the treatment of Typhoid Fever, and I 
 am justified to state that as a preventive for this disease and for all 
 contagious diseases of the alimentary tract, Ozonized water adminis- 
 tered internally, w*ll always give the most satisfactory results. 
 
 TREATMENT OF TYPHOID FEVER. 
 
 By Dr. Elmer Lee, ok New York. 
 
 (Abstract from the Chicago Medical Record, April, 1894.) 
 
 According to Dr. Elmer Lee the keynote of the treatment is 
 cleanliness, external and internal. The value of cleanliness consti- 
 tutes one of the greatest discoveries of the age in medicine, and has 
 done more for therapeutics than all else. The important question in 
 Typhoid Fever is how to save life; produced by contaminated water, 
 there is elaborated in the intestine a poison, which if it could be 
 removed in time, the life and health of the infected would be saved. 
 Remaining, the poison is absorbed, and Typhoid Fever follows its 
 course. Now, if at this time the poisonous matter and germs in the 
 intestine can be neutralized by remedial measures or washed away, 
 the disease will be checked and health will be restored. 
 
 The first thing to do, in a suspected case of Typhoid, is to make 
 the patient surgically clean by free use of water internally first, and 
 externally afterwards. To do this the bowels are irrigated copiously 
 with hot water, containing some vegetable liquid soap such as Elixo. 
 This practice, gives the greatest of relief to the patient, and it is a 
 delight to the physician. Some authorities fear that something may 
 be ruptured by introducing into the intestine such large quantities of 
 
45 
 
 water, but, his experience shows that "the fear of doing harm maybe 
 entirely and forever dismissed." The procedure may at first be 
 troublesome, but practice soon overcomes this, and the method 
 will appear as easy as it is beneficial. The temperature of the 
 water used for this purpose should vary with the temperature of 
 patient; if high, the best results will be secured by using cool water 
 (about 75 F. ), whereas if the patient be chilly or the temperature be 
 low, the water should be heated to about ioo° F. During the first 
 week of Typhoid the irrigation should be used every morning and 
 evening, after which only one irrigation should be practiced every 
 day until convalescence. Bathing the body is important and should 
 be performed at regular intervals; if the patient is strong enough, the 
 bath tub should be used, but if not. sponging with cold water is grate- 
 ful, and reduces the temperature while it conserves the strength of the 
 patient. The wet pack, accomplished by wrapping the patient in a 
 wet sheet, is the most effective way of applying cold. He should be 
 left in the pack from one-half hour to an hour, or longer, if he is com- 
 fortable. This measure not only reduces the temperature, but by 
 opening the pores of the skin removes the waste products of the body. 
 
 The basis of the internal treatment is plenty of cold water to 
 drink, which cools the body and assists it in the elimination of the 
 poison produced by the bacteria. Dr. Lee says: "Let the sick have 
 water, it can do no harm in any case; water only does good." To 
 each tumblerful of water is added a half tablespoonful of Hydrozone, 
 as it is the best and safest antiseptic remedy that can be given in this 
 disease. This should be continued for a few days, and then Glycozone 
 substituted. Glycozone is harmless and can be taken as freely as pure 
 glycerine. It is best prescribed in teaspoonful doses, taken in a wine- 
 glassful of water several times a day. To allay nervousness and 
 induce sleep, from one-half to one grain of sulphate of codeine is given 
 by the mouth, or one-quarter to one-half grain hypodermically. 
 
 Dr. Lee advocates the above treatment because of its simplicity, 
 its rationality, and the fact that nearly every case is saved by it, when 
 uncomplicated. 
 
 The treatment summed up in brief, consists in : 
 
 First. — Irrigation of the bowel with water, either simple, or made 
 soapy with some pure liquid soap. 
 
4 6 
 
 Second. — Frequent sponging with cold water, or the use of the 
 wet pack. 
 
 Third. — Remedies: "Hydrozone and Glycozone, for the oxidizing 
 effect of the nascent oxygen, which is set free in the alimentary tract. 
 But to be of real value these remedies are to be taken in considerable 
 quantities largely diluted with water; the capacity of the bowels is so 
 great that a little of anything cannot spread over the enormous area 
 to affect it beneficially. Cleanliness is the principle governing the 
 use of Hydrozone and Glycozone." Codeine is the best remedy to 
 soothe, and to induce sleep. 
 
 Fourth. — Foods; Milk is the best; milk and whipped eggs and 
 pressed juice from boiled meat; the juice from ripe fresh fruit. 
 Nourishment should be taken regularly every four hours. Stimulants 
 and drugs are believed by the author to be injurious without exception. 
 
 Dr. Lee says: ''Typhoid Fever affects all cases, but if food and 
 water were always pure, no class or age need contract the disease. 
 Cleanliness everywhere and always is the means at hand which makes 
 it possible to escape Typhoid Fever and other diseases of the bowels. 
 Internal cleanliness as well as external is a reasonable proposition to 
 hope for the cure of the unhappy multitude of sick and discouraged 
 humanity." 
 
 See also articles headed: "H2O2 in Typhoid Fever," by Dr. H. F. 
 Wiggin,p. 92, — "The Treatment of Typhoid Fever," by Dr. M. A. 
 Clark, p. 150, — "Diseases of the Alimentary Canal," by Dr. J. O. De 
 Courcy, p. 156, — "The Requirements of a Modern Antiseptic," by 
 Dr. R. C. Kenner, p. 247, — "Predisposition to Disease," p. 5. 
 
 H2O2 IN CONTAGIOUS DISEASES. 
 
 CHOLERA — YELLOW FEVER — TYPHUS — TYPHOID FEVER. 
 
 By Cyrus Edson, M. D., New York. 
 Formerly Commissioner of Healthy Health Department, New York City. 
 (Abstract from The Doctor of Hygiene of New York City, April, 1893.) 
 The writer emphasizes in a few words, the fact that we have in 
 H2O2 a powerful antiseptic agent which may be administered with- 
 out harm to the human system, and by means or which the alimentary 
 tract can be more thoroughly disinfected than by any other agent in 
 
47 
 
 our present range of therapeutics. In other words, there is no other 
 antiseptic that will effect, the amount of germ destruction in the 
 alimentary tract without inflicting injury. 
 
 This is true for two reasons: 
 
 First. — H2O2 has no toxic properties and consequently may be 
 administered in larger amounts than can the toxic antiseptics. 
 
 Second. — H2O2 ranks higher as a bactericide than does any other 
 non-toxic agent, and indeed than do most of the toxic ones. 
 
 The elaborate reports made by such men as Paul Bert and Reg- 
 niard, Baldy, Pean, Larrive and Gibier, prove these two facts as con- 
 clusively as they can be proven. 
 
 It logically follows that we have in H2O2 a curative agent from 
 the use of which we may expect good results in cases of disease arising 
 from germ infection of the stomach and rjowels. 
 
 In this connection one fact must be borne in mind: H2O2 
 decomposes rapidly in the presence of organic compounds. We must 
 consequently administer the drug rather freely in order to produce 
 the best effects. Free irrigations of the lower intestines are devised 
 and recommended by Dr. Elmer Lee, of New York, (Medical Record, 
 December 17, 1892), so as to effect the greatest good. 
 
 In his paper Dr. Lee details the results of his experiments in 
 the treatment of Asiatic Cholera at St. Petersburg last year, and he 
 advocates the intestinal irrigation for the cure of the disease. 
 
 In addition to irrigation or washing out of the intestines, Dr. 
 Lee administers internally Marchand's H2O2 (medicinal), two ounces 
 diluted with eight ounces of distilled water, in cupful doses every two 
 hours. The addition of distilled water is made in order to increase 
 the bulk of fluid in the stomach. 
 
 It is the opinion of the writer, that this treatment will prove to 
 be "par excellence" in Cholera Nostras, Dysentery, Typhus and Ty- 
 phoid Fever. 
 
 In the latter disease H2O2 has already been used with beneficial 
 results, administered by the mouth. 
 
 For Yellow Fever H2O2 must be considered a specific. Gibier 
 has shown that this disease is characterized by the presence of micro- 
 organisms in the intestinal tract. 
 
 The writer has used a solution of H2O2 (medicinal) for washing 
 out the stomach through the syphon tube (lavage) in cases of Gastric 
 Catarrh, with most excellent results. 
 
The therapeutii range ol HaOa ig daily enlarging; arompara 
 tively new remedy, it has already won foi It sell s place in thi fori 
 most i.mks ol oui really valuable medii inal agenti. 
 
 The advance of medical Bcienci ia necessarily slow, becausi it 
 must follow in the wake of the development ol allied sciences, upon 
 win. h it depends foi its i esoun < 
 
 Chemistrj has only recently given us HaOa (medicinal) In its pure 
 form and to the efforts ol Charles Marchand, ol New York, more than 
 to any othei man, do we owe this Invaluable remedy, \ host ol 
 imitators have deluged the market with imitations, but the write] has 
 found his preparation /./. tit princepi 
 
 So i e Hydro one will always give bettei results than Man hand's 
 EiaOa (medicinal) on account ol its being twice the strength «-i I ii<- 
 Pei oxide. 
 
 Yellow Fevci'. Wconling to the recent researches made by 
 i >i Paul Gibier, it seems to be a positive fact that Yellow Fevei is 
 characterised by the presence of bacteria in the Intestines, This theorj 
 being supported by othei prominent bacteriologists, the most Logical 
 treatment, in ordei i<> Bubdue this Infectious disease, is f" admin 
 Lsti i some laxatives in i <>nn<-< tion with antiseptic n medii 
 
 The us.' ol poisonous antisepti* s .is .1 k-. i.il injei tion should be 
 absolutely discarded See article headed "Requirements ol an Inti 
 Beptic," i>. 7, and "The Rational Treatmenl «>i Diseases," i» 8, 
 
 Treat incut, i-v m< .ms of a hard rubbei rectal syringe an enema 
 should be administered three times daily, with one pint ol .1 mixture 
 made ol 
 
 1 .urn. <• ni 1 1 y.h ozone 
 
 with 1 quai 1 <>i lukewai m wato r, 
 
 rii. patient should retain the enema as long as 1 omfortable, and 
 hi must drink during the day, three oi foui tumblerfuls 61 Ozonized 
 water, made of one ounce ol Hydrozone diluted with two quarts "i 
 . «.i<i water, alternating with two tablespoonfuls ol Glycozone <iiini<<i 
 wii h hall .i 1 umblei ful <>' watei 
 
 rii. Internal administration <>i Ozonized watei during an epl 
 demii ol Vellow Fevei is the safest and most powerful preventive foi 
 
 I lir. .lis. .1 ,. 
 
 (See articles headed, Cholera Prevention and Treatment, b) 
 1 * * Eimei Lee, p. 160, The Rational Treatmenl <»i Gastrii and in 
 1. .1 inal 1 lisoi dei s, i> ',7.) 
 
49 
 
 Cholera Infantum. — Dysentery. — These summer complaints 
 which are characterized by the presence of pathogenic germs in the 
 alimentary tract, heal rapidly under the Ozonized water and Glycozone 
 treatment. 
 
 First. — Administer Ozonized water (made of one ounce of Hydro- 
 zone with two quarts of water) half an hour before meals in form of 
 tablespoonful to wineglassful doses, depending upon age of child. 
 
 Second. — Administer Glycozone immediately after meals in the 
 proportion of one teaspoonful diluted with a wineglassful of water. 
 
 In addition to the above local treatment of the stomach, an enema 
 should be administered morning and evening with a mixture of: 
 i ounce of Glycozone, 
 i pint of lukewarm water. 
 
 The discomfort which may be experienced by the patient after 
 drinking the Ozonized water is fully explained on p. 37, article 
 headed Dyspepsia. 
 
 The above treatment is safe and most effective in all cases. 
 
 In order to make Ozonized water more palatable, a small quan- 
 tity of honey may be added to it before drinking. 
 
 HYDROZONE AND MARCH AND'S EVE BALSAM 
 IN INFLAMMATORY AND CONTAGIOUS DISEASES OF THE EYE. 
 
 Marchand's Eye Balsam which is made of chemically pure Vege- 
 table Glycerine combined with fifteen times its own volume of Ozone, 
 is positively harmless, and its healing properties upon diseased tissues 
 of the eyes are most powerful. 
 
 Catarrhal Conjunctivitis, or Ophthalmia. — Causes. — The 
 profession well know that all forms of Conjunctivitis which are accom- 
 panied by secretion are characterized by the presence of germs which 
 develop imder more or less favorable circumstances, producing a local 
 infection which is contagious to the highest degree. 
 
 The virulence of the contagion increases with the impurity of 
 the atmosphere, and this disease is communicated by conveyance of 
 secretion from one to another, by towels, handkerchiefs, etc., with a 
 prodigious rapidity. 
 
 Besides a proper ventilation, it is necessary to isolate sick people, 
 and also to keep them perfectly clean, in order to prevent the con- 
 tagion; for instance, when any form of Conjunctivitis appears in a 
 
5° 
 public institution, it is urgent to put all the affected personsapart 
 
 from t he healthy. 
 
 Numerous analyses which I have made in order to ascertain the 
 nature of trie remedies ordinarily prescribed in diseases of the eyes 
 show that they are as follows: 
 
 Nitrate of Silver. — Sulphate of Zinc. -Sulphate of Copper. — Bichloride 
 of Mercury. — Red Oxide of Mercury —Calomel. -Carbolic Acid.— Alum. — 
 Sugar of Lead. — Tannin. — Borax. Boracic Acid. —Sulphate of Atropine. — 
 Cocaine. — Rose Water. — Etc. 
 
 See articles headed: Predisposition to Disease, p. 5, Requirements of 
 an Antiseptic, p. 7, Rational Treatment of Diseases, p. 8. 
 
 Although some of these remedies have a powerful destructi 
 
 act ion upon the microbian element which is present, such remedies 
 
 should be condemned, owing to their corrosive and irritating prop- 
 erties. They always injure the cornea, and very often destroy not 
 Only the germs, hut also weaken or even destroy the optie nerves; 
 for this reason their use proves more dangerous than the disease itself. 
 
 In fact, poisonous antiseptics destroy both the germs and the 
 
 health)' tissues with which they come into cont act . They also weaken, 
 the vitality of the healthy animal cells beneath, so that the microbial! 
 
 element constantly finds a soil which is favorable t<> its development. 
 
 Tannin, borax, boracic acid and rose water are not dangerous 
 remedies, but their bactericide power is so feeble that they could 
 not accomplish a cure. 
 
 On the contrary, I lydrozonc not only destroys the morbid ele- 
 ment but it restores the diseased tissues to their normal and healthy 
 condition. 
 
 Marc hand's Kye Balsam by its strengthening and healing proper 
 ties makes the mucous membranes of the eye grow stronger daily. 
 
 Treatment. — First cleanse and disinfect the eyelids by a thor- 
 ough washing made with a mixture of: 
 1 ounce of Hydrozone 
 with 2 quarts of water, 
 then, by means of a glass dropper, apply to the inner portion of the 
 eye, next to the nose, one or two drops of the Kye Balsam, every 
 night before retiring, and the first thing in the morning. 
 
 If no dropper is at hand, apply the remedy with a soft earners 
 hair brush, dipped in the Kye Balsam, to the outer t6ge of the e 
 with an outward motion of the brush, or it may be applied with the 
 
5i 
 
 finger. In whatever manner Marchand's Eye Balsam is applied, it 
 penetrates the inner surface of the eye by simply opening and shutting 
 the eye repeatedly a few times. 
 
 At first it causes smarting, and even very severe pain for a few 
 seconds, but it soon passes away. 
 
 Everybody knows, that owing to excessive tenderness of the 
 mucous membrane of the eyes, the application of any remedy always 
 causes a severe pain. Therefore the patient should know that if the 
 application of the Eye Balsam is quite painful, the relief of the trouble 
 is so promptly obtained, that he should not mind the pain. 
 
 Blepharitis heals promptly under the above treatment. 
 
 Purulent Conjunctivitis. — Ophthalmia Neonatorum, or 
 Ophthalmia in Children. —The oculists well know that Ophthal- 
 mia Neonatorum, or Ophthalmia in children, is much more dangerous 
 in its consequences than the Catarrhal Conjunctivitis. 
 
 This disease, which is the most frequent source of blindness in 
 children, can always be cured if treated as follows. 
 
 First. — Cleanse the eyelids by a'thorough washing with a mixture 
 made of: 
 
 i ounce of Hydrozone 
 
 with i quart of lukewarm water. 
 
 This Ozonized water should be used three times, or at least morn- 
 ing and evening, every day. 
 
 Each cleansing should be immediately followed by the application 
 of Marchand's Eye Balsam. 
 
 See article headed, H2O2 in Conjunctivitis, p. 154. 
 
 Granular Eyelids. — Same treatment as Catarrhal Conjunc- 
 tivitis. 
 
 In all diseased conditions of the eyes, patients should expose 
 themselves to air-draughts or bright light as little as possible, and the 
 bowels should be kept open by suitable internal medication. 
 
 Note, that when injurious antiseptics have been used for a long 
 time, the animal cells of the mucous membranes of the eyelids become 
 so weak that it requires more or less time before the Ozonized water 
 and Eye Balsam treatment may restore their vitality to its normal con- 
 dition, but in all cases the patient will promptly be relieved, and a 
 cure will be accomplished, providing no other remedies are applied. 
 
52 
 
 HYDROZONE 
 IN INFLAMMATORY AND PURULENT DISEASES OF THE EAR. 
 
 Owing to its wonderful bactericide properties, Hydrozone is of 
 great value in cases of .obstinate chronic suppuration of the middle 
 ear, especially in such cases where it is difficult to reach all the suppu- 
 rating tract by any harmless local agent. See article headed "Require- 
 ments of an Antiseptic," p. 7. 
 
 The fact that it can be forced through the osseous sinuses with- 
 out danger highly commends its value in these diseases. 
 
 In case of profuse suppuration, the cleansing and destruction of 
 pus should be made perfect by applying the remedy in the following 
 manner: 
 
 Treatment. — By means of either a glass or a hard rubber syr- 
 inge, inject repeatedly into the cavity, morning and evening, eight or 
 ten drops of warm Hydrozone full strength. Let the remedy act dur- 
 ing two or three minutes, then apply as a dressing, a small quantity 
 of absorbent cotton well impregnated with Glycozone. 
 
 Two washings with Hydrozone, followed by two dressings with 
 Glycozone, made every day, will cure the most obstinate chronic case 
 in a very short time. 
 
 When the disease is not chronic, the suppuration being rather 
 small, instead of applying Hydrozone, full strength, it should be 
 diluted with warm water, in the proportion of one ounce of Hydrozone 
 with two ounces of water. It is urgent to always use warm Hydro- 
 zone into the ear. 
 
 The local dressing should always be made with pure Glycozone, 
 as heretofore explained. (See articles headed "H2O2 and its uses in 
 Ear Diseases," by Dr. Walter B. Johnson, p. 108, — "Wax in the Ear," 
 by Dr. A. S. Tuckler, p. 91, — "Hydrozone in Purulent Otitis Media," 
 by Dr. Wm. Clarence Boteler, p. 211, — "Diseases of the Ear," by Dr. 
 Albert H. Buck. Abstract, p. 215,— "The Use of H2O2 in Diseases 
 of the Nose, Throat and Ear," by Dr. W. Scheppegrell, p. 224, — "The 
 Treatment of Chronic Suppuration of the Middle Ear," by Dr. Seth 
 Scott Bishop, p. 249, — "H2O2 in Mastoid Complications," by Dr. M. F. 
 Weymann, p. 252). 
 
53 
 HYDROZONE IN DENTAL SURGERY. 
 
 See articles headed Dental Medicine, by R. M. Chase, D. D. S. r 
 M. D., p. 94, — The Successful Treatment of Rigg's Disease, by H, 
 E. Lewis, M. D., p. 180. 
 
 Owing to its wonderful bactericide properties, Hydrozone can 
 be used without danger or risk of poisoning the patient, and yet it is 
 the strongest bactericide and purifier known; it should always be used 
 in order to cure promptly the dental diseases and Ulcerations of the 
 Mouth, which are known to be characterized by the presence of patho- 
 genic germs, such as, for example: . 
 
 Alveolar Abscess and Abscess of the Inferior Maxilla. 
 
 Laceration, Inflammation and Ulceration of the Gums, Rigg's 
 Disease, Stomatitis, etc. 
 
 Necrosis and Caries of the Teeth. 
 
 Dentists well know that the antiseptic agents used in the treat- 
 ment of these diseases have been as follows: 
 
 Salicylic Acid. — Chloride of Zinc. — Nitrate of Silver. — Creosote. — Car- 
 bolic Acid. — Boric Acid, Etc. See article headed "The Requirements of an 
 Antiseptic," p. 7. 
 
 With the exception of boric acid, which is powerless to destroy 
 the microbian element, the other above mentioned remedies are 
 poisonous, and owing to their corrosive properties, the dentists can- 
 not always limit their action to the affected parts. 
 
 Creosote and carbolic acid are most objectionable not only on 
 account of their being injurious to the surrounding healthy tissues but 
 also owing to their offensive odor. They should never be used. 
 
 On the contrary, Hydrozone is absolutely harmless, its odor and 
 taste being rather pleasant than objectionable to the patient. 
 
 By its healing and stimulating properties, the diseased surface is 
 made healthy and the surrounding tissues remain in their normal con- 
 dition. 
 
 It has no destructive action upon the enamel of the teeth. 
 
 A tooth, being submitted for several days to the action of 
 Hydrozone, full strength, remains intact, but it is bleached. 
 
 Hydrozone should never be made neutral before using. (See p. n.) 
 
 Alveolar Abscess and Abscess of the Inferior Maxilla. — 
 Treatment, — When an Alveolar Abscess is caused by any constitu- 
 
54 
 
 tional derangement, internal medication would necessarily have to be 
 prescribed. 
 
 The local treatment demanded is such as will destroy the accu- 
 mulated pus. 
 
 At first the Abscess should be opened, then the cleansing and 
 destruction of pus will be accomplished instantaneously, as follows: 
 By means of a silver, gold or platinum syringe, inject into the 
 cavity morning and evening, a mixture of: 
 i part of Hydrozone 
 with 6 to 8 parts of water. 
 In case of Abscess of the Inferior Maxilla, where there is no 
 free egress for the pus and debris, much more energetic treatment is 
 required, and the dentist need not hesitate to inject morning and 
 evening, a mixture of- 
 
 i part of Fiydrozone 
 with 4 parts of water. 
 In chronic cases, in order to prevent the sore from closing be- 
 tween two applications, floss silk, or absorbent cotton impregnated 
 with Glycozone, should be thrust into the cavity immediately after 
 each cleansing. 
 
 In addition to the above local treatment, the mouth should be 
 kept clean by copious washings (especially after eating), with a mixt- 
 ure made of: 
 
 i tablespoonful of Hydrozone 
 diluted in i tumblerful of tepid water. 
 By following this treatment, the diseased tissues become strong 
 and healthy after one or two applications,and an absolute cure is accom- 
 plished in half the ordinary time. 
 
 Laceration, Inflammation and Ulceration of the Gums. — 
 Stomatitis. — Treatment. — Hydrozone is the most powerful rem- 
 edy which may be applied in order to subdue these tenacious and 
 painful affections. 
 
 It should be used freely and repeatedly as a mouth-wash, morn- 
 ing and evening, in the following proportion: 
 i ounce of Hydrozone 
 diluted with i pint of water. 
 Rinse the mouth repeatedly, and retain the liquid for one minute 
 or so at each washing. No injurious action whatever upon the 
 enamel of the teeth need be feared. 
 
55 
 
 The gums are strengthened by this treatment, healthy granula- 
 tions develop rapidly, and an absolute cure is quickly effected. 
 
 When the above mentioned diseases are caused by constitutional 
 derangement, internal medication would necessarily be prescribed. 
 
 Necrosis and Caries of the Teeth. — Caries is a very common 
 cause of Necrosis. Excessive medication, especially with mercury, 
 will often produce partial, and occasionally, total Necrosis. 
 
 Dentists know that the most common agents that injure the teeth 
 are originated in the mouth by the decomposition of animal and vege- 
 table food. 
 
 Inflammation of the mucous membrane of the mouth is a common 
 result of diseased teeth. 
 
 The Caries may be constitutional or local; if constitutional, it 
 may be modified by therapeutic treatment of the general system. 
 
 In all cases of Caries, the disease will always be checked by using 
 frequently and copiously, as a tooth wash, a mixture of: 
 2 ounces of Hydrozone 
 with i pint of water. 
 
 Rinse the mouth well, at least morning and evening, and retain 
 the liquid for one minute or so at each washing. 
 
 When the Caries is local, the above treatment may promptly 
 accomplish a cure. 
 
 Dr. J. A. Whipple, Prof, of Anatomy, Northwestern College of 
 Dental Surgery, of Chicago, recommends the use of Hydrozone to 
 bleach discolored or devitalized teeth, in the following manner: 
 
 "In order to obtain the best results, saturate a small pledget of 
 cotton in Hydrozone, place it in the cavity, and then turn on hot air, 
 repeating until the desired shade is obtained." 
 
 Rigg's Disease. — Loosening of the teeth, characterizes this 
 peculiar disease. Although all sorts of remedies have been used in 
 Rigg's disease, still the dental profession acknowledge that they have 
 failed to even relieve their patients of this trouble. 
 
 Hydrozone, by its healing and strengthening action upon the 
 gums, quickly checks this trouble when applied at an early stage of 
 the disease. 
 
 In that case, the remedy should be used as a mouth wash morn- 
 ing and evening, also after eating, in the proportion of: 
 2 ounces of Hydrozone 
 with i pint of water. 
 
56 
 
 When the disease has developed, by means of a soft camels' hair 
 brush, apply Hydrozone, full strength, to the gums, morning and 
 evening and wash the mouth repeatedly, at least every three hours, 
 also after each meal, with a mixture of: 
 4 ounces of Hydrozone 
 with i pint of water. 
 
 Rinse the mouth well, and retain the liquid for one minute or so 
 at each washing. 
 
 The above treatment will accomplish an absolute cure of Rigg's 
 disease in a very short time, if earnestly followed by the patient. 
 
 HYDROZONE AS A MOUTH AND TOO III WASH. 
 
 By means of a medium hard tooth brush, scrub the teeth well 
 and rinse the mouthrepeutedly morning and evening with a mixture of: 
 i tablespoonful of Hydrozone, 
 i tumblerful of tepid water. 
 The mouth and teeth will be kept clean, the breath sweetened, 
 and a pleasant and delightful effect produced. 
 
 Teething. — Dentition. — In order to either prevent or subdue 
 the irritation produced by the pressure of the tooth on the superin- 
 cumbent gum (sometimes causing Pyrexia, Convulsions, Diarrhoea, 
 etc.) apply to the gums several times during the day, a mixture of: 
 i part of Hydrozone, 
 4 parts of water. 
 It is safe and effective. 
 
 HYDROZONE IN CHRONIC AND ACUTE ULCERS. 
 
 Open Sores, Abscesses, Carbuncles, Cancerous Sores, 
 Lupus, Burns, Syphilitic Sores, Etc. — See the following reports 
 of cases: "The Operative Treatment of Kistula-in-Ano," by Dr. Lewis 
 H. Adler, Jr., p. 109, — "Wound Closure after the Empyema Operation," 
 by Dr. Charles W. Aitkin, p. 98, — "H2O2 in Pelvic Abscess, " Bacterio- 
 logical World, editorial, p. 94, — "An Interesting Case of Empyema 
 with Special Reference to the Use of H2()2,"by Dr. H. F. lirownlee, 
 p. 99, — "Treatment of Acute and Chronic Ulcers," by Dr. James Os- 
 born DeCourcy, p. 147, — "A Resume of the History and Practical Ap- 
 plication of H2O2 in Surgical Affections," by Dr. S. Potts Eagleton, 
 p. 84, — "Some of the Uses of H2O2 in General Surgery," by Dr. Th. 
 
57 
 
 H. Manley, p. no, — "The Etiology, Diagnosis and Treatment of 
 Ulceration of the Rectum," by Dr. Joseph M. Mathews, p. 141, — "The 
 Necessary H2O2," by Dr. Robert T. Morris, p. 72,— "The H2O2 
 (medicinal), an Indispensable Wound Sterilizer," by Dr. George H. 
 Pierce, p. 106, — "Sinus Treated with H2O2" "Practice," editorial, p. 
 81, — "Intestinal Obstructions, Diagnosis and Treatment," by Dr. Fred- 
 erick Holme Wiggin, p. in, — "Pathology and Treatment of Indolent 
 Ulcers," by Drs. P. N. Russel, G. H. Aiken and A. J. Pedlar, of 
 Fresno, Cal., p. 235, — "A Case of Traumatic Synovitis of the Knee, 
 Operation, Recovery," by Dr. H. C. Dalton, p. 238, — "A Case of Lupus 
 of Six Years' Standing," by Dr. Truman Sexsmith, p. 246, — "Essential 
 Requirements of a Modern Antiseptic," by Dr. Robert C. Kenner, p. 
 247, — "The Treatmentof Chronic Suppuration of the Middle Ear," by 
 Dr. Seth Scott Bishop, p. 249, — "H202in Mastoid Complications," by 
 Dr. M. F. Weymann, p. 252, — "An Ulcer Resulting from Anthrax, and 
 Its Treatment," by Dr. J. Osborn DeCourcy, p. 254. 
 
 Hydrozone is the most powerful pus destroyer and cleansing agent 
 for pus discharging surfaces, for the instant it touches pus, Ozone is 
 set free, effervescence takes place and continues until Hydrozone and 
 pus are both decomposed. Physicians may apply this remedy with per-, 
 feet safety, in abdominal surgery, to cleanse and sterilize the peritoneal 
 cavity, as they will always meet with the most satisfactory results, pre- 
 venting blood poisoning after a surgical operation. See article headed, 
 "The Requirements of an Antiseptic," p. 7. 
 
 Hydrozone and Glycozone are most successfully used in the 
 treatment of all open sores, acute or chronic: 
 
 Open Boils, Open Abscesses, Phlegmonous Abscesses, Buboes, 
 Mastoid Abscesses, Acute or Chronic Ulcers (syphilitic or not), 
 Chancres, Scrofulous Sores, Piles, Fistula, Lupus, Cancerous Sores, 
 Bed Sores, Gangrenous Sores, Broken Ampulla or Blisters, Burns, 
 Aphthae, Ulceration of the Mouth, Stomatitis, Rigg's Disease, Skin 
 Diseases, Herpes Zoster or Zona, Psoriasis, Salt Rheum, Eczema, 
 Poisoning Ivy, Itch, and all microbian affections. 
 
 Treatment. — As a rule the above mentioned diseases should be 
 treated as follows: 
 
 First. — By means of a glass dropper or a camel's-hair brush, apply 
 Hydrozone to the sore, and take care not to remove the white foam 
 which generates when it comes in contact with the diseased surface; 
 let it remain until it disappears, which occurs in a few minutes. 
 
Then, by means of a glass dropper or otherwise, apply Glycozone 
 to the sore and complete the dressing with a double thickness of 
 surgical lintsoaked in Glycozone. Cover the whole with oiled silk so 
 as to prevent drying. 
 
 It is advisable to apply Hydro/one and Glycozone full strength, 
 until the pus formation is checked, but in case of excessive tench i 
 ness of the sore. Hydro/one may be used diluted with water, and 
 Glycozone should be diluted with chemically pure glycerine. 
 
 When the discharge ceases being profuse, Hydro/one must 
 always be used diluted with water, and Glycozone should be thor- 
 oughly mixed with chemically pure glycerine, in order to prevent the 
 healthy granulations from forming too quickly. 
 
 The degree of dilution should vary with the rapidity with which 
 the healthy granulations develop. 
 
 In all cases the dressing should be covered with oiled silk. 
 
 Note, that although Glycozone deteriorates by absorbing the mois- 
 ture of the air, (the deterioration beginning to take place only after 
 18 to 24 hours) it gives the best results when applied as a dressing t<> 
 a surface which has been previously cleansed and rendered aseptic 
 by Hydrozone. Its action takes place before the water interferes 
 with its healing properties. Healthy granulations develop quickly 
 and the vitality of the surrounding tissues become strong enough (<> 
 resist the destructive action of vegetable cells (germs). In fact it 
 prevents the organic chemical reaction mentioned on p. 5, from tak- 
 ing place. 
 
 Anthrax — Carbuncle. — This affection which is characterized 
 by the presence of the bacillus anthracis, is at first a local disease 
 which requires a most powerful antiseptic treatment, as soon as the 
 Carbuncle has been opened by a surgical operation. 
 
 The bacillus anthracis, is readily neutralized or rendered inert by 
 Hydrozone. See article headed, "H2O2 and Ozone, Their Anti- 
 septic Properties," by Dr. Paul Gibier, p. 73. I lydrozone being twice 
 as powerful as Marchand's H2O2 (medicinal) its destructive action 
 upon anthracis bacillus is twice as active. 
 
 Treatment. — Wash or irrigate the sore morning and evening with 
 Hydrozone, full strength, taking great care that the liquid should l><- 
 thrust into the discharging sinuses, so as to secure a thorough con- 
 tact with the microbian element; the germs and the pus are destroyed, 
 
59 
 
 by the oxidizing action of the remedy, the cleansing and disinfection 
 of the sore being perfect. 
 
 As a local dressing a double thickness of surgical lint should be 
 soaked with Glycozone and applied to the sore. Cover the dressing 
 with oiled silk. See article headed "Ulcer Resulting from Anthrax," 
 by Dr. J. O. De Courcy, p. 254. 
 
 The above local treatment does not exclude the internal medication. 
 
 Cancerous Sores. — Gangrenous Sores. — Lupus. — Treat- 
 ment. — When a Cancer has been thoroughly removed by the knife, 
 (preferably by means of the thermo-cautery) an absolute cure of the 
 wound may be accomplished by repeatedly applying to the sore, 
 morning and evening, Hydrozone full strength, until the cleansing has 
 been made perfect. 
 
 Then, as a local dressing, a double thickness of surgical lint 
 should be soaked with Glycozone and applied to the sore. Cover the 
 dressing with oiled silk. 
 
 Same treatment for Gangrenous Sores and Lupus. 
 
 When Cancerous Sores have been previously treated by means of 
 injurious remedies, the life of the surrounding tissues is impaired to 
 such an extent, that in most all cases, the Hydrozone and Glycozone 
 can only give relief to the patient, and prevent the sore from becoming 
 aggravated. 
 
 On the contrary, when Hydrozone and Glycozone are used, from 
 the beginning, a cure may be accomplished in a very short time. 
 
 The offensive odor which characterizes Cancerous Sores is thor- 
 oughly removed by following the above treatment, and the patient is 
 made comfortable. (See articles headed "H2O2 as a Deodorizer in 
 Cancer of the Uterus," p. 101, — "A Case of Lupus of Six Years' 
 Standing," by Dr. Truman Sexsmith, p. 246.) 
 
 Empyema. — Collection of pus or other abnormal fluid in some 
 cavity of the body and particularly in that of the pleura, which is 
 called Pleural Empyema, following Pleurisy, may be cured by the 
 following treatment: 
 
 First. — Perform an opening into the pleural cavity and allow the 
 pus to run out. 
 
 Second. — By means of a double current hard rubber catheter, 
 inject slowly into the cavity two ounces of Hydrozone (full strength). 
 
6o 
 
 The gas (white foam) which generates, will find a free egress through 
 the outlet opening of the catheter. 
 
 When the accumulation of pus is great (sometimes 4 to 8 quarts), 
 the Hydrozone should be injected twice at each dressing, so as to 
 thoroughly destroy the pus, and at the same time, check its formation. 
 This being done, inject two ounces of Glycozone and insert a drainage 
 tube (rubber tubing) into the opening. The patient will be relieved 
 at once, and an absolute cure may be accomplished inside of two to 
 four weeks. 
 
 No other antiseptics should be used, as it might interfere with 
 the cleansing and disinfecting properties of Hydrozone, also with the 
 healing action of Glycozone. See articles headed, "Wound Closure 
 After the Empyema Operation," by Dr. Chas. Aitkin, p. 98,-" An Inter- 
 esting Case of gmpyema," by Dr. H. F. Brownlee, p. 99. 
 
 ULCERATION OF THE RECTUM.— PHAGEDENIC CHANCRE.— 
 
 FISTULA-IN-ANO.— PILES. 
 
 Ulceration of the Rectum. — When the Ulceration is external, 
 a cure may be promptly accomplished by frequent and repeated 
 applications of a mixture made of: 
 1 ounce of Hydrozone 
 with 4 to 8 ounces of water. 
 
 When the parts have been thoroughly cleansed and disinfected, 
 apply a small quantity of Glycozone all over the surface. Avoid 
 scratching. 
 
 In cases of Ulceration of the lower gut, inject into the rectum 
 two fluid ounces of the above mixture, retain it as long as comfor- 
 table. 
 
 Immediately after evacuation, administer a rectal injection with 
 one ounce of pure Glycozone. The above treatment is safe and at 
 the same time more powerful than any medication which may be 
 prescribed in order to subdue this troublesome disease. 
 
 Phagedenic Chancre of the Rectum. — Treatment.— The 
 
 appropriate internal medication being prescribed by the attending 
 
 physician, will help considerably to accomplish a cure of this disease. 
 
 Asa local treatment, Hydrozone, full strength, should be applied 
 
 repeatedly, morning and evening, so as to cleanse the sore and ren- 
 
6i 
 
 der it aseptic, then apply a small quantity of Glycozone and avoid all 
 external causes of irritation. 
 
 Fistula-in-Ano. — Whatever may be the depth of the Fistula, 
 and whatever may be the pain which accompanies the application of 
 the remedy, Hydrozone, full strength, should be injected repeatedly 
 morning and evening, by means of a glass syringe, until the cleansing 
 of the cavity is made perfect. Usually, three injections administered 
 at each dressing will be sufficient. 
 
 This being done, insert into the sore a roll of absorbent lint 
 impregnated with pure Glycozone, so as to reach as near as possible 
 the bottom of the cavity. 
 
 As soon as the healthy granulations begin to generate, apply 
 Hydrozone diluted with water in the proportion of one ounce of 
 Hydrozone with four ounces of water, because it is important that 
 the sore should heal slowly. 
 
 See articles headed: "The Operative Treatment of Fistula-in- 
 Ano," by Dr. Lewis H. Adler, Jr., p. 109, — "Abstract from a 
 Treatise on the Diseases of the Rectum, Anus and Sigmoid Flexure," 
 p. no, — also "The Etiology, Diagnosis, and Treatment of Ulceration 
 of the Rectum," by Dr. Joseph M. Mathews, p. 141. 
 
 Piles, (External.) — Treatment. — When Piles are external, a 
 prolonged bathing of the parts, being attended to, morning and even- 
 ing, with a mixture made of one ounce of Hydrozone with four ounces 
 of water, followed by an application of Glycozone, full strength, will 
 accomplish promptly an absolute cure of this trouble, providing the 
 constipation (which is one of the causes of this disease) is sub- 
 dued by a proper medication of the alimentary canal. Avoid 
 scratching. 
 
 See p. 43, article headed, Constipation. 
 
 Piles, (Internal.) — One ounce of the above mixture of Hydro- 
 zone with water, should be injected into the rectum morning and 
 evening. Retain it for one minute, then inject one ounce of Glycozone. 
 Use always a glass or hard rubber syringe. 
 
 Hemorrhage will promptly be subdued by the above treatment. 
 
 See p. 225, article by Dr. M. F. Coomes, — also p. 13, Nasal Hem- 
 orrhage. 
 
 Note that the abuse of cathartics and laxatives will, in most all 
 cases aggravate the piles. (See p. 43, Constipation.) 
 
62 
 
 THE RATIONAL TREATMENT - 
 OF 
 ACUTE AND CHRONIC DISEASES OF THE GENITO-URINARY TRACT. 
 
 Inflammatory and suppurative diseases of the genitourinary tract 
 are always characterized by the presence (into either the urethra, 
 vagina or uterus) of pathogenic germs. 
 
 The prolonged contact of germs with weakened animal cells of 
 the mucous membrane, causes a morbid condition, which is accom- 
 panied with suppuration. 
 
 By referring to article headed Predisposition to Disease, p. 5, it 
 will be readily understood, that all individuals are not equally predis- 
 posed to catch disease. It is only when the animal cells of the mucous 
 membrane of the genito-urinary tract are weak, that is to say, when 
 their vitality is impaired, that the microbian element may cause dis- 
 ease. 
 
 When the animal cells are strong and full of life, the pathogenic 
 germs are readily neutralized or else driven away from the system, 
 therefore no disease sets in. 
 
 When our animal cells are powerless to either neutralize or else 
 drive away from the system the microbian element, antiseptic reme- 
 dies must be resorted to, so as to help nature in its work. 
 
 The list of antiseptics, which are used in diseases of the genito- 
 urinary tract, is given on p. 7. 
 
 On account of being injurious to healthy tissues, these drugs 
 destroy both the pathogenic germs and the animal cells. 
 
 Therefore, they may aggravate the disease by weakening slowly 
 but constantly, the surrounding healthy tissues. In fact, they do 
 fully as much harm as the microbian element itself. 
 
 I feel justified to repeat here, that whenever a patient recovers 
 under the action of injurious drugs, "Nature has surely accomplished 
 wonders," since it has been powerful enough to either eliminate or else 
 neutralize both poisons, viz. : the toxines and the injurious drugs. 
 
 The rational treatment of suppurative and inflammatory diseases 
 of the genito-urinary tract is based upon the use of a powerful anti- 
 septic, answering certain requirements. See p. 7, article headed 
 Requirements of an Antiseptic, where I explain that Hydrozone (30 
 
63 
 
 volumes aqueous preserved solution of H2 O2) which is always on a 
 strain to break up into water and Nascent Oxygen near to the condi- 
 tion of Ozone, is bound to fill all the requirements of a powerful and 
 at the same time harmless antiseptic. It is the most powerful 
 oxidizing agent known, and yet it is harmless. 
 
 GONORRHOEA. — GLEET. — URETHRITIS (SPECIFIC OR NOT,) ETC. 
 
 Treatment. — By means of either a glass or hard rubber pointed 
 syringe, administer (morning, noon and night) injections with a mix- 
 ture made of: 
 
 1 ounce of Hydrozone, 
 
 10 to 20 ounces of water, 
 
 according to the degree of sensitiveness and irritability of the urethra; 
 retain the remedy into the urethra for a few seconds. In acute cases 
 when the mucous membrane is exceedingly tender,reduce the strength to 
 
 1 ounce of Hydrozone, 
 30 ounces of water. 
 
 In a female, the urethra being about one inch and a half long, 
 (while in the male the urethra is from eight to ten inches long) one 
 portion of the above mixture may find its way into the bladder, but it 
 could not produce any pressure owing to the fact, that being very wide 
 at its commencement, the urethra allows a free egress for the Nas- 
 cent Oxygen gas which instantly generates when Hydrozone comes 
 in contact with the unhealthy secretions. 
 
 In case of Chronic Gonorrhoea or Gleet, in addition to the above 
 treatment, the physician should prescribe one injection with Glycozone, 
 (pure or diluted with C. P. Glycerine) immediately after using the 
 Hydrozone. 
 
 In this way, Glycozone will act upon a clean surface, promoting 
 healthy granulations and accelerate the cure. 
 
 The dangers of stricture resulting from the use of caustic and 
 astringent drugs are avoided, when the attending physician follows 
 the above local treatment. 
 
 The internal treatment should consist of anaphrodisiac remedies, 
 such as, bromide of potassium, iodide of potassium, camphor and 
 purgatives, as they help to accomplish a cure. Pure oil of Santa! 
 
6 4 
 
 wood such as Santal Middy gives also the most gratifying results, 
 especially in acute cases. 
 
 All physical causes of local irritation and alcoholic beverages 
 should be strictly avoided. 
 
 When the urethra is exceedingly tender, in acute cases, each 
 injection of diluted Hydrozone should be preceded by cocaine or 
 ether, for the purpose of quieting the smarting. See articles: "H2O2 
 in Gonorrhoea," by Dr.R.Charest, p. 69, — U H202 in Gynecology and in 
 Obstetrics," by Dr. Egbert H. Grandin, p. 79, — "H2O2 in Chronic 
 Gonorrhoea," by William Roberts, Hospital Steward, U. S. A., p. 100, — 
 "H2O2 in Cancer of the Uterus," by Dr. Geo. W. Kaan, p. 101. — 
 "H2O2 in Gonorrhoea with Report of a Case," by Dr. J. J. Sullivan, p. 
 125, — "Hydrozone for Disorders of the Genito-Urinary Tract," by Dr. 
 John Aulde, p. 229, -"Essential Requirements of a Modern Antiseptic," 
 by Dr. Robert C. Kenner, p. 247, — "Hydrozone and Glycozone in 
 Gonorrhoea," by Dr. Warren E. Day, p. 256. 
 
 women's weaknesses. 
 
 Whites. — Leucorrhcea. — The Whites or Uterine Catarrh 
 resuLts from acute or chronic inflammation, or from irritation of the 
 membrane lining the genital organs of the female. 
 
 Vaginal Leucorrhcea as well as Uterine Leucorrhcea are often 
 attended with pain and a sense of heaviness in the back, loins, abdomen 
 and thighs, with gastric and intestinal disorders. (See article headed 
 "The Rational Treatment of Gastric and Intestinal Disorders," p. 37.) 
 
 All forms of Leucorrhcea require the local use of a powerful and 
 at the same time harmless antiseptic. See article headed: "The 
 Requirements of an Antiseptic," p. 7. 
 
 Astringent injections which are so often employed, especially 
 when the discharge is great, cannot do any good, since they have no 
 healing properties whatever, upon the inflamed surface. They merely 
 deceive the patient. 
 
 Poisonous antiseptics invariably aggravate the trouble, by weaken- 
 ing the tissues. On the contrary, Hydrozone by its stimulating and 
 healing action upon the diseased mucous membrane, restores the 
 
64 A 
 
 tissues to a healthy condition and checks the discharge in a very short 
 time. 
 
 The best results are obtained as follows: 
 
 Treatment. — By means of a fountain syringe (free from metal- 
 lic parts) such as the King's Thermometer syringe, vaginal douches 
 should be administered morning and evening, with a mixture made of: 
 
 1 to 4 ounces of Hydrozone, 
 
 2 pints of warm water, 
 
 according to the amount and nature of the discharge. 
 
 When the discharge is profuse and its odor offensive, use as a 
 douche a stronger mixture made of: 
 
 4 to 6 ounces of Hydrozone, 
 2 pints of water, 
 
 until the offensive odor disappears. 
 
 Clitoritis, or inflammation of the clitoris, which is so troublesome 
 on account of the constant itching and burning sensation, may be 
 promptly subdued by applying Hydrozone, full strength to the parts, 
 morning and evening, following with Glycozone. I mention this 
 local affection, because when neglected, it may cause serious vaginal 
 disorders. If adhesions are present, of course they should be 
 broken up. 
 
 Vaginitis. — Inflammation of the vagina accompanied with 
 leucorrhcea, should be treated as above explained. (Whites.) 
 
 In case of vaginitis granulosa, owing to the growth of papillary 
 projections or pathogenic growths, on the surface of the membrane, 
 administer douches morning and evening with diluted Hydrozone, 
 (See article headed Whites,) then at night before retiring, a suitable 
 pledget of prepared lamb's wool, which is tied around with a string 
 (for easy withdrawal) being impregnated with Glycozone, should be 
 introduced into the vagina. 
 
 Metritis. — Endometritis. — Ulceration of the Cervix 
 Uteri. — Treatment. — Inflammation of the uterus either in its 
 internal or external lining membrane, may be quickly relieved by 
 vaginal douches administered with diluted Hydrozone, but in order 
 to accomplish a cure, in addition to the douches, injections should be 
 administered every day, into the uterus with a mixture made of: 
 
(. pi 
 
 2 to s miners of I lydrozone, 
 i quai t ol warm water, 
 Vaginal iloiu lu-s with diluted llydroione, morning and evening, 
 will keep the parts clean and healthy 
 
 \t night, apply Glycozone on a tampon as explained (See 
 \ aginitis). 
 
 Caution. Although in some eases an ordinary dilatation maj 
 
 be employed to distend the cervix, so as to permit a free egress oi 
 
 the nascent oxygen gas whieh generates I have sli.uir. te.isoie. Im 
 recommending the use of a double eurrent hard rubbei catheter, foi 
 in jeCt ions intO the uterus. 
 
 The Pritsch'^ douche double current catheter answers this pur- 
 pose, The llydro/.one entering the uterine cavity is quickly decom 
 posed into nascent oxygen, the unhealthy secretions are readil) 
 destroyed, while the white foam and debris come out through the 
 
 return flow. 
 
 in this way, no abnormal pressure develops into the uterus, * on 
 sequently, no morbid element can be forced through the Fallopian 
 tubes into the peritoneal cavity, causing uncontrollable disordei 
 Peritonitis in the most acute form would set in and cause the patient's 
 death, 
 
 This cut illustrates the I I its, h 's .Ion. h,-, ,l.»ul»!<- .uiinil, I.m iilniiu< InjeCtlOM 
 
 Cancer and Gangrene of the Uterus should he treated 
 explained at the article headed Metritis ami Kndo metritis, p, <> | i, 
 
 As a deodorizer, in earner ol the utei us, Hydrosone, full strength 
 injected into the uterus, gives the most gratifying results, but owing 
 to the fact that it cannot reach the scat ol the malignant growth, .1 
 cure cannot be accomplished. See article headed: "I I .•( >• is a Deo 
 dorizer in Cancer oi the Uterus," by i>r. (■. W, fctaan, p, rox, 
 
 In Chronic Endometritis and Uterine Ulcer, with accumu 
 lation ol RIUCO pus, llydro/.one being injected (into the uterus) lull 
 
64c 
 
 strength, accomplishes chemically a thorough cleansing of the internal 
 lining membrane, and it does away with the dangers following the 
 curettage of the uterus. The morbid element is destroyed by the 
 Hydrozone, and the surrounding healthy tissues remain intact. 
 
 On the contrary, by curetting the uterus, the surgeon not only 
 removes the muco pus and debris, but also some of the healthy tis- 
 sues, leaving the surface beneath in a dreadful condition. See articles, 
 "H2O2 in Gynecology and Obstetrics," by Dr. Egbert H. Grandin, p. 
 79, — ''Treatment of Vaginitis," by Dr. Hermann L. Collyer, p. 126, — 
 "Chronic Cervical Endometritis," by Dr. Walter S.Wells, p. 163, — 
 "Local Treatment of Uterine and Vaginal Diseases," by Dr. W. C. 
 Wile, p. 167,— "A Case of Protracted Labor," by Dr. J. N. Upshur, 
 p. 220, — "Hydrozone for Disorders of the Genito-Urinary Tract," by 
 Dr. John Aulde, p. 229, — "Essential Requirements of a Modern Anti- 
 septic," by Dr. Robert C. Kenner, p. 247. 
 
 Note. — As a preventive for inflammatory and contagious diseases of the 
 genito-urinary tract (either in the male or female) a thorough washing, 
 followed by an injection (immediately after exposure) with a mixture of one 
 ounce of Hydrozone to a pint of water, will cleanse the parts and destroy 
 all germs instantaneously. No disease whatever need be feared when the 
 above directions are followed. By coagulating the albuminoid medium in 
 which germs can develop, it makes an improper soil for their growth, there- 
 fore they are annihilated. 
 
 Pelvic Abscess.— Abscess of the Vagina. — Treatment. — 
 
 In case of Pelvic Abscess and Abscess of the Vagina, the profuse sup- 
 puration following a surgical operation may be quickly subdued by 
 injecting repeatedly into the sore, Hydrozone full strength. The 
 large amount of unhealthy secretions which are present in the vaginal 
 cavity dilutes the Hydrozone so much, that it is always advisable to 
 use it full strength. 
 
 As soon as the discharge ceases being profuse, inject morning and 
 evening a mixture made of: 
 
 1 to 4 ounces of Hydrozone, 
 16 ounces of warm water, 
 
 taking great care that the patient should be kept in a recumbent 
 position. 
 
When healthy granulations generate too quickly under the 
 
 Stimulating action of HydrOZOne, USea still weaker solution. 
 
 After each cleansing of the sore, apply Glycozone on absorbent 
 
 lint, as explained in the article headed Vaginitis, p. d j i. 
 
 Fistula (Recto-Vaginal). — Treatment. — In chronic cases, 
 
 especially when injurious antiseptics have been used, in order to 
 restore the life of the animal cells to its normal condition, Hydro/one 
 lull strength should he injected into the sore, no matter how painful 
 it may be. 
 
 As soon as the diseased tissues assume a healthy appearance 
 inject into the cavity, morning and evening, a weaker mixture made of: 
 i ounce of 1 I ydroxone, 
 4 to 8 ounces lukewarm water. 
 
 Complete the dressing by inserting into the cavity a roll of 
 absorbent lint impregnated with Clyeozonc. 
 
 INFLAMMATORY and SUPPURATIVE DISEASES OF THE BLADDER. 
 
 PURULEN i ' 1 situs. 
 
 Cystitis may be acute or chronic; it is a Catarrhal Inflammation 
 of the lining membrane of the bladder, accompanied with suppuration. 
 In chronic cases, the internal membrane is coated with a thick deposit 
 of dead mucous membrane. 
 
 In all cases of Cystitis, the patient should observe a careful diet, 
 avoiding irritating beverages, alcohol, etc. 
 
 Antiseptic remedies should be resorted to, as^a local treatment. 
 Therefore, Hydrozone which readily destroys, and at the same time 
 Stimulates healthy granulations, is indicated, and when used in time, 
 it does away with complications, which so often arronipany Cystitis, 
 
 such as (rangrene of the Bladder, etc. .See article headed "Require- 
 ments of an Antiseptic," p. 7. 
 
 The best results are obtained as follows: 
 
 Treatment. — By means of a double current hard rubber cathe 
 
 ter, irrigate the bladder morning and evening, with six to eight fluid 
 ounces of a mixture made of: 
 
 1 ounce of I Iydrozone, 
 
 1 pint of water. 
 
64E 
 
 At the beginning of the treatment of Chronic Cystitis, half an 
 ounce (or even one ounce) of Hydrozone full strength, should be in- 
 jected into the bladder every day, using a double current hard rubber 
 catheter so as to allow a free egress for the nascent oxygen gas which 
 generates. 
 
 In cases of Urethritis, Acute Inflammation or Ulceration of the 
 Bladder when the pain is very great, Dr. Robert T. Morris, recom- 
 mends the use of cocaine or ether before the application of H2O2 or 
 Hydrozone, for the purpose of quieting the smarting. (See articles 
 headed, "The Necessary H2O2," by R. T. Morris, M. D., p. 72, — 
 "H2O2 in Gynecology and in Obstetrics," by Dr. Egbert H. 
 Grandin, p. 79, — "Hydrozone for Disorders of the Genito-Urinary 
 Tract," by John Aulde, M. D., p. 229.) 
 
 In addition to the above treatment a cure can be accomplished in 
 a much shorter time by injecting once daily into the bladder (after it 
 has been cleansed by Hydrozone) one ounce of Glycozone. Allow it 
 to remain in the bladder. 
 
 The above remedies are the most powerful topical agents to use 
 in order to subdue inflammatory diseases of the bladder. 
 
 Nephritis can be successfully treated by Ozonized water, alter- 
 nating with doses of Glycozone. See article headed, "Suppurative 
 Nephritis, Report of a Case," by Dr. W. Peterson, p. 256. 
 
 Diabetes can be checked and even cured by following the Ozonized 
 water and Glycozone treatment as explained in the article headed, 
 Gastric and Intestinal Disorders, p. 37. 
 
 HYDROZONE AND GLYCOZONE IN SKIN DISEASES. 
 
 Eczema.— Psoriasis. —Salt Rheum. — Lupus. — Itch. — Bar- 
 bers' Itch. — Erysipelas. — Sun Burn. — Ivy Poisoning. (See 
 articles headed, "H2O2 as a Local Application in Rhus Tox Poison- 
 ing," by Dr. N. H. Haight, p. 102,— "Poison Ivy," by R. M. Clark, p. 
 192, — "A Case of Lupus of Six Years' Standing," by Dr. Truman Sex- 
 smith, p. 246.) 
 
 In reference to Poisoning Ivy, Dr. John Aulde, of Philadelphia, 
 Pa., writes as follows in the Alkaloidal Clinic, of Chicago, for Septem- 
 ber, 1897. 
 
64F 
 
 "There has long existed an urgent demand for an antidote to the 
 effects of Rhus, the usual remedies being extremely unsatisfactory. 
 We have in Hydrozone an exceptionally successful remedy for the 
 relief of Rhus Poisoning, a single application being sufficient to con- 
 vince the most skeptical. It should be applied freely at intervals of 
 two to four hours; and usually in less than twenty-four hours the 
 inflammation will be fully under control. 
 
 What a comfort this news will be to the bicycle riders throughout 
 the country. It is safe, it is effective and it is prompt." 
 
 Dr. C. E. Ehinger, of the State Normal School of Pa., writes as 
 follows: (October 21, 1897.) 
 
 "I have jilst used Hydrozone with the greatest success in a case 
 of Ivy Poisoning, \t checked the eruption at once and prevented it 
 from spreading where it had already commenced." 
 
 The best results are obtained in skin diseases by applying Hydro- 
 zone and Glycozone as follows: 
 
 First. — Wash the surface with a solution of borax, made of one 
 ounce of borax for one pint of lukewarm water. Pure vegetable liquid 
 soap such as Elixo, may also be used with good results to cleanse 
 the surface. Rinse well. 
 
 Second. — By means of a soft camel's hair brush, or spraying 
 apparatus made of hard rubber and glass, apply to the diseased 
 surface, Hydrozone full strength, and let it dry. When it is dry, 
 repeat the application of the remedy until the amount of white foam 
 which generates is relatively small. 
 
 As soon as the surface is dry, rub over it gently with Glycozone. 
 Avoid scratching and cover the parts with lint soaked with Glycozone. 
 
 Two dressings made morning and evening, will promptly accom- 
 plish a cure. 
 
 When the disease is due to constitutional disorders, such as 
 specific disease of the blood, a proper internal medication should be 
 prescribed. 
 
 In cases of Erysipelas the internal treatment should be prescribed 
 by the attending physician in order to subdue the fever. 
 
 . In cases of Psoriasis and Salt Rheum, the above described 
 local treatment being earnestly observed, the attending physician 
 
64G 
 
 should prescribe the Ozonized water and Glycozone treatment, so as 
 to subdue the gastric disorder which always accompanies these dis- 
 eases. "See Rational Treatment of Gastric and Intestinal Disorders," 
 
 P- 37- 
 
 Herpes Zoster or Zona. — When the diseased surface is exceed- 
 ingly tender, apply Hydrozone diluted with water half and half, until 
 the acute state is subdued, following with pure Glycozone. After 
 four or five days, the itching generally ceases. From that time use 
 both Hydrozone and Glycozone full strength. An absolute cure may 
 be accomplished inside of three to six weeks. 
 
 Acne, Pimples on the Face. — Whatever may be the cause of 
 this disease (if it is due to constitutional derangement or not) which 
 is always accompanied with impaired digestion, it should be treated 
 locally as follows: 
 
 First. — By means of a sharp needle, 'open each pimple, and avoid 
 squeezing. 
 
 Second. — Apply Hydrozone full strength or diluted with water 
 half and half, according to the degree of sensitiveness. Allow the 
 white foam which generates to disappear. 
 
 Third. — Rub gently over the surface Glycozone. 
 
 When the disease is constitutional, an appropriate internal medi- 
 cation must be prescribed by the attending physician. 
 
 The gastric and intestinal disorders should be treated as explained 
 on p. 37, article headed "Gastric and Intestinal Disorders." 
 
 Note, that in all cases of skin diseases, the surface assumes a 
 dark red appearance after each application of Hydrozone and Glyco- 
 zone. This is due to the stimulating action upon healthy tissues, but 
 there is no danger whatever of producing irritation. 
 
 Hydrozone should be used, diluted with water (more or less) only 
 when the diseased surface is unusually tender. 
 
 Freckles and Moth Patches, can be removed as follows: 
 
 First. — Apply to the colored surface a solution of borax, made of 
 one ounce of borax to one quart of water. Allow it to dry. 
 
 Second. — By means of a soft camel's hair brush, (free from metallic 
 parts) apply repeatedly to the spot Hydrozone, full strength, allowing 
 it to dry between "each application. It causes an itching sensation 
 which soon passes away. 
 
64H 
 
 Third. — As soon as the skin is dry, rub over it gently with 
 Glycozone. 
 
 The above treatment must be repeated daily morning and even- 
 ing, until the skin has assumed its normal color. From that time 
 apply Hydrozone and Glycozone once or twice every week, otherwise 
 the trouble will surely return. 
 
 Chapped Hands can be quickly cured by a few applications of 
 Glycozone at night. Rub well and cover with linen. 
 
 Dandruff can be removed by repeated applications of Glycozone 
 to the scalp, after it has been thoroughly cleansed with pure vegetable 
 liquid soap, such as Elixo. Rinse well with lukewarm water. 
 
 It prevents the hair from falling off by keeping the scalp in a 
 healthy condition. 
 
OPINION OF THE MEDICAL PROFESSION. 
 
 SOME CLINICAL FEATURES OF DIPHTHERIA AND THE 
 TREATMENT BY PEROXIDE OF HYDROGEN. 
 
 By GEORGE B. HOPE, M. D.', New York. 
 
 Surgeon Metropolitan Throat Hospital; Professor Diseases of Throat, University 
 
 of Vermont. 
 
 (Extract from the New York Medical Record, October 13, 1888.) 
 
 The sentiment, so long divided, with regard to the constitutional or local 
 inception of diphtheria, seems to be now almost universal in the direction of the latter 
 theory. Consequently, in the light of this opinion, it is clear that the rational 
 treatment must rest more on the recognition of some local agent which will surely 
 destroy the specific germ before a full development of the constitutional infection is 
 reached, rather than on any system of general medication which might be presumed 
 to act more or less as an antidote in combatting the septic influences occurring in the 
 course of the disease 
 
 On account of their poisonous or irritant nature, the active germicides have a 
 utility limited particularly to surface or open-wound applications, and their free use in 
 reaching diphtheritic formations in the mouth or throat, particularly in children, is 
 unfortunately not within the ranges of systematic treatment. In Peroxide of 
 Hydrogen, however, it is confidently believed will be found, if not a specific, at least 
 the most efficient topical agent in destroying the contagious element and limiting the 
 spread of its formation, and at the same time a remedy which may be employed in the 
 most thorough manner without dread of procuring any vicious constitutional effect. 
 Although the Peroxide is by no means of recent date, its medicinal value has been 
 chiefly confined to the cleansing of foul ulcers and suppurating wounds, and there is 
 hardly more than a casual mention of its utility in the treatment of diphtheria 
 previous to a paper of Dr. Mount Bleyer on this subject.* Quite independently of 
 these observations, somewhat over eighteen months since, at the Metropolitan Throat 
 Hospital, several cases of well-marked buccal diphtheria were treated with the 
 Peroxide, with the effect of confirming in the most satisfactory manner the results 
 obtained by Dr. Bleyer. The report of these cases was consequently omitted, 
 pending the experiences it was supposed others would be quick to furnish on a more 
 extended scale of the new remedy so warmly advocated. Among the somewhat small 
 number of trial cases which have appeared at various times in the medical press, there 
 
 * The Medical Record, August 13, 1887 
 
66 
 
 are none in which a distinctly negative opinion is expressed, and where only a partially 
 satisfactory result is attained there has appeared to be sufficient cause to permit 
 reasonable explanation for the fact 
 
 A further explanation for the uncertain results attending the use of the Peroxide 
 lies in the direction of the preparation itself, as also in the manner of its topical 
 application. The usual descriptions allow the diluted strength of from three to seven 
 volumes of distilled water. Inasmuch as the efficacy depends upon the ozonized 
 oxygen in solution, it has seemed desirable to rely on the full strength of the officinal 
 preparation of fifteen volumes, especially when used in the fauces, where any slight 
 irritation from its acidity is not apparent. In all the cases treated, a fresh, standard 
 Marchand's preparation of fifteen volumes was that on which the experience of the 
 writer has been based. An equally important element is in making the application in 
 such a manner as to produce the most determined effect on the diseased tissues with 
 as little local disturbances as possible. Swabbing the tonsils and pharynx is the rough 
 and ready method commonly resorted to, with the second motive of detaching, if 
 possible, the membranous formation. Such treatment is not only unnecessarily 
 harsh toward the patient, but also in intrinsic efficacy falls far short in securing the 
 best therapeutic value^of the remedy. It is properly recognized that the removal of 
 the membrane, unless it occurs spontaneously, is not favorable to the local conditions; 
 moreover, the glary mucous coating of the surface does not permit the application to 
 come fairly in contact with the disease, or so superficially as to require the most 
 constant repetition. The latter criticism holds the same bearing, only modified in a 
 degree, to the hand-ball vapor and spray-producing instruments that have been 
 recommended. 
 
 A steady, coarse spray, with an air-pressure of twenty pounds or more, will in a 
 few moments' time produce a more positive action than prolonged efforts to reach the 
 fauces by means of cotton applicators. The force of the spray should be sufficient to 
 cleanse at once the surface accumulations, as to destroy the necrosial elements with 
 which it comes in contact. In this manner the removal of the debris and the action on 
 the deeper structure go hand in hand. 
 
 It will be noticed that immediately on contact with the Peroxide, a white, cloudy 
 coagulum is formed on and about the diphtheritic patches, readily floated off and 
 exposing a more sharply defined and a flatter, smooth and whiter base. Properly 
 speaking, there is no liquefaction of the exudation, but the decomposition of the 
 inflammatory products is so complete that the cells are broken up and freed from the 
 entangling fibrous net- work beneath. In a particular instance, in the case of 
 apparently a continuous diphtheritic slough, involving the tonsils and extending in an 
 unbroken line across the margin of the soft palate, a solitary application exhibited 
 this effect in such a degree that the natural color of the mucous membrane appeared 
 in spots as if the exudation might have bridged across sound tissue without as yet 
 securing attachment to the sub-epithelial layers. 
 
 How frequently the treatment is to be followed up depends to a considerable 
 extend on the density as well as the era of the surface involved. It may be said, 
 however, that two applications a day, in the great majority of cases, should be 
 sufficient, if thoroughly performed, to arrest all danger of extension and accomplish 
 the gradual resolution of the local formation. 
 
 If the experience of the writer is confirmed, it is apparent how much time, 
 trouble and unnecessary handling is obviated when contrasted with the methods 
 outlining hourly or half -hourly swabbing, or, as one has more frankly expressed it, 
 "scrubbing," with nauseating applications, and culminating in the exhaustion of the 
 patient, if not the most indifferent success. No reasonable objection can be raised 
 either on the score of the expense or the difficulty of transporting the apparatus 
 necessary, as small portable air-receivers can be readily obtained in the instrument 
 shops, on the model of those devised by Codman & Shurtleff, of Boston, and which 
 for the purpose are equally efficient as the larger stationary office fixtures. 
 
67 
 
 The more recent experience of Dr. Gifford (the Medical Record, September i, 
 1888), establishing the active germicidal properties of .Peroxide of Hydrogen, rapidly 
 diminishing in proportion to its dilution in what might be called a geometrical ratio, 
 appears to emphasize in a marked degree the clinical observations on which the main 
 features relating to its employment have been based. 
 
 SOME PRACTICAL HINTS IN CONNECTION WITH INTU- 
 BATION OF THE LARYNX, AND A RESUME OF 206 
 CASES OF DIPHTHERIA OPERATED ON FROM 1886 
 TO 1888. 
 
 By J. MOUNT BLEYER, M. D. 
 
 New York Medical Journal, February 2, 1888. 
 
 {Extract.} 
 
 . Irrigation. — This is an admirable method of washing away the 
 
 products of the local lesion. I used a No. 8 soft-rubber catheter which is attached to a 
 
 fountain-bag syringe; the catheter is passed into the nostrils, first the right and then 
 
 the left. The solution which is used is made by taking Peroxide of Hydrogen 
 
 (Charles Marchand's), fifteen volume solution, chemically pure, one ounce to twelve 
 
 ounces of water. With this solution irrigate each nostril thoroughly. After this has 
 
 been done, the next move is to wash out the mouth, pharynx and larynx. If the 
 
 child can be managed without forcing the mouth open, there is no need of the 
 
 insertion of a gag; but if not use it. The patient is to be held well forward over a 
 
 basin for the reception of the returning fluid. Make a second mixture of the Peroxide 
 
 of Hydrogen of the strength of four drachms to twelve ounces of water. The catheter 
 
 is passed well down into the larynx, the surrounding parts, and thoroughly irrigated. 
 
 The fluids are very seldom swallowed, and if this fluid mixture should be swallowed 
 
 there is no danger of poisoning, as it is a perfectly harmless antiseptic. The fluid is 
 
 generally immediately expelled by coughing. The mouth is to be kept wide open and 
 
 the head well forward. By this mode of treatment patches of membrane, inspissated 
 
 muco-pus, etc., can be washed away without difficulty and without pain. My 
 
 experience with Peroxide of Hydrogen for the last four years has made me familiar 
 
 with its varied use in the treatment of diseases of the nose and throat. From a 
 
 consideration of the action of Peroxide of Hydrogen upon the deposit of diphtheritic 
 
 membranes, and the rapid reproduction of bacteria, it will at once be evident that the 
 
 earlier the application of the remedy is adopted, the better. While the membrane is 
 
 thin and friable, the action of this agent is thorough, quick, and effective; the deposit 
 
 melts down before the contact of it like sugar in water, to be reproduced in a short 
 
 time and again removed until the diseased tissue beneath can be plainly seen free 
 
 from this characteristic covering. In this way, also, the spread of the membrane is 
 
 checked and its limits often sharply circumscribed, until after some days, when the 
 
 germinating power of the membrane is conquered and the poison ceases to produce its 
 
 kind, no more deposit takes place, and the diseased tissues heal. In view of the rapid 
 
 reproduction of bacteria already mentioned, it is evident that the applications should 
 
 be no longer apart than two hours, or even less, according to the rapid reproduction 
 
 of the membranes. Gargling may be practiced by those who are able, but irrigation 
 
 is preferred, as a more thorough application is thereby made. Irrigation is easily 
 
 learned by the nurse, and there is absolutely no danger connected with its use. . . 
 
 For internal use I give the preference to Glycozone, which is chemically pure 
 
68 
 
 glycerine saturated with active ozone. It is to be used locally, as a substitute for 
 bichloride of mercury, carbolic acid, permanganate of potash. This is the most 
 powerful of all organic disinfectants and bactericides. I give to a child over two years 
 of age half a teaspoonful of Glycozone, well diluted with water or milk, every two 
 to four hours, and under that age twenty drops. 
 
 ON THE MEDICINAL USES OF HYDROGEN PEROXIDE. 
 
 By E. R. SQUIBB, M. D., Brooklyn. 
 
 Read before the Kings County Medical Association, February 6, 1889, during the 
 discussion on diphtheria, and published in Gaillard's Medical Journal for 
 March, 1889, p. 267. 
 
 {Extract.') 
 
 Throughout the discussion upon diphtheria very little has been said of the use of 
 the Peroxide of Hydrogen, or hydrogen dioxide, yet it is perhaps the most powerful of 
 all disinfectants and antiseptics, acting both chemically and mechanically upon all 
 excretions and secretions, so as to thoroughly change their character and reactions 
 instantly. The few physicians who have used it in such diseases as diphtheria, 
 scarlatina, small-pox, and upon all diseased surfaces, whether of skin or mucous 
 membrane, have uniformly spoken well of it so far as the writer knows, and perhaps 
 the reason why it is not more used is that it is so little known and its nature and action 
 so little understood. Until within the last few years, except in a few manufacturing 
 processes, it was chiefly known as a chemical curiosity, rarely seen because difficult to 
 make. 
 
 In order to use it intelligently both the pharmacist and the physician must know 
 something of its nature and properties. The name hydrogen dioxide expresses its 
 composition, and its formula, H 2 2 represents this name. Hydrogen monoxide, H 2 0, 
 or water, can under certain conditions be made to combine with a second molecule of 
 oxygen, the result being a water-like liquid, H 2 2 . 
 
 This second atom of oxygen is very loosely combined, and the compound molecule 
 is always on a strain to break up into water and oxygen, and when it breaks up, either 
 slowly or rapidly, the oxygen separates in that nascent or most active and potent of its 
 conditions next to the condition known as ozone. It is in the change of this breaking 
 up into the water and active oxygen that the latter element exerts its power, and the 
 simple contact with organic matters, which are themselves of complex nature and in 
 condition to be changed, is sufficient to break up the dioxide and liberate the active 
 oxygen. For example, some albuminoids are instantly changed by contact with 
 hydrogen dioxide, as is shown by rinsing the mouth with a dilute solution, when the 
 albuminoid matters of the secretions are at once coagulated. Then, as all virus is 
 albuminoid, whether propagative or not, it is destroyed, or by coagulation rendered 
 inert by simple contact with this agent, just as it is by contact with corrosive 
 sublimate. This simple experiment of rinsing the mouth with a dilute solution of 
 hydrogen dioxide and examining the discharge of liquid can hardly fail to convince any 
 one of the destructive potency of this active oxygen on some albuminoids, and of its 
 thoroughly cleansing effects upon the mucous surfaces. 
 
 Now, if diphtheria be at first a local disease, and be auto-infectious — that is, if it 
 be propagated to the general organism by a contagious virus located about the tonsils, 
 and if this virus, be as it readily is an albuminoid substance, it may and will be 
 destroyed by this agent upon a sufficient and a sufficiently repeated contact. 
 All kinds of spray and injection apparatus can now be easily obtained with fittings of 
 hard rubber or glass, and such only should be used. 
 
69 
 
 A child's nostrils, pharynx, and mouth may be flooded every two or three hours, or 
 oftener, from a proper spray apparatus with a two- volume solution without force, and 
 with very little discomfort; and any solution which finds its way into the larynx or 
 stomach is beneficial rather than harmful, and thus the effect of corrosive sublimate is 
 obtained without its risks or dangers. Adults and children old enough to gargle the 
 pharynx and rinse the mouth will get a better effect in this way, equally without much 
 discomfort, from a three-volume solution; and this applies not only to diphtheria, but 
 to scarlatina and other conditions of the mouth and throat which require cleansing and 
 disinfecting. As vaginal injections in cases of uterine cancer, etc., the strength must 
 be increased until the disinfectant effect is obtained. A copious flushing out with a 
 one-volume solution will often be sufficient. When wetted cloths are laid over external 
 sores an over-covering of oiled silk should be used. 
 
 As, in passing through several hands after leaving those of the maker, a little 
 mismanagement may spoil the solution, some easily applicable tests of quality and 
 strength are needed. 
 
 So long as the solution will yield any active oxygen at all, it will give this off with 
 active effervescence when poured onto a crystal or two of potassium permanganate. 
 A solution containing only a quarter of its volume will give an effervescence so strong 
 as to be misleading, and therefore a quantitive test is needed. The following is a 
 modification of a testing process given to the writer, with much other useful information 
 by Mr. Charles Marchand, of No. 10 West 4th £treet, New York City, one of the 
 oldest and best makers of Peroxide of Hydrogen, and one who supplies it to all parts 
 of the country. 
 
 If this agent is to be generally used in the treatment of diphtheria, as it well 
 deserves to be on well established principles of action, it is very important that it be 
 freely applied in the earliest possible stages of the disease, or while it is yet local; and 
 therefore the agent should be easily and promptly accessible in places known to physi- 
 cians, and not over a mile apart throughout the city, and in hands which know the agent 
 well, and know how to keep it from change and to dispense it on physicians' orders. 
 
 If all pharmacists should undertake to keep it — or even all the prominent ones — 
 it would soon share the fate of many other important medicines. . . . 
 
 PEROXIDE OF HYDROGEN FOR GONORRHCEA. 
 
 Report of R. CHAREST, M. D., St. Cloud, Minn. 
 
 {Medical World, Philadelphia, Pa., June, i88g.) 
 
 Editor Medical World: 
 
 I intended for some time to give to the readers of the Medical World my favorite 
 treatment for gonorrhcea and gleet, and I will take the opportunity of Dr. H. E 
 Stroud's offer to do so now. 
 
 What I consider the simplest, quickest and least harmful treatment of gonorrhcea 
 is Peroxide of Hydrogen in injection a j to the § of distilled water, three to five times 
 a day. 
 
 Internally ten to fifteen grains of soda bicarb., every three hours, to keep the 
 urine alkaline. 
 
 Walking to be avoided as far as possible, also beer, coffee, pepper, etc.; keep the 
 bowels regular; use a syringe with tapered end and soft rubber tip for the injections. 
 
 The Peroxide of Hydrogen is used a good deal in commerce for bleaching pur- 
 poses, so there are different qualities of it on the market. 
 
 For medical use it must be neutral to the litmus paper, odorless and colorless.* 
 
 * See page 5, article headed "Important Information on Peroxide of Hydrogen." 
 
7° 
 
 This kind you may have from C. Marchand, ioWest Fourth Street, New York City. It 
 must be kept at a temperature below 65 ° F., and no metal must come in contact with it. 
 
 In writing to the above-named firm you will receive a pamphlet on this valuable 
 remedy well worthy to be studied. 
 
 I consider it the best germicide, as it is the least harmful and the most effective. 
 For the past two weeks I have used it in the form of a spray, in one of the worst 
 cases of eczema, of four years' standing, which had so far resisted the assaults of a 
 dozen doctors backed up by as many drug stores, and is now almost well. 
 
 For syphilitic ulcers, soft chancres, diphtheria, ulcerated cervix, in fact, whenever 
 there is pus or germs, this is the true remedy. 
 
 In gonorrhoea, when the penis is highly inflamed, use the injection four to five 
 times a day and the inflammation will rapidly be subdued, leaving the urethra in a 
 perfectly healthy condition. The use of a suspensory is a great relief to the patient. 
 
 The fl. ext. of black willow is very good for the erections. 
 
 It is also the remedy par excellence in gleet, and there is nothing like its inhalation 
 to cut short a paroxysm of asthma. 
 
 I don't claim the Peroxide of Hydrogen (H 2 O2) to cure gonorrhoea in three or 
 eight days, for I don't believe there is anything that will do so without danger; but it 
 will cure it in three w^eks and leave the unfortunate in the best of condition. 
 
 MEDICINAL USE OF HYDROGEN PEROXIDE. 
 
 (Editorial New York Medical Record.} 
 
 It is with pleasure that we pe\use the new issue of Squibb 's Ephemeris for July, 
 1889, confident as we are that whatever it tells us in accord with the latest scientific 
 advances, and is the result of careful thought and research. Among its articles is one 
 by E. R. Squibb, on "Hydrogen Peroxide" (published also in Gaillard's Medical 
 Journal, March, 1889). This substance which is one of the most powerful and at the 
 same time the least harmful of all antiseptics and disinfectants, has never come into 
 general use, probably because it is so unhandy and spoils so readily (Dr. Squibb thinks 
 it is because it is so little known and so little understood). It is made in large quanti- 
 ties by several large firms, but is used chiefly in the preparation of secret remedies. 
 Its properties have been known for a long time. It is a compound of hydrogen and 
 oxygen which is easily decomposed, yielding water and nascent oxygen which quickly 
 oxidizes substance with which it is in contact. The mere application of a solution of 
 Peroxide of Hydrogen to certain albuminoid substances is sufficient to liberate its oxy- 
 gen, which immediately coagulates the albuminoid substance within its reach. Thus 
 all sorts of virus, whether propagative or not, are destroyed, or by coagulation rendered 
 inert in its presence, just as when strong corrosive sublimate solutions are applied to 
 them. The undiluted liquid peroxide is from its nature very unstable, and on slight dis- 
 turbance breaks up into water and oxygen with almost explosive rapidity. Therefore it 
 is never made nor used undiluted, but is always dissolved in water. The "Peroxide of 
 Hydrogen" which is furnished to the physician is really a solution of the pure liquid 
 in water to which a little hydrochloric acid has been added, the acid being necessary to 
 prevent rapid decomposition of the peroxide. A solution which will yield its own 
 volume of active (nascent) oxygen is called a one-volume solution. The fifteen volume 
 solution (yielding fifteen times its volume of nascent oxygen) is that which is generally 
 supplied by the makers. It is put up in pint bottles, containing about fifteen fluid 
 ounces, sold at $9 a dozen. It is colorless and nearly odorless, tastes slightly acid, 
 and leaves a slight fleeting, not unpleasant after-impression. Changes in this solution 
 are indicated by the formation of bubbles of gas, which rise through the liquid or 
 
7i 
 
 adhere to the sides of the bottle, and also by increased pressure within the bottles. 
 At or below 59° F., the solution does not change for a long time. At 68 Q F., it does 
 change, sometimes very rapidly, giving off oxygen gas. The solutions, whether strong 
 or dilute, should be kept cool, outside of the window of the sick-room in winter, and 
 on ice or in ice-water in summer. The bottles in which the solutions are contained 
 must not be held in the hand for any considerable time, as its warmth will cause 
 decomposition. It must not be kept in contact with metals, nor applied by means of 
 metal apparatus, as it not only ruins the instruments, but forms poisonous salts from 
 the metal. It does not attack hard rubber or glass. It is not necessary to apply it as 
 strong as when it comes from the maker. The ordinary fifteen-volume solution sold 
 is not injurious, but it is stronger than necessary, and to use it undiluted is wasteful. 
 For the irrigation of a child's nostrils, pharynx, and mouth, a two-volume (made by 
 adding two ounces of the fifteen volume solution to a pint of water solution,) may be 
 used every two or three hours, and any part of this solution passing into the stomach 
 will do good rather than harm. 
 
 Adults and children who can gargle — especially in scarlatina and diphtheria — may 
 use, as a gargle and mouth-wash, a three-volume solution (three ounces of fifteen- 
 volume solution to a pint of water). For vaginal injections, as in cancer, etc., a 
 thorough washing with the one-volume solution will always suffice, but it maybe neces- 
 sary to increase the strength until the desired effect is produced. When cloths wetted 
 in a solution are laid upon external sores they should be covered with oiled silk. The 
 methods for testing the activity of any solution are given in full, but need not be 
 repeated here. Mr. Charles Marchand, of No. 10 West Fourth Street, New York 
 City, is referred to as one of the best makers and furnishers of hydrogen peroxide. 
 It is very necessary to get a good article, as careless preparation and after-handling 
 may render it inactive. It is desirable that it should be applied very early when used 
 in diphtheria, before the deposits in the throat have caused disease of the adjacent 
 parts or of the general system. 
 
 PEROXIDE OF HYDROGEN FOR THE RELIEF OF BITES 
 
 FROM VENOMOUS INSECTS. 
 
 By PHILIPPE RICORD, M. D., Newark, N. J. 
 
 (Page 148, New York Medical Record, February 8, 1890.) 
 
 "Recently, while charging my atomizer with the full strength of fresh standard 
 Marchand's preparation of Peroxide of Hydrogen, at the bedside of a child suffering 
 with diphtheria, my attention was attracted by the patient's mother, who appeared in 
 pain, and stated that while taking up a blanket to wrap about her child she supposed 
 she had been pricked by a needle, and on further examination discovered a hornet 
 between the folds she had touched. Thereupon I immediately directed the Peroxide 
 of Hydrogen spray into the wound, the surrounding tissues in a few seconds that 
 had elapsed, being swollen to such an extent as to distinctly mark its site. Instantly 
 all pain ceased, and the swelling rapidly disappeared. In this case the wound was 
 still sufficiently open to readily admit the Peroxide of Hydrogen, and the destruction 
 of the virus was apparently in a moment so completely accomplished that no further 
 treatment was afterward required. May we not, therefore, infer that it is quite 
 possible to annihilate many other poisons, likewise, by the prompt application of so 
 powerful yet safe an agent as the Peroxide of Hydrogen?" 
 
72 
 
 THE NECESSARY PEROXIDE OF HYDROGEN. 
 
 Read in the Section of Surgery and Anatomy, at the Forty-first Annual Meeting of 
 the American Medical Association, held at Nashville, Tenn., May, 1890. 
 
 By ROBERT T. MORRIS, M. D., New York. 
 
 Published by the Journal of the American Medical Association, Chicago, August 9, 
 
 1890, page 216. 
 
 Stop suppuration! That is the duty that is imposed upon us when we fail to pre- 
 vent suppuration. 
 
 As the ferret hunts the rat, so does Peroxide of Hydrogen follow pus to its narrowest 
 hiding place, and the pyogenic and the other micro-organisms are as dead as the rat 
 that the ferret catches when the Peroxide is through with them. Peroxide of Hydro- 
 gen, H 2 2 , in the strong 15-volume solution, is almost as harmless as water; and yet, 
 according to the testimony of Gifford, it kills anthrax spores in a few minutes. 
 
 For preventing*suppuration we have bichloride of mercury, hydronaphthol, carbolic 
 acid, and many other antiseptics; but for stopping it abruptly, and for sterilizing a 
 suppurating wound, we have only one antiseptic that is generally efficient, so far as I 
 know, and that is the strong Peroxide of Hydrogen. 
 
 Therefore I have qualified it, not as "good" not as "useful" but as "necessary." 
 In abscess of the brain, where we could not thoroughly wash the pus out of tortuous 
 canals without injuring the tissues, the H 2 2 injected at a superficial point will follow 
 the pus, and throw it out, too, in a foaming mixture. It is best to inject a small quan- 
 tity, wait until foaming ceases, and repeat injections until the last one fails to bubble. 
 Then we know that the pus cavity is chemically clean, as far as live microbes are 
 concerned. 
 
 In appendicitis, we can open the abscess, inject Peroxide of Hydrogen, and so 
 thoroughly sterilize the pus cavity that we need not fear infection of the general peri- 
 toneal cavity, if we wish to separate intestinal adhesions and remove the appendix 
 vermiformis. Many a patient, who is now dead, could have been saved if Peroxide of 
 Hydrogen had been used when he had appendicitis. 
 
 The single means at our disposal allows us to open the most extensive abscess psoas 
 without dread of septic infection following. 
 
 In some cases of purulent conjunctivitis, we can build a little wall of wax about 
 the eye, destroy all pus with Peroxide of Hydrogen, and cut the suppuration short. 
 Give the patient ether, if the H 2 2 causes too much smarting. It is only in the eye, 
 in the nose and in the urethra that Peroxide of Hydrogen will need to be preceded by 
 cocaine (or ether) for the purpose of quieting the smarting, for it is elsewhere almost 
 as bland as water. 
 
 It is possible to open a large abscess of the breast, wash it out with H 2 2 , and 
 have recovery ensue under one antiseptic dressing, without the formation of another 
 drop of pus. 
 
 Where cellular tissues are breaking down, and in old sinuses, we are obliged to 
 make repeated applications of the H 2 2 for many days, and in such cases I usually 
 follow it with balsam of Peru, for balsam of Peru, either in fluid form or used with 
 sterilized oakum, is a most prompt encourager of granulation. 
 
 If we apply H 2 2 on a probang to diphtheritic membranes at intervals of a few 
 moments, they swell up like whipped cream and come away easily, leaving a clean 
 surface. The fluid can be snuffed up into the nose and will render a foetid ozcena 
 odorless. 
 
 It is unnecessary for me to speak of further indications for its use, because wher- 
 ever there is pus we should use Peroxide of Hydrogen. We are all familiar with the 
 
73 
 
 old law "Ubipus, ibi evacua," and I would change it to read "Ubipus, ibi evacua, 
 ibi hydrogenum peroxidum infunde." That is the rule. The exceptions which prove 
 the rule are easily appreciated when we have them to deal with. 
 
 Peroxide of Hydrogen is an unstable compound, and becomes weaker as oxygen is 
 given off, but Marchand's 15-volume solution will retain active germicidal 
 power for many months if kept tightly corked in a cold place. The price of 
 this manufacturer's preparation is $1.00 per lb., and it can be obtained from any 
 large drug house in this country. When using the H 2 2 it should not be allowed to 
 come into contact with metals if we wish to preserve its strength, as oxygen is then 
 given off too rapidly. 
 
 H 2 2 must be used with caution about the hair, if the color of the hair is a matter 
 of importance to the patient; for this drug, under an alias, is the golden hair bleach 
 of the nymph's despare, and a dark-haired man with a canary-colored moustache is a 
 stirring object. 
 
 PEROXIDE OF HYDROGEN AND OZONE. 
 
 THEIR ANTISEPTIC PROPERTIES. 
 
 Read before the International Medical Congress, held at Berlin, Germany, on the 7th 
 of August, 1890. Published by Medical News of Philadelphia, October 25, 1890. 
 Pp. 416-418. 
 
 By PAUL GIBIER, M. D. 
 
 Director of the Pasteur Institute of New York. 
 
 Gentlemen: 
 
 Since the discovery of Peroxide of Hydrogen by Thenard, in 1818, the therapeut- 
 ical application of this oxygenated compound seems to have been neglected both by the 
 medical and the surgical professions; and it is only in the last twenty years that a few 
 bacteriologists have demonstrated the germicidal potency of this chemical. 
 
 Among the most elaborate reports on the use of this compound may be mentioned 
 those of Paul Bert and Regnard, Baldy, Peanand Larrive. 
 
 Dr. Miguel places Peroxide of Hydrogen at the head of a long list of antiseptics, 
 and close to the silver salts. 
 
 Dr. Bouchut has demonstrated the antiseptic action of Peroxide of Hydrogen, 
 when applied to diphtheritic exudations. 
 
 Prof. Nocart, of Alfort, attenuates the virulence of the microbe symptomatic of 
 carbuncle, before he destroys it, by using the same antiseptic. 
 
 Dr. E. R. Squibb,* of Brooklyn, has also reported the satisfactory results which 
 he obtained with Peroxide of Hydrogen in the treatment of infectious diseases. 
 
 Although the above-mentioned scientists have demonstrated by their experiments 
 that Peroxide of Hydrogen is one of the most powerful destroyers of pathogenic 
 microbes, its use in therapeutics has not been as extensive as it deserves to be. 
 
 In my opinion the reason for its not being in universal use is the difficulty of 
 procuring it free from hurtful impurities. Another objection is the unstableness of the 
 compound, which gives off nascent oxygen when brought in contact with organic 
 substances, f 
 
 Besides the foregoing objections the surgical instruments decompose the peroxide, 
 hence, if an operation is to be performed, the surgeon uses some other antiseptic during 
 
 * GaillarcTs Medical Journal, March, 1889. 
 
 + The Peroxide of Hydrogen that I use is manufactured by Mr. Charles Marchand, of New York. 
 This preparation is remarkable for its uniformity in strength, purity and stability. 
 
74 
 
 the procedure, and is apt to continue the application of the same antiseptic in the sub- 
 sequent dressings. 
 
 Nevertheless, the satisfactory results which I have obtained at the Pasteur Institute 
 of New York with Peroxide of Hydrogen, in the treatment of wounds resulting from 
 deep bites, and those which I have observed at the French clinic of New York, in the 
 treatment of phagedenic chancres, varicose ulcers, parasitic diseases of the skin, and 
 also in the treatment of other affections caused by germs, justify me in adding my 
 statement as to the value of the drug. 
 
 But, it is not from a clinical standpoint that I now direct attention to the anti- 
 septic value of Peroxide of Hydrogen. What I now wish is merely to give a full report 
 of the experiments which I have made on the effects of Peroxide of Hydrogen upon 
 cultures of the following species of pathogenic microbes: Bacillus anthracis, bacillus 
 pyocyaneous, the bacilli of typhoid fever, of Asiatic cholera, and of yellow fever, 
 streptococcus pyogenes, micro-bacillus prodigiosus, bacillus megaterium, and the 
 bacillus of osteomyelitis. 
 
 The Peroxide of Hydrogen which I used was a 3.2 per cent, solution, yielding fifteen 
 times its volume of Oxygen; but this strength was reduced to about 1.5 per cent., cor- 
 responding to about eight volumes of Oxygen, by adding the fresh culture containing 
 the microbe upoti which I was experimenting. I have also experimented upon old 
 cultures loaded with a large number of the spores of the bacillus anthracis. In all cases 
 my experiments were made with a few cubic centimetres of culture in sterilized test- 
 tubes, in order to obtain accurate results. 
 
 The destructive action of Peroxide of Hydrogen, even diluted in the above pro- 
 portions, is almost instantaneous. After a contact of a few minutes, I have tried to 
 cultivate the microbes which were submitted to the peroxide, but unsuccessfully, owing 
 to the fact that the germs had been completely destroyed. 
 
 My next experiments were made on the hydrophobic virus in the following manner: 
 
 I mixed with sterilized water a small quantity of the medulla taken from a rabbit 
 that had died of hydrophobia, and to this mixture added a small quantity of Peroxide 
 of Hydrogen. Abundant effervescence took place, and as soon as it ceased, having 
 previously trephined a rabbit, I injected a large dose of the mixture under the dura 
 matter. Slight effervescence immediately took place and lasted a few moments, but the 
 animal was not more disturbed than when an injection of the ordinary virus is given. 
 This rabbit is still alive, two months after the inoculation. 
 
 A second rabbit was inoculated with the same hydrophobic virus which had not 
 been submitted to the action of the peroxide, and this animal died at the expiration of 
 the eleventh day with the symptoms of hydrophobia. 
 
 I am now experimenting in the same manner upon the bacillus tuberculosis, and if 
 I am not deceived in my expectation, I will be able to impart to the profession some 
 interesting results. 
 
 It is worthy of notice that water charged, under pressure, with fifteen times its 
 volume of pure oxygen has not the antiseptic properties of Peroxide of Hydrogen. 
 This is due to the fact that when the peroxide is decomposed nascent oxygen separates 
 in that most active and potent of its conditions next to the condition, or allotropic form, 
 known as "Ozone." Therefore it is not illogical to conclude that ozone is the active 
 element of Peroxide of Hydrogen. 
 
 Although Peroxide of Hydrogen decomposes rapidly in the presence of organic 
 substances, I have observed that its decomposition is checked to some extent by the 
 addition of a sufficient quantity of glycerine; such a mixture, however, cannot be kept 
 for a long time, owing to the slow but constant formation of secondary products, 
 having irritating properties. 
 
 Before concluding I wish to call attention to a new oxygenated compound, or 
 rather ozonized compound, which has been recently discovered and called "Glycozone" 
 by Mr. Marchand. 
 
 This Glycozone results from the reaction which takes place when glycerine is. 
 
75 
 
 exposed to the action of ozone under pressure — one volume of glycerine with fifteen 
 volumes of ozone produces Glycozone. 
 
 By submitting the bacillus anthracis, pyocyaneous, prodigiosus, and megaterium 
 to the action of Glycozone, they were almost immediately destroyed. 
 
 I have observed that the action of Glycozone upon the typhoid fever bacillus, and 
 some other germs, is much slower than the influence of Peroxide of Hydrogen. 
 
 In the dressing of wounds, ulcers, etc., the antiseptic influence of Glycozone is 
 rather slow if compared with that of Peroxide of Hydrogen, with which it may, how- 
 ever, be mixed at the time of using. 
 
 It has been demonstrated in Pasteur's laboratory that glycerine has no appreciable 
 antiseptic influence upon the virus of hydrophobia; therefore, I mixed the virus of 
 hydrophobia with glycerine, and at the expiration of several weeks all the animals 
 which I inoculated with this mixture died with the symptoms of hydrophobia. 
 
 On the contrary, when glycerine has been combined with ozone to form Glyco- 
 zone, the compound destroys the hydrophobic virus almost instantaneously. 
 
 Two months ago, a rabbit was inoculated with the hydrophobic virus, which had 
 been submitted to the action of this new compound, and the animal is still alive. 
 
 I believe that the practitioner will meet with very satisfactory results with the use 
 of Peroxide of Hydrogen for the following reasons: 
 
 1. This chemical seems to have no injurious effect upon animal cells. 
 
 2. It has very energetic destructive action upon vegetable cells — microbes. 
 
 3. It has no toxic properties; five cubic centimetres injected beneath the skin 
 of a guinea-pig do not produce any serious result, and it is also harmless when given 
 by the mouth. 
 
 As an immediate conclusion resulting from my experiments, my opinion is, that 
 Peroxide of Hydrogen should be used in the treatment of diseases caused by germs, if 
 the microbian element is directly accessible; and it is particularly useful. in the treat- 
 ment of infectious diseases of the throat and mouth. 
 
 HYDROGEN PEROXIDE IN DIPHTHERIA. 
 
 By DAVID PHILLIPS, M. D. 
 
 (Extract from the New York Medical Journal, December 6, 1890.) 
 
 To the Editor of the New York Medical Journal: 
 
 Sir: — I would suggest the following local treatment for diphtheria: The applica- 
 tion to the membrane of Marchand's solution of Peroxide of Hydrogen, fifteen volumes, 
 with an equal bulk of water, then scraping the membrane off with a curette and apply- 
 ing the Peroxide of Hydrogen, one-third dilution, every hour for six or seven hours, 
 then every two hours. If there is no reappearance of membrane after two days, spray 
 the throat occasionally with an antiseptic spray. In this way the membrane is 
 removed at once. The operation is done at a period of the disease when there is no 
 danger of heart failure, so that the struggles of a child need not be minded. 
 
 I am aware that the removal of the membrane in former years was regarded as 
 somewhat dangerous, but at that time nothing was known of disinfectants and germi- 
 cides. 
 
 It would seem that a remedy which, applied to the diphtheritic membrane, 
 removed it after some hours, would prevent its formation. In tolerant patients the 
 peroxide may be put on three or four times so as to be sure of complete disinfection 
 before curetting. A small Thomas' uterine curette answers the purpose admirably, 
 A patient treated as described was comparatively well in two days. 
 
7 6 
 
 PEROXIDK OF HYDROGEN. 
 
 r.v \. LIVEZEY, M. D., v midi by, Pa, 
 
 (Extract from Medical Summary, December, 1890. Page 9x4.) 
 
 After trying for the past five years innumerable therapeutic agents for my lupus 
 or epithelioma, I was advised by Dr, Cutter, a celebrated microscopist and scientist of 
 New York, to spray the ulcer with the peroxide and afterwards apply cotton saturated 
 with the same. I used three different local applications, aristol, Howe's salve, and 
 the Peroxide; marked the cotton and sent the same to him. 
 
 He reported the best results from the peroxide and advised its continuance. 
 Thoughit did not kill tin- sons it made them inactive, while no perceptible difference 
 could be seen upon them from the other two. This peroxide bore the initials P, &, \\ '., 
 ournoted Philadelphia chemists. Seeing Marchanas advertisement in the Summary, 
 [ concluded to try nis, and sent for some. lie kindiy included in the order his glyco 
 zone to use in conjunction with the peroxide. A marked change was the result. The 
 sore Looked better, cleaner, healthier, and upon examination oi the cotton, Dr, C, 
 wrote me to continue the use ol Marchand's. Here was a decided test and in favor oi 
 Ch, Marchand's. The ulcer has steadily progressed for the better. * x * * 
 
 HYDROGEN DIOXIDE; A RESUME. 
 
 W\ JOHN AULDE, M. I)., l'niiAi. 1:1. mi \. 
 
 Member ofUhe American Medical Association, of the Medical Society of the State of 
 Pennsylvania, of the Philadelphia County Medical Society, etc, 
 
 (Published by the New York A/eificaf Journal \ December 27, 1890.) 
 
 Within the past ten years the use of hydrogen dioxide (Peroxide of Hydrogen) h.is 
 become quite general among practitioners whose business has led them to give special 
 attention to SOme particular class of disorders. Many general practitioners, however, 
 have not availed themselves of the benefit afforded by this comparatively recent addition 
 to our therapeutic resources, owing to the expense and the care required in looking 
 after details, together with the uncertainty which attended its employment. These 
 difficulties no longer exist; but, when we consider the advantages to be gained from its 
 list-, the process of evolution has been remarkably slow, notwithstanding tlu-spoiadic 
 attempts which have been made to attract the attention of the medical profession. 
 Novel methods of treatment are too frequently shunned without investigation by 
 regular physicians, while, on the contrary, these innovations are readily adopted to 
 the wants of the quack. 
 
 In the present instance, although tint furore for antiseptics continues unabated, 
 the true position of oxygen has been ignored by those who should have given it their 
 first attention. Long-continued and persist enl effort has erected an imposing 
 
 superstructure upon a theoretrical foundation, losing sight of the marvelous influences 
 
 constantly at work in nature. The corner-stone of this ornate edifice originally 
 adopted was carbolic acid; the pilasters which gave strength and beauty to its walls 
 were composed of carbolatcd gauze, while cornice and roof were made of protective 
 which had been submitted to a carbolizing process. This highly flavored substance 
 has given place to a number of others, some of which are safer, but no more useful; 
 others are more efficient than Carbolic acid, but, as usually employed, are far more 
 dangerOUS. As the foundation for asepsis rests upon absolute cleanliness, so the 
 foundation for antisepsis must rest Upot) an equally safe I regards the patient. 
 
77 
 
 The only agent known at the present time which fully meets our requirements is 
 oxygen in some of its forms. While the spores of anthrax bacilli resists our most 
 poisonous products — such as solutions of hydrochloric acid (two per cent.), boric and 
 salicylic acids in concentrated solutions — oxygenated water alone, in sufficient quantity 
 was shown by Paul Bert and Regnard to possess the power of destroying the bacteria. 
 
 The wonderful properties of ozone are but partially understood; like some other 
 powerful agents, it cannot be safely handled, but it gives great promise of usefulness 
 in the future. The statement has been made that ozone is but an allotropic form of 
 oxygen, and that it is identical with hydrogen dioxide (the subject of the present 
 article,) and for all practical purposes, from a therapeutic standpoint, they may be 
 considered substantially the same. Having, then, at our command a remedy 
 possessing such remarkable properties as a bactericide, one which is perfectly harmless 
 when brought into contact with healthy tissues, it will be worth while to study the 
 indications for its use in the treatment of disease. In the first place, however, I 
 should say a word with reference to the causes which have contributed to prevent its 
 universal employment by physicians — causes already referred to incidentally. * * * 
 
 3. The uncertainty following the employment of the peroxide has arisen from 
 various causes, and, as this is a subject of paramount importance, the items will be 
 considered in detail. In the pure state hydrogen peroxide is exceedingly unstable, 
 and, in order to render it less susceptible to the action of heat, which causes it to part 
 with nascent oxygen rapidly, minute quantities of hydrochloric and phosphoric acids are 
 added to the usual fifteen-volume solution; but this, instead of retarding, rather 
 heightens the effect of the remedy when applied to unhealthy structures, especially 
 mucous surfaces. When the container is allowed to remain in a warm room, or when 
 it is not properly stoppered, the activity of the preparation is materially lessened, if 
 not entirely lost. An excess of acid is objectionable, however, as it renders the 
 peroxide irritating instead of soothing. 
 
 Commercial peroxide which is used extensively for bleaching purposes and in the 
 arts, is doubtless responsible for unsatisfactory results, but, as compared with the 
 medicinal preparation, it is a very inferior product, sold at a cost of about eight cents 
 a pound. Physicians should know that this product always contains a large proportion 
 of acids (two to five percent.), hydrofluoric, sulphuric, hydrochloric, oxalic, and nitric 
 acids, and, knowing this to be the case, they should be careful to examine the 
 reactions and see that the medicinal preparation obtained by patients is supplied in 
 original packages. The commercial product is not "just as good" nor will it "do as 
 well" for the patient; and if these suggestions are kept in view, the success of the 
 peroxide is assured. 
 
 Another important thing which I have learned is, that the mixture of the peroxide 
 with glycerine does not make "glycozone," but, instead, a mixture which generates 
 slowly but constantly secondary products, which appear to possess irritating properties 
 almost as toxic as those of formic acid, well known in Central Africa as a deadly 
 arrow poison. I am of the opinion also that when the peroxide is used in the form of 
 an inhalation by heating with water, a considerable proportion of the nascent oxygen is 
 transformed into ordinary oxygen before reaching the affected tissues, and while I can 
 readily understand how this must detract from its efficiency, remarkably prompt results 
 have attended its administration in this manner. The only obstacle in the way of 
 securing immediate and favorable results from the exhibition of this agent is our 
 inability to command at all times a freshly prepared and thoroughly reliable product, 
 free from the impurities incident to its manufacture; but that difficulty, I believe, is 
 no longer an excuse, as it can be supplied by the principle druggists throughout the 
 country. * * * 
 
 Therapeutics — From the Peroxide of Hydrogen we may obtain, in the form of a 
 vapor or spray, the therapeutic effects of nascent oxygen, and as a surgical application 
 or antibacterial substance this product is far superior to the gas itself. Used in the 
 form of a vapor by inhalation, it increases the secondary assimilation by favoring the 
 
7» 
 
 slimination of excrementitious products through the stimulating effect upon internal 
 respiration. Just as pure mountain air arouses the activity of functions which have 
 been depressed and promotes health, so oxygen evolved in this manner increases tissue 
 .change and prevents the suboxidation which attends upon the arrest of cell function. 
 Oxygen is a tissue builder as well as an oxidizer of carbonaceous and excrementitious 
 products. When it is introduced into the alimen ary tract, abdominal fermentations 
 are arrested by the destruction of the germs which produce them; unhealthy mucous 
 secretions are destroyed, while the vitality of the cells lining the walls of the intestine 
 is augmented; and their power against the absorption of ptomaines and leucomaines 
 greatly increased. The surgeon will find the peroxide an efficient and most convenient 
 antiseptic, as it can be freely used in cavities, in discharging sinuses, and upon the 
 most delicate tissues, without danger of producing the slightest irritation. In all 
 cases of threatened collapse, in low conditions of the system, and during convalescence 
 from severe illness, the physician should bear in mind the wonderful revitalizing 
 properties of this remedy. Perhaps the reader will gain a more practical idea of the 
 applications by a reference to some of the more prominent indications, and I shall 
 briefly pass in review some of the diseases in which it may be used with beneficial 
 results. * * * 
 
 Since it has been determined that in yellow fever and cholera the poison germ is 
 found only in the intestine, the peroxide promises to afford exceptional relief in these 
 diseases. "When it is introduced into the rectum, the heat of the body will cause 
 oxygen gas to be evolved, while the local action of the drug will destroy all unhealthy 
 products which may be present in the lower bowel. The nascent oxygen will be taken 
 up by the absorbent structures and enter the general circulation ; but if we accept the 
 doctrine of phagocytosis, it will do even more than this, by reason of its stimulating 
 action upon the modified white corpuscles, which are now regarded as the special 
 enemies of bacteria escaping through the walls of the intestines. And for the same 
 reason it may be used with advantage as a lavement in the treatment of diarrhoea, 
 dysentery, and in typhoid fever. In the latter disease I have used the pure oxygen 
 gas with very great satisfaction, and have found a solution of the peroxide superior as 
 a mouth wash during the progress of the most tedious disorder. 
 
 The peroxide should be used in all forms of indigestion, and more especially when 
 the stomach is weak and depressed to such an extent that the usual antiseptics are not 
 well tolerated. Those who use it once for the relief of indigestion, gastritis, gastralgia, 
 and the arrest of fermentation, or an abnorrmtl flow of mucous, will have no cause 
 to regret the selection. A large number of cutaneous affections are dependent upon an 
 unhealthy condition of the alimentary tract, such as urticaria, eczema, etc., and, of 
 course, are benefited by the use of the peroxide. 
 
 Pulmonary affections have long claimed the attention of those who dabbled 
 with oxygen inhalations, and it is in this class of cases where faithful attention to 
 details will produce most marked effects, although I can not be convinced that any 
 medicament in itself can arrest the progress of the disease. The continued use of the 
 peroxide internally improves the primary assimilation; the regular and systematic 
 inhalation of the vapor will not only improve the secondary assimilation, but will also 
 destroy any morbid products with which it comes into contact in the pulmonary tissues, 
 and, judging from my own experience with this agent, I have no hesitancy in saying 
 that its value is not yet appreciated by a large number of physicians who, with it, 
 might be the means of prolonging human life. My observations with the vapor and 
 spray in asthmatic conditions have been surprising, and I have found them of signal 
 service in meeting emergencies, such as asphyxia from coal gas, sudden collapse from 
 hemorrhage, typhoid and other fevers. The long continued use of the vapor has a 
 marked effect in restoring the resiliency of the air-vesicles in emphysema when it 
 occurs along with asthma in young persons. A gentleman now under treatment has 
 suffered from asthma since he was six weeks old, and is now twenty-five, but under 
 this treatment he has gained weight, is able to sleep regularly every night, and has 
 
79 
 
 increased sixteen pounds in weight during the past three weeks, while the chest 
 measurement has apparently decreased. This method of treatment is valuable in 
 phthisis at all stages, but it should be used as an adjuvant to other treatment and 
 .attention given to diet. In this connection should be mentioned the usefulness of the 
 vapor in the treatment of bronchitis, subacute and chronic, and at the same time the 
 value in aborting attacks of acute catarrh. 
 
 Inhalations of the vapor will prove useful as an adjuvant in neuralgia, anaemic 
 headaches, general debility, malarial toxaemia, and corpulence, combined with diet 
 adapted to the various disorders mentioned. 
 
 In surgical practice, when the solution of the proper strength is brought into 
 contact with diseased tissues, a brisk effervescence takes place and continues until all 
 the pus corpuscles present are destroyed. The solution may be used topically in 
 nearly all cases of catarrh of the upper air passages in the form of a spray, and it may 
 be used as an antiseptic after the removal of pus in empyema. The substance 
 possesses the advantage over other antiseptics of being harmless, and can therefore be 
 used freely in diphtheria and croup. There are so many indications for its employment 
 that it would be difficult to mention all the topical uses, although the following may be 
 referred to, viz., boils, carbuncles, indolent ulcers, carcinoma, and venereal diseases 
 as an injection. 
 
 The gynaecologist will find numerous applications for this agent. It may be used 
 in the form of a douche in leucorrhcea, elytritis, vaginismus, and a cotton-wool 
 tampon may be saturated with and placed in a gelatine capsule (veterinary size) and 
 introduced into the vagina in the case of ulceration, vesico- vaginal fistula, and 
 endometritis. The ophthalmologist and aurist will likewise find that it furnishes them 
 the most complete and safe antiseptic that can be had, and gradually its employment 
 will extend to every department of medicine and surgery. 
 
 The most flattering commendations of "Marchand's Peroxide of Hydrogen 
 (medicinal)" have been given voluntarily by numerous well-known authors and 
 contributors to medical literature within the past few years, some of whom may be 
 mentioned as additional evidence that the methods here recommended are worthy of 
 further investigation: Dr. W. B. Clarke, of Indianapolis, Ind.; Dr. George B. Hope, 
 Surgeon to the Metropolitan Throat Hospital, New York; Dr. J. Mount Bleyer, of 
 New York; Dr. Robert T. Morris, of New York; Dr. Paul Gibier, Director of the 
 New York Pasteur Institute; Dr. R. Charest, of St. Cloud, Minn.; Dr. E. R. 
 Squibb, of Brooklyn, N. Y. ; and others whose names cannot now be recalled. 
 Dr. Morris refers to it as "the necessary Peroxide of Hydrogen", and I have found 
 Marchand's product to possess in a remarkable degree the properties so essential to 
 success — viz., uniformity in strength, purity, and stability. 
 
 PEROXIDE OF HYDROGEN IN GYNECOLOGY AND IN 
 
 OBSTETRICS. 
 
 By EGBERT H. GRANDIN, M. D. 
 
 Obstetric Surgeon New York Maternity Hospital, Visiting Obtetrician Nezv York 
 
 Infant Asylum, etc. 
 
 (Published by The Times and Register, of Philadelphia, January 31, 1891.) 
 
 Modern methods of antisepsis enable us in the vast proportion of cases to prevent 
 suppuration. The problem remaining is how arrest it when present, or abort it when 
 imminent. 
 
 The virtues of peroxide of hydrogen (H 2 O s ) in general surgical practice have re- 
 cently been heralded by Dr. Robert T. Morris, of this city, in the columns of The 
 
8o 
 
 Times and Register ■.* The object of the writer is to exemplify his personal experience 
 with this agent, through the brief record of a few cases in which he has tested it. 
 
 Case I. Sub-mammary abscess. — About one year ago I was consulted by a 
 
 Mrs. G. She was nursing a two and a half months' puny infant, notwithstanding the 
 fact that the right mamma was fairly riddled with sinuses, and the left presented to my 
 touch faint fluctuation. Her previous medical attendant had exhausted all routine 
 measures, and yet, as she expressed it, "she was going from bad to worse." She had 
 hectic fever and other symptoms of sepsis; her appearance suggested the absolute neces- 
 sity of rapid action. 
 
 I at once weaned the child, of course; made a deep incision in the left mamma, 
 giving exit to a mass of fetid pus, washed out the cavity with bichloride (1-1,000), and 
 packed it with gauze. I thoroughly wetted the sinuses in the right mamma, irrigated 
 and packed them similarly. In a few days I had control of the sepsis, but the pyogenic 
 membrane and its product resisted all my efforts. In despair, and without much hope 
 of success, I washed out the cavities with peroxide of hydrogen (half diluted with 
 glycerine), and applied a compressed gauze bandage. At the end of ten days the 
 abscesses were cured. 
 
 Case II. Suppurating pelvic hematocele. — This case was seen in consultation. 
 
 The patient was a young prostitute, and the only etiological cause I could determine 
 was copulation during menstruation. The tumor bulged in the retro-uterine pouch, 
 and I treated it as follows: Under antiseptic irrigation I aspirated along the finger 
 as a guide, and obtained a mixture of blood and pus. Using the aspirator muzzle as 
 a director, I enlarged the opening transversely, sufficiently to admit a Palmer dilator. 
 Inserting this I divulsed, curetted the cavity — which measured fully three inches 
 square — and washed it out with equal parts compound tincture of iodine and water. 
 I next inserted a flange-rubber drain tube. The cavity was washed out daily through 
 this tube with two and one-half per cent, carbolic, but contrary to my experience with 
 similar cases, it had not contracted much at the end of a week, and was still secreting 
 pus. I then inserted a small Chamberlain glass uterine tube, and distended the 
 cavity with undiluted peroxide of hydrogen. This checked suppuration at once, and 
 when the patient was seen three weeks thereafter, an induration in the posterior 
 vaginal cul-de-sac was the only remnant of the hematocele. 
 
 Case III. Puerperal septic endometritis. — Seen in consultation. Fifth day 
 post-partum. Patient had fcetid lochia, tenderness over uterus, rise of temperature, 
 rapid pulse. A number of intra-uterine bichloride douches had been administered 
 before I saw the case. Having differentiated extra-uterine source of the general 
 sepsis, I curetted the cavity of the uterus, according to the method I have repeatedly 
 described and advocated, removing a mass of degenerated decidual matter, and then r 
 instead of applying pure phenic acid to the cavity, and irrigating it with iodine and 
 water, I washed it out through a Chamberlain glass tube with a pint of peroxide of 
 hydrogen (undiluted). The local sepsis was thus at once checked ; the patient made 
 a rapid convalescence under the means which suggest themselves for meeting the 
 sepsis already in the sysetm. 
 
 These cases typify instances in which the peroxide of hydrogen will be found use- 
 ful by the gynecologist and obstetrician. As opportunity offers I propose to resort to 
 this agent in vaginitis, urethritis and purulent cystitis. Further, and in this di- 
 rection I am as yet only experimenting, I am hopeful that in this agent we will 
 find we possess a means which will enable us to avoid laparotomy in certain instances. 
 of pyosalpinx. My conclusions on this point, however, it would be premature to state. 
 
 My experience thus far with the peroxide of hydrogen justifies the statement that 
 it is absolutely harmless, and that it is at the same time the most efficient of all the 
 agents at present at our disposal for preventing the ravages which uncontrolled 
 suppuration is capable of causing. 
 
 * See p. y 2 , reprint of article headed "The Necessary Peroxide of Hydrogen," by Dr. Robert T„ 
 Morris. 
 
8i 
 
 SINUS TREATED WITH PEROXIDE OF HYDROGEN. 
 
 (Extract from Practice, Richmond, Va., February, 1891.) 
 
 Dr. William F. Waugh tells in the Times-Register of an old woman who stepped 
 on a nail, which penetrated the foot almost to the superior surface. A sinus formed, 
 and had been discharging for two months when the patient was first seen. Marchand's 
 peroxide of hydrogen was injected into the sinus by means of a hypodermic syringe. 
 The first effect was to destroy the leather of the piston. The sinus was found to be 
 of a horse shoe shape, the probe passing almost through the foot, between the meta- 
 tarsal bones, and when the peroxide was injected a hard lamp could be felt one inch 
 from the opening on the sole of the foot. This was laid open, and a stream of pero- 
 xide was sent through. Result: Cured in a week. 
 
 DIPHTHERIA AND THE USE OF HYDROGEN DIOXIDE 
 
 IN ITS TREATMENT. 
 
 Read before the Chemical Society of Maryland, February 6, i8qi. 
 
 By Dr. EDW. J. BERNSTEIN, Baltimore. 
 
 (Extract from Maryland Medical Journal, February 21, 1891.) 
 
 In this very elaborate paper, Dr. E. J. Bernstein says: (p. 361). . . In my 
 first case of diphtheria I began the use of Sulphide of Calcium, but finding that not 
 only was it disagreeable to both the taste and smell, and that it also soiled the bed linen 
 and clothing of the patient, but that the patient continued to get worse, that the 
 membrane which at first was limited to large necrotic patches on the tonsils, now 
 covered the entire anterior pillars of the fauces and the uvula, which was now 
 considerably swollen. 
 
 I discarded the nostrum and began the use of Hydrogen Dioxide, which I directed 
 to be sprayed into the throat every hour of the day and night, gradually relaxing the 
 number of night sprayings as the case went on to improvement. I also directed that 
 the nose should be sprayed at least twice a day with the same solution. Within a few 
 hours the mother said she noticed a change for the better in her child, and when I 
 made my evening call it was quite perceptible. I also noticed, which fact I have since 
 seen corroborated by others who had used the drug, the better color of the child. 
 The lips, which before its administration were quite blue, were now of a healthy red 
 color. The membrane in the throat had made no increase. By the following morning 
 there was a decided decrease in the pseudo-membrane^ and from now on began to dis- 
 appear. 
 
 In conjunction with the above local treatment, I gave large doses of tinct. ferri chlo. 
 in combination with tonic dose of quinia every three hours. 
 
 Cream of tartar lemonade was given ad libitum to appease thirst and to relieve con- 
 gestion. The air of the room was regularly charged with steam, generated on a small 
 alcohol stove, to which had been added an alcoholic solution of menthol, eucalyptol and 
 thymol. It is well to say that the strength of the hydrogen dioxide was 50 per cent, of 
 Ch. Marchand's 15-volume solution. 
 
 In three other cases which came under my observation, I followed out the same line 
 of treatment, and each recovered without any untoward after effects. In the hope that 
 some of you here this evening may be induced to try this plan of treatment, I submit 
 this paper. 
 
82 
 
 HYDROGEN PEROXIDE IN DIPHTHERIA. 
 
 By G. F. ADAMS, M. D., Pulaski, N. Y. 
 (Published in the Medical Era of Chicago, 111., March, 1891.) 
 
 The article in the December Era copied from the Medical Times, by Dr. George 
 W. Major, in regard to the use of Peroxide of Hydrogen in diphtheria, I can heartily 
 indorse. I have just discharged three cases of diphtheria that I treated with Ch. 
 Marchand's Peroxide of Hydrogen. I sprayed the throat with an atomizer filled with 
 full strength 15-volume solution of peroxide in the early stages. The membrane was 
 removed almost at once, and after the first application and one complete clearing of the 
 throat, I then reduced the 15-volume solution by adding three parts water to one of 
 peroxide, and by spraying the throat thoroughly as often as once an hour, all membrane 
 was destroyed, the breath was kept sweet, and the throat in a fairly comfortable condi- 
 tion. When used at first in full strength the patient may complain of a slight smart- 
 ing, but no irritation results. 
 
 The atomizer should consist of nothing but glass and rubber, as the peroxide has 
 a strong affinity for afl metals, except gold, silver, and the rare metals. 
 
 I can assure all who try Peroxide of Hydrogen as a local application in diphtheria 
 that they will be thoroughly well pleased with it. 
 
 SCARLATINAL DIPHTHERIA. 
 
 By WM. F. WAUGH, M. D. 
 (Extract from The Times and Register \ Philadelphia, March, 7, 1891.) 
 
 I desire to place upon record a case that is unique in my own experience; though 
 my readers may, perhaps, have the better results. The case was that of a child under 
 four years of age. He had been attended by a dispensary physician during the first 
 part of the illness; and this gentleman, when he gave up the case, had given a gloomy 
 prognosis, with which I heartily coincided. On my first visit I found thechild's throat 
 covered with blackish sloughs, the lips and tongue covered with fissures and ulcers, the 
 nose discharging freely the irritating and offensive secretions of nasal diphtheria, the 
 eyes showing spots of pus at the inner canthus. The child complained of earache and 
 of pain in the forehead, so that the disease had passed up the Eustachian tubes and into 
 the frontal sinuses. Reddish spots and blotches appeared on the face and body. The 
 stench was dreadful, the urine totally suppressed, but the few drops that were passed 
 could not be saved for examination. The child had been delirious for some time, not 
 being able to recognize his parents. The one good point was that his stomach retained 
 milk fairly well. 
 
 It has not been my good fortune to witness the recovery of many such cases. In 
 fact, the more extended is my experience with diphtheria, the more I dread it; especially 
 when it has become firmly established in the Schneiderian mucous membrane, and in the 
 passage leading from the naso-pharynx. 
 
 I felt it my duty to inform the parents that death was the only result to be expected; 
 and that they could be very thankful if their other children, six in number, should escape. 
 
 However, I gave them a bottle of Marchand's Peroxide of Hydrogen, and directed 
 them to syringe the nostrils and wash the mouth out with a solution diluted to one-fourth 
 its strength. This was repeated every hour, day and night. No other treatment was 
 employed, and whiskey was given with the milk, as the only food. The child began at 
 ■once to improve; the right tympanic membrane gave way, and then the solution was 
 
83 
 
 thrown into the ear, and bubbled out at the nose. The urine began to be secreted more 
 freely, and the child was pronounced out of danger one week from my first visit. 
 
 One of the other children was seized with sore throat, enlarged tonsils and torticollis; 
 .another had a mild attack of scarlatina, but the others escaped without contracting the 
 disease. This in itself is notable, as the children were all kept at home, in a crowded 
 .little house, with miserable sanitation. 
 
 THE PEROXIDE OF HYDROGEN— ITS USES IN 
 ABDOMINAL SURGERY. 
 By CHARLES P. NOBLE, M. D., 
 
 .Surgeon-in-Chief of the Kensington Hospital for Women, Philadelphia. 
 (Published by Philadelphia Medical News, April II, 1891.) 
 
 The importance of the Peroxide of Hydrogen as a germicide, and more especially 
 ■as a pus-destroying agent, is becoming firmly established by rapidly accumulating clinical 
 evidence. A very considerable experience with the drug has made me enthusiastic con- 
 • cerning its remarkable qualities; and I find myself extending its application almost daily. 
 In general, in order that antiseptic or germicidal agents may be used effectively, it is 
 absolutely essential that all foreign material, discharges, etc., be first removed, so that 
 the agent may be brought in direct contact with the surface or tissue to be acted upon. 
 It is also true that the power of penetration of the antiseptics in common use is slight, 
 so that they are reliable only in combatting strictly superficial septic processes. This is 
 particularly true of corrosive sublimate solution, which, by its action on albuminous dis- 
 charges, forms an impenetrable covering which prevents the solution from coming in 
 contact with the tissues to be acted upon. In this respect the action of the peroxide 
 solution is essentially different. It attacks, disintegrates and oxidizes all discharges and 
 dead tissue with which it comes in contact, thus favoring its contact with and action 
 upon underlying tissues. Moreover, the products of its activity escape as water and 
 -carbonic acid gas. At this time I do not propose to discuss the relative value of the 
 Peroxide of Hydrogen as a germicide. I believe that our knowledge upon that subject 
 will be far more exact after a little time than it is at present. The fact, however, that 
 this agent has the power to oxidize dead organic matters suggests to my mind a wide 
 field of usefulness for it in preventing saprsemia or ptomaine poisoning, in the treatment 
 -of suppurating tracks and cavities in which dependent drainage cannot be had, and in 
 which free irrigation with water is impracticable 
 
 In my work in abdominal surgery I have found Peroxide of Hydrogen of positive 
 value. 
 
 In cleaning the hands preparatory to operation I have found it very useful, 
 especially when the skin around the finger-nails has become somewhat horny or rough- 
 ened from too much use, or from frequent washings, or from prolonged contact with 
 antiseptic solutions. Its power to loosen and to remove dead epithelial cells, and to 
 soften the skin about the nails, is quite remarkable. Moreover, all foreign material 
 about the nails is either oxidized and removed or it is made more accessible to the 
 sublimate solution which is used later. In practice I have used the peroxide after 
 scrubbing my hands through three waters with soap and the nail-brush, then soaking 
 them in turn in saturated solutions of permanganate of potassium and of oxalic acid, 
 and before soaking them in corrosive sublimate solution. 
 
 Bacteriological examinations have shown that even this method (omitting the 
 peroxide solution) does not make asepsis certain, as germs have been removed from 
 ;the subunguial spaces after it has-been faithfully carried out. I have not been able to 
 
84 
 
 test the value of the addition oi the peroxide ^i hydrogen solution- in. securing asep 
 by bacteriological experiments, but practically I feel convinced thai ii Is ^( service lo 
 securing that end, The settlement of the question authoritatively will be oi great 
 interest to all those who believe In satisfying an antiseptic conscience, 
 
 in i in- management of the drainage-tub^ after abdominal section, under special 
 conditions, the peroxide solution has been oi signal service, tn typical cases, Ln which 
 the drainage-tube is removed after from one t<> three days, there is no Indication for its 
 use. But when from any cause the- drainage tube must remain In Longer; it is useful 
 
 in keeping the tube ami drainage track sweet anil free from pus. ( >n a nuinbei oi 
 
 occasions after a tube had been in a place from a week to ten. days, and the discharge 
 has become slightly purulent, I have been able to combat successfully the tendency to 
 suppuration, to shorten the tube gradually, finally to Institute a gauze plug foi the 
 glass tube, and to secure rapid healing of the drainage track; when otherwise asinui 
 
 would have resulted. One such case was one of a ruptured large OVarlan tumor, 
 
 having contents of a jelly-like consistency, which had become distributed throughout 
 the peritonea] cavity. Jelly like materia] was discharged through the tube foi two< 
 
 weeks, and yet by the use of the peroxide solution rapid healing was obtained, 
 Another ease was 041- of post-opcrat i\ e intra-pei itoneal hemorrhage, Tany blood 
 
 was discharged through the tube for ten days, yet the same care secured the same 
 result, Another striking case was one of faecal fistula which formed, after the removal 
 of a dermoid ovarian cyst -presumably caused by the growth of a small bum hoi hail 
 from the cyst into the bowel, The track was kept clean and the peroxide was used 
 freely. The faecal fistula closed in three weeks, and the remaining sinus closed within 
 two months from the date of the operation, being, kept open for a time by an Infected 
 omental ligature, and closing promptly after its discnaj 
 
 The peroxide solution has been applied to the drainage track and to the inside oi 
 the tube by saturating absorbent cotton, held In a slender Long-handled forceps, and 
 
 passing this down the tube. The peroxide solution Ii. is been ii'.nl puiv or diluted (one 
 
 to two or three.) 
 
 1 have not used the peroxide solution within the peritoneal' cavity during opera 
 tion, but believe ii will prove useful in disinfecting Infected pedicles, in remo 
 pus sacs rupture frequently occurs, deluging the broad ligaments with pus. Under 
 these circumstances the ligature applied to secure the pedicle necessarily becomes 
 Infected, Heretofore l have washed away septic material with boiled water, and 
 later applied bichloride solution on a Bponge to the region of the ligature, Ln Buch 
 
 eases it seems |)robable that the peioside solulion will be oi le.d value. 
 
 In cleaning the abdominal wound preparatory to removing the Butures, the 
 peroxide solution has proven very efficient; especially if a dry dressing boric acid or 
 
 iodoform — h.is been iced. finally, il liny pus has loinied in the ti.iek of the drain I 
 tube or any of the sutures, the peroxide solution, will remove it more efficiently than 
 any other agent, 
 
 A RESUME OF THE HISTORY AND PRACTICAL APPL] 
 CATION OF HYDROGEN PEROXIDE IN SURGICAL 
 AFFECTIONS. 
 
 i;, s. pOT is EAGLETON; m. D'. 
 
 Resident Physician in the Children^ Hospital % Philadelphia, 
 
 i Medical and Surgical Reporter of Philadelphia, May l6, [891.) 
 
 Hydrogen peroxide was discovered by M. Thenard, a F"ren< h chemist, In the yeai 
 [818, since which time ll has, like many other therapeutical remedies, lain dormant, 
 occasionally being brought forward by some "enthusiast! 1 and its virtues highlv 
 
85 
 
 •extolled for a time. But the drug, unequal to the task of proving all that had been 
 •said in its favor, was again and again returned to its stall of oblivion. Within the past 
 few years, it has been brought before the medical profession, on account of its 
 antiseptic properties, and apparently has awakened into active therapeutic life. 
 
 In looking over the literature on the subject, I find that Dr. B. W. Richardson,* 
 in 1862, called attention to the action of hydrogen peroxide in an article upon the 
 subject, which excited widespread interest in the profession at that time and has led 
 to many experiments with the drug, both in surgery and medicine. 
 
 It is my purpose to confine myself in this study entirely to the treatment of 
 •surgical affections. Before referring to the results of my own experience, during the 
 past few months, I will briefly allude to some of the most important monographs which 
 have appeared from time to time in our medical journals. C. T. Kingzettf believes 
 that the substance exhibits striking antiseptic effects and is capable, even in very small 
 •quantities, of arresting the so-called process of fermentation which is originated by 
 living organisms. He further calls attention to the fact that care should be exercised 
 Jn making the solution neutral before using, and yet admits that neutral solutions are 
 by no means as stable as those of a slightly acid reaction. In closing his 
 monograph he states that the expectations of several noted surgeons of France in the 
 treatment of wounds with this compound have been amply realized; among those 
 may be mentioned M. Baldy, M. Regnard and M. Beau. In summing up his article 
 he futher says that, in his opinion, hydrogen peroxide is far superior to phenol, and 
 that it has been demonstrated beyond question that all wounds treated with peroxide 
 of hydrogen have progressed well, healing generally by first intention. 
 
 A. E. Prince^ speaks most favorable of the results obtained with this remedy. 
 
 C. E. Shelley§ considers it to possess anaesthetic properties, and at the same time 
 ■claiming for the drug, not only a pus destroyer, but that it is an actual stimulant to the 
 surface of wounds. To the carefully conducted experiments of Dr. P. Miquel, quoted 
 by W. D. BizettJ we owe the establishment, on a firm basis, of hydrogen peroxide as 
 a positive germicide. The line of experimentation pursued had the following aim: to 
 •determine the quantity of various substances, commonly used as germicides, which, 
 added to a quart of beef tea, would prevent decomposition. Miquel found among a 
 long list of substances used by him, that only two were more powerful than hydrogen 
 peroxide. The following table shows the relative strength, according to his experi- 
 ments, of the four most powerful germicides: 
 
 Biniodide Mercury 0.025 grains. 
 
 Biniodide Silver 0.03 grains. 
 
 Hydrogen Peroxide 0.05 grains. 
 
 Bichloride Mercury 0.07 grains. 
 
 The results thus obtained place hydrogen peroxide ahead of bichloride mercury 
 as a germicide, with the advantage, also, of being absolutely void of any toxic action, 
 while the corrosive sublimate is a most virulent poison. BizettJ claims that when the 
 pure peroxide, which is syrupy in appearance, is brought into contact with living 
 tissues, it acts as a direct caustic. Various experiments were made by II . Gifford** 
 directly with the disease germs, thus testing the germicidal action of the peroxide. 
 Two methods of- determining its ability to destroy germs, were used, that of Koch, and 
 his own well-known method. The preparation of peroxide used, was that of Chas. 
 Marchand's (15 vol.). Gifford found that the white and yellow cocci, as well as the 
 foacilli anthrax, were killed in exposures of from f to i\ minutes, It required but £ of a 
 minute to destroy fully developed anthrax spores. He further found that the solution 
 
 *B. W. Richardson, Tr. M. Loc. Lond., 1862, vol. II, pp. 51-53. 
 
 *tlbid. 
 
 $A. E. Prince, St. Louis, M. and S. Journal, 1884, vol. XLVI, pp. 246-252. 
 
 §C. E. Shelley, Practitioner, Lond., 1884, vol. XXXII, p. 196. 
 
 II W. D. Bizett, Atlanta M. and S. Journal, 1888-0, N. S. 
 
 1 W. D. Bizett, Atlanta M. and S. Journal, 1888-9, N. S. 
 
 ** G. Gifford, Med. Rec, N. Y., 1888, Vol. XXXIV, p. 243. 
 
86 
 
 exposed for 40 days, to a temperature of 68-75 killed the yellow pus cocci in from 
 io-ii minutes. The same solution of peroxide, when diluted with four times its bulk,, 
 requires an exposure of 30 minutes to kill the pus cocci. If diluted with an equal 
 volume, it kills within § minute. After an experience of six months, I. N. Love* 
 sums up the action of hydrogen peroxide as follows: It is a most efficient means of 
 cleansing purulent surfaces, deep cavities and sinuses, stimulating the healthy process, 
 in ulcerating parts. As a destroyer of microbes, a cleanser and securer of comfort, it is 
 of great value as a local application. 
 
 My own experience with this drug in surgical affections, during the past ten 
 months; has been most satisfactory. During that time I have used the remedy in the 
 following affections: Abscesses (acute and chronic, of various kinds), suppurating 
 glands, sloughing gangrenous wounds, empyema of the chest, necrosis (general and 
 localized), suppurative otitis media, and wounds of all descriptions. The ages of the 
 cases treated, varied from two to thirteen years. The mode of applying the peroxide 
 was as follows: All cavities, crevices, etc., were syringed with the bichloride of 
 mercury (1-2000, to 1-6000) and then carefully cleansed with the hydrogen peroxide 
 (Marchand's). 
 
 At first one volume of this solution was diluted with two to three times its bulk. 
 Later pn, I used the full strength. The first effect noticed after applying the 
 peroxide, was the rapid oxidation of all purulent or bloody material, which would 
 cause the distension of crevices, no matter how minute, with the oxygen, which was 
 eliminated as a frothy (often yellowish, depending upon the quantity of pus present) 
 bubbling substance. After the oxidation was completed, the wound was always left 
 in a clean, sweet condition, absolutely free from pus. The wounds were then gently 
 dusted over with iodoform and the usual antiseptic dressings of gauze, etc., were 
 applied. On removal of the dressings, a few days later, it was noticed that the 
 wounds were in almost every instance cleaner (especially marked in acute cases), more 
 healthy in appearance and with a decided diminution in the quantity of pus secreted. 
 The thought being suggested, that possibly the bichloride and not the peroxide was 
 instrumental in producing the favorable results noticed, I commenced a series of 
 control experiments. I would, at one dressing, use simply the bichloride of mercury, 
 following this, at the next dressing, with the peroxide. Thus making actual 
 comparisons in the same cases. After several alternate dressings as above, I found 
 without exception that the hydrogen peroxide perceptibly diminished pus formation to- 
 a much greater degree than simply the bichloride alone. 
 
 The belief that iodoform should not be used in conjunction with the peroxide, for 
 fear of liberating free iodine, which, as a direct irritant, would defeat the object in 
 view, is, I believe, erroneous. I found that when a quantity of iodoform was placed 
 in a small receptacle covered with the peroxide solution and then set aside for periods 
 varying from three hours to three days, on being treated chemically for free iodine, 
 with the ordinary starch test, gave negative results. Although one drop of a solution 
 of iodine, on being added to the same solutions, gave a brilliant reaction on addition of 
 the starch. 
 
 In all cases in which the peroxide was given a fair trial, I have observed a direct 
 healing effect upon the granulating tissues. It is therefore evident that, owing to its 
 oxidizing action on the pus and the diminution of the purulent secretions after its use, 
 it does, either directly or indirectly, cause a destruction of the anthrax bacillus, In 
 concluding my article, I think, from the chemical as well as the experimental evidence 
 which has been deduced, we can safely sum up the action of peroxide of hydrogen in 
 the treatment of surgical affections, as follows: 
 
 1. Hydrogen peroxide is a positive germicide and a possible stimulant to 
 granulating tissues. 
 
 2. Owing to its especial property of eliminating oxygen, it is of unparalleled value 
 
 * I. N. Love, Phila. Med. Times, 1887-1888, Vol. XVIII, pp. 362-364. 
 
87 
 
 in the distension of suppurating sinuses and cavities, especially in the mastoid region, 
 or where it is almost impossible to reach unhealthy surfaces by other means. 
 
 3. The diluted solution is perfectly harmless and can with safety be used in any 
 quantity. * 
 
 4. The strong concentrated solution, syrupy in consistence, is a direct irritant to 
 all tissues and should never be used. 
 
 5. It possesses healing and cleansing qualities as well as those germicidal in 
 nature. 
 
 6. When exposed to light it loses strength; care should therefore be exercised in 
 keeping the bottles well stoppered with rubber corks, and in a cool, dry place. 
 
 7. Fibrin, cellular tissue and some metals, instantly decompose it. In contact 
 with sugar and starch it eliminates carbon dioxide (C0 2 ). 
 
 8. In washing suppurating surfaces, it should be used until oxidation ceases, 
 thus showing a complete destruction of all existing purulent material.* 
 
 EXTRACT FROM PAPER ON "ADJUVANTS OR AIDS TO 
 GYNECOLOGY— NEITHER MEDICAL NOR SURGICAL." 
 
 By C. A. PHILLIPS, M. D., Boston, Mass. 
 
 Read before the International College of Homoeopathy, held at Atlantic City, June 
 
 19, 1891. 
 
 . . . Another local application of great service in the treatment of gonorrhoea! 
 or syphilitic and all ulcerative conditions of the genital organs is Marchand's Peroxide 
 of Hydrogen. While its power to destroy germs and septic matter with which it comes 
 in contact is unsurpassed by any other germicide or antiseptic, it is perfectly harmless 
 to living tissues. With a swab of cotton saturated with this solution the parts can be 
 more thoroughly cleansed than by any other means with which I am acquainted, — thus 
 removing effete poisonous or septic matter, and I cannot understand wherein this is 
 any more objectionable than cleansing the skin with soap and water, or the teeth with 
 a brush. 
 
 MEDICINAL PEROXIDE OF HYDROGEN AND GLYCOZONE. 
 
 By Dr. J. H. DeWOLF, Baltimore, Md. 
 
 {The Southern Medical and Surgical World, of Baltimore, Md., August, 1891.) 
 
 The topical application of Oxygen is capable of immense benefit. In the pitting 
 of Small-pox I most earnestly advocate and urge its use, either in the form of 
 Glycozone or properly diluted Marchand's Peroxide of Hydrogen (Medicinal). I 
 believe much deformity can be obviated by its use, and the force of the disease 
 lessened. Foul and indolent ulcers, when treated by iodoform, carbolic acid, etc., 
 are apt to poison the patients; such cases have occurred. With oxygen that would 
 be impossible. In large suppurating sores, where the various germicides are dangerous 
 on account of the large breach of continuity and absorption of the poison, the topical 
 application of oxygen is perfectly safe, and to say the least, equally efficacious. 
 
 Ophthalmia is advantageously treated by the topical application of either the Peroxide 
 or Glycozone. Styes can be aborted if Glycozone be rubbed on the lids at the commence- 
 ment; and as styes are painful, and swelling and pain last for a few days, the use of 
 
 (Read before the D. Hayes Agnew Surgical Society of the undergraduates of the Medical Depart- 
 ment of the University of Pa., February, 1891.) 
 
88 
 
 Glycozone is satisfactory to both patient and physician. In nasal catarrh, when the 
 mucous membrane is dry and crusts form, prompt and more satisfactorily results can 
 be obtained from Glycozone than from any other means known. 
 
 In the various chronic inflammations of the throat which are ordinarily obstinate to 
 treatment, I have frequently satisfactorily treated by the Peroxide (diluted,) especially 
 when the orifice of the eustachian tube was closed by swelling, and the patient rendered 
 uncomfortable by temporary deafness and ringing in the ears. 
 
 PEROXIDE OF HYDROGEN, MATERIA MEDICA AND 
 
 THERAPEUTICS. 
 
 Vol. II, Page 681, 1891. 
 By JOHN V. SHOEMAKER, A. M., M. D. 
 
 Professor of Materia Medica, in the Medico Chirurgical College, of Philadelphia, Pa 
 
 Pharmacology. — The usual strength of peroxide of hydrogen is called the fifteen- 
 volume solution, because each portion of the solution yields fifteen volumes of the 
 oxygen. It is prepared by Charles Marchand, New York, for medical use, and is an 
 active oxidizing and antiseptic agent. Glycozone is the trade name of a similar 
 preparation in which glycerine is the vehicle. 
 
 Therapy. — Though less powerful than many other antiseptics, the solution of 
 hydrogen peroxide has a special place in surgery, gynecology, and obstetrics, on account 
 of its powers of decomposing pus and destroying the microbes of suppuration. Being 
 free from all irritating qualities, it can be poured oyer wounds, injected into sinuses, or 
 into the ear, or used as a spray in ulceration of the pharynx and of the larynx. 
 
 It produces a frothing up when it encounters pus, owing to the liberation of oxygen, 
 and the cessation of this commotion indicates the removal of all pus. The surface of 
 the wound or ulcer becomes blanched, but is not injured by the application. 
 
 Tubercular and mammary abscesses especially are well treated in this way. In 
 ulcerative tonsilitis, fetid breath, and in some bronchial affections, a spray of dilute 
 hydrogen peroxide is productive of benefit. A spray of this agent is likewise of utility 
 in chronic nasal catarrh, ozcena, and scarlatinal angina. It has been administered, well 
 diluted, in gastric affections, and is said to be very useful in flatulent dyspepsia, heart- 
 burn, catarrh of the stomach and bowels, etc. 
 
 In diphtheria and croup its value has been established; a two volume solution is 
 especially recommended in young children as a local application, and particularly after 
 separation of the membranes, in order to remove the odor and disinfect the surface. 
 Internally it is too quickly decomposed in the stomach to render much service as a 
 source of oxygen to the blood. It might prove of value in gastric ulcer. 
 
 PEROXIDE OF HYDROGEN IN DISEASES OF THE 
 
 MUCOUS AND SEROUS MEMBRANES. 
 
 By W. S. MULLINS, M. D., Henderson, Ky. 
 
 A paper read before the International Homcepathic Congress, Atlantic City, N. J, 
 
 June 16-23, 1891. 
 
 (Published by the Medical Era of Chicago, November, 1891.) 
 
 Since the discovery of Peroxide of Hydrogen in 1818 by the French chemist, 
 Thenard, and its introduction to the medical prof ession by Richardson, in 1858, it has, 
 like most remedial agencies brought forth by the empirical school of medicine, enjoyed 
 great favor for a few years, only to fall into disuse, not because it did not possess virtues 
 peculiar to itself, but from the fact that it was an impure chemical substance, producing 
 
8 9 
 
 escharotic effects when applied locally, and poisonous effects upon the system when 
 diluted. 
 
 What it may do outside of its remedial effects upon mucous and serous membranes, 
 I know not. But the results obtained in diseases of the nose, throat, ear, skin and womb, 
 I have had an extended clinical experience of ten years. It is Marchand's Peroxide of 
 Hydrogen, H 3 Og, that I speak. 
 
 I know of no chemico-therapeutical substance of modern use, that brings the 
 physician a more decided and powerful curative action, in its range of indications. 
 
 Before entering into its chemical adaptation, permit me to say, by way of caution, 
 that in no instance, and under no circumstances, should the commercial and poisonous 
 Peroxide of Hydrogen be used. Neither should it be applied or inhaled except by means 
 •of glass, rubber, porcelain or gold instruments, as its effects are certainly contaminated, 
 if not entirely destroyed, by any other appliances than the ones named. 
 
 In acute, subacute or chronic cases of catarrh of the head, when accompanied by 
 an acrid, excoriating discharge, and much sneezing, it will almost certainly control the 
 sneezing and change the nature of the discharge from acrid to bland. 
 
 In chronic nasal discharge, either from the anterior or posterior nares, of a yellowish 
 greenish fetid character, with an accumulation of hardened pus and scabs in the nose, it 
 will soften them and cleanse the nose effectually. 
 
 In both conditions of nasal catarrh as enumerated to be followed by an application 
 <of glycozone on a cotton swab; or, better still, to saturate a small cotton tampon of 
 borated cotton with the glycozone and place it well up each nostril; allow it to remain 
 from one to two hours, cautioning your patient to remove it gently and to desist from 
 any forcible blowing of the nose between treatments. 
 
 In granular pharyngitis, produced by smoking apply by means of a spray as follows: 
 
 ]$ Peroxide of Hydrogen, 15 volumes, § ss. 
 Aqua distillata, § ijss. 
 To be followed by inhalations of ozonized vapor. It is a radical cure. Three 
 .sprayings and three inhalations in bad cases, and once a day in simple cases, should be 
 used cautioning your patient to hawk as little as possible. 
 
 In diphtheria, an early application of copious and frequent spraying of the nose, 
 mouth, throat, pharynx and larynx, administered with a mixture of: 
 
 ]$ Peroxide of Hydrogen, 15 volumes, § ss. 
 Aqua distillata, § iij. 
 When diphtheria is well developed, irrigate copiously and frequently, the nostrils, 
 pharynx, mouth arid larynx, with a stronger mixture as follows: 
 
 I£ Peroxide of Hydrogen, 15 volumes, § jss. 
 Aqua distillata, § ss. 
 The above is the best local application for this most dread disease. It is to be used 
 <of course with the indicated internal remedies. 
 
 In bronchitis and asthma, administer ozonized vapor inhalations three or four times 
 a day with a solution made as follows: 
 
 1$ Peroxide of Hydrogen, 15 volumes, § iss. 
 Glycerine, § j. 
 Koch's lymph or Shurley-Gibbes iodine, chloride of gold and sodium, are nowhere 
 in benefiting your consumptive patients, when compared with the following: 
 
 1$ Peroxide of Hydrogen, 15 volumes, § ij. 
 Pure glycerine, § j. 
 M. Sig. Shake well, inhale for ten minutes, four times per day, in alternation 
 with the following: 
 
 I£ Fl. ext. Hydrastis, | ss. 
 Glycerine, § j. 
 Kreasotum, m vj. 
 Aqua distillata, § jss. 
 M. Sig. As directed. 
 
9° 
 
 In cases of the many different varieties of eruption seen so often upon the faces of 
 young girls from 15 to 23 years of age, including blackheads, by applying first for 
 about three minutes, to the face, a flannel cloth as hot as can be, wrung out of hot 
 water, then apply by means of a sponge Marchand's full strength Peroxide of Hydrogen, 
 followed by rubbing well into the skin, boracic acid; one to three applications per day, 
 according to the severity of the case, will give you all the reputation you desire as a 
 dermatologist. 
 
 CONJUNCTIVITIS. — The following makes a splendid application for catarrhal 
 or granulated conjunctivitis: 
 
 ty Glycerine, § j. 
 Boracic acid, § j. 
 
 Mix well in a mortar and add Peroxide of Hydrogen, \ j. Apply by means of a 
 camel's hair brush. Keep well corked. 
 
 CHRONIC ULCER. — I have just dismissed from my office, cured, an old chronic 
 ulcer of the leg of fifteen years' duration. It was one inch deep, three inches long and 
 two inches wide. 
 
 The only treatment the patient received was the application of Peroxide of Hydrogen, 
 15 volumes, dropped on carefully night and morning by an ordinary glass dropper, 
 being careful not to disturb the white foam thereon. The whole was then covered by 
 borated cotton, saturated with glycozone, oil silk over this, the leg kept bandaged from 
 the foot to the knee by an Empire elastic bandage — by the way, far superior to Martin's. 
 
 During the three months he was under my treatment, he received three doses of 
 sulphur, 47m, ten doses of Arsenicum, 3x, ten doses of Argentum nit., 6 X , ten doses 
 of Lachesis, 6 X , ten closes Calcarea sulph., 6 X , which, in my mind, contributed much to 
 curing the case. 
 
 GYNECOLOGY. — In the field of gynecological work, nothing serves me as well 
 and often, nor is there anything in my opinion, to take its place. 
 
 ABSCESS OF THE LABIA. — Puncture with bistoury, cleanse with pure Peroxide 
 of Hydrogen, 15 volumes, then by hypodermic syringe inject slowly into the sac, 10 or 
 15 drops of Glycozone; very little reaction follows, and the results are perfect. 
 
 VAGINITIS. — As a vaginal douche, use hot buttermilk; then by aid of the 
 speculum and a small cotton swab on an applicator, apply the pure Peroxide of 
 Hydrogen, 15 volumes, to the entire mucous membrane, including the cervical canal, 
 to be followed at once by an application of Glycozone. Insert into the vagina a roll of 
 cotton saturated with Glycozone, which serves to keep the inflamed surfaces apart. Use 
 the same treatment for vulvitis. 
 
 ENDOMETRITIS. — In endometritis, when the discharge is white and acrid, or 
 yellowish, greenish and fetid, apply full strength, 15 volumes, being careful not to wipe 
 off the foam generated, follow by one application of a tampon, or tampons, saturated 
 with Glycozone. 
 
 CHRONIC METRITIS.— Copious hot water vaginal douches; then apply full 
 strength, Peroxide of Hydrogen, 15 volumes, followed by tampons of Glycozone, applied 
 every other day. This treatment is worth the consideration of any member of this 
 institute. It is, of course, understood that in all cases the indicated remedy must be 
 used, combined, in the judgment of the physician. 
 
 In almost all cases where the Peroxide of Hydrogen is used in the nose or throat, it 
 should be diluted one-third, one- fourth, one-half, three-fourths, and sometimes four- 
 fifths, with pure distilled water. 
 
 My rule has been, except in cases of nasal catarrh, accompanied with much sneez- 
 ing and very acrid excoriating discharge, to use it just strong enough to produce a very 
 slight tingling sensation. 
 
 It should be borne in mind that, when used in the nasal cavities, it produces fre- 
 quent sneezing, and if too excessive, should be diluted still more. If its use on irritated,, 
 inflamed or ulcerated surfaces should produce a too free discharge of blood, you may 
 conclude that it needs further weakening. 
 
 
9 1 
 
 If you desire a better, quicker and more effective local treatment for carbuncles 
 than carbolic acid, in conjunction with your constitutional remedies, inject pure medicinal 
 Peroxide of Hydrogen by use of hypodermic syringe; a keen, cutting, stinging pain 
 follows. When the pain has subsided, inject by same means, a few drops of Glycozone. 
 I am only sorry my time will not permit me to enter as fully as I would like in explana- 
 tion of its beneficial use, and speak of its great curative powers in eczematous vesicular 
 eruptions, in vesicular erysipelas, in aphthous and cancerous conditions of the mouth 
 and of its value as an internal remedy in gaseous dyspepsia that will not respond to 
 Lycopodium, China, Argentum, Magnesium, Phosphorus or Carbo veg. 
 
 As I have already indicated, I have great faith in the Peroxide of Hydrogen, in 
 the treatment of consumption. Give inhalations on alternate days, of the Peroxide, and 
 Hydrastis, at the same time giving nourishing food, and attending to other conditions. 
 It has helped me to cure several well-developed cases of consumption. The use of the 
 Hydrastis is not original with me, but the plan of alternating the two I have never 
 known to be used by others. 
 
 I am loth to leave this, to me, interesting subject. I trust that it maybe of benefit 
 to you. 
 
 WAX IN THE EARS. 
 
 By A. S. TUCKLER, '92, C. M. C, S. F, 
 
 (Published by the California Medical Journal, San Francisco, Cal., June, 1892.) 
 
 A simple method of removing "wax in the ears, v is to take Peroxide of Hydrogen, 
 (Marchand's), warm it in a water bath, then with an atomizer spray the meatus for 
 about five minutes. This will soften and partially dissolve the cerumen. An ear spoon 
 will now remove the mass, and to the surprise of the patient, the sense of hearing will 
 be immediately restored. A little more of the spray to cleanse the parts will be all that 
 is necessary. This is a far safer method than the digging-out process, and not liable to 
 perforate tympanum, an experience which the writer has been subjected to. 
 
 SOME PRACTICAL POINTS IN THERAPEUTICS. 
 
 By JOHN A. LARRABEE, M. D. 
 
 Professor of the Principles and Practice of Medicine, Hospital College of Medicine % 
 
 Louisville , Kentucky. 
 
 (Abstract of paper read before the Louisville Medico-Chirurgical Society, Oct. 2, 1891.) 
 
 Permit me, in conclusion, to make mention of those therapeutic agents which, 
 during the summer months, have been weighed in my practice and have not been found 
 wanting. In entero-colitic diarrhoea, the so-called "summer complaint" of cities, 
 dependent upon the various micro-organisms, vitiated air, and bad food, salol, naphtha- 
 line, carbolic acid (nascent), calomel in minute doses and nitrate of silver, have stood 
 the test. In gastro-enteritis, I have found salicylate of bismuth useful, and in inflam- 
 matory diarrhoea (the dysentery of some authors) of infants and older children, Rochelle 
 or Epsom salts in acid infusion of roses with small doses of laudanum. In chronic 
 cases the nitrous acid camphor mixture of Dr. Hope has not failed. For the gastric 
 fevers so common in children, the preparations ammonia-phenique and sulpho-phenique 
 of M. Declat have been used exclusively in a large number of cases with much better 
 
9 2 
 
 ^results than any former treatment; also the same for the exanthema. For "whoop 
 ing-cough," Declat's syrup coqueluche is nearly a specific. In diphtheria, locally, 
 Marchand's Peroxide of Hydrogen and whiskey internally have established their value. 
 A word in regard to the use of the peroxide. It should always be purchased in the 
 smaller four-ounce bottles, protected from the light by blue glass bottles and corked 
 with rubber. That sold by the druggists from large bottles is, in the majority of cases, 
 worthless. It is a very unstable article, and unless it causes immediately a white, foamy 
 reaction when brought into contact with the false membrane, it should be discarded and 
 another lot obtained. lam satisfied that I use it more freely and more persistently than 
 most practitioners. I use mops made by twisting a sort of absorbent cotton upon sticks, 
 using as many as thirty or forty in the twenty-four hours. Such mops will take up 
 nearly a half ounce apiece, and when forced well back into the pharynx reach all parts. 
 The gagging and resistance of the child assists in the distribution of the fluid. As soon 
 as a mop has been used it is committed to the fire. In this way I have treated the 
 worst as well as the milder forms of diphtheria with complete success. I believe that 
 the systematic use of definite, although often topical doses of whiskey, even in children 
 ^of tender age, to be the surest safeguard against heart failure. 
 
 PEROXIDE OF HYDROGEN IN TYPHOID FEVER. 
 
 By F. H. WIGGIN, M. D., 55 w. 36TH ST., New York. 
 (Published by the New York Medical Record, November 28, 1891.) 
 
 Having had good results in using Peroxide of Hydrogen locally in diphtheria and 
 tonsilitis, and in infected wounds, it occurred to me, when a case of typhoid fever came 
 under my care, during my summer practice, that this remedy might be beneficial, it 
 being the most powerful non-poisonous germicide we possess. 
 
 On August 24th I was called to see Abby M — , who gave a history of having been 
 ill for a week with fever and diarrhoea. On examination I found a characteristic case of 
 typhoid fever with temperature 104^-° F.; pulse, 130; rose spots, abdominal pain, tym- 
 panites, diarrhoea, and mild delirium. I prescribed one ounce of 15-volume Peroxide 
 • of Hydrogen* to eight ounces of water, to be taken every three hours, by the mouth. 
 On the following day I found the patient more comfortable ; temperature 103° F.; pulse 
 112; had had only two movements during the twenty-four hours; less delirium and less 
 pain in head. On the 26th had had one movement; temperature 102° F., pulse 104; 
 less tenderness in abdomen, and pain in the head diminishing. On the 27th, tempera- 
 ture ioo£° F.; pulse 98; no movement; tympanites disappeared, and head, though still 
 weak, clearer. On the 29th, temperature 99^°.; no movement. On the 30th, tem- 
 perature normal; pulse, 84: formed movement. The case went on now uninterruptedly 
 to recovery, with nothing further of interest to report. On the 9th of September I dis- 
 continued my visits, the patient being discharged, cured, though weak. 
 
 One swallow does not make a summer, but I report this case hoping that some one 
 who has larger experience for treating typhoid fever may take up the suggestion and 
 let the result be known. The remedy is perfectly harmless, easy to take, and appar- 
 ently was of great value in this case. 
 
 *Since the above report has been published by the New York Medical Record, Dr. F. H. Wiggin 
 ; stated April 14, 1892, that Marchand's Peroxide of Hydrogen (medicinal) was used by him in this 
 .case. 
 
93 
 SUBSTITUTION AND ITS ATTENDANT EVILS. 
 
 By JOHN AULDE, M. D., 4719 Frankford Ave., Philadelphia, Pa. 
 
 (Published by the Journal of the American Medical Association, Chicago, 111., Decem- 
 ber 5th, 1891.) 
 
 The evils attendant upon substitution and sophistication of remedial agents have 
 long been surmised; they have not, however, until recently, received attention at the 
 hands of the medical profession. Increased diagnostic skill, along with greatly im- 
 proved facilities for the manufacture of medicaments, favor an approach toward mathe- 
 matical exactness in computing therapeutic results. When these are wanting we 
 challenge the character of the remedy. The question which presents itself is: Has our 
 patient received the true medicament or a base counterfeit? However attractive in 
 theory, it will be found impractical for the medical profession to drift away from the 
 pharmacists and it should be our aim to reward the faithful and bring the guilty to pun- 
 ishment. The friendly bond between the two professions should be honesty, as neither 
 can afford to work independently; there is an interdependence which makes them mutu- 
 ally helpful.' 
 
 It is said of Lawson Tait, that he has returned to first principles and carries a mill 
 with him, so that when ergot is needed, he prepares it fresh with his own hand. The 
 reliable character of Squibb's ether has been maintained through his business sagacity in 
 having it prepared chemically pure and distributed all over the world in sealed cans, 
 thus precluding the possibility of sophistication or substitution. 
 
 The life of a patient suffering from rheumatism may depend upon his being supplied 
 with sodium salicylate prepared by a combination of Merck's chemically pure bicarbonate 
 of soda and true salicylic acid obtained from oil of wintergreen, and yet few pharmacists, 
 even in large cities, pretend to keep either in stock. They are the exception in Phila- 
 delphia, and doubtless the same is true of other cities. 
 
 Some years ago Dr. Squibb, of Brooklyn, set his seal on Marchand's Peroxide of 
 Hydrogen, by endorsing its character and defending its merits as the most powerful and. 
 yet harmless bactericide which could be employed in the treatment of various formidable 
 and fatal diseases. Dr. Robert T. Morris, Dr. Paul Gibier, and other well-known 
 authorities have corroborated his statements from clinical observation, and as a conse- 
 quence, a revolution has taken place in our methods of treatment in both medical and 
 surgical practice. The efficacy of this simple remedy, its innocuousness and extended 
 field of application, have shed a flood of light upon modern therapeutics, but at the 
 same time there has followed in its train a host of worthless imitations. 
 
 The substitution of the commercial for the medicinal peroxide is calculated to work 
 serious injury and destroy our confidence in a most potent remedy. In the treatment of 
 diphtheria, for instance, the commercial product is positively harmful. When death re- 
 sults shall we blame the attending physician or the unscrupulous druggist who substi- 
 tutes a base imitation for the genuine product? And still, pharmacists who claim to be 
 respectable, do not hesitate to trifle thus with human life. Is it any wonder then, that 
 our mortality percentages are on the wrong side? 
 
 Cascara sagrada has been counterfeited and sophisticated until it is almost impossi- 
 ble to secure a reliable preparation of this most useful medicament, although Parke, 
 Davis & Co. , the pioneers in its introduction, have adopted every means in their power for 
 the protection of fhe medical profession. Antipyrin, a patented preparation, has met 
 with phenomenal sales, and possesses distinct therapeutic properties, and as a result, 
 imitations and substitutes are off ered to take its place in medical practice. Whether these 
 imitations are better or worse than the original product, I do not care to discuss; neither 
 is it for the druggist to decide. The decision here, as to any special remedy or prepara- 
 tion, rests entirely with the physician, as he alone is responsible for the condition of his 
 patient; no one else, not even the druggist, should be permitted to interfere with his. 
 
94 
 
 •directions. Substitution is an evil which should be guarded against; it is an evil which 
 must be eradicated, or the entire medical structure will collapse. It is a duty we owe to 
 ourselves and to our patients to look after this unnatural condition of affairs in which we 
 are so vitally interested, and the time is near at hand when a systematic effort must be 
 made with a view to accomplish the desired end. 
 
 This subject is commended to the attention of the American Medical Association, 
 with the suggestion that a committee be appointed who shall recommend suitable meas- 
 ures for the protection of the medical profession from the evils of substitution and so- 
 phistication on the part of unscrupulous druggists. Shall we have a list? 
 
 HYDROGEN PEROXIDE IN PELVIC ABSCESS. 
 
 (Published by the Bacteriological World ol Battle Creek, Mich., December, 1891.) 
 
 We have for a number of years made the use Peroxide of Hydrogen (Marchand's) 
 in the treatment of suppurating surfaces, abscesses, etc. , with excellent results, but have 
 never observed a more gratifying result than that recently obtained in a case of pelvic 
 abscess of long standing. The abscess discharged by a small opening just behind the 
 
 • cervix uteri, and was very profuse, and extraordinarily foetid. Our stock of Peroxide of 
 Hydrogen happened to be exhausted at the time, the new supply ordered being somewhat 
 
 •delayed in reaching us, and we at first employed listerine, using it ir. the proportion of 
 one part to three of distilled water. There was no apparent effect upon the discharge, as 
 regards either quantity or character. The odor continued as bad as ever. When the new 
 supply of Peroxide of Hydrogen arrived, we immediately began using it in the proportion 
 of one part to ten of distilled water, with the result that after the first washing the in- 
 tensely fcetid odor disappeared entirely, the discharge became healthy in appearance, and 
 diminished in quantity so rapidly that within ten days there was no discharge whatever, 
 
 ■ except at the washing, and then the quantity evacuated was not more than a dram, when 
 it had previously been several ounces, besides continuous discharge in the intervals be- 
 tween the washings. 
 
 After the first washing with Peroxide of Hydrogen, the patient's temperature, which 
 had for several months previously been above normal, fell to normal and has remained 
 at that point since. There is certainly at present no agent known which could properly 
 replace hydrogen peroxide as a disinfectant of unhealthy surfaces. 
 
 It would seem to be especially valuable in the treatment of abscesses, the discharges 
 of which, through the relation of the cavity and the lower part of the alimentary canal, 
 usually possess so repulsive an odor as to render the existence of the patient almost un- 
 endurable. J. H. K. 
 
 DENTAL MEDICINE. 
 
 By R. M. CHASE, D. D. S., M. D., Bethel, Vt. 
 
 Abstract of paper read before the New England Dental Society, October 29, 1891. 
 
 (Published by the International Dental Journal, Philadelphia, January, 1892,) 
 
 Peroxide of Hydrogen still stands at the head as a germicide, and undoubtedly is one 
 
 of the best antiseptics yet discovered to annihilate germs, bacteria, or microbes, Charles 
 
 Marchand's preparation, H 2 On, is, I believe, the best article in the market, as Peroxide 
 
 ■ of Hydrogen is very susceptible to certain conditions. To get the best results it should 
 
95 
 
 rbe kept in a cool place, well stoppered and when required for use as much as desired 
 •should be poured from a large bottle into a small receptacle, and only what it to be used 
 •should be exposed to the light. When small cavities are to be cleansed it should be in- 
 jected with a small glass or rubber syringe, as metal should not be brought into contact 
 with it as it quickly destroys its utility. For reaching pulp canals I find a small glass 
 medicine dropper very convenient as by pressing upon the rubber bulb quickly it is 
 ' forcibly ejected and thus forced into the pulp canal without much trouble. I use a wooden 
 i tooth pick reduced in size to still further push it into the root. In treating all ill-con- 
 i ditions of the oral cavity I make it a rule to first rinse thoroughly the mouth with peroxide 
 
 • diluted, and then apply remedies suitable for the same. Much more could be said and 
 
 • undoubtedly will be brought out in this discussion upon this and other valuable antiseptics. 
 
 PEROXIDE OF HYDROGEN IN THE TREATMENT OF 
 
 DIPHTHERIA. 
 
 ■ (Published by the North Western Medical Journal, Minneapolis, Minn., February, 1892) 
 
 In the next chapter, we shall give further details, with regard to the treatment of 
 'diphtheria, but at this point we feel that we should not close without announcing in the 
 most emphatic terms, that one of the most available agents that we have for the fighting 
 of diphtheria locally, and preventing constitutional involvement is the "Necessary Peroxide 
 of Hydrogen" made by Chas. Marchand, of New York. We would take no chances by 
 using any other manufacture. Charles Marchand was the pioneer in the development of 
 this particular agent, for medical use. It is the "Medicinal Peroxide of Hydrogen which 
 can be depended upon to render diphtheria germs inert as thoroughly as water can bede- 
 pended upon to put out a fire, or as heat can be relied upon to annihilate the icicle. We 
 believe that every case of sore throat, whether pronounced diphtheria or not, as well as 
 every case of scarlet fever, should have applied to the throat at intervals varying accord- 
 ing to the necessities of the situation, the full strength of the Marchand's Peroxide of 
 Hydrogen. It may be used as a gargle, though I am somewhat in favor of flushing the 
 parts with a good syringe, or if this is not available, owing to the objection of the patient, 
 particularly if it be a little one, atomizers are now furnished which act very efficiently, 
 and by using them frequently, the full effects can be secured. It is well to give internally 
 occasionally, teaspoonful doses of the peroxide. It maybe diluted or not, as one pleases, 
 All the secretion which has been swallowed will thus be acted upon in the stomach. In ad- 
 dition, there is a general accumulation of fermentative products in the stomach, undi- 
 gested food, etc. The oxidization of these irritants is desirable. If the patient complains 
 that the application is irritating it may be diluted with one, two or three parts of water. 
 
 The position which we took nearly four years ago with reference to the use of Perox- 
 ide of Hydrogen in the treatment of diphtheria in a paper read before the St. Louis Medi- 
 cal Scciety, has been strengthened with the experience which has followed. We would 
 emphasize every material point then made in that paper. If asked "if we were to depend 
 upon only one agent in the local treatment of diphtheria, what would we call for," the re- 
 sponse would be emphatic, in thundering tones, "Marchand's Peroxide of Hydrogen, "and 
 if we ascertain that any druggist furnished our patient with any other than Marchand's 
 it would be sufficient for us to condemn that druggist and rather than run the gauntlet 
 of his repeating the offense, we would supply the medicament at our own expense. 
 
9 6 
 
 RECENT INVESTIGATIONS RELATING TO THE 
 PREVENTION OF DIPHTHERIA AND SCARLET FEVER^ 
 
 By Dr. J. LEWIS SMITH. 
 
 Professor Diseases of Children, Bellevue Medical College, New York. 
 
 Abstract of paper read before New York County Medical Association, March 21, 1892.. 
 
 (Published by the Doctor s Weekly, March 26, 1892.) 
 
 In his report the author entered fully into the pathology and etiology of the two' 
 diseases, and dwelt at some length on their differential diagnosis. He related many 
 interesting facts in connection with the contagiousness of diphtheria, spoke of a case of 
 the disease resultiong from the employment of a brush that had been used for swabbing 
 the throat four years before in a similar trouble. Does not believe diphtheria ever origi- 
 nates de novo, that it is dependent at all times on the presence of a specific microbe. 
 Damp cellars, the presence of sewer gas and other unsanitary conditions contribute 
 largely to its development. Many mild attacks of the disease are overlooked by the 
 attending physician, and as a consequence it is communicated to others, notably in the 
 school room. He believes in thorough disinfection as a means of preventing a spread of 
 the disease. Does not have much faith in sulphur for this purpose; prefers a strong 
 solution of corrosive sublimate or five per cent, solution of carbolic acid. This should 
 be v.sed freely oji walls and floors of rooms where the disease prevails. With the same 
 solution the bedstead and other articles of furniture should be thoroughly washed. 
 
 In examining patients suspected of having diphthena or scarlet fever, the physician 
 should place himself on one side or in the rear and not in front, as is usually the prac- 
 tice. In this manner he avoids the dangers of any diseased matter that might be coughed 
 up by the patient. After such examinations the physician should thoroughly bathe his 
 hands and face in a solution of corrosive sublimate. Exclude everybody but the physi- 
 cian and nurse from the room where a case of either disease exists. While small-pox is 
 thoroughly under control in this city, he doesn't think it possible to gain such controL 
 over the two diseases under discussion. The crowded condition of our large tenement 
 houses supplies so much material for their ravages that it is impossible to stamp them, 
 out. For the purpose of illustration, the reader related the following experience: 
 
 He was called to seethe child of a poor woman, living in a tenement house in which 
 there were twenty-seven families. He found a child two years old very sick with diph- 
 theria. Five other children lived in the same rooms; of these, two were away at time 
 of his visit, at school. Just think of the hundreds of children thus exposed! The sick, 
 child died two days later. 
 
 For purpose of fumigation the author recommended the following: 
 
 ]$ 01. eucalyptus, 
 
 Acid carbolic, aa § j. 
 Spir. turpentine, § viij. 
 
 M. Add two tablespoonfuls of this mixture to a pint of water and evaporate by aid 
 of a lamp; or cloths saturated with the mixture may be hung around the room. 
 
 Does not believe in the efficacy of sulphur fumigation. Microbes. in a state of activity 
 may be found in the sweepings obtained from a room that has been fumigated with sulphur. 
 
 For the local treatment of diphtheria and scarlet fever, he recommends the following: 
 
 I£ 01. eucalyptus, 
 
 Acid carbolic, aa 3 j. 
 Ol. olive, § vij. 
 
 M. Sig. Apply every three hours. 
 
 He also uses Marchand's medicinal Peroxide of Hydrogen one part, to three parts^ 
 
97 
 
 of water, with much satisfaction. It is prompt in action and quickly destroys the diph- 
 theric membrane. 
 
 Dr. Smith's paper was discussed by Drs. Leale, Tyndale and Koplik. 
 
 SOME NOTES ON THE VALUE OF PEROXIDE OF 
 
 HYDROGEN. 
 
 By ROBERT T. WILSON, M. D., Baltimore, Md. 
 
 Assistant Surgeon to the Hospital for the Women of Maryland, 
 
 Editor of Practice, Richmond, Va. : 
 
 Having read in the January number of your excellent 'journal, the experience of Dr. 
 S. Potts Eagleton in the use of "Hydrogen Peroxide in Surgical Affections," I am 
 prompted to send you for publication the following: 
 
 In January I was called to see a lady in her seventy-six year of age, suffering, as her 
 husband supposed, from an inguinal hernia, but upon careful examination, I diagnosed 
 a deep-seated abscess, and at once ordered hot poultices, to be made of equal parts of 
 flax-seed and corn meal, and applied in the following manner over the skin: White gauze, 
 hot poultice, muslin, oil silk. After a few poultices had been used it was in a condition 
 to be opened. A good incision, giving free drainage was made. The cavity was eight 
 inches in depth. Every day the cavity is syringed with "Peroxide of Hydrogen" (Mar- 
 chand's) full strength. 
 
 The first effect noticed was the rapid oxidation of all purulent matter, which caused 
 the distention of the cavity with the gas eliminated as a frothy yellowish (or yellowish* 
 green) bubbling substance. After the oxidation is completed the wound is always in a 
 clean, sweet condition, absolutely free from pus. The cavity is dusted with iodoform, 
 and antiseptic dressings applied. The cavity is gradually healing up from the bottom. 
 In my experience "Peroxide of Hydrogen" (Marchand's) perceptibly diminishes the pus 
 formation. In this connection, I will also state that I am using "Peroxide of Hyrdogen" 
 in a case upon which I operated February 16, and from which was removed a large 
 multilocular ovarian tumor and also an enlarged uterus with many fibroids (hysterec- 
 tomy). The wound (stump) is in a healthy condition; her general condition is good. 
 Indeed, she is getting along finely. The clamp came away yesterday. The sixteenth 
 day was up yesterday, counting by hours, from the time of the operation. The wound 
 is in a healthy state, and perfectly healed. Hardly a day passes that I am not using the 
 "Peroxide of Hydrogen" in my practice. I send you these notes, hoping they will 
 assist some brother practitioner who may be a reader of your practical journal. Doctors 
 talk with each other about their cases, and I believe they are as much interested in 
 exchanging their experiences by correspondence. We are all mutually concerned. 
 
 DIPHTHERIA, LOCAL TREATMENT. 
 
 By I. N. LOVE, M. D., St. Louis, Mo. 
 
 (Published by the Medical Mirror, of St. Louis, March, 1892.) 
 
 Judgment should be exercised in this as in everything else. If we select the applica- 
 tions properly they will be sufficiently agreeable as not to annoy or irritate more than 
 they benefit It may be necessary to avail an opportunity for the application; for the 
 patient may be fretful, easily demoralized by being disturbed; we should wait until rest 
 has been secured, until the sensibilities have been obtunded by proper internal medication. 
 
9 8 
 
 We 9hould bring to bear our ingenuity to the fullest and diplomacy also; if possible ascer- 
 tain if the child has a fondness for any particular thing. We should arrange a plan by 
 which a reward in prospect may assist in accomplishing our desires. 
 
 For its germicidal effect, and also for the removal of the mechanical obstruction 
 produced by the diphtheritic membrane, Marchand's Peroxide of Hydrogen, (medicinal) 
 should be used promptly, in its full strength, but later it may be diluted to one-half 
 strength. As the mucous membrane becomes exposed after the removal of the deposit, 
 by the means just mentioned, it is important to have on hand an application which is 
 soothing, astringent and at the same time as much antiseptic as it can be made. 
 
 I have found the following valuable for this purpose. 
 
 I£ Katharmon., § ij. 
 Glycerine, § j. 
 Aquae Cinnamonis, § iij. Sig. 
 
 The Peroxide of Hydrogen may be labelled No. I, the formula just written No. 2. 
 The best means of applying both applications is either by a glass syringe or an atomizer 
 made of hard rubber; but in case neither of these appliances are at hand or available, a 
 piece of wire (silver or platinum) of good strength, may be bent, with a hook at the end, 
 in such a manner, as to serve as a probang by wrapping a pledget of absorbent cotton at 
 the point; the application may be made after thoroughly wetting the same with the 
 solution. No. 2 application should follow No. 1 , and will be gratefully received by the 
 little patient. 
 
 WOUND CLOSURE AFTER THE EMPYEMA OPERATION. 
 By CHARLES W. AITKIN, M. D., Flemingsburg, Ky. 
 (Published by the Ohio Medical Journal, of Cincinnati, April, 1892.) 
 
 Several times the writer has found it difficult to close the wound made in an operation 
 for empyema, especially if the empyema was of any magnitude or of long standing, so 
 that the lung's function was destroyed by compression, and bound down by adhesions. 
 
 Mrs. V., set. 32, of Bath County, Ky., was confined April 20, 1891. The physician in 
 attendance, Dr. Judy, informs me that there was nothing abnormal in the labor. On 
 April 30th the patient had a chill, and for several days the temperature ranged from 103 
 to 104. 5 . After a few days more she began to complain of pain in left chest and 
 shoulder. I saw her on May 24, in consultation with Drs. Judy and Sharpe, and we agreed 
 to aspirate the left chest; over four pints of (fluid were removed; two and one-half pints 
 were fair serum, but the last one and one-half pints had some purulent appearance. 
 During the next six weeks the patient was aspirated several times, and over ten pints of 
 sero purulent fluid was removed at these various tappings. At this time a thoracotomy 
 was decided upon. The patient was taken to the Good Samaritan Hospital, and with the 
 aid of Dr. French, with the house physicians, Drs. Buel and Schoolfield, I opened the 
 chest and let out over four pints of pus, the cavity was thoroughly washed with a saturated 
 boracic solution, and the usual drainage and dressing applied, the case was left in Dr. 
 French's care. The flow of pus was considerable for a week, after that time the boracic 
 irrigation was followed by washing the cavity every day with Peroxide of Hydrogen. 
 The quantity of pus rapidly diminished, the patient gained in strength and weight, and 
 in about four weeks more came back to her Kentucky home. Her husband continued 
 washing the cavity with both the boric solution and H 3 O s until September 12, when I 
 again looked after the case for a week, preparatory to closing the wound, but as there 
 was still an ou»nce or so of pus passing per diem, it was thought advisable to continue 
 the Peroxide a while longer. This was kept up a month, when the quantity discharged 
 was not more than one-half ounce a day, but to shut off this drainage for twenty-four 
 hours would cause an elevated temperature and general septic symptoms; at this time a 
 
 < ♦. 
 
99 
 
 I to 4000 bichloride solution was substituted for the boracic solution, the H 2 2 being 
 continued, a slight bloody discharge was thrown out for a few days, but lessened 
 gradually, until November 3, when I washed the cavity with a I to 5000 bichloride 
 solution, followed with the Peroxide of Hydrogen for a few days, and let the wound 
 heal without any unpleasant symptoms. The chest was measured during February, 
 1892, and at auxiliary, mammary and ensiform levels, the left semi-circumference was 
 one inch less than the right. The Peroxide of Hydrogen certainly aided very materially 
 in arresting the suppurative process. Marchand's pure Peroxide of Hydrogen was used 
 with but little dilution. 
 
 AN INTERESTING CASE OF EMPYEMA WITH SPECIAL 
 REFERENCE TO THE USE OF PEROXIDE OF 
 
 HYDROGEN. 
 
 By H. F. BROWNLEE. M. D., Danbury, Conn. 
 
 (Published by New England Medical Monthly, June, 1892.) 
 
 This case is interesting in many ways; namely, the length of time which elapsed 
 previous to diagnosis, the degree of exhaustion present at that time, the amount of pus 
 evacuated, and finally, the perfect and rapid recovery of the patient. 
 
 Previous to his sickness, this patient was a strong healthy man of about 30 years of 
 age, but who for a few years past had indulged in rather frequent dissipation. 
 
 About December 20th he was suddenly taken very sick. The attending physician 
 -diagnosed pneumonia and began a vigorous course of treatment which he continued for 
 four weeks. The pneumonia did not resolve but the attending physician continued 
 diligently in his efforts to bring about resolution and at the time I saw him first, over 
 four weeks after the beginning of the attack he was supplied with four glasses of medi- 
 cine with instructions to take a teaspoonful of each every hour. Upon examination I 
 diagnosed empyema and demonstrated it by the introduction of a hypodermic needle. 
 
 At this time the patient was in a condition of extreme exhaustion; temp. 105, pulse 
 hardly perceptible, respiration 48. I had him removed at once to the Danbury hospital; 
 a small amount of ether was administered and a resection performed, removing about an 
 inch of the sixth rib in the axillary line. An opening was then made into the pleural 
 cavity and two gallons of pas evacuated. I did not know the maximum amount of pus 
 ever evacuated in a case of this kind, but I can hardly conceive of a greater amount 
 being contained in the pleural cavity of an ordinary man. The cavity was washed out 
 with Thiersch's Sol., and two large drainage tubes placed in the wound. The patient 
 became quite cyanotic during the operation and required very active stimulation for 
 several hours afterward. 
 
 So much for the case itself, now a few words in regard to his treatment and course 
 of recovery. For two weeks the pleural cavity was washed out every day with Thiersch's 
 Sol. The patient slowly improved but his temperature continued to rise every evening 
 to 102 or 103. I then substituted a Sol. Hydrarg. Bichloride 1-5000, This was used 
 about a week when a very active salivation presented itself. During this tii»e the tem- 
 perature did not run so high but still continued at about 101 to 101^- in the evening. I 
 then began washing out the cavity with Peroxide of Hydrogen and if I had done this 
 before I would certainly have gained considerable time. I used Marchand's prepara- 
 tion, full strength, putting in a considerable quantity of it with a small syringe, then 
 allowing it to escape and finally washing it all out with a weak Borated Solution. 
 
 From this time my patient began rapidly to improve. The temperature fell to 
 almost nothing, rarely exceeding 99-i- at night. In two weeks from this time the dis- 
 
 wc 
 

 IOO 
 
 charge had entirely stopped and I was enabled to remove my drainage tubes, the wound 
 closing in a few days. He gained rapidly in strength and in eight weeks from the day 
 of operation he was able to return to work. 
 
 I cannot say too much in praise of Marchand's Peroxide of Hydrogen (Medicinal) 
 in the treatment of this case. It kept the pleural cavity so clean that there was hardly 
 any septic absorption and finally prevented all formation of pus, the discharge ceasing 
 entirely in two weeks from the time I began its use. 
 
 THE VALUE OF PEROXIDE OF HYDROGEN IN THE 
 
 TREATMENT OF CHRONIC GONORRHCEA, 
 
 ILLUSTRATED BY A CASE. 
 
 By WILLIAMS ROBERTS, Plattsburgh Barracks, N. Y. 
 
 Hospital Steward, U. S. Army. 
 
 (Published by Journal of the American Medical Association, Chicago, 111., April 30, 
 
 1892.) 
 
 During the past few years, the many articles on new drugs in the treatment of gon- 
 orrhoea leave nothing to be desired in this way. The present article contains nothing 
 new, but simply gives the history of a case of chronic gonorrhoea arrested by the use of 
 Peroxide of Hydrogen — a drug that is "going the rounds," probably to be discarded by 
 reason of its being so unhandy and so little understood. 
 
 The following case might serve to illustrate the value of Peroxide of Hydrogen, 
 when used under conditions favorable to the preservation of the drug. 
 
 J. H., citizen, age 23, contracted a gonorrhoea March 20, 1890, and received the 
 usual orthodox treatment by internal medication up to July 7th, 1890, the date at which 
 the patient came under my observation. I found a subacute gonorrhoea, which was 
 somewhat relieved by urethral injections, including the iodoform et tannic injection of 
 Dr. Otis. 
 
 On August 15th, 1890, the patient complained of difficult micturition, and upon 
 examining the urethral canal, I found the following condition: 
 
 Size of urethra at bulb, No. 32 French; 4 inches from meatus, a No. 21 stricture, 
 meatus contracted to No. 20. 
 
 The constriction at the meatus was relieved by incision, and the stricture readily 
 yielded to gradual dilatation, and on August 31,1890, a No. 31 sound was passed without 
 pain. On September 1, 1890, an examination of the urethral canal showed the presence 
 of a small ulcer at the side of the old stricture, and stimulating injections were ordered 
 — without, however, relieving the "morning drop." This drop I examined microscop- 
 ically, and found pus and mucus corpuscles, with small gonorrhceal threads. 
 
 On December 10, 1890, I again examined the urethra, and found the conditions 
 about the same. I had tried the whole list of anti-gonorrhceal remedies, including 
 the medicated urethral bougies and the passage of steel sounds, and was somewhat 
 puzzled to relieve the obstinate form which the disease had assumed. 
 
 On January 26, 1891, I commenced the use of Marchand's Peroxide of Hydrogen, 
 15 volumes, and "Glycozone," with the following results: Two drachms of a mixture of: 
 
 B) Peroxide of Hydrogen, ^ ss. 
 Aquae, § iss. M. 
 was used to distend the urethra, and held for thirty seconds, and then allowed to escape, 
 The decomposition of the H 2 O2 was verv active, showing the presence of pus. I then 
 
 0% 
 
IOI 
 
 injected I drachm, which was allowed to remain in the canal two minutes. I repeated 
 this procedure t, i. d., and at bedtime injected one drachm of "Glycozone." This 
 treatment vfas pursued up to February 9, 1891, when there was no discharge, and the 
 patient declared himself cured. 
 
 I had watched this case with great interest, for it was the most obstinate one I had 
 ever seen in not yielding to some one of the many lauded cures for chronic gonorrhoea. 
 During seven months the patient had been under constant treatment, to find that a three 
 weeks' course of treatment by Peroxide of Hydrogen terminated the case quite satis- 
 factorily. 
 
 The above data might naturally turn the reader's thoughts to the nature of the 
 remedial agent that succeeded where all others had failed. 
 
 The Peroxide of Hydrogen was that prepared by Chas. Marchand of New York. 
 The chemistry of this compound together with the pathological conditions it may be 
 applied to, I will leave to the many advertising agents, and will simply state the care 
 with which the preparation should be preserved, for there are factors which utterly 
 destroy the medicinal properties of this valuable agent. 
 
 PEROXIDE OF HYDROGEN AS A DEODORIZER IN CANCER 
 
 OF THE UTERUS. 
 
 By GEORGE W. KAAN, M. D. 
 
 Surgeon to Out-Patients, Free Hospital for Women, Boston, 
 
 (Published by the Boston Medical aud Surgical Journal, April 7, 1892.) 
 
 The value of Peroxide of Hydrogen in washing out sinuses and abscess cavities, has 
 led me to use it recently as a vaginal injection in cancer of the uterus; and with gratifying 
 results. 
 
 My cases have been few; but in each the distinctive cancerous odor was noticeable 
 about the patient before the use of the Peroxide of Hydrogen and absent afterwards. In 
 one out-patient case the fetor was so pronounced, that the air of the room seemed 
 saturated with it, the moment she entered. When I last saw her in making an examination 
 no odor was perceptible a foot from the vulva, and only slightly so, close to it. In this case 
 she had used the injection the night before, and a cancerous mass as large as a man's 
 list, hangs in the vagina, within two inches of the vulva. This case has had palliative 
 treatment in the hospital, by curreting, Paquelin's cautery, and chloride of zinc applica- 
 tions. When she first came to me the disease had extended over the whole anterior 
 vaginal wall; since then the Peroxide of Hydrogen has been used, and the anterior wall is 
 clear. It seems to me that the injections have had some, curative action. 
 
 Further observation, of course, is necessary, but bearing in mind what Sir Spencer 
 Wells says of cancer and cancerous diseases, that everything in relation to it is so impor- 
 tant that nothing should be thought a trifle, and my material being limited, I venture to 
 state the facts as they appear to me in this case. 
 
 Regardless, however, of any value it may have as a curative agent, its use as a deo- 
 dorizer, and this without substituting another odor for the cancerous one, makes it of 
 inestimable worth in adding to the comfort of the patients, where palliative treatment 
 alone is all that remains. 
 
 The method of using has been to take about an ounce of the Peroxide of Hydrogen 
 and an equal quantity of water, warmed by being placed in a pan of hot water, and 
 injected through a soft rubber catheter, so that the injection shall be sure to reach the 
 back part of the vagina. Such an injection once or twice a day has been sufficient. 
 
102 
 
 PEROXIDE OF HYDROGEN AS A LOCAL APPLICATION IN 
 
 RHUS TOX POISONING. 
 
 By N. H. HAIGHT, M. D., Oakland, Cal. 
 (Published by The Homcepathic News, of St. Louis, Mo., July, 1892,) 
 
 May 20, 1892, I was called to treat a young lady who was suffering from the 
 effects of poison oak. She had been suffering for nearly a week, and had tried every- 
 thing that friends had recommended, but continued to grow worse. The left side of 
 her face was so badly swollen that the eye of that side was entirely closed and she 
 was suffering intense itching and pain. 
 
 I have never heard of Peroxide of Hydrogen being employed in such cases before, 
 but not feeling satisfied with the treatment that I had used in the past, I decided to ex- 
 periment on this case. I used Marchand's Peroxide of Hydrogen (medicinal), feeling 
 sure it would reduce the inflammation, and by so doing, it would naturally allay 
 the itching. I used in the following proportions: Peroxide of Hydrogen, 1 part; dis- 
 tilled water 2 parts; applied to the affected parts every hour. I also gave internal treat- 
 ment of croton tig. 200. The next morning I called to see how the case was progress- 
 ing, and found her very comfortable, the itching and swelling being very much less. I 
 continued the same treatment, and on the fourth day the case was cured. On another 
 case I used H 2 2 1 part, tincture grendilla robusta 2 parts, with equally good results 
 but no better. 
 
 MEDICINAL VS. COMMERCIAL PEROXIDE OF HYDROGEN. 
 By W. B. DEWEES, M. D., Salina, Kas. 
 
 To the EDITOR OF THE Medical Herald, St. Joseph, Mo. : 
 
 Professional indifference and professional inactivity are probably the two greatest 
 enemies to our individual progress in the profession. Whereas cultivation will alone fit 
 us individually with that broad-gauge knowledge, the practical appreciation of which 
 marks, with lasting effect, the progress to success. Hence, earnest interest and labor 
 are essential requisites, if we would learn to discriminate between the opportunities pre- 
 senting, lest we cultivate a flowerless plant or we find weeds instead of roses when we 
 look for success. This is aptly illustrated by the course pursued with regard to the 
 selection of remedial agents by so many of us in the profession, from time to time, and 
 probably in no instance more forcibly than in the use of Peroxide of Hydrogen, 
 (H 2 2 .) In this connection, I feel it but a personal duty to the profession to record 
 my own experience with this agent, having for several years made use of Peroxide of 
 Hydrogen in suitable cases (/. e. , chiefly where pus formation was found), with very 
 varying results. Like most of my brethren, I took it for granted that H 2 2 was the 
 same, so long as it was made by our leading manufacturing chemists, and consequently 
 paid no attention as to the effects of special brands, since I felt confident that my drug- 
 gist was handling only the products of first-class manufacturers, and could distinguish 
 between the "Commercial" and "Medicinal" articles. The result being that I was not 
 impressed with anything like an absolute confidence in this agent to arrest pus forma- 
 tion. It was not till in October, 1891, when in attendance at the annual meeting of the 
 Mississippi Valley Medical Association in St. Louis, that in a personal interview with 
 Dr. Charles Marchand, of New York, relative to the product of his manufacture, that I 
 decided to give this agent another fair trial, and watching the effects carefully with 
 reference to the different makes in the market. This upon the avowed assurance of Dr. 
 Marchand, there was a most striking difference in the result of using the product of 
 different manufacturers. After almost another year of numerous trials and careful 
 
103 
 
 accurate observation with a number of different makes in the market, I am prepared to 
 confidently endorse all that is claimed for the superiority of Marchand's make. I have 
 used three different products alike in abscesses of almost every description, ulcers, gan- 
 grene, cancer, endometritis, specific vaginitis, diphtheria, etc., etc., and in each and 
 every instance Marchand's preparation proved above all, not only the most effectual, 
 but in every way a most satisfactory agent for arresting pus formation, and as a non- 
 irritating antiseptic for general use. Therefore, I most earnestly counsel my fellow 
 co-laborers in the profession to be particular in specifying Marchand's Peroxide of Hy- 
 drogen (medicinal) whenever this agent is called in use by them. 
 
 RETAINED NASAL SECRETION OR SYPHILITIC 
 
 RHINITIS ? * 
 
 By C. E. PERKINS, M. D., Sandusky, O. 
 - (Published by the Medical Standard, of Chicago, 111., Oct., 1892.) 
 
 Few cases of acute catarrhal rhinitis are sufficiently severe to compel a patient to 
 consult a physician. When such cases occur the symptoms are severe and the diagnosis 
 difficult. 
 
 February 7, a 30-year-old unmarried woman, with negative family history as to 
 tuberculosis, rheumatism or lues, consulted me. There was no evidence of lues. The 
 patient had an attack of measels in 1891, from which she and five other members of the 
 family recovered without results of any kind. Up to the commencement of this trouble 
 she had been exceptionally healthy and robust, having never required the services of a 
 physician. 
 
 In the latter part of October last she was taken with what she considered an ordi- 
 nary cold. There was the ordinary symptoms of acute catarrhal rhinitis, viz. : malaise, 
 dryness and heat of the nose followed by discharge, etc., but she had in addition to all 
 these a severe neuralgia on the right side of the face, which persisted for about a month. 
 Early in December complete stenosis of the right side of the nose developed and the left 
 was partially occluded. At this time there was a swelling across the nose, frontal and 
 nasal pains, and slight epiphora, and there was very little running from the nose and 
 that of a watery character. About these same symptoms continued until just before 
 Christmas when she consulted her physician. I am quite certain that he considered the 
 case as one of nasal syphilis, for he prescribed mercurial inunctions and insufflated iodo- 
 form daily. She continued under his care for six weeks. At one time in January she 
 had a hoarseness for one week. The right nostril continued occluded, and the left be- 
 came completely so, although he was adopting rigorous anti-syphilitic treatment. Not 
 making any improvement she consulted me on February 9. I found her weak and 
 angemic and somewhat emaciated. There was complete loss of apetite, and swelling, 
 redness and pains across the nose. 
 
 These pains were so severe as to interfere with sleep ; there was complete stenosis 
 of both nasal passages which caused the characteristic voice of nasal occlusion. This, 
 upon inspection, appeared to be due to thickening and infiltration of the tubinated 
 bodies and septum; they were in contact about one-fourth of an inch from the anterior 
 nares. Having benumbed the parts with cocaine, I introduced a probe wound with cot- 
 ton, beyond this point of contact and brought out some cheesy matter of disagreeable 
 odor. I was unable to get a thorough view of the nasal cavities at that time, so I 
 directed her to return on the following day; then I found the oedema somewhat subsided, 
 and saw that there was a polypoid enlargement of the little turbinated bodies which 
 acted as a valve to imprison the decomposing material. 
 
 *Ohio Med. Soc. Trans. Cond. 
 
104 
 
 This I removed with a cold wire snare, and thus opened up a regular cavity on each 
 side, from which I removed at least an ounce of foul-smelling, cheesy pus. I might add 
 that this accumulation was above the middle turbinateds so far as I could make out. 
 As the parts were thus opened, and the discharge was enabled to make an exit, it gave 
 rise, by running down into the throat, to a very distressing nausea. This I succeeded 
 in relieving by daily removing these secretions and spraying the nares with a solution of 
 Peroxide of Hydrogen ("Marchand's") one to four of water, with a mixture taken intern- 
 ally, of pepsins and bismuth. I also prescribed champagne. Under this treatment the 
 patient soon began to improve. She regained her appetite, the stenosis was relieved, 
 fcetor stopped, and she began to gain in flesh and strength, and on March 4 1 permitted 
 her to go home, some ten miles, to report occasionally; she continued to improve until 
 March 24 when she returned complaining of obstruction in the right nasal cavity. Then 
 I removed the last bit of decomposed mucus, which had become very much hardened; 
 since which time she has remained well. I examined her on April 26 and found the 
 nasal catities as nearly normal as we are accustomed to see them ; there is no ulceration 
 nor was there any more perforation of the septum, or anything to suggest that a syphi- 
 litic process had been going on. 
 
 TREATMENT OF DIPHTHERIA. 
 
 By S. H. SHERMAN, M. D., Boston. 
 
 Read before the Massachusetts Hotneopathic Medical Society. 
 
 (Published by "Cat New England Medical Gazette, Boston, Mass., October, 1892.) 
 
 Intelligent treatment of diphtheria as well as intelligent treatment of other diseases 
 presupposes true conceptions of the nature of the disease. I take it for granted, with 
 the incontrovertible evidence on the subject, that the cause of the disease, diphtheria, is 
 the introduction into the system of microscopic germs, bacteria. Without these germs 
 no diphtheria. The first point of attack is the natural one wherein the act of breathing 
 they would come in contact with the tonsils and soft palate or mucous membrane of the 
 nose. In mild attacks the disease remains a local one, the general system becoming lit- 
 tle affected. In the severe cases it extends to almost every organ in the body. 
 
 On the supposition that the disease is caused by germs, then to cure the disease, 
 we must destroy or antagonize them. Have we any remedy that will do this? Yes, 
 several; bichloride of mercury is the chief, but doses sufficient to overcome the germs 
 would be dangerous to the patient. We have long been looking for a remedy that 
 would be a potent germ-destroyer and still one harmless to the patient. I believe that 
 remedy is now found. Some four years ago there was sent to me a pamphlet treating 
 of Peroxide of Hydrogen, and the author especially dwelt upon the efficacy as an oxi- 
 dizer of pus. About this time I had a patient in the Homoeopathic Hospital under 
 treatment for cancer of the cervix uteri, and asked one of the staff of the able corps of 
 surgeons what he thought of Peroxide of Hydrogen as an application to the broken 
 down cervix. His reply was that he did not think much of it; and having such great 
 confidence in my friend's judgment, I relegated it to the list of the numberless nostrums 
 that we are invited to investigate. A few months ago my attention was again called to 
 this remedy by a circular of testimonials from men eminent in the profession, and from 
 all schools of practice. These men had proven it to be a safe and certain germicide. I 
 sent for half pound bottle of this remedy and waited for a suitable case on which to test 
 it. It soon came. On August 29, 1891, I was called to Mrs. B — , Athens Street, an 
 unhealthy locality, with cesspool connecting with street sewer directly in front of the 
 house, and the street a very narrow one. Found my patient in bed with history of three 
 days' illness; fever, malaise, sore and swollen throat. On looking into the throat I 
 
i°5 
 
 found tonsils, uvula, and soft palate covered with the characteristic diphtheritic deposit, 
 and portions of it assumed that dark hue so characteristic of fatal cases, and almost 
 certain to be followed by the septic form of the disease. There was much swelling of 
 the sub-maxillary, sub-lingual, cervical and parotid glands. Deglutition was accom- 
 plished with great difficulty, a considerable portion of any liquid swallowed returning 
 through the nose. There was also prominent laryngeal symptoms, croupous cough, 
 etc., showing that the disease had already invaded the larynx. From previous experi- 
 ence in such cases my prognosis was unfavorable, for such cases are generally fatal even 
 in good constitutions, under which head this patient could not be classed; her general 
 health being rather below par. I began treatment by spraying the throat with Mar- 
 chand's Peroxide of Hydrogen (medicinal) by means of a hand atomizer with hard 
 rubber attachments, as metallic ones are oxidized by the remedy. The effect was im- 
 mediately apparent on the diphtheritic deposit. I could see dissolution of the mem- 
 brane about the thin edges, the fibrinous portion contracting into a smaller compass. 
 The patient complained, however, of an extreme smarting sensation in the throat so that 
 I felt obliged to dilute the peroxide with an equal quantity of water which did not seem 
 to materially impair its efficacy. These inhalations or rather sprayings were repeated 
 every two hours, and the time occupied at each seance from five to ten minutes. The 
 dark necrotic condition had changed in twelve hours to the more common grayish- white 
 deposit. From this time on there was a gradual diminishing nf the exudation, although 
 there was a persistent tendency to re-appearance of the membrane after it had been re- 
 moved. The only internal remedies given were arsenicum, bichromate of potash, and 
 glycozone. The arsenicum for the general condition of the system, the bichromate for 
 the croupy or laryngeal complications, and the glycozone to destroy the bacteria, the 
 ptomaines and leucomaines that may have found their way into the stomach, alimentary 
 canal, the absorbent and circulatory systems. It was five days before the throat was 
 free from diphtheritic deposit, and some eight days before the glandular swelling had 
 subsided. There was but a remnant of the uvula left after the sloughing off of the 
 membrane, and a loss of voice from the fourth to the fifteenth day. The patient was 
 greatly prostrated from the first, and rallied rather slowly under the use of concentrated 
 nutriment and mild stimulants. On the whole, considering the gravity of the case, the 
 result was better than I have before witnessed in similar cases. 
 
 Another case worthy of mention in this connection is the following: On March the 
 31, 1892, was called up very early in the morning to see Master Terrance V. Freeman, 
 aged three years and three months. The father told me the child had been ill for about 
 a week with what he and his wife considered an ordinary cold, but soon after midnight 
 of the present morning he was seized with a distressing croupy cough. On visiting the 
 little patient I found the characteristic croup symptoms were apparent. I made an ex- 
 amination of the throat and found both tonsils covered with diphtheritic membrane. My 
 prescription was bichromate of potash first decimal trituration in half a glass or water, 
 and carbonate of ammonia, one drachm in four ounces of cinnamon water. These 
 remedies were given in alternation every one and one-half hours, and the throat was 
 sprayed every two hours, night and day, with equal parts of Marchand's Peroxide of 
 Hydrogen and water by means of a hand atomizer with hard rubber attachments. This 
 line of treatment was persisted in with alternate remission and exacerbation of the symp- 
 toms for five days, when the disease seemed under subjection, an^ convalescence secured, 
 which continued uninterruptedly until the tenth day, when I discharged the case. This 
 child was naturally a frail-looking child, though it showed a remarkable vitality through 
 this severe and protracted disease. It was given from the first all the nutritious food it 
 could be induced to take, consisting mostly of milk and bovinine. That it was diph- 
 theritic croup was evidenced by the membrane detached and coughed up at different 
 times during the disease. On one or two occasions the child nearly suffocated by the 
 loose membrane being drawn into the larynx or trachea, and subsequently expelled. It 
 is my opinion that this child would have died had it not been for the Peroxide of Hy- 
 drogen. It may seem a difficult thing to spray a child's throat effectively for five min- 
 
io6 
 
 • 
 
 utes at each seance, as the child will not voluntarily hold its mouth open. I overcome 
 this difficulty by putting a fork-handle between the teeth on one side of the mouth, and 
 having it held by an assistant standing behind the child and holding its head in position, 
 at the same time. 
 
 I have used this remedy, Peroxide of Hydrogen, in several other cases of diphtheria 
 of a mild form, which would not be of interest to report as they all made satisfactory 
 recoveries, and probably would have under usual treatment. 
 
 What is Peroxide of Hydrogen? "The name hydrogen dioxide expresses its com- 
 position, and its formula H 2 2 represents this name. Hydrogen monoxide, H 2 0, or 
 water, can under certain conditions, be made to combine with a second molecule or oxy- 
 gen, the result being a water-like liquid, HgOg." This agent is one and one-half times 
 more potent as a germicide than corrosive sublimate and perfectly harmless. It is 
 adapted to all zymotic diseases and suppurative processes. It will follow a pus sinus as 
 a ferret will follow a rat, and be sure of destroying the pus and germs. 
 
 I alluded to this remedy some months since at a meeting of the Boston Homoeopathic 
 Medical Society, when the subject of Gonorrhoea was under discussion, and the editor 
 of our much valued Gazette remarked that there was hardly anything in medical litera- 
 ture concerning it, and that what was known about the remedy came chiefly from the 
 manufacturer. This caused me to look up the subject, and I find an amount of pub- 
 lished testimony altogether -too voluminous to be quoted. 
 
 MEDICAL DEPARTMENT SURGEON-GENERAL'S OFFICE. 
 
 Headquarters of the First Brigade Michigan State Troops. 
 
 Chas. Marchand, N. Y.: 
 
 Dear Sir — I promised you I would write you further about the Peroxide of Hy- 
 drogen (medicinal) manufactured by yourself. 
 
 I have cured a great many cases of throat diseases with it, and one case of severe 
 cystitis in an old man of 70, which I had treated with mild solutions of corrosive subli- 
 mate for nearly two weeks; he was benefited a little. I then used one-half ounce of 
 your Peroxide of Hydrogen to a pint of boiled and strained rain water, and washed out 
 the bladder thoroughly with this, — the man got up next day and was up every day after 
 that, was well in three days with only one injection or washing, it is worth its weight if 
 used only in cases of cystitis. 
 
 Yours truly, 
 
 C. M. Woodward, Surg. General M. S. T. 
 Tecumsch, Mich., Sept. 15, 1892. 
 
 THE PEROXIDE OF HYDROGEN (MEDICINAL); AN INDIS- 
 PENSABLE WOUND STERILIZER. 
 
 By GEORGE H. PIERCE, M. D., Brooklyn, N. Y. 
 
 (Published by New England Medical Monthly, November, 1892.) 
 
 Probably the use most frequently made of this preparation, is in the cleansing of 
 pus cavities, and suppurating surfaces. Any trace of pus remaining in any recess which 
 an ordinary douche will not reach, is at once sought out by the peroxide, decomposed, 
 and brought to the surface, in bubbles of gas. It is useful in cleansing off ulcers, 
 sloughs and gangrenous tissues, chancres, diphtheritic patches, etc., and in cleansing 
 sinuses, and suppurating cavities, such as the pleural in empysema, and the uterus where 
 
107 
 
 there is putrid discharge, and in cleansing discharges where either puncture or free incis- 
 ion has been made, it is invaluable, clearing out the pus as nothing else can do. There 
 is one class of disease where its local action as a cleanser must be seen to be appreciated ; 
 and that is as a disinfectant for gangrenous growths. In a case of extensive epitheliomia 
 of the face, where only pilliative measures were of use, I found the Peroxide of Hydro- 
 gen a very Godsend. This case was one of the most foul I had ever witnessed. When 
 I first saw it, the odor from it was so great that it filled the house. It was covered with 
 a cloth into which the discharge had accumulated, thus adding a greater bulk of fetid 
 decomposition; and to add to the horror, for such it was, upon removing the cloth, the 
 surface was swarming with maggots, as large and active, as may be found in a heap of 
 decomposing garbage, and not only on the surface, but they extended deeply in sinuses 
 below the ear where it was impossible to reach them, except as they would come to the 
 surface. My first impulse was to invoke Beelzebub for some patent exterminator, but 
 finding myself left to my own resources, I set about bringing destruction as best I could. 
 As time was of some moment, I removed what I could reach with dressing forceps, then 
 douched with bichloride, i-iooo, then with Peroxide of Hydrogen, 15 vol. strength, rinsed 
 this off with warm water, and douched again thoroughly, with permanganate of potash 
 solution, and finally dusted the whole with beechwood charcoal, which, in addition to act- 
 ing as an absorbent to the gases, made an appearance very much to be preferred to the 
 ordinary gangrenous appearance. I ordered the cloth to be left off entirely; first, be- 
 cause it only added an additional fetid surface, and second, because the growth was very 
 vascular and would bleed easily on being disturbed. It was dressed morning and night, 
 and henceforth was kept almost entirely free from odor. 
 
 The same routine was gone through with each day. First, Peroxide of Hydrogen, 
 which was applied by pouring it directly from the frottie in which it came, on absorbent 
 cotton held by dressing forceps, so that it dropped directly on the growth; when im- 
 mediately a white foam would cover the surface, from the disintegration of pus, gangren- 
 ous shreds, blood, etc. Second, rinsing off with warm water, then with permanganate 
 of potash sol. gr. ij., cupful of water, allowing it to drip from a wad of cotton over the 
 surface. Third, dusting with charcoal and leaving it uncovered. An immense lot of 
 Peroxide was consumed in this case, being purchased in \ lb. bottles, six at a time. This 
 seems to me a very effective means of keeping clean these foul discharging growths of 
 the carcinomatous class; the Peroxide and permanganate, being the most thorough disin- 
 fecting combination; and if employed in any case of cancerous growth, where palliation 
 alone must be relied on, will make that life and the lives of those closely associated with 
 it, more endurable. One important fact remains in regard to the chemical properties of 
 the Peroxide. To be effectual it must be kept from the air, tightly corked, in a dark 
 bottle, and in a cool place. It must be used directly from the original bottle. Do not 
 permit the druggist to pour from one bottle to another when dispensing it, else the oxy- 
 gen will escape, and it will be powerless. If when using, the white foam does not ap- 
 pear, it is because the preparation has lost its strength, and is absolutely of no use, of no 
 more value than so much water, H 2 2 must be present. It is the additional atom of 
 O combined with the H, that does the work, by giving up that nascent O for the pur- 
 pose of oxidation. The strength should be 15 volumes. The preparation which I 
 always use is Marchand's Peroxide of Hydrogen (medicinal). 
 
 GLYCOZONE IN THE TREATMENT OF GASTRIC 
 
 TROUBLE. 
 
 (Extract from Doctor s Weekly, October 29, 1892.) 
 
 Editor of Doctor's Weekly: 
 
 Dear Sir. — I received your paper this morning and was pleased to see a notice of 
 glycozone. I have used it recently with great success in two cases of gastric trouble 
 
io8 
 
 when almost all the useful remedies had failed, and with the happiest results. It is a 
 perfect antiferment, relieving all the distressing dyspeptic trouble and aids digestion 
 better than all the pepsins I have ever seen. Respectfully, 
 
 Oliver D. Nostrand. M. D., 
 Cincinnati, O., Oct. 22, 1892. 286 West Fourth St. 
 
 PEROXIDE OF HYDROGEN AND ITS USE IN EAR 
 
 DISEASES. 
 
 By WALTER B. JOHNSON, M. D., Paterson, N. J. 
 
 Surgeon to the Paterson Eye and Ear Infirmary. 
 (Published by the Journal of the American Medical Association, October 29, 1892.) 
 
 The peroxide solution may be used advantageously in the treatment of mastoid 
 disease after an incision has been made. The action of the remedy upon bone denuded 
 of its periosteum, and even upon carious or necrotic bone, is unique; it causes a disin- 
 tegration of the molecular particles, and they are gradually subdivided and carried away 
 in the frothy product of the chemical action, until a healthy surface appears upon which 
 the solution seems to nave only a beneficial effect. The action of the solution upon 
 dead bone can be readily demonstrated by placing a small portion of necrotic bone in it; 
 the bone in a short time will begin to disintegrate and continue to do so until it is 
 entirely divided into minute particles. 
 
 In some of the cases of mastoiditis treated, in which the denuded surface was very 
 extensive, in from three to six weeks the bone would be in a perfectly healthy condition, 
 the discharge of pus controlled, and the subsequent closing of the wound, when allowed, 
 occurred rapidly and was perfectly satisfactory. 
 
 In one of the cases, in which for three years any attempt to allow the closing of the 
 sinuses would be followed by an exacerbation of the inflammation, the carious condition 
 was relieved and the opening allowed to close after two months of treatment. 
 
 The treatment is very simple and consists in syringing through the opening and 
 into the meatus with a small glass syringe a sufficient quantity of the fifteen-volume 
 solution, at each sitting, to render the pus thoroughly aseptic, then packing the ear and 
 the wound lightly with strips of sheet lint or gauze thoroughly soaked in the same solu- 
 tion, great care being taken to allow the wound to close, although the packing must not 
 be so introduced that it will prevent the free exit of any pus which may be formed 
 during the interval between the dressings. The external incision should be made ample 
 and if the packing does not prevent the opening from closing during the progress of the 
 treatment it must be reopened with the knife. Glycozone has been suggested for use in 
 keeping the wound open, being used instead of the Peroxide in the dressing. 
 
 The result of this line of treatment, which has been followed in a considerable num- 
 ber of mastoid cases, has indicated the possibility of a degree of conservatism in the 
 treatment of mastoid disease which is very desirable. 
 
 All the cases treated have done well, no deaths have occurred, and in no case was it 
 considered necessary to scrape the bone or to remove any portion of it, while the period 
 of time necessary for the wound to assume a sufficiently healthy condition to render it 
 advisable to permit it to close, did not seem longer than the time which must ordinarily 
 elapse after the operation for thoroughly scraping the mastoid, and was much shorter 
 than the time required before the wound produced in chiseling the mastoid could possi- 
 bly be allowed to close. 
 
 Special care should be taken to keep all the applicators or sprays, used either with 
 the Peroxide of Hydrogen solution or Glycozone, perfectly clean, especially in case of 
 
109 
 
 mixtures of glycerine and Peroxide, which should be made fresh every second or third 
 day, to prevent the possible formation of formic acid; only silver, hard rubber, glass or 
 porcelain, should be used for measuring purposes. 
 
 If care is taken to properly keep the solutions, they are perfectly harmless and cal- 
 culated to be of inestimable benefit to all who use them. 
 
 THE OPERATIVE TREATMENT OF FISTULA-IN-ANO. 
 
 By LEWIS H. ADLER, Jr., M. D., 
 
 Adjunct Professor of Diseases of the Rectum, Philadelphia Polyclinic and College for 
 
 Graduates in Medicine. 
 
 Read before the Phila. County Medical Society, November 23, 1892. 
 
 (Reprinted from the International Medical Magazine for October, 1892.) 
 
 THE AFTER-TREATMENT. 
 
 After the operation of fistula in ano, I am in the habit of packing the wound with 
 iodoform gauze, which is left undisturbed for twenty-four hours. This is done to pre- 
 vent subsequent hemorrhage. A pad of gauze and cotton and a T-bandage are next 
 applied. 
 
 The subsequent dressing of the case should be daily attended to by the surgeon 
 himself. The parts should be kept perfectly clean, and the wound syringed with 
 Peroxide of Hydrogen (Marchand's), carbolic acid solution, etc., after which a single 
 piece of iodoform gauze laid between the cut surfaces of the wound will be all the 
 dressing required. 
 
 In the after-treatment of these cases I have seen the healing process greatly retarded 
 by the excessive packing of the wound with lint, or delayed by the undue use of the 
 probe. Such interference is to be avoided. 
 
 If the granulations are sluggish and the discharge is thin and serous, it will be well 
 to apply some stimulating lotion, such as Peroxide of Hydrogen, or a weak solution of 
 copper sulphate (two grains to the ounce). 
 
 The surgeon should be on the watch during the healing process to avoid any bur- 
 rowing or the formation of fresh sinuses. Should the discharge from the surface of the 
 wound suddenly become excessive, it is evidence enough that a sinus has formed, and 
 a careful search must be made for it. Sometimes it is under the edges of the wound 
 that it commences, at other times at the upper or lower ends of the cut surface, and 
 occasionally it seems to branch off from the base of the main fistula. 
 
 Pain in or near the seat of the healing fistula is another symptom of burrowing, and 
 when complained of, the surgeon should carefully investigate the cause. 
 
 After an operation for fistula, the patient's bowels should be confined for three or 
 four days, for which purpose opium is usually given. At the end of this time the 
 bowels may be opened by the administration of a dose of castor oil, and so soon as the 
 patient feels a desire to go to stool, I am in the habit of ordering an enema of warm 
 water to be administered, which has a tendency to render the faeces soft and fluid and 
 hence to make their passage easier. The patient should be kept in a recumbent pos- 
 ture until the fistula is healed and until the bowels are moved ; the diet should be liquid 
 such as milk, beef-tea, and broths. The time required for a patient to recover after an 
 operation for fistula in ano varies with the extent of the disease. In an average case it 
 will be necessary to keep the patient in bed for two weeks, and confined to the house 
 for a couple of weeks longer. 
 
no 
 
 ABSTRACT FROM A TREATISE ON DISEASES OF THE 
 RECTUM, ANUS AND SIGMOID FLEXURE. 
 
 By JOSEPH M. MATTHEWS, M. D. 
 
 Prof, of Principles and Practices of Surgery, and Clinical Lecturer on Diseases of the 
 Rectum; Kentucky School of Medicine, Louisville, Ky. 
 
 Page 188. — After the operation is performed, Dr. Matthews writes as follows: 
 I then syringe the cavity out freely with a solution of bichloride of mercury (i to 
 5000). Then a tent made of iodoform gauze is introduced into the cavity, just as much 
 as it will hold. After the expiration of twelve hours, I withdraw the iodoform gauze 
 and allow any accumulation to pour out freely. I have used the bichloride solution 
 here first, because I believe it to be a good antiseptic and at the same time a good stim- 
 ulant to the cavity. However, afterward I substitute another agent — viz. , Peroxide of 
 Hydrogen. Of course our great object in dealing with cavities of this kind are two- 
 fold: First, to stop suppuration; second, to heal the diseased structure. For prevent- 
 ing suppuration, we have chiefly relied upon solutions of bichloride of mercury and car- 
 bolic acid. Every surgeon is well aware of the fact that dangers attend the use of car- 
 bolic acid in the treatment of suppurating diseases, and the too free use of the bichloride 
 of mercury in large suppurative cavities might not only cause too much inflammatory 
 action, but also produce a general effect upon the system which would be shown in 
 ptyalism. We have in a strong solution of Peroxide of Hydrogen a substitute for these 
 two without any of their attending dangers. Undoubtedly the best preparation of this 
 agent is Marchand's Peroxide of Hydrogen (medicinal). His fifteen-volume solution 
 will retain active germicidal power for many months, if kept tightly corked in a cold 
 place. It can be used, of course, in any strength that the surgeon desires. Marchand 
 has devised a hand atomizer and ozonizer for the purpose of using the agent in an easy 
 manner. 
 
 The abscess cavity is injected once a day with this agent, either pure or diluted 
 with water, from three to ten parts, and each time the tent of iodoform gauze is pushed 
 gently into the external opening, but not so as to fill the cavity. As the healing pro- 
 cess goes on, a less amount of gauze is used. If large rectal abscesses are treated in 
 this manner, the number of cases of fistula will be greatly reduced. 
 
 
 SOME OF THE USES OF PEROXIDE OF HYDROGEN IN 
 
 GENERAL SURGERY. 
 
 By THOMAS H. MANLEY, M. D., New York 
 (Published by the New England Medical Monthly, Danbury, Conn., Dec, 1892.) 
 
 Sincjfe Marchand placed upon the market a pure, unadulterated Peroxide of Hy- 
 drogen, and Morris, of New York, called attention to the marvelous power of this 
 preparation as a deodorizer, the profession have very generally employed it in such 
 pathological conditions as will enable us to apply it directly to the diseased surfaces. In 
 general medicine it has been employed on an extensive scale in the phagedenic, sore 
 throat of malignant scarlatina, diphtheria, and other maladies. 
 
 In surgery, it has been particularly recommended in non-malignant, suppurating 
 sores. 
 
 Since it has now come to be very generally known, that with very few exceptions 
 all chemical solutions of sufficient potency to kill germs, possess such irritating proper- 
 ties as to interfere with healthy cellular proliferation, there has been a demand for 
 
Ill 
 
 something which might nullify germ activity, and at the same time in no way interfere 
 with the recuperative energy in the histological elements. In a large class of cases 
 Peroxide of Hydrogen seems to provide this want. 
 
 In the Harlem Hospital and Dispensary service, the Peroxide, Marchand's medi- 
 cinal, is largely employed; and, in appropriate cases, with better results, than with any 
 other agent. 
 
 It seems to possess a special affinity for the lethal elements, in all suppurating pro- 
 cesses, which tend to run into chronicity. 
 
 We have largely employed it in those cases of fistular sinuses, so seriously resulting 
 from suppurating lymphatic glands in children and adults; as well as in those buboes 
 which are sure to heal and discharge, for a long time, a sero-purulent matter. 
 
 The only class of sinuses in which its use should be employed with caution, are 
 those in which the fistula extends into a lesion in the osseous elements. 
 
 In many cases, in which a long, deep rent has been made in the tissues, in stru- 
 mous subjects, in which healing processes are delayed, its employment is very satisfac- 
 tory in effecting primary union. Now, whether it acts as antiseptic; or, by imparting 
 fresh vitality to the cells, is a question by no means settled. 
 
 When we use it, it should be applied in such strength as different cases require. 
 In foul-smelling, copiously discharging processes, it may be used in a concentrated 
 form, while in milder cases, particularly in children, it should be diluted. 
 
 In my own private practice none has given me so much satisfaction as that manu- 
 factured by Chas. Marchand, and as we have seen in Dr. Squibb's "Ephemeris," for 
 this year, the preparation seems to be regarded by chemical analysis, to maintain a high 
 and uniform standard of strength and purity. • 
 
 INTESTINAL OBSTRUCTIONS. 
 
 DIAGNOSIS AND TREATMENT. 
 
 By FREDERICK HOLME WIGGIN, M. D., New York. 
 
 Attending Surgeon City Hospital, Blackwell's Island. 
 
 (Extract from the Medical Record, July 23, 1892.) 
 
 Irrigation of Abdominal Cavity. — As to the irrigation of the abdominal cavity, 
 the practice inclines toward the use of plain water or so-called natural salt solution, six- 
 tenths per cent. My own experience and observation lead me to believe that many of 
 the complications following laparotomy can be traced directly to the use of chemical 
 solutions during the operation, either for irrigation, for disinfecting the hands of the 
 operator, his instruments or sponges. In a case where the abscess is circumscribed, it 
 is bad practice to irrigate, owing to the danger of infecting the general cavity. In all 
 aseptic cases irrigation should be avoided. When irrigation is necessary, while the nor- 
 mal salt solution is best, still, in some cases, I believe this may be followed by a second 
 douche containing a small quantity of hydrogen dioxide, I have used it for several 
 years in all kinds of surgical work, and ©nee in the general abdominal cavity, in a case 
 already alluded to (the patient dying shortly after the operation, no deduction can be 
 drawn from it), and where pus was present, have found it in proper solution more effi- 
 cient and less irritating than anything else. In some of the New York hospitals it feas 
 been used for irrigating the pleural cavity in empyema, and it "has proved satisfactory. 
 I have been unable to find any record of a case where this compound has been used for 
 irrigating the general cavity. In the letters already referred to, Dr. Senn says: "Have 
 used the hydrogen dioxide in cases of limited peritonitis, and should not hesitate to use 
 it in the diffused form " 
 
112 
 
 Dr. Mann says, "And I have never used hydrogen dioxide in the general cavity, 
 but have applied it to the cut ends of tubes, holes in the intestines and bladder, etc., 
 with good results." 
 
 Dr. Clement Cleveland says, "I have never used the dioxide in the peritoneal 
 cavity. I have used it pure in the uterine cavity, in puerperal septicaemia, with excel- 
 lent results." 
 
 Dr. Robert T. Morris writes, "In localized septic peritonitis, where I have occasion 
 to expose directly the affected locality with retractors. I pour in the Hg Og in full 
 strength and without any warming whatever. After allowing it to remain for a minute 
 or two I sponge out and repeat, leaving the second lot for five minutes, sometimes not 
 removing it all, but putting my gauze wick down into it, and allowing it to be sucked 
 up at leisure by the drainage wick. I have used it twice only in general septic peritoni- 
 tis. One of the cases was an appendicitis (perforated), with the patient moribund at the 
 time of application of the H 2 O 2 , I poured in a very large quantity, enough to bathe all 
 of the abdominal organs; a very little hot water was poured into the peroxide just at the 
 moment of using it, to 'take the chill off.' The peroxide was then siphoned out and the 
 patient was made very much easier by the treatment, although he finally died. The 
 other patient died too. The case was one of general septic peritonitis that had gone on 
 to suppuration after removal of a gangrenous ovarian cyst. The post-mortem examina- 
 tion showed that the H 2 O s had cleansed the cavity beautifully, and although my patient 
 died, I nevertheless obtained the impression that one has after such observations, that 
 the H 2 O s was very useful, and evidently harmless in itself. There are lots of cheap 
 peroxides on the market that contain acids, and such would be harmful." (See article 
 by Robert T. Morris, page 72, also article by Dr. H. F. Wiggin, page 92.) 
 
 PEROXIDE OF HYDROGEN. 
 
 By L. C. SCHUTT, M. D., Toledo, Ohio. 
 (Published by the Toledo Medical Compend, December, 1892.) 
 
 Referring to Peroxide of Hydrogen (medicinal) Dr. Schutt writes as follows: 
 
 Diphtheria — As a local application in this disease, Marchand's Peroxideof Hydro- 
 gen (medicinal), can be used full strength, but in the majority of cases it is better to dilute 
 it with from 20 to 30 per cent, of water. It may be applied with a brush or atomizer, 
 and used as often as the severity of the case may require. 
 
 Pitting of Small-Pox. — The topical application of peroxide of hydrogen or glyco- 
 zone is very beneficial. It allays the irritation of the skin and lessens the pitting and 
 force of the disease. 
 
 The local application of the peroxide in hay fever has proven very beneficial when 
 mixed with an equal quantity of water and glycerine. It should be used at the very 
 outset of the disease. 
 
 As A Cosmetic. — When applied to the face it will make imperceptible a dark downy 
 growth on the face when the hairs are numerous and fine and cannot be removed by elec- 
 trolysis. It should be applied several times a day with a camel's hair brush until the 
 hairs are thoroughly whitened and after that as often as necessary. The grease which 
 adhers to every hair should be removed by applying a solution of powdered borax in 
 water. 
 
 In deep cuts and ulcers you will find the greatest benefit from the use of peroxide of 
 hydrogen. 
 
 I will report one case in which very decided benefit was obtained from the use of this 
 preparation. 
 
 Mr. P. O. H., a young man 23 years old. He received an injury to his right hip, 
 while helping to unload a cannon. It terminated in hip-joint disease, which confined 
 
U3 
 
 him to the house for more than a year. Finally suppuration occurred, leaving him with 
 two sinuses and several openings. All kinds of washes were used but the pus kept up. 
 At last I commenced treating it with peroxide of hydrogen, using it pure and diluting it 
 with water. We used it every day for seven months at which time all discharge of pus 
 had stopped and the openings nearly closed. I am sure no other bactericide could have 
 been used so long and with such good results, without injury to the parts or general 
 system. 
 
 SURGICAL MEASURES OF RELIEF IN STENOSIS OF THE 
 
 UPPER AIR PASSAGES.* 
 
 By THOMAS H. MANLEY, M. D., New York. 
 
 During the past ten or fifteen years the discussion of the etiology, pathology and 
 surgical treatment of stenosis of the serial passages, particularly in. children, has occu- 
 pied an important position in medical literature, both home and foreign. 
 
 Yet with all that has been written on this subject, it must be admitted that the 
 profession is in anything but accord on the most appropriate measures, either prophy- 
 lactic, or remedial, in those maladies which jeopardize life through impending asphyxia 
 or apneea. 
 
 It was hoped with the application of the invaluable apparatus of Dr. O'Dwyer that, 
 at last, the most formidable obstacles in the way of treatment had been forever removed; 
 that the scalpel and tracheal tube might be laid aside, and that hereafter relief-measures 
 would be as prompt and bloodless as they were efficient and permanent. 
 
 But it was soon discovered that, like every other relief-measure, intubation has its 
 limitations; that there is a considerable proportion of cases in which the perforated, 
 laryngeal plug may, when introduced, destroy every possible prospect of recovery. 
 Our aim should be in all cases, to occupy a middle ground; as neither too zealous par- 
 tisans of- the one, nor uncompromising foes of the other. Some would impose so far on 
 the credulity of their brethren as to have them believe that intubation is the sovereign 
 remedy when applied early and skillfully. Others there are, who have cast it aside alto- 
 gether. Of this latter I saw a practical proof in the Princess Augusta's large ward for 
 children in the Frieriechshal-Hospital in Berlin. Here their experience with intuba- 
 tion had been so unfortunate that they had discarded it altogether. Hence, while we 
 all agree that divulsion of the laryngeal chink through the buccal cavity occupies an 
 important place in surgical therapy, it constitutes but one of our resources. In the con- 
 troversial side of the question, it is not my purpose, at this time, to enter. 
 
 The conditions that give rise to a mechanical impediment to respiration in the upper 
 air passages are dependent on inflammation — infectious, specific, neoplastic and 
 traumatic. 
 
 The fundamental principle underlying every phase of treatment, of whatever de- 
 scription instituted, is to secure a patent air-passages until nature has removed the bar- 
 riers to normal respiration. To most safely accomplish this purpose we must depend 
 chiefly on three agencies: First, on constitutional treatment, which is more or less appli- 
 cable in all phases of laryngeal stenosis; second, on local medicative measures, third, 
 on surgical invention. 
 
 As the surgeon's aid is seldom invoked until the time is past for internal medica- 
 tion, only the second and third of these agencies will be considered here. 
 
 For the first of them, there are but two substances with which I am acquainted 
 that possess such properties as will commend them in the majority of cases. I may add' 
 
 ♦Read before the Section of Psediatry, Academy of Medicine, New York, Feb. 9, 1893. Pub- 
 lished by The Medical and Surgical Reporter, of Philadelphia, Pa., Feb. 25, 1893. 
 
ii4 
 
 parenthetically, that unless the patient is on the border line of the moribund state, local 
 measures should be pressed with energy for a short time before surgical intervention is 
 resorted to. 
 
 Mercury pre-eminently occupies the first position. First, because of its well known 
 power as an antiseptic agent; and secondly, for its effects on the general system when 
 taken up by absorption through the mucous membrane. It may be administered by 
 fumigation — when calomel is incinerated; or through the spray — when we employ the 
 bichloride solution of a strength varying from 1:500 to 1:3000 according to the age of 
 the patient, its impression on the system, or the urgency of the symptoms. The objec- 
 tions to the employment are the possibility of ptyalizing the patient or salivating the 
 nurse or attendant. Besides, though this agent possesses active bactericide powers, it 
 it not a deodorizer. 
 
 In many cases of an infectious or gangrenous character extending into the larynx 
 or trachea, the ideal solution is one which is gentle and simple in its application, but 
 energetic in action; one best tolerated and possessed of the greatest affinity for the ne- 
 crotic residue of diphtheritic or other inflammatory products. To attain this end there 
 is nothing with which I am familiar, which may be administered so continuously as the 
 peroxide of hydrogen medicinal. 
 
 An eminent medical authority* has recently warned the profession not to use this 
 agent in throat troubles, because, as he alleges, it may cause diphtheria itself. This view is 
 totally at variance with clinical experience and with our knowledge of the fundamental 
 etiology of the disease; though we must concede, if an inferior quality be used, or it is 
 employed in too strong solution, an exudate is formed, but this exudate must be rather 
 attributed to its injudicious employment than to any inherent power of the drug to pro- 
 duce such exudate. In all cases, when we employ this gaseous agent we should be 
 assured of its purity and standard strength; hence it is my custom to employ Marchand's 
 medicinal, alone, when it can be secured. The inhaler which goes with this medica- 
 ment, in my hands, in the hospital and elsewhere, has served an admirable purpose in 
 pharyngeal or laryngeal affections. ' The immense number of unsophisticated medical 
 men all over this country whose anxiety is for new and effective remedies, and who are 
 stimulated by these miserable surroundings"! may be safely trusted with the .best and 
 safest in the matter of chemical solutions, as in the selection of wines, meat juices, pro- 
 prietary medicines or other pharmaceuticals. 
 
 When it appears futile to persist further with local applications, and the symptoms 
 of approaching asphyxia are urgent, the time has arrived for prompt surgical interference. 
 It is well known that in tracheotomies the results following, depend mainly on two fac- 
 tors, viz: the violence of the constitutional infection, and the mannerin which the oper- 
 ation for relief is performed. The former is beyond our control, but not so with the 
 latter. For, with the aid that modern surgery has placed within our reach, the techni- 
 que of opening the air passages above the sternum has been greatly simplified. The 
 elder Gross regaided tracheotomy as one of the most formidable operations known to 
 surgery. 
 
 The dangers immediately connected with the surgical technique of a tracheotomy 
 are: 
 
 (1) Those which have reference to pulmonary anaesthesia. 
 
 (2) Hemorrhage. 
 
 (3) Shock. 
 
 With every one who has ever administered an anaesthetic, or seen it given to one 
 with an embarrassed respiration, it is needless to rehearse here the difficulties in the way. 
 In the first stage of anaesthesia the little one struggles and strangles so that the anaesthe- 
 tizing agent must be given intermittenly. As the second stage or anaesthesia is reached 
 a deep cyanosis sets in. With the accession of the third stage the corneal reflexes are 
 
 *Dr. A. Jacobi, Note on Peroxide of Hydrogen. Archives of Pediatrics, Dec, 1892. 
 ^Ibidem. 
 
 
n5 
 
 paralyzed and the asphyxia deepened so that the operator is warned to hasten on or 
 death will quickly end the scene. But our patient is a child, and it is a matter of com- 
 mon observation that children, proportionately to their* age, take a large quantity of 
 anaesthetics and come from under their influence very quickly. Hence, under the cir- 
 cumstances here considered, the circulation already toxemic must be further super-sat- 
 urated with another lethal agent, and along with this, the fear of the patient's returning 
 consciousness hurries the surgeon on with the procedure in which it is always imperative 
 to proceed with caution and deliberation. Anaesthesia is, it must be admitted, one of 
 the positive dangers in opening of the trachea. 
 
 Without question the next difficulty in this operation is profuse hemorrhage. Here 
 the escape of blood is dangerous in a dual capacity. First, through mortal anaemia, 
 and next through leakage into the trachea inducing fatal asphyxia, or by being sucked 
 into the bronchial radicles and causing septic pneumonia. As the trachea in the child is 
 deeply lodged beneath an immense network of blood vessels which lie immediately under 
 the skin, the deep cervical fascia and over the thyroid isthmus, the division of the deeply 
 situated parts is not unlike the splitting of a saturated sponge. Nevertheless, if ample 
 haemostatic precautions are observed, after the first gush in penetrating the deep cervical 
 fascia, it will be slight and neither will annoy the operator nor endanger the patient. 
 
 In May, 1890, Paul Reclus, in the Gazette Hebdomadaire, published his remarkable 
 ■contribution on "Cocaine Analgesia." The year preceding, Prof. VV. W. Dawson had 
 presented an able essay entitled "Bloodless Tracheotomies."* Although Reclus re- 
 ported more than two hundred cases. in which he had successfully operated under cocaine, 
 he mentioned none for tracheal stenosis. After I had carefully read the essays of both 
 the Ohio and the French surgeons, it occurred to me that, by a combination of both ex- 
 pedients, the ideal tracheotomy operation was at last secured. Within one month of the 
 publication of Reclus' essay I was favored, at the Harlem Hospital, with an opportunity 
 ■of testing for the first time, and estimating the full value of, a surgical procedure which 
 I have designated "Tracheotomy by the Reclus-Dawson Method." 
 
 I, personally, claim nothing for myself in connection with this invaluable device, 
 :save in evolving a new operation by a combination of analgesia with haemostasis, and 
 priority in being the first to operate by this method and to publish its history and tech- 
 nique. This I did in the Journal of the American Medical Association, i8gi. 
 
 Though I have had four opportunities of employing it in the adult, up to this time 
 I have had but one child, an infant, on which to test its merits. This was a patient of 
 Dr. Murray's, but two months of age, which was suffering of submucous tubercular ab- 
 scess of the larynx. All my patients recovered. 
 
 In a nutshell, its technique is as follows: Rigorous antisepsis; a one per cent, solu- 
 tion of hydrochlorate of cocaine hypodermically administered after Reclus' plan ; the 
 drug hypodermically employed, never to exceed the maximum dose by the mouth. I 
 always douche the surfaces of the integument, either by a spray from a siphon of carbon- 
 ated water, or else pure cold water from a height which accomplishes the same end, be- 
 fore I make the first incision. The cocaine injection serves a triad purpose in these 
 cases; first, as an analgesic; secondly as a cardiac stimulant, and thirdly, as a styptic or 
 haemostatic. In these cases which we tracheotomize for infectious or acute inflamma- 
 tory obstruction, and in which patency of the opening is but a temporary expedient, I 
 am confident that the best tracheal tube is none at all. In this infant of two months, 
 by passing two sutures through the divided tracheal walls on either side an ample air 
 vent was effected. 
 
 I am confident that as the new procedure is more generally adopted, tracheotomy 
 "will regain its lost ground. For by it, when it succeeds, deglutination is not interfered 
 with, perfect drainage is secured and the inconvenience and danger always attendant on 
 tubation of any description, is obviated. It is unnecessary to add that by it, too, the 
 dangers of collapse and shock will be minimized. 
 
 *Jour. Amer. Med. Ass'n., July 13, 1892. 
 
n6 
 
 DISCUSSION ON DR. MANLEY'S PAPER. 
 (Reported Stenographically by J. J. Sullivan, M. D.) 
 
 Dr. Chaffee, of Brooklyn, said that he believed that if Dr. Manley's method of 
 using cocaine was adopted, it would make tracheotomy more popular than ever before, 
 and operators would not have the dread of the operation as they have at the present 
 time. He was a great admirer of intubation but he never regarded the two operations 
 of tracheotomy and intubation as direct rivals. 
 
 Dr. Stewart was very glad to hear Dr. Manley stand up for mercurialism in the 
 treatment of diphtheria. He always found that the further he departed from the use of 
 mercury in the treatment of diphtheria, the more apt the patient was to die, and he has 
 never seen a case of ptyalism in a child with true malignant diphtheria from the use of 
 mercury. He still used bichloride in combination with Marchand's peroxide of hydro- 
 gen (medicinal) with the best results possible. 
 
 He used a five per cent, solution of Marchand's peroxide of hydrogen in water, and 
 about 1-3,000 of the bichloride. He also gave the same drug internally and has had 
 much better results than formerly with the old, iron, chlorate of potash and like reme- 
 dies, z 
 
 Dr. Fruithight said he would like to bear testimony to the good results he has se- 
 cured in the treatment of diphtheria by calomel fumigation. He has used calomel fumi- 
 gations recently if? three very grave cases and they all recovered. He has used as a local 
 remedy Marchand's peroxide of hydrogen. 
 
 Dr. Stanton has been using bichloride of mercury in the treatment of diphtheria for: 
 the past four or five years, and he regretted to say that his experience was disappointing. 
 So far as local treatment is concerned, he has used a spray of Marchand's Peroxide of 
 Hydrogen, and he has never found any reason to regret its use. He has read the criti- 
 cisms of Dr. Jacobi, and he never experienced any such results as he has seen from the 
 use of Peroxide of Hydrogen. He, Dr. Stanton, uses a fifteen volume strength of the 
 Peroxide, and dilutes it one-half; spraying the affected parts every two hours with it. 
 
 Dr. Dillon Brown stated that his experience with the Peroxide of Hydrogen hasr 
 been the same as Dr. Jacobi's, but he considers this condition referred to, to be due tc 
 the irritating effect of the acid in the Peroxide of Hydrogen. He still believed that Per- 
 oxide of Hydrogen was the best remedy they had in the treatment of diphtheria. 
 
 The way to overcome this acrid condition of this solution was to add to the fifteen 
 volume solution, sufficient ammonia to make it neutral, or if they wished to dilute the 
 Peroxide, to dilute it with lime water which does not in anyway effect its chemical prop- 
 erties, and the results are just as good. 
 
 They do not then get those lesions that affect the mucous membrane as described by 
 Dr. Jacobi. So used, he considered the Peroxide of Hydrogen the best remedy they had 
 in the treatment of diphtheria. The acid he spoke of contained in the solution was sim- 
 ply an impurity which it was expensive to get rid of, and consequently more profitable 
 to leave in. 
 
 Dr. Manley in closing the discussion said that in reference to the question of Per- 
 oxide of Hydrogen increasing the area of the membranous exudation it cannot be denied 
 that when they sprayed the throat with Peroxide of Hydrogen there was a membrane at 
 once formed, that is, if they called a deposit of mucus coagulated by the acid of the 
 Peroxide of Hydrogen, a membrane, they had such a membrane every time they em- 
 ployed the Peroxide, as they would have a membrane if they were to use a strong solu- 
 tion of nitrate of silver, but nothing more. 
 
 He regarded intubation as a wonderful thing, but he would emphasize the fact that 
 it had its limitations. In intubating the larynx, the great difficulty was the mechanical 
 one in getting a tube that will adjust itself to the lumen of the passage. These passa- 
 ges are very irregular in form and outline, and if the tube did not fit, it acted as a foreign 
 body, giving rise to irritation and necrosis. 
 
Ii 7 
 
 APPENDICITIS. 
 
 By ROBERT T. MORRIS, A. M., M. D., New York. 
 
 A Clinical Lecture at the New York Post-Graduate Medical School, February, n, iSgj, 
 
 (Reprint from the New England Medical Monthly for April, 1893.) 
 
 Gentlemen: 
 
 "How many appendicitis patients have you in there?" I asked when driving by a 
 grave-yard in company with a physician, one day last week. "Two of my own and four 
 that were seen in consultation," he said. "I was just counting them up when you spoke, 
 and I feel that none of them would be there if they could have had timely operations." 
 
 If the grave-stone of every appendicitis patient who need not have died were to give 
 out a light, every cemetery in the land would shine at night. 
 
 Before removing the appendices from our two patients this afternoon, I will show 
 two fresh specimens which illustrate widely different types of the disease. This first 
 wicked looking specimen I removed on Tuesday from a patient who was in the eleventh 
 day of an acute general peritonitis. The patient was then moribund. To-day he is re- 
 covering. There is always a question as to the policy of operating upon such patients 
 but accumulative experience enables us to attack cheerfully the most vicious of cases. 
 
 Up to the year 1890 we lost a good many appendicitis patients after operation, but 
 from the vast mass of recent data, we have reduced a few apparently trifling changes in 
 technique that give our patients chances for life; changing the whole outlook of these 
 operations, just as ideas about peritoneal operations in general underwent a transforma- 
 tion a very short time ago. 
 
 Again let us look at this dark and ragged specimen which has been slit along the 
 free border to show the interior. A stricture at its middle occludes the lumen. 
 
 The stricture is a hieroglyphic in high relief and we can read it. It says that the 
 patient once upon a time had appendicitis, that a bit of mucous membrane was murdered 
 and cast out into the bowel; and that the resulting ulcer filled the gap with a collar of 
 connective tissue. 
 
 When the stricture contracted it entrapped two fecal bullets in the distal half of the 
 lumen and left the appendix loaded. Last week the bullets went through the wall and 
 shot the patient. 
 
 The physician who asked me to see the case was doubtful about its being one of 
 appendicitis, because there was no particular pain at McBurney's point and because there 
 was no dullness on percussion in the right inguinal region. Nevertheless, he remembered 
 my earnestness in insisting that acute peritonitis in adult males and in children of both 
 sexes was a fire alarm calling the surgeon to come quickly and put out the appendix. 
 The reason why there was no particularly tender spot and no inguinal dullness was be- 
 cause the abdomen was tense and shiny with acute general peritonitis and because one 
 of the abscess cavities in the inguinal region was stretched with hissing, stinking gas. 
 How did we find it out? We looked! When I had placed the patient in Trendelenburg's 
 position and had evacuated a large amount of pus and gas, one of the consultants thought 
 we had done enough. After sterilizing the abscess cavity with peroxide of hydrogen 
 (Marchand), I proceeded to separate all adhesions and finally came to a large secondary 
 cesspool of pus, containing the riddled gangrenous appendix. 
 
 Now the patient can live. 
 
 Don't forget what happened after it was thought advisable to rest content with 
 draining the first abscess. 
 
 A word about opium. I am about through with opium in any form in peritonitis of 
 any sort. Mr. Tait, I believe, says that he has banished it from his pharmacopoeia alto- 
 gether. 
 
 My two definitions for opium in peritonitis are these: 
 
itf8 
 
 1. A drug which stupefies the physician who gives it more than it does the patient 
 who takes it. 
 
 2. A drug which generally relieves the distress of the physician who without it would 
 be compelled to do something rational for the patient who has put confidence in him. 
 
 Opium and peritonitis breed a vampire which lulls the patient to sweet repose while 
 his life is being sucked out, and the doctor is looking the other way. Remove the cause 
 for peritonitis when you can. Remove the products of peritonitis when you can do noth- 
 ing better. Avoid as carefully as possible the teachings of our honored preceptors who 
 did the best they could in the days when symptoms were treated and not prevented. 
 
 An abdomen swollen with peritonitis looks to me like a great big ripe boil and need- 
 ing the treatment that boils usually receive. 
 
 Figure i. 
 
 Longitudinally split appendix. Perforated by concrements. Gangrenous, 
 i. Point of exit of fecal bullets. 
 
 2. Old stricture occluding lumen. 
 
 3. Hard, dry fecal bullets. 
 
 Here is the second appendix. It is apparently normal as you observe, excepting at 
 the tip where it is rough and clubbed. I removed it last Thursday from a young man 
 who three weeks ago was laid up for a week with colic and vomiting, associated with 
 swelling and tenderness in the right inguinal region. He found that "something pulled" 
 whenever he made exertion, and the tender spot remained. The roughness at the tip 
 shows where adhesions fixed the tip of the appendix to parietal peritoneum, and that is 
 
II 9 
 
 what caused the pulling and the tenderness. His appendix is what I call a "growler/' 
 
 The first patient of to-day's clinic is ready. The history is briefly this: Shortly after 
 childbirth, fifteen years ago, agonizing colic, bilious vomiting, rigors, febrile reaction, a 
 lump in the right inguinal region. Acute attacks have recurred several times and of late 
 years the lump has been permanent. Intestinal obstruction has lately become a serious 
 feature of the case. My analysis of her symptoms is this. At childbirth a foreign bod)' 
 in the appendix was compressed until it injured the mucous tube and allowed bacteria to 
 enter the adenoid tissue. The colic means that the intestine was trying its muscles on 
 disagreeable company, which needed to be forced away. The colic is sometimes awful, 
 and always unnecessary, if the surgeon is near. Bilious vomiting means that absorbed 
 septic matter was being excreted by the liver, and the ptomaine bearing bile on reaching 
 the duodenum mischievously reversed the lever of the duodenum and flooded the stomach 
 with bile. A reversed peristalsis caused by certain irritants is familiar to some of you as 
 a laboratory experiment. The rigors and the febrile reaction meant that microbe products 
 were poisoning sympathetic nerve centers. The inguinal lump indicated that local peri- 
 tonitis had welded several structures together in order to protect the peritoneal cavity 
 against the company that the intestine was trying to rid itself of. The intestinal obstruc- 
 tion means that adhesions have contracted. 
 
 The peritoneal exudates make a lymph cake. Sometimes this lymph cake is a simple 
 pound cake, that the peritoneum digests as soon as the appendix has been temporarily 
 appeased. Sometimes it is a cream cake, and the pus if not absorbed, finds its way into 
 a large vein or into the ureter or into the bladder, or somewhere where no reputable sur- 
 geon would think of making an opening. Nature tries to do some surgical work but she 
 is a good deal more of a success at making lilies. 
 
 Then again, we are never sure when nature prefers to save the patient or to en- 
 courage a particularly fine bed of microbes. It is a pretty conceit for us to assume that 
 she cares more for one specimen of homo sapiens than for a whole lot of streptococcus 
 pyogenes aureus. The presence of a lymph cake in the vicinity of an appendix vermi- 
 formis is the piteous signal of the peritoneum for help, and the sympathetic surgeon must 
 respond instantly, bearing in his hand the little wand that will vanquish the witch. A 
 diseased appendix which is not walled in with lymph cake needs equally prompt attention 
 by the surgeon. 
 
 Under procrastinating medical treatment by the good physician, a surly appendix 
 may often be coaxed back into its hole where it mutters and sulks and prepares for an- 
 other spring at the patient. 
 
 Our patient is now placed in Trendelenburg's posture. The reason for that is, be- 
 cause we do not want to play a jack-in-the-box game with intestines, but prefer to attend 
 strictly to business. Another reason is because we wish to have pus run out instead of 
 running in. Another reason is because one look at the involved parts is better than two 
 feels and four guesses. The side of the appendix is exposed through the customary lat- 
 eral incision. The lump is found to consist of a heterogeneous mass of omentum, 
 mesentery and ileo-caecal intestine, and firmly welded together. When the bass are biting 
 fast and my line gets into this kind of a snarl I cutout the whole snarl at once and throw 
 it away. I believe that we must do that in some cases of these old appendicitis with in- 
 testinal obstruction, but I have succeeded in undoing so many similar snarls that we will 
 try it once more, Guided by the small granular lumps of fat we separate the adhesive 
 omentum. That is easy. Guided by the direction of the blood vessels, we separate the 
 adhesions of the mesentery. That requires sharp eyes, for the bowel as usual rolled itself 
 up in mesentery when it first became frightened. Guided by the direction of muscular 
 tissue we slowly work the iluem free. Here comes a sudden burst of pus which runs out 
 upon the abdomen because of the Trendelenburg's position. The abscess cavity is irrigated 
 with peroxide of hydrogen (Marchand). This is done because the peroxide is a search- 
 ing sterilizer and it throws pus and debris out of nooks and crannies. It is easy to ob- 
 serve that the appendix is practically gone into solution in the abscess cavity, and here I 
 find a piece of apple core encrusted with phosphates that has caused all the trouble. The 
 
120 
 
 caecum has disappeared. It was drawn up by adhesions, strangled, and forced to join 
 the abscess. There is no ileo-csecal valve but in its place a rigid, narrow, tortuous chan- 
 nel about five inches in length. 
 
 Gaze upon this wreck of vitals, produced progressively by successful attacks of ap- 
 pendicitis, and then consider the responsibility of the physician who in appendicitis 
 cases advises the patient to wait. How easy an early operation in this case! How 
 desperate the operation now! I ought to respect the intestine right here, but the 
 patient has been absorbing pus for several months so I will make a fecal fistula to relieve 
 the ileum, and resect the intestine a month later. The shock we will treat with nitrate of 
 amyl to the nose at first and then hypodermic injections of nitro-glycerine and strychnine, 
 together with the routine resources of hot bottles, hot rectal injections and elevations of 
 the legs. 
 
 Our next patient is genial Dr. Robert Kennedy, Jr., of proteinol fame, whom 
 most of you know. Judging from his appearance he has never lived upon anything more 
 artificial than a thick tender porter house steak. His appendix must come out, however. 
 Two years ago after exposure to cold sea winds, the Doctor was suddenly attacked with 
 colic and abdominal cramps, but at the end of a week was practically well again. Eight 
 months ago he was again attacked in the same way, but with added symptoms of rigors 
 and vomiting, together with pain and tenderness in the right inguinal region. After sub- 
 sidence of the acute symptoms there remained a persistent feeling that something was 
 wrong with the appendix. He was constantly inclined to press with his hand over the 
 region of the appendix and found discomfort in certain positions when sitting. That 
 is a pretty good history of early infectious appendicitis. 
 
 After his history had been taken, our conversation was something like this: 
 
 Q. Well! What do you advise me to do about it? 
 
 Ans. That depends. If you are always where good medical attendance is within 
 easy reach, it would be as well to pay no particular attention to the appendix at present. 
 
 Q. But I travel a great deal, and am liable to be caught with an acute exacerba- 
 tion at any time and place, am I not? 
 
 Ans. Certainly. 
 
 Q. Is the next attack likely to be more severe or more mild than the last one? 
 
 Ans. No one can possibly predict! 
 
 Q. Is sloughing or perforation as likely to occur in the third attack as in the 
 tenth one? 
 
 Ans. Surely! 
 
 Q. Can I recover completely and have no further trouble without an operation? 
 
 Ans. Yes! 
 
 Q. Am I likely to? 
 
 Ans. N.o! 
 
 Q. What are the dangers of an operation now? 
 
 Ans. I have never been anxious for my patient no matter what the complications 
 were, excepting in desperate cases with pus and septicaemia to deal with at the time of 
 operation; when these two features were absent the technique which buries the stump 
 of the appendix and which ensures against ventral hernia later has given me perfect ease 
 and comfort in a responsible position, and the patients have made uninteresting re- 
 coveries. 
 
 Q. The greatest danger from the surgeon, then, is when there is greatest danger 
 from the disease? 
 
 Ans. A la bonne heure! 
 
 Q. Well, I like the opposite combination better! If by having my appendix cut 
 now, I can escape the ever present dread of exacerbation and can save the time lost in 
 attending to mild attacks. If you do not now dread the operation and if you will dread 
 it when I am in danger from the disease, why is it not good business judgment to decide 
 that the appendix should come out? 
 
121 
 
 Ans. That is for you to say. I am at your service. 
 
 Q. When will you take it out? 
 
 Ans. On Saturday, 4. 30 P. M. , if you are willing to go before my class at the 
 Post-Graduate Medical School. The matriculates have shown unusual interest in my 
 appendicitis cases there. 
 
 Figure 2. 
 
 Final. All right! Glad to give them points! I'll be there! 
 
 And here he is. A man in fine health, suffering only a little discomfort, deciding 
 to have his infectious appendix removed as a plain matter of forethought and discretion, 
 
 Figure 3. 
 
 The patient being placed in Trendelenburg's position my incision is made over the 
 normal site of the appendix. The incision is about two and a half inches long, through 
 skin and muscle and about one and one quarter inches long through transversalis fascia 
 and peritoneum. Intestine presents, I see by the longitudinal band that it is colon. 
 
 Figure 4. 
 
 Transverse section of longitudinally split appendix. 
 1, Mucosa and adenoid coat bulging a little. 
 
 Moderate exudation. 
 
 2. Submucous connective tissue thicker than the combined muscular and peritoneal coats. 
 
 3. Muscular and peritoneal coats. 
 
 Passing it through the fingers in a direction which will put the caecal peritoneum upon 
 the stretch, we soon come to a halt. The appendix must be very near. Here is its base 
 presenting in the wound. I pull the appendix out through the opening. It is about 
 
122 
 
 five inches long, hard and congested. While an assistant holds it with forceps, the 
 mesentery of the appendix is ligated with cat gut and divided, the peritoneal and mus- 
 cular coats of the appendix are clipped through at the csecal junction. The mucous 
 
 Figure 5. 
 
 Transverse section of longitudinally split appendix. Exudative. A "pop corn" appendix. 
 
 1. Mucosa and adenoid tissue bulging prominently. 
 
 2. Submucous connective tissue much distended. 
 
 3. Combined muscular and peritoneal coats. 
 
 tube is ligated well down into csecal mucous membrane with the finest of eye silk. The 
 peritoneum of the caecum about the base of the appendix is scarified with the point of a 
 needle until pink serum exudes, and those of us who are accustomed to experimental 
 
 Figure 6. 
 Photo-micrograph of transverse section of infectious appendix of Br. K. Mucosa, x 50. Intense 
 
 round cell infiltration. No epithelium remaining. 
 
 abdominal work in the lower animals, realize that this is one of the most important 
 points in the technique, and must never be neglected in cases like this one. The mu- 
 cous tube is stripped away, leaving a trifling stump. Four Lembert sutures of cat gut 
 
123 
 
 bury the stump. If the silk ligatures and its tiny stump must escape for any reason they 
 would go into the lumen of the bowel. The relative position of sutures after this 
 method of suturing, is shown in Figure 2. 
 
 The method of ligating which is apt to leave an Esquimaux window at the site of 
 the appendix is illustrated in Figure 3, and I should have no confidence in such a scar. 
 
 In closing the wound of the abdominal wall, peritoneum and transversalis fascia 
 and transversalis aponeurosis receive one tier of silk worm gut sutures. Internal oblique 
 and external oblique aponeurosis each receive a separate tier of silk gut sutures, the 
 knots to remain permanently, and skin and fat are honored with a cat gut tier. This 
 patient now will not have a ventral hernia. 
 
 Let us examine the specimen removed. As I slit it along the free border you will 
 observe that the inner tube hastily bulges out. It is what I call a "pop-corn" appendix, 
 and on comparing it with the normal portion of this other appendix the reason for the 
 name is apparent. 
 
 
 
 
 j. 
 
 
 
 ■■■'• - ■■■■■ ■:' '■■■'■■ . ■ -■ ■."■- -, '" ■ "■■'■■: ■ ' .... -\ -. 
 
 fr; 
 
 
 - m 
 
 
 ? . '. ; *^ 
 
 
 
 - - ' !■':'' ;'■ " ■■- ■--. ■■■.'■■' '" .,.■■■.■ ■ 
 
 |Y' 1 - \ 
 
 
 
 ■ '"■"■ - ■■" : .■ ': "' :■' ' ■ 
 " . Y "*^W^ "■ >*^Y ^Y^P^ -" ■■■■' *..'"-., 
 
 ■- '■:><■ S - "*' \ V ^ - *Y ; \* " "'*' "v^§B *' ^ 
 
 Y-^^S^xT 
 
 1 
 
 
 ? V-'^'-""^* ' - r 
 
 V. . - \ N\ 
 
 .1 
 
 11 
 
 v" V V : ' ' ' ■:■" 
 
 *y~ * ^ 
 
 
 i 
 
 '^'U- YY' : - \ Y-, - ■■'' : ' \^— - '' X: -vY'Y,'.-. /Y^Y": ^'"--^Y 
 
 ' 
 
 Figure 7. 
 
 Same case as Figure 6. Submucous and muscular coats infiltrated x, 250. Other secretions of this 
 same specimen show that the subserous tissue and even the walls of the blood vessels were invaded and 
 the lymphatics were clogged with products of this infectious exudative inflammation. 
 
 The condition shown in Figure 5, is, I think, characteristic of infectious appendi- 
 citis. This elastic inner tube apparently swells within the outer tight tube until the 
 crowding cuts off circulation and then little or big sloughs of mucosa and adenoid tissue 
 occur. These either decompose and escape into the bowel, leaving an ulcer; or they 
 escape bodily through the wall of the appendix leaving a perforation. That I think is a 
 pretty good history of appendicitis no matter whether the infection began through the 
 influence of exposure, or foreign bodies, or local tuberculosis, or amoebae coli, nema- 
 todes, or typhoid fever, or dysentery. So far as I can learn, authors have not noted the 
 
124 
 
 fact that patients sometimes depreciate rapidly in health without discoverable cause for a 
 week or for several weeks before the first acute symptoms of appendicitis appear. The 
 natural explanation is that they are absorbing products of the infectious inflammation at 
 the appendix before exudation has swollen the mucous tube enough to make strangula- 
 tion. It is sometimes asked how can I reconcile this theory and the condition of dropsy 
 of the appendix, in which all structures are widely distended. My answer is: Slow, 
 low grade inflammation giving time for dilatation of all structures, and not associated 
 with tonic muscular spasm of the muscular wall of the appendix, such as we would expect 
 in acute catarrhal inflammation. The theory of causation of appendicitis carried out to 
 meet the common principal symptoms, is arranged thus: 
 Colic. — Simple vomiting. Right inguinal tenderness, choking of swollen inner tube in 
 
 tight muscular tube which is made more rigid by tonic muscular spasm. 
 Colic. — Bilious vomiting. Right inguinal tenderness. Formation of tiny or large inner 
 
 tube sloughs, and absorption of septic products from the decomposing sloughs. 
 Colic. — Bilious vomiting. Right inguinal lump. Oozing through or slow perforation of 
 
 appendix wall by sloughs and other contents, met by lymph exudate from peri- 
 toneum. 
 Colic. — Bilious vomiting. Collapse. Rapid perforation of appendix wall by sloughs 
 
 and other contents, allowing no time fcr formation for protecting lymph exudate. 
 
 The reason why the inner tube is so hard pressed in the tight tube of peritoneum and 
 muscle is because* of the great round cell infiltration and serous distension. I will ask 
 Dr. J. C. Smith to make a section of this infectious appendix in the pathological labora- 
 tory and then give us a photo-micrograph. 
 
 It seems strange to me that the life insurance companies pay so little attention to a 
 disease which daily claims its large quota of deaths. Patients who have exacerbating ap- 
 pendicitis can at present take out heavy policies in anticipation of a fatal termination of 
 the malady. The insurance companies will not always discover that a patient has ap- 
 pendicitis if the diagnosis which patients bring to the surgeon form any guide. I am 
 keeping a record of diagnoses that were made for patients of mine who had typical ap- 
 pendicitis, and the list up to the present time includes bilious colic, bilious peritonitis, 
 gall stones, typhoid fever, typhilitis, perityphilitis, caecitis, la grippe, abscess of the ab- 
 dominal wall, pyosalpinx, ovarian abscess, and psoas abscess. 
 
 I wish the physicians who make the diagnosis of typhilitis, perityphilitis and idiopathic 
 peritonitis, could know how farcical such a diagnosis sounds to those of us who have fre- 
 quent occasion to look and who find the case to be appendicitis. 
 
 This subject of appendicitis, Gentlemen, is very near to my heart. Friends of mine 
 attacked in the prime of manhood are now gone forever, because their physician waited 
 to see if they would not get better without operation.. When they were a little worse 
 consultants were called in, and the consultants gave cheer and hope to the anxious fami- 
 lies by describing similar cases of theirs which had made most excellent recovery. Fin- 
 ally, when my friends were dead, the physician said: There ! Those were the cases for 
 early operation. 
 
 As to the after treatment of these cases I treat cases of appendicitis as I do surgical 
 abdominal cases in general, strictly recumbent position upon the back for twenty-four 
 hours or more. Hot water to quench the thirst, and practically nothing else for twenty- 
 four hours. Sometimes, however, when there is much nausea and giddiness from either, 
 it is well to quiet it with a dessertspoonful of effervescing bromo-soda in a half-glassful 
 of cold water — not iced. At the end of twenty-four hours begin a diet with proteinol, 
 three tablespoonfuls every three hours; then for twenty-four hours proteinol two table- 
 spoonfuls every hour and milk four ounces every three hours, giving them separately. 
 Watch the effect of the milk carefully. Should its casein curdle in masses causing pain 
 and flatulence with irritation, we must not continue to use it raw. 
 
 After about 60 hours, should nothing untoward have happened, the patient may be 
 put upon regular diet. Care of course being taken that cold cabbage, pickles, beets, 
 cheese and fried foods be omitted. Even at the risk of being monotonous let us keep 
 
i 2 5 
 
 them on plain soups, roast and broiled beef, mutton and chicken; eggs, boiled or in 
 plain omeletts; vegetables to be sparingly used unless known to be of no harm, toma- 
 toes, potatoes stewed, baked, hash-brown or au gratin, not fried or boiled, lima beans, 
 asparagus, etc. Cabbage and cucumbers had better be eschewed. Milk and dry toast 
 well done, but not carbonized. But little food should be taken at a time, but often, 
 allow all the milk they want, should it agree. As to proteinol the more they take and 
 the oftener they take it, the stronger they will be. Always give proteinol by itself, one, 
 two or three tablespoonfuls at a time according to the patient's age and inclination. All 
 pastries should be denied, puddings well made may be allowed as well as a fair amount 
 of fruit, raw or cooked, so as to keep the bowels in good working order. Omitting all 
 unripe and. distinctly acid fruits that may occasion pain or diarrhoea. 
 
 If the patient has been in the habit of smoking and requests it after about a week, I 
 allow it in moderation. The same as regards stimulants. If the bowels have not moved 
 on the second day after the operation I advise an enema of soap suds one pint, glycerine 
 one ounce, and olive oil one ounce, the whole to be well mixed and injected gently, 
 retained as long as possible, then ejected into a bedpan. By no means must a patient 
 try to get up or to help himself in these matters. From this on the bowels should move 
 each day or every other day; should they not naturally move they should be made to move 
 by internal medication. The mildest and gentlest methods must of course be used. It 
 goes without saying the room is warm, comfortable and cheerful. The dressings are 
 not to be moved as long as the patient has not disarranged them, or pain, fever, and dis- 
 comfort generally does not call for it. In about 14 days they can be removed and the 
 wound dressed, if pus is present ferret it out with Peroxide of Hydrogen (Marchand's), 
 dust with aristol, cover with absorbent sublimated gauze, then a layer of absorbent cotton 
 or wood wool, then either use adhesive strips or spica bandage to keep the dressing in 
 place, the size and condition of the wound will determine you in this. It is best that 
 patients should not sit up in the bed before the 17th day, then for a little while, more on 
 the 18th, sitting up beside bed on the 19th, on the 20th a little walking around the 
 room is allowed. On the 21st day patients are generally ready to leave the hospital. 
 
 Since the original article was presented for publication the author has completed a series of 
 researches which prove that appendicitis is an infectious, exudative inflammation following entrance of 
 bacteria into the mucosa and adenoid tissue. The inflammation once begun probably does not stop 
 until slow erosion or rapid necrosis cause entire disappearance of the mucosa and adenoid tissue. 
 Years may be required for the completion of the infectious process, and in the interval the patient is 
 subjected to the danger of poisoning of peritoneum, or thrombosis of mesenteric vessels, of local 
 cellulitis, and of various other septic complications. 
 
 PEROXIDE OF HYDROGEN IN THE TREATMENT OF 
 GONORRHOEA.— WITH REPORT OF CASE. 
 
 By JOHN J. SULLIVAN, M. D., New York. 
 (Published by the Medical Summary for July, 1893.) 
 
 My recent experience with Peroxide of Hydrogen in the treatment of gonorrhoea has 
 led me to believe that we have in this agent a most prompt and efficacious remedy. There 
 is no doubt that Peroxide of Hydrogen thoroughly destroys the gonococci and promptly 
 renders the urethral canal aseptic and free from pathogenic germs. 
 
 Acting upon the theory that antiseptics have the effect of maintaining any cavity or 
 canal in the state of asepsis (without being deleterious to healthy tissues), which is the con- 
 dition most favorable for the cure 'of suppuration, I have found by the use of this drug 
 that the danger of an extension of the inflammation into the posterior urethra is 
 lessened, the course of disease is decidedly shortened, and gonorrhceal complications 
 avoided. 
 
126 
 
 The following plan of treating acute gonorrhoea has proved very gratifying in my 
 experience. I instructed the patient to use as an injection three times a day: 
 
 I? Hydrogen Peroxide, Marchand's, (medicinal,) i oz. 
 Aquae dist. , 6 oz. Mix. 
 
 I present a brief history of two cases treated according to this method: 
 
 Case i. — M. S., a married man, aged forty-five years, came tome in great pertur- 
 bation of mind, stating that he had recently contracted gonorrhoea from a prostitute. 
 He had all the characteristic symptoms of acute gonorrhoea. I gave him the above 
 preparation requesting him to use it three times a day, and told him to call again in the 
 course of three days, which he did, when I found him completely cured. 
 
 Case 2. — The second case was that of a young man (unmarried), twenty-four years 
 of age, who came with gonorrhoea of six weeks' duration. He had tried a host of reme- 
 dies prescribed by druggists for the trouble, but in vain. It had gone from bad to worse, 
 and made him feel in a very dispondent frame of mind. An examination revealed the 
 tissues of the penis to be in a very swollen and painful condition, with a profuse puru- 
 lent discharge from the meatus, the lips of which were much inflamed and angry 
 looking. He complained of great pain of urination, and was restless at night. I gave 
 him the Peroxide of Hydrogen as above, directing him how to use it, and requested him 
 to call again in the course of five or six days. When he presented himself five days later 
 I found that the inflammatory process was subdued, the pain of. urination had disap- 
 peared, and the p*atient expressed himself as feeling in every way comfortable. Ten 
 days after this he had reported himself as entirely cured. 
 
 It will be understood, of course, that in these cases I have directed the patients to 
 observe the usual rule for diet and internal treatment. 
 
 TREATMENT OF VAGINITIS BY PEROXIDE OF HYDROGEN. 
 
 (MEDICINAL). 
 
 By HERMAN L. COLLYER, M. D., New York. 
 (Published by the Annals of Gynecology and Pediatry ,oi Philadelphia, Pa., Sept. 1893.) 
 
 There is no disease, aside from the grave maladies so annoying and distressing to 
 the patient as vaginitis. The married and single alike may be attacked by it in one or 
 another of its varieties, and its treatment by routine methods is slow and unreliable. 
 
 In all its forms, vaginitis starts as do other inflammations, with heat, pain, redness 
 and dryness of the parts. The condition is soon followed by slight 5,welling of the labia, 
 and by a discharge which becomes muco-purulent. Medical advice is usually sought 
 after this stage has become established. It was an old-time custom, and is to-day 
 observed by some, to order douches, with different mucilaginous substances, and to 
 make local applications, many of which have wrought harm. The patient was dosed 
 meanwhile with various drugs supposed to have a specific effect on the inflamed parts, 
 regardless of the causes of this disease. 
 
 Dr. Egbert H. Grandin, of this city, called my attention some time ago to the 
 valuable properties of Peroxide of Hydrogen, (medicinal) Marchand's, in cases of vaginitis. 
 I then began its use in this disease, whether specific, simple or senile, and have been 
 able to cure my cases in a more speedy and effective manner than by other methods. 
 
 It is my custom in the treatment of a case of vaginitis (purulent) first to wash the 
 parts with warm creoline water ( 3 ss toOj), getting rid of all the secretions possible; then 
 through a glass or rubber cylindrical speculum to thoroughly wash out the vagina. I 
 use peroxide of hydrogen (medicinal) plentifully, either full strength or diluted with luke- 
 warm water, and rub the surface with a pledget of cotton, withdrawing the speculum at 
 the same time (but not allowing it to come out), so as to allow the peroxide to get deep 
 
127 
 
 into the crypts, destroying the pyogenic membrane and the gonococci, if any have 
 imbedded themselves into the epithelium; I treat the vagina throughout in this manner, 
 and also the vulva, especially in the folds of the labia and the orifices of the Bartholin 
 ducts. Having destroyed every vestige of the pus with the Peroxide of Hydrogen, I 
 pour into the speculum about one ounce of sol. argenti nitratis ( 3 ss to § i) and coat the 
 denuded membrane throughout, inserting a strip of iodoform or aristol gauze to keep the 
 parts separated, swabbing the external parts with the same solution (gr. xv to § i). 
 
 I repeat this process every second or fourth day, as the case demands. The patient 
 is instructed to remove the gauze on the following day, and to use in acute attacks, a 
 cool, weak solution of the lotion plumbii.et opii or muriate of ammonia sol. (3 ii to Oi) 
 water, two or three times daily. When, the symptoms become milder, the use of astrin- 
 gents is necessary, as sodii biborat, sulpho-carbolate of zinc or alum. 
 
 In specific vaginitis the endometrium and the urethra have often become affected. I 
 treat those cavities in the same manner, of course observing the precautions necessary 
 for each, in all cases securing free drainage. 
 
 ETIOLOGY OF THE VARIOUS DEFORMITIES OF HIP-JOINT 
 
 DISEASE. 
 
 By A. M. PHELPS, M, D., New York. 
 
 * 
 
 Professor of Orthopedic Surgery in the University of New York and the New York 
 Post-Graduate School and Hospital; Professor of Surgery in the University of 
 Vermont; Surgeo?i to the City Hospital; President of the American Orthopedic 
 Association. 
 
 Read before the American Orthopedic Association, September, 1892. 
 
 (Published by the New England Medical Monthly, January, 1894.) 
 
 We are all familiar with the deformities which occur in' the first, second and third 
 stages of hip-joint disease. The typical deformities are: In the first, abduction, slight 
 flexion, and outward rotation, with apparent legthening (see Fig. 1); in the second, an 
 exaggeration of the deformity which occurs in the first (see, Fig. 2); while in the third 
 stage the entire picture changes to that of flexion, abduction, inward rotation; and real 
 shortening, with the toe resting upon the opposite instep (see Fig 3). In a considerable 
 per cent, of cases erratic deformities are observed; such as extreme flexion with outward 
 rotation and shortening of the affected limb, the deformities of the second stage occur- 
 ring in the third. Abduction and shortening, without flexion, is sometimes seen. 
 
 This division into stages is made merely for clinical convenience, and relates only to 
 semeiology. 
 
 Barwell says that we may conclude that the appearances indicate certain processes of 
 disease, but with morbid anatomy the divison into stages has no direct connection. I 
 have adopted this classification of the deformities in my observations and in writing. 
 
 A limb with shortening, from destruction of bone, I classify as belonging to the 
 third stage, without regarding the deformities present. A limb with abduction, flexion, 
 and inward rotation, I classify as disease in the third stage; even though there be no 
 shortening, / have observed in cases excised, that these deformities of the three stages as 
 already described, follow very closely, and quite accurately interpret, certain pathological 
 changes taking place in, or about, the joint. 
 
 The question under consideration is, what causes these various deformities? 
 
 I. Why does the limb assume, nearly always, the position of abduction, flexion, 
 and outward rotation without fixation, in the first and second stages, and abduction, 
 flexion, and inward rotation in the third stage? (See Figs. 1, 2 and 3.) 
 
128 
 
 2. Why, in certain percentage of cases, do the deformities of the second stage 
 occur in the third, i. e., flexion, abduction, and outward rotation? 
 
 Barwell makes no attempt to explain these phenomena. I quote from this book:* 
 "While the muscles thus waste, the joint assumes a fixed position, natural to itself, 
 abnormal only in its persistency toward the side of the flexion. This is the case at the elbow, 
 wrist, and ankle, while at the shoulder abduction pertains ; at the knee an inward twist of 
 the tibia is usually combined with considerable flexion; at the hip very complicated posi- 
 tions, to be studied in a futute chapter, are assumed. These postures assume in nearly 
 
 Fig. i. 
 
 Fig. 2. 
 
 Fig. 3- 
 
 every case of joint disease, almost with the certainty of an unchangeable law. There is 
 then, in all joint diseases, a tendency of the flexor muscles to contract, while the ex- 
 tensors, if not in absolute relaxation, do not, at all events, retract such action." 
 
 "It is true that the flexors are probably, in the limbs, strongerthan the extensors, 
 but in fact a mere examination will show that on the flexor side muscles are rigid and on 
 the opposite side flaccid. Our knowledge is as yet insufficient to account for the 
 phenomenon." 
 
 We will consider these statements later. The experiments of the Germans and of 
 Edwin Owen, of London, England, demonstrated that the joint, when forcibly injected 
 
 * Barwell, p, 106. Wood's Library, 1881. 
 
129 
 
 from within the pelvis, produced eversion, flexion, and abduction of the limb and im- 
 mobilization of the joint. 
 
 Sayre concludes from these experiments, that effusions are always present in joints 
 diseased, that the intra-capsular hydraulic pressure is the cause of the deformity in the 
 first and second stages of hip disease. 
 
 He says (his book p. 248): "The peculiar position of the limb gives to the second 
 stage of the disease the name 'apparent lengthening,' but I prefer to designate it as the 
 stage of effusion." 
 
 And he accounts for the deformity of the third stage, viz., flexion, adduction, and 
 inward rotation, by the rupture of the capsule and the escape of the fluid, thus relieving 
 
 Fig. 4. 
 
 Fig. 5- 
 
 intra-articular pressure. This he claims, allows the legs to swing to the deformity of 
 the third stage. He says (p. 259). 
 
 ' 'And rupture of the capsule takes place and the imprisoned fluid escapes into the 
 surrounding tissues. When this has occurred the disease is in the third stage. 
 
 "The limb is now adducted, inverted, and flexed. 
 
 "The change in position is due to the fact that the fluid in the joint cavity has been 
 evacuated. 
 
130 
 
 "The distension of the capsules, which was the mechanical cause of the flexion and 
 adduction of the limb, having been relieved, nothing now obstructs the free action of the 
 adductors, and the limb is therefore adducted and inverted." 
 
 So far as I know, this hypothesis of the Germans, approved and indorsed by Dr. 
 Sayre, is the only explanation we now have of the etiology of the various deformities of 
 the hip-joint disease. Bar well offers none; but makes among others, a broad statement 
 that, "It is true that flexors are probably, in all limbs, stronger than extensors." 
 
 A moment of thought will convince us that this last statement is certainly an error. 
 
 In the knee-joint the quadriceps is much stronger than the flexors. This we have 
 demonstrated in the course of our experimental work, and it will be published shortly. 
 The same is also true of the hip-joint. The fluid hypothesis is certainly erroneous, for 
 the following reasons: 
 
 i. A very large per cent, of cases of morbus coxarius are unattended by fluid 
 effusions. Still, the same picttire of deformity is seen as in those cases attended by large 
 effusions. 
 
 2. I have observed in our clinics and have operated upon cases of extra-capsular 
 disease, in which the joint was not diseased but the same picture of de fortuity presented 
 itself. 
 
 Barwell says (p. 292) "While inflammation, or even suppuration about the epiphysis 
 of the femur arises, certain pains, forms of lameness, etc., are produced, while as yet 
 there is no effusion or suppuration within the joint cavity; no morbid change of the 
 parts which form its walls. We have, namely, so-called symptoms of morbus coxarius, 
 while as yet in the hip (joint) there is no disease." 
 
1 3 l 
 
 3o Cases of suppurating joints with large effusions, often take the erratic deformi- 
 ties of the third stage — i. e., abduction, flexion, and outward rotation — even after the 
 joint contents have discharged. 
 
 4. There can be no reason why, after the evacuation of the joint, the limb should 
 not return to the deformity of the second stage instead of the third ; because the three 
 
 Fig 7. 
 
 Fig. 8. 
 
 great glutei and outward rotators are strongerthan the. abductor group, unless the limb is 
 flexed beyond twenty degrees. These are the chief, and I believe, valid reasons why the 
 explanation of these deformities by the fluid hypothesis is incorrect. 
 
132 
 
 I have become fully convinced that as yet a correct explanation has not been offered for 
 these deformities. 
 
 After concluding several dissections of the hip-joint, I desire to place before you for 
 your consideration and criticism the theories and hypothesis upon which we worked, and 
 the conclusions at which we arrived. 
 
 It became necessary before any experimental work was performed, to carefully com- 
 pile clinical data in a large number of cases. Assisted by Dr. Plymptom and Greenway, 
 these observations were made at our clinics at the University Medical College, and also 
 at our Out-Door Department and the Orthopedic Ward of the New York Post-Graduate 
 
 School and Hospital, two places 
 which afforded us ample opportun- 
 ities for observation. The con- 
 clusions reached were: 
 
 i. That abduction nearly 
 always preceded flexion, or was 
 attended by it, in the first stage. 
 
 2. Abduction and outward 
 rotation, are always present in the 
 second stage. Flexion was nearly 
 always present, but was absent in 
 a few cases. 
 
 3. When the limb flexed 
 beyond forty degrees, and fre- 
 quently at a much lesser degree 
 (twenty degrees), it quite rapidly 
 passed to the deformity of abduc- 
 tion, inward rotation, and flexion, 
 whether the capsule contained fluid 
 or not. (The degrees alluded to- 
 are from a horizontal plane.) 
 
 4. A few cases exaggerated the 
 deformity to the second stage for 
 
 Fig. q. 
 the third. In other cases there was outward rotation, abduction, shortening, with but 
 slight flexion in the third stage. (See Fig. 4.) 
 
 In another case observed by Dr. Plymptom, abduction and inward rotation, without 
 flexion, occurred with three-fourths of an inch shortening. (See Fig. 5.) 
 
 5. That there was always spasm and contraction of muscles about the joint, and 
 in nearly every case all the various groups were in a state of spasmodic contraction. 
 That shortening annulled or modified the action of the abductor group. 
 
 These observations, together with dissections which Dr. Greenway and I made, 
 presented numerous problems which will be considered later. At the University dissect- 
 ing-room, we made a series of dissections, from which I think a fair explanation can be 
 .given of every deformity which may occur in any case of hip disease. 
 
133 
 
 The hip-joint is surrounded on its outer aspect by a mass of muscles running 
 diagonally from the pelvis to the great trochanter from all directions. When the limb 
 is in a straight position the combined action of these muscles produces abduction of the 
 limb. The capsule is wound around the neck of the bone. The tension of this capsule, 
 together with that of the Y-ligament, holds the head of the bone firmly in the socket and 
 produces great pressure upon the joint when the limb is in the straight position. (See 
 
 Fig. 6. Straight position.) 
 
 The great abductor group of muscles 
 pass diagonally downward from the pelvis 
 and are inserted into the shaft at the femur 
 posteriorly along the lineaaspera. (See Fig. 7.) 
 The flexor group arises from within the 
 pelvis, passes downward over the pubes, 
 taking a reinforcement which arises from the 
 anterior surface of the capsule of the joint, 
 and is inserted into the lesser trochanter. 
 This group acts over the pubes as a cord 
 over a pully, and its power increases as the 
 leg flexes. This flexor group is antagonized 
 by the inferior portion of the glutaeus 
 maximus. 
 
 The external rotators are antagonized 
 by the tensor vaginae femoris and a porlion 
 of the glutaeus minimus and medius. Thus 
 we have the several groups in their respective 
 order when the limb is in the straight 
 position, viz.: 
 
 Glutei group, abductors, antagonizing 
 adductor group. 
 
 Flexor group, antagonizing extensor 
 group. 
 
 External rotator group, antagonizing 
 internal rotator group. 
 
 To determine the relative strength of 
 each group the muscles were weighed separ- 
 ately, and the triangle in which they operated 
 measured, as also was the length of lever 
 upon which they operated. The glutaeus 
 maximus muscle, which weighed two and one- 
 half pounds, acting in a triangle formed by 
 a line drawn from its insertion near the great 
 trochanter to the centre of the head of the 
 bone, three inches; from the head of the 
 bone to the origin of the muscles, six inches; 
 from its origin to its insertion, six inches, 
 was assumed to be capable of lifting fifty 
 pounds one inch. This was taken as the 
 unit of strength. Other triangular muscles 
 of different weights, operating in dissimilar 
 triangles, could be accurately estimated as to 
 their comparative strength. The rule which I followed was that laid down by Haugh- 
 ton (see "Haughton's Principles of Animal Mechanics," p. 183), from which I quote: 
 
 "The work done by the same (a triangular) muscle will be proportional to double 
 the perpendicular, let fall upon the side of a triangle from the foot of the bisector of the 
 vertical angle." The quality of the muscular fibres of each group very closely cor- 
 
134 
 
 respond. In each group are found fine or coarse muscular fibre in about the same pro- 
 portion. The rule applied to ascertain the relative strength of the great adductor and 
 abductor group gives to the adductor group a decided advantage, because they stand 
 paralel with the plane of the triangle, whereas the glutei muscles do not, but were so 
 
 measured and estimated. In spite 
 of this advantage given in the 
 estimates the abductor group acting 
 on the shorter lever was found to 
 be much stronger than the adduc- 
 tors, the proportion being one 
 hundred and thirty-one pounds to 
 the abductors, to one hundred and 
 sixteen pounds to the adductors in 
 the subject examined. Then, when 
 all the muscles are affected by 
 spasm equally and the limbs parallel, 
 the abductors would produce ab- 
 duction because of their superior 
 strength. 
 
 From our clinical observations 
 / at once concluded that the reason 
 why the limb went over to the de- 
 formity of the third stage of the hip- 
 joint disease tvas because the action 
 of these mtiscles were all changed 
 by the flexion of the limb, or from 
 pathological destruction of the joint 
 changing or annulling the action 
 of the muscles by destroying the 
 leverage, or localized irritation of 
 nerve-plates in the area of disease, 
 producing spasms of groups of mus- 
 cles receiving nerve-supply from the 
 same common tract. 
 
 The question of nerve destruc- 
 tion within the joints quite surely 
 plays an important part in determin- 
 ing deformities occurring in circum- 
 scribed foci of disease. But after 
 the entire joint becomes involved, 
 the element must be left out of the 
 question only so far as general 
 spasm is produced in all muscles 
 about the joint. I quote from a 
 letter of Dr. Towle, Professor of 
 Anatomy in the University of Vir- 
 ginia, which seems to demonstrate 
 that the nerve-supply comes from 
 different trunks. 
 
 "As to nervous supply of hip, 
 what I have seen is as follows: The 
 obturator immediately on emerging 
 through the obturator foramen gives off a branch which pierces the capsule ; the sacral plexus 
 or the upper part of great sciatic, gives off two small branches which enter the back of 
 the capsule, the nerve to obturator interims, from sacral plexus, leaving through great 
 
 
i35 
 
 sacro-sciatic foramen, gives a branch to back of capsule. What particular struc- 
 ture of joint is supplied by each I cannot say, as I have only traced it to capsular 
 ligament. 
 
 When the limb becomes flexed, the abductors begin immediately to lose their power 
 as abductors, and in proportion to flexion become inward rotators. 
 
 Figs. 8 and 9, taken from the dissections, represent the glutaeus medius, with the 
 
 limb in a straight position, 
 and then flexed to thirty- 
 five degrees. In Figure 
 8 the muscle acts as an 
 abductor, while in Figure 
 q its action is changed 
 to that of an internal 
 rotator when the limb 
 is flexed to thirty-five 
 degrees. 
 
 Figs. 10 and 11 are 
 from photographs of our 
 dissections of the glutaeus 
 minimus. In Fig. 10, the 
 limb straight, the muscle 
 acts as an abductor; where- 
 as the limb being flexed 
 ||.only fifteen degrees, it 
 |j becomes a powerful internal 
 'rotator and increases in 
 power as the limb flexes, 
 as does the tensor vaginae 
 femoris (see Fig. 11): the 
 outward rotators become 
 abductors when the limb is 
 flexed to an angle of about 
 forty degrees, with the ex- 
 ception of the quadratus 
 femoris and obturator ex- 
 ternus. The change of 
 action in the other muscles 
 is quite as marked as in 
 these which have been 
 illustrated and presented as 
 examples. (See Figs. 10 
 and 11.) This brings us 
 to a consideration of the 
 problem before us. 
 
 Question 1. Why in 
 the first stage is the limb 
 slightly abducted, out- 
 wardly rotated, and flexed 
 with apparent lengthening? 
 Answer. Because of a voluntary effort on the part of the patient to relieve 
 tensions of the capsule and Y-ligament. (See Fig. 6.) 
 
 Question 2. Why does this deformity increase, constituting the second stage of 
 the disease ? 
 
 Answer. Spasm of the muscles about the hip-joint is present. The great glutei, 
 outward rotators, tensor vaginae femoris, and flexors acting together have the advantage 
 
 Fig. 12. 
 
136 
 
 of leverage and strength (being irritated and affected by spasm, and aided by a voluntary 
 effort, or non-resisting effort of the patient, the same as in the first stage) the limb still 
 exaggerates the deformity of the first stage. 
 
 Question 3. Asa rule, with an occasional exception, why do limbs assume the 
 deformity of the third stage only after flexion to twenty-five degrees has taken place ? 
 
 Answer. Because after the limb passed to twenty-five degrees of flexion, the 
 abductors to a very great extent become internal rotators (see Figs. 8, 9, 10, 11); the 
 external rotators almost totally lose their power as external rotators (see Fig. 11), and 
 become abductors, with the exception of the quadratus femoris and obturator externus, 
 and the tensor vaginae femoris becomes a powerful inward rotator. Resistance or an- 
 
 Fig. 13. 
 
 Fig. 14. 
 
 tagonism to the powerful abductors and flexors of the thigh being modified or annulled 
 by flexion, the limb must pass to the deformity of the* third stage, namely, abduction, 
 flexion, and inward rotation. 
 
 Question 4. Why do some cases in the third stage of the disease continue the 
 deformity of the second ? 
 
 Answer. These may be, and usually are, cases characterized by great abduction 
 and outward rotation from the commencement of the disease, or soon after. Many of 
 these erratic deformities occur in bed cases from positions of case assumed while lying. 
 In others the head of the bone is thrust forward against the anterior and upper border 
 of the acetabulum, cutting it away producing a partial dislocation forward. This 
 extreme abduction puts the abductors on the stretch and partially paralyzes them by 
 
137 
 
 tension. The abductors and outward rotators become permanently contractured, 
 adhesions form, and the limb is held in this extreme position of deformity of the second 
 stage in the third. 
 
 I have excised two cases of this deformity, and in both cases the head of the bone 
 had pef orated the acetabulum anteriorly and superiorly, and the bone was held firmly 
 against the pelvis by bands of adhesions. 
 
 Fig. 1 6. 
 
 Fig. 12 is taken from a photograph of a case where the head of the bone had cut 
 away the acetabulum anteriorly and superiorly, and was about to escape through the 
 openings forming in the acetabulum into the pelvic cavity. 
 
 Dislocations may take place anteriorly and posteriorly; posteriorly, often from large 
 effusions or other pathological cause; but anteriorly from destruction of the anterior border 
 of the acetabulum, due to the action of the external rotators and glutei muscles and 
 
138 
 
 destruction of bone from disease. The shortening of the neck of the femur destroys the 
 action of the flexors and the abductors by changing the leverage. 
 
 Question 3. Why did one of the cases have abduction, outward rotation, and 
 shortening without flexion? (See Fig. 4.) 
 
 Answer. Because of the destruction of the head and neck of the femur, or the 
 passing of the head through the acetabulum anteriorly. This destroyed the leverage of 
 the glutei and flexors, which gave the abductor full power to abduct while the external 
 rotators still acted. The same cause explains the deformity in Fig. 5, only the head took 
 a backward course owing to destrtiction of bone in that part of the acetabulum. 
 
 Nerve distribution within the joint undoubtedly plays an important part in producing 
 special actions of groups of muscles, depending on the location of the lesion. As for 
 
 Fig. 17. — The Cheap 
 Dispensary Splint. 
 
 Fig. 18.— The Double 
 Dispensary Splint. 
 
 example, in the knee-joint flexion is never seen in disease of the patella alone. This is 
 due to the fact that this portion of the hip-joint is supplied from the anterior crural and ob- 
 durator nerves, which trunks supply the extensors of the limb, and not the flexors. 
 Whereas flexion occurs in disease of the condyles, the nerve supply of which is derived 
 from the great sciatic, which nerve-trunk supplies the chief flexors and not the extensors 
 of the limb. 
 
 To furthur illustrate the action of the muscles about the hip-joint, the limb being 
 
*39 
 
 straight and then flexed, I present this manikin, with rubber straps so placed as to repre- 
 sent the action of the various groups of muscles. Fig. 13 should represent the limb 
 parallel, but the artist failed to place them so. Abduct the limb, as seen in Fig. 14, and 
 the pelvis tilts and the right limb appears too long,. This relieves the pressure within 
 the joint by unwinding the capsule (see Fig. 6), and puts the abductors on the stretch, 
 enfeebling their action until flexion commences or the head and neck are destroyed by 
 disease. The abductor group being stronger, holds the limb in position, (See Fig. 15, 
 
 19. — The Patent Splint Adjustive 
 High Shoe, and Crutch. 
 
 Fig. 20. — Inside Bar and Lateral 
 Traction-lever. 
 
 side view, limbs parallel.) Then as flexion commences the action of every muscle is 
 changed or modified (see Fig, 16), and the limb must assume the position of the third 
 stage of hip-joint disease, viz., flexion, abduction, inward rotation. 
 
 Conclusions . — Normal or typical deformities are produced by change of leverage 
 and action of muscles due to — 1. A voluntary effort. 2. Involuntary spasm or con- 
 traction of muscles. 3. Nervous irritation of groups of muscles due to location of 
 lesion in or about the joint. 
 
 The erratic deformities are produced by change of leverage, due — 1. To patho- 
 
140 
 
 logical causes, e. g., destruction of bone, head, neck, or acetabulum. 2. Nervous irri- 
 tation of groups of muscles, due to location of disease in and about the joint. 
 
 The pathological causes of erratic deformities are — 1. Shortening of the head and 
 neck of the femur. 2. Perforation of the acetabulum. 3. Shortening of the limb from 
 either of the last named causes. 4. Burrowing of pus through groups of muscles, 
 either irritating them to contraction or destroying them. 5. Dislocations from destruc- 
 tion of bone. 6. Dislocations from large effusions. 7. Cicatricial contraction binding 
 down and restricting the limit of motion of the femur. 
 
 The explanation of the cause of the deformities existing in hip-joint disease is applia- 
 ble to every joint in the body, and very soon I will publish the result of experiments on 
 all the other joints. 
 
 I have for the sake of brevity omitted the mathematical work, and also the results of 
 the study of the action of flexor and extensor groups, for to my mind they play altogether 
 a secondary part in the drama. 
 
 The reader at once asks the question, "Why all this work? what good can come 
 of it?" I will briefly answer: In the treatment of hip-joint disease fixation to prevent 
 motion, and extension, to overcome intra-articular pressure, is the law of treatment. 
 
 We have observed that these great and powerful groups of muscles act upon the 
 thigh with so much force as to produce great deformities. That the patient voluntarily 
 assume certain positions to relieve the tension of the capsular ligament whether there is 
 effusion or not. That these groups of muscles do not act on an axis with the shaft, but 
 nearly on a line parallel with the axis of the neck of the femur. From these facts we 
 must decide that to relieve intra-articular pressure by overcoming the contraction of the 
 muscles traction should be made in the line of the axis of the neck and not of the shaft. 
 
 Patients with deformity should be put to bed with two lines of extension one in a 
 line with the axis of the shaft and deformity, and the other at right angles to the shaft. 
 If abscesses are present they are always incised and washed out with bichloride of 
 mercury, solution I to 1000, then thoroughly disinfected with Marchand's Peroxide of 
 Hydrogen (H 2 O2 medicinal), then the joint and abscess cavity filled with iodoform 
 and glycerine, one-half to four ounces, and finally packed with gauze, dead bone is 
 removed to any extent up to complete excision if necessary. Then when the deformity 
 is overcome I place them on a lateral traction fixation splint, which I devised with a high 
 shoe on the well limb, and a pair of crutches, and allow them to take plenty of out-door 
 exercise. A glance at the cuts will convey the idea. 
 
 The thoracic portion is necessary to fix the joint. It is argued that the patient can- 
 not sit down. This is incorrect. The patient sits on the side of a high chair and the 
 leg and splint fall to the side the same as any other hip splint. Sayre says the patient's 
 leg must stick out and be in the way. 
 
 So must it when his hip or knee-splint is adjusted. He also, says anchylosis must 
 result from this fixation, that motion is necessary to prevent the accident. / have not 
 observed bony anchylosis nor angular deformity in- over two hundred cases, many of 
 zvhom have been fixed from one to four years without motion. 
 
 Sayre's knee-splint fixes the knee by extending from below to above the knee without 
 a joint. If fixation is good for a diseased knee, why is it not good for a diseased hip ? 
 Is there any difference in the treatment of the same disease, whether in the hip or in the 
 knee? Should we have a plan of fixation for the knee and motion for the hip? 
 
 Shaffer's statistics show anchylosis in about sixty per cent, of his cases reported. He 
 uses the long traction splint, essentially the same splint used by Sayre, Taylor, and others 
 — one that per?nits of free motion at the hip-joint. The patient is allowed to walk upon 
 the splint, and nearly every case recovers- with angular deformity. This is wholly 
 unnecessary. No case need recover with bony anchylosis or angular deformity. 
 
 I do not pretend to have solved all the problems of the causes of the deformities 
 occurring in morbus coxarius; but I offer this paper as a preliminary one to further 
 study of this most complicated joint in a condition of disease. 
 
 These splints are made by Ford of New York. 
 
141 
 
 THE ETIOLOGY, DIAGNOSIS AND TREATMENT OF 
 
 ULCERATION OF THE RECTUM. 
 
 By JOSEPH M. MATHEWS, M. D., Louisville, Ky. 
 
 Read before the Mississippi Valley Medical Association, at Indianapolis, Oct. J, iSgj.. 
 
 (Published by the New England Medical Monthly, January, 1894.) 
 
 The time allowed to reading papers before the society is too limited to permit of an. 
 exhaustive review of my subject. 
 
 I will therefore only deal with it in a general way. For a matter of convenience I 
 will classify these ulcers under four heads, viz.: benign, malignant, tubercular and 
 specific. To this division there might be a valid objection based upon correct patho- 
 logical grounds. As for instance: In this classification I make the term malignant, 
 synonymous with cancer, and yet the tubercular ulcer may in truth be malignant, 
 without assuming the characteristics of cancer. Again, some writers would have us. 
 believe that the tuberculous patient was closely akin at last to the syphilitic one, or 
 vice-versa, and thirdly, there is a well grounded belief with pathologists that innocent, 
 or simple ulceration may at any time take on proportions of malignancy These sub- 
 jects would take more time than is given me, to discuss them to-day. Therefore to begin 
 in the order named I would say that benign ulceration is not so frequently found 
 in the rectum as is supposed. Indeed whenever I 'meet with a well defined ulceration 
 existing in the rectum I immediately begin to suspect some special diathesis. One 
 would think that from the office of the rectum it was particularly liable to become ulcerated. 
 But if we study the part anatomically it will be seen that nature has provided it well for 
 the purpose it serves. For instance its mucous membrane is much thicker than any other 
 portion of the intestinal tract, and therefore more able to resist irritation. The pouch of 
 the rectum is very capacious and sufficiently able to accommodate the supply. It is only 
 when the physiology of defecation is interfered with that any danger is to be feared. The 
 lumen of this portion of the gut is not narrowed by any ordinary causes. For these and 
 other reasons I have long since been forced to believe that such ascribed causes as preg- 
 nancy, dysentery, etc., were not great factors in producing ulceration of the rectum. 
 
 Malignant Ulceration. — The rectum is a favored seat for cancer. Many times the 
 disease is overlooked entirely or diagnosticated as some other affections. It has occurred 
 to me several times to have had patients referred to me for some trivial rectal trouble and. 
 found cancer instead. One would think that of all diseases affecting this portion of the 
 body that cancer could be most easily told. If we take the books as guides I can very 
 readily see that a faulty diagnosis is quickly arrived at. If we are to believe that such 
 symptoms as pain, hemorrhage, and the discharges, are characteristic, and that the odor 
 is pathognomonic, then cancer is quickly told. But when it is a fact easily demonstra- 
 ted that cancer may exist without even one of these symptoms being recognized, it then 
 becomes a matter of much confusion. You might ask, have we not in the microscope 
 an infallible resource for diagnosis? I would answer, I think not. Upon five different, 
 occasions has the microscope told me that I was dealing with a carcinoma when the 
 after treatment revealed the fact that it was not so. I am inclined to believe that about 
 as much as we know on this subject was known many years ago. "The cancer cell is 
 widely different from the gland cells, and they are grouped differently from the natural 
 cells." What are we to do, then, when dealing with a suspected case of cancer? Take: 
 the general clinical history, with symptoms, to aid our diagnosis. 
 
 Tuberculous. — This is a more common form of ulceration of the rectum than is 
 generally supposed, reversing, in my opinion, the verdict in the case of benign ulceration. 
 Koch's discovery of the tubercle bacillus has thrown much light on this subject, and 
 aided us materially in the treatment or all forms of tubercular affections. The treatment 
 of tuberculous joints, bone, tissues, etc., has nearly been revolutionized by this dis- 
 
142 
 
 covery, and although it has knocked out of joint that old and most sacred teaching of 
 heredity, it has done much for the afflicted. It had become almost a part of theology 
 to believe that the sins of the father were visited upon the children for generations, but 
 it is unorthodox (medical) for one now to believe that consumption is hereditary. I 
 have seen many cases of tubercular ulceration of the rectum that went on to a fatal 
 termination, without the slightest sign of tubercle in the lung. The diathesis bears 
 such unmistakable symptoms that it is hard to mistake. 
 
 Specific Ulceration. — That syphilis is the cause of ulceration of the rectum no one 
 will deny. That it is responsible for fully one-half of the cases, I am fully convinced. 
 Although I have been criticised for saying this, I am more convinced every day that it is 
 true. I have taken occasion before to say that whenever I see a well-pronounced case of 
 ulceration of the rectum, and can clearly eliminate cancer, then in the majority of cases 
 it will prove to be syphilitic. 
 
 It is estimated by a late writer that fully six million people in the United States have 
 syphilis. Admitting that it often shows itself in the form ulceration in the rectum, it 
 is no wonder that the estimate in numbers could occur. One does not have to be in 
 rectal practice long until he is surprised at the number of such cases met with. 
 
 Having just incidentally referred to the four causes of ulceration of the rectrm 
 without going fully into the aetiology, you will permit me to refer in few words to the 
 
 DIAGNOSIS. 
 
 I know of no class of disease that requires more absolutely a correct diagnosis than 
 do these. The treatment must in every individual case depend upon a correct opinion of 
 it. We cannot treat a benign ulcer as we would a malignant one; nor a tubercular ulcer 
 as a specific one; nor the last named as the first named. 
 
 Benign ulcej-alion must begin as a lesion to the mucous membrane. The term 
 trauma here would be most appropriate. Therefore, a history of a wound, cr anything 
 that might lacerate, break, or in any way damage the membrane, must be scught after. 
 Of course the class 6f ulcers called irritable cannot be considered in this article. They 
 have one symptom that will always diagnose them, viz., pain coming on directly after 
 stool, and a search reveals the ulcer on, or embracing the sphincter. The appearance 
 of a benign ulcer is very different from any other character of ulceration. Its edges are 
 hard and resist invasion. The base and margins are likewise, and a quick disposition to 
 heal exists with the slightest treatment. In other words, an innocent ulceration in the 
 rectum is very much like the same located anywhere else. A malignant ulceration 
 possesses properties directly opposite to the benign type of ulcers. Their disposition is 
 to infiltrate, and break down. No treatment will prevent this. The edges and base 
 quickly yield and the ulceration rapidly extends. I would much rather trust to these 
 conditions to tell me the nature of the ulceration than the so-called pathognomonic signs 
 of bleeding, pain and odor. The tubercular ulcer is closely allied to the malignant one 
 in general appearance and some characteristics. It bleeds freely when touched, is dis- 
 posed to break down and sometimes its progress is rapid. One characteristic, how- 
 ever, is that the process is painless. I have seen cases of this kind where the buttock 
 was nearly destroyed, involving the rectum, and the patient complained of but little 
 pain. There are two things, however, that will quickly aid in the diagnosis: 
 
 1. The diathesis, which is easily discerned. 
 
 2. The discovery of the special bacillus. 
 
 In malignancy the peculiar color or cachexia is secondary to the existence of the 
 primary cause, the tumor. In tubercle, ulceration is secondary to the diathesis. The 
 physical signs of cancers are nodules, those of tubercle, a ragged and irregular edge. 
 
 Cancer begins subcutaneously as a growth and ulcerates afterward. 
 
 Tubercle begins either as an ulceration or cold abscess. 
 
 The discharge from a malignant ulcer is pus, or pus mixed with blood; from a 
 tuberculous ulcer, broken-down tissue serum, and an occasional pus-producing microbe. 
 
 Outside of all physical signs, the microscope would make the diagnosis in tuber- 
 cular ulceration. 
 
143 
 
 In the specific, or syphilitic ulcer, we generally have the history of the disease from 
 the patient or prima facie evidence of its existence in symptoms. Besides this the 
 feeling given to the finger is unlike any other character of ulceration — not nodular, as 
 cancer — nor ragged, as tubercular. Nor does it possess that distinct appearance of the 
 benign ulcer. It is not circumscribed by a wall of lymph either, for it comes from the 
 ulcerating process of a gummatous deposit, and may extend for inches up the rectum. 
 It is more insidious than cancer, and yet attended by all its horrors; in other words, 
 just as incurable after it gets a good foothold in the rectum. It is slower in its pro- 
 gress than cancer, but cruel in the length of time it takes to destroy. The most terrible 
 cases of it that I have ever seen have been in pure, virtuous women, the victims of the 
 husband's vices. 
 
 Treati7ient. — I can barely allude to treatment of these different ulcerations and will 
 make it suffice to call attention to the methods briefly: 
 
 Benign. — Local application. 
 
 Malignant. — Extirpation. 
 
 Tuberculous . — The curette. 
 
 Syphilitic. — Anti-syphilitic treatment. Colotomy, local medication, extirpation. 
 
 In the treatment of the first-named, benign ulcerations, it is absolutely necessary to 
 have rest for the part. Mr. Hilton gives us a most excellent hint in this regard in his 
 little book called Rest and Pain. Every surgeon has recognized how utterly fruitless 
 have been his efforts to heal ulcers on the lower extremities while his patient persisted 
 in walking about. So with the rectum, if it is to be used every day in evacuating the 
 bowels, that disturbance will prevent the healing process. The first thing to be done is 
 to thoroughly purge the intestinal tract; second, confine the patient to bed; third, local 
 applications. Having the bowels purged, a large enema of hot water should be given, 
 the patient put upon a liquid diet and if the ulcer is in the veins and is at all indolent, 
 it should be touched with nitrate of silver or other stimulating applications; after healthy 
 action is established an injection made into the rectum daily of: 
 
 1$ Sweet almond oil § j. 
 Iodoform, gr. v. 
 Sweet nit. bismuth, 3 ss. 
 will do much to cure the ulceration. Every fourth day the patient should be given an 
 aperient. I need not call your attention to the fact that these patients are often treated 
 per mouth for dysentery, which they have not, when a few days of local treatment will 
 effect a cure. 
 
 Malignant Ulceration. — In the introduction of treatment I have said that ulcers of 
 a malignant type should be extirpated. I know how common the idea and practise is 
 to resort to colotomy for this condition. By comparison it is in substance this. By a 
 colotomy you do a disgusting operation, and leave the offending mass just where it was; 
 by extirpation you remove or attempt to remove that which is sure to kill if left. By 
 Kraske's operation we are enabled to accomplish that in many cases. 
 
 Tuberculous Ulceration. — According to modern thought and investigation we 
 must believe that from any given point of a tuberculous deposit, infection of neighbor- 
 ing or distant parts may take place. The conclusion then is irresistible that said point 
 must be destroyed. 
 
 It is clearly demonstrated that if that point be in the rectum the curette is the best 
 instrument or way to get rid of it. In so doing, however, the same hint that is to be 
 observed in removing cancer must be observed here, it must be done thoroughly. 
 
 Syphilitic Ulceration. — The ratio of difference between cancer and syphilis of the 
 rectum is in the time that each takes to kill, and the advantage that accrues to the pa- 
 tient will be given to cancer, for it ends the misery much quicker than its competitor, 
 syphilis, which inflicts a long drawn out misery with a certain death. I have often said, 
 and still insist, that where a syphilitic ulceration with coincident stricture of the rectum 
 exists, the condition is just as incurable as cancer. 
 
 If then the ulceration is seen in its incipiency, which it really is, we must rely upon 
 
144 
 
 anti-syphilitic and local treatment; if a stricture exists and is within reach it should be 
 resected; if located beyond the reach of the finger and is a close constriction, an inguinal 
 colotomy is advisable. In all these operations around the rectum I am in the habit of 
 using as a cleansing agent, Marchand's Peroxide of Hydrogen. Indeed I consider the 
 preparation indispensable in my work. Whatever strict asepsis will do in wounds else- 
 where it is best in wounds around the rectum to use chemical agents, and the best of 
 these is Peroxide of Hydrogen. Not having time to elaborate the points hinted at in 
 this paper, I will close by saying that if any additional light has been thrown upon this 
 very important subject by this paper, I am repaid. 
 
 DIPHTHERIA— FALSE MEMBRANE EXPELLED— 
 
 RECOVERY. 
 
 By PERCIVAL LANTZ, M. D. f Alaska, W. Va. 
 
 (Published by the Medical Brief , St. Louis, Mo., January, 1894.) 
 
 During my absence at the World's Fair and St. Louis (where I had the pleasure of 
 meeting the genial and scholarly editor of the Brief,) Roy W., aged five years, was 
 taken ill of diphtheria. Dr. Hodgson, of Cumberland, who had charge of my practice, 
 was called and treated the case secundum artem, and the patient seemed to be getting 
 along very nicely until on Monday, September 18, when he was discharged by Dr. H. 
 
 I arrived home on Monday and on the following day was called to see the patient. 
 I found him very much prostrated, breathing sonorously and with great difficulty; 
 croupous cough, unable to speak above a husky whisper, diminished respiratory mur- 
 mur, and moist bronchial rales. The last two symptoms being ascertained upon aus- 
 cultation and implicating an invasion, by the false membrane, not only of the larynx 
 and trachea, but also of the bronchi and bronchial tubes; This condition of affairs had 
 existed, I was informed, since the evening before, but the family, not knowing that I 
 had returned, did not send for me. When I arrived at the house, I realized the fact 
 that the case was a critical one, as the larynx, trachea, bronchi and bronchial tubes had 
 been invaded by the false membrane. 
 
 As the little fellow had so much difficulty in breathing, his parents were very 
 anxious that I should "give him something to make him breathe better," so I concluded 
 to give him carbonate of ammonia in order to thin and render less tenacious the profuse 
 bronchial secretion, and thus allow it to be more readily expectorated. I did not have 
 any of the carbonate with me, however, so I placed him on the following: 
 
 R- Ammonii chloridi, gr. xl. 
 Spts. ammon. aromat., 3 ij. 
 Aquae, q. s, ad § ij. 
 
 I also ordered inhalations of the steam from hot vinegar, and had the iron and 
 potash mixture, left by Dr. H., continued. 
 
 On the following (Wednesday) morning, I called again and found the patient in the 
 same condition, but much weaker. Parents and friends had given up all hopes of his 
 recovery, but I ordered the medicine and inhalations continued, telling them that it 
 couldn't do him any harm and there was a possibility of the false membrane being ex- 
 pelled if it should become sufficiently loosened by the steam and medicine. I did, by 
 the way, suggest intubation or tracheotomy as a last resort, but the parents were inclined 
 to think, from what Dr. H. had told them, that it could only prolong life for three or 
 four days, and so did not consider it worth while to try it, as they felt that the child 
 could not live long under any circumstances. 
 
 I was called again on the afternoon of the same day, but before I reached the house 
 (it being five miles from town), the patient had, during a violent attack of coughing, 
 
145 
 
 expelled the false membrane, and though completely exhausted, was breathing very 
 naturally. The membrane, which I still have preserved, is a perfect cast of the larynx, 
 trachea, bronchi, and on on€ side, of three bronchial tubes. My professional brethren 
 who have seen it say they have never seen or heard of so extensive a cast of membrane 
 being expelled. The patient was very weak for awhile, and was given two teaspoonfuls 
 of whiskey every half hour for thirty-six hours, then the same amount of whiskey every 
 two hours, and in addition 1.130 grain of strychnia sulph., every three hours, continuing 
 the ammonia mixture and a spray in nose and throat of Marchand's Peroxide of Hy- 
 drogen. The patient made a good recovery. For a few weeks his Voice was consider- 
 ably impaired, but it is now about the natural tone. 
 
 I might state that my treatment of diphtheria varies somewhat according to cir- 
 cumstances. As a rule, however, I give a mixture of tincture ferri chloridi, potassii 
 chloratis, glycerini and aquae every hour. Also a spray of listerine or Peroxide of Hy- 
 drogen, and stimulate the patient. I always give a sufficient quantity of hydrarg. chlor. 
 mite in the beginning of the attack, or when I first see the patient, to move the bowels 
 and often continue it in small doses, say one-tenth grain, throughout the course of the 
 disease. I consider it a good plan to keep turpentine boiling on the stove or over a 
 lamp in the sick-room, and I always have this part of the treatment carried out. The 
 turpentine, either the spirits or oil, should be renewed as often as necessary to render 
 the odor distinctly noticeable by the attendants. Have also found the vapor from 
 slackened lime or hot vinegar very useful, especially in cases of diphtheritic laryngitis. 
 
 FRACTURE OF THE SEPTUM NARIUM— IRRITATIVE 
 CONGESTION OF THE TURBINATES. 
 
 By CLARENCE C. RICE, M. D. 
 
 Professor of Diseases of the Nose and Throat at the N. Y. Post-Gradnate Medical 
 
 School and Hospital. 
 
 (Reprinted from The International Journal of Surgery, March, 1894.) 
 
 Gentlemen: 
 
 As this is the first time that this patient has presented himself at the clinic, I will 
 give you a brief history of his symptoms. He is a fireman, age 34, and seven years ago 
 sustained a fracture of the nasal septum. He coughs a great deal on getting out of bed 
 in the morning, and complains of a considerable amount of mucus dropping down from 
 the nose into his throat. 
 
 This symptom of mucus dropping down the throat, I wish, incidently, to remark, 
 does not necessarily result from a hyper-secretion, but rather is due to an occlusion of 
 the nares, in consequence of which the normal secretion collects in the back of the nasal 
 cavity and is carried into the pharynx by the force of gravitation. This is an im- 
 portant point for you to remember, for in the treatment of this condition we are not 
 called upon so much to use astringents, as to open the nostrils, so that the air can enter 
 and carry off the nasal secretions. If this were a condition of mucous membrane secret- 
 ing more mucus than it should, then the use of astringents would be indicated. We 
 know from long experience that by opening the nostrils, so that a good current of air 
 will pass through them, this symptom of dropping of mucus into the pharynx is decreased. 
 I wish to say that almost all anterior nasal obstructions are due to trouble upon the 
 septum rather than with the turbinated tissues, and this is very important for you to re- 
 member. I have seen cases where the whole mucous covering of the anterior turbinate 
 had been destroyed by some caustic so that the functionating part of the nose had been 
 irretrievably damaged, while the real cause of obstruction, a bony projection of the sep- 
 
146 
 
 turn, hud been left untouched. I saw a case of a young woman a few days ago where 
 the whole turbinated covering had been destroyed by chromic acid. You might call 
 such a condition as this a traumatic atrophic rhinitis, because the mucous membrane is 
 dry, and the secretions dry into scabs. The pharynx also becomes dry, and there is a 
 condition known as pharyngitis sicca. 
 
 Now, so far as this man's external deformity is concerned, we notice a dropping of 
 the nose at its end and a prominence on the right side at the junction of the cartilagin- 
 ous with the bony septum, as a result of the blow he received seven years ago. 
 The cartilaginous septum should join the bony septum, as you know, in a straight line, 
 but in this case they are placed at an angle to each other. 
 
 On examining this man's nostrils we find a few points of interest. In the first place 
 the anterior end of the cartilage is turned to the right, and we see what is called a chon- 
 drosis on the left side of the septum — that is a proliferation of the cartilage at that point. 
 Now, what is to be done for this condition? If he obtains a sufficient supply of air 
 through the right nostril — and he seems to — I should not do anything here because the 
 projection of the anterior end of cartilage acts as a protection against the dust. If it 
 were necessary to give him a little more breathing space I should with scissors cut off 
 a piece of this tissue, but I should certainly not adopt this procedure till I had given him a 
 proper amount of breathing space in the other nostril. The important nostril is the other 
 one, and here you see there is a deflection of the septum on itself. Now this convexity 
 corresponds to the concavity just behind this prominence on the other side, and has re- 
 sulted from the traumatism. 
 
 What is the operation necessary in this case? There will be no difficulty in remov- 
 ing, with a straight saw, what is necessary from this cartilaginous prominence. We 
 avoid the danger of perforation by not cutting too deeply, but there are cases where the 
 tissues are so thin that it is impossible to prevent this occurrence. The disagreeable 
 features of perforation are that if the opening is situated anteriorily, you are apt to get 
 a sinking of the nose from lack of support and a tendency to ulceration. We will here, 
 as a preliminary measure to the operation, insert a piece of cotton saturated with an eight 
 per cent, solution of cocaine, and permit it to remain five or six minutes, then we will 
 take a swab, dip into a solution of Peroxide of Hydrogen (Marchand's) and cleanse the 
 nostrils thoroughly. We will not proceed further with the case till we have cocainized 
 the interior of the nostril. 
 
 We will now look at his pharynx, and there you see a condition that can be styled 
 a catarrhal pharyngitis, with lymphatic thickenings on the posterior wall. I always like 
 to have the gentlemen look at the pharynx the moment the patient opens his mouth. It 
 was a very red pharynx when we looked at it first, but now, as a result of three or four 
 inspirations through the mouth and evaporation from the mucous membrane, the color 
 has disappeared. Now you notice little points on the posterior wall of the pharynx. 
 That is the same condition you see in children who have enlarged adenoid tissue in the 
 vault of the pharynx. 
 
 We see here, a localized congestion of the posterior nasal space, or posterior nasopharyn- 
 gitis, and our aim is to remove this congestion . We do that in a case like this by curetting the 
 vault of the pharynx, or applying a sixty grain solution of silver to the ounce to the part. 
 
 Now to return to this man's nasal trouble, we will remove the cocainized piece of 
 cotton from the septum and excise a portion of this thickened tissue that I call your at- 
 tention to. As this is a cartilaginous deflexion, it is proper to use a saw or a trephine 
 for its removal. You are able to apply the saw better by having an assistant hold the 
 patient's head at such an angle as to make the enlargement of the septum stand out 
 prominently until the operation is completed. Having removed this portion of tissue 
 we will take powdered boracic acid and blow it into the nostrils, and in ten or fifteen 
 minutes repeat this procedure. The only cleansing we advise here is to have the patient 
 blow his nose thoroughly with a handkerchief, and we use no wash until the third day 
 for fear of washing away the clot that forms. On the third we generally use a posterior 
 nasal syringe with a 25 per cent, solution of Peroxide of Hydrogen. 
 
147 
 
 The next patient is a young man twenty years of age. As we look at his nostrils 
 we observe a slight projection on the left of the septum. This may be a passive or 
 hypostatic congestion and due to a posterior turbinated swelling. Now to improve the 
 condition in this nostril we will use the galvano-cautery, applying it to one little point, 
 for we do not believe in creating a burning wound covering a great extent of surface. 
 We simply make a small line with a cautery which will be sufficient to contract the 
 general soft swelling. 
 
 There was a time when I would have called this a hypertrophy of the inferior tur- 
 binate, and perhaps would have applied the galvano-cautery, chromic acid or some other' 
 destructive agent. If you take a probe and press on the swelling of the inferior turbin- 
 ated, you will find that you can push the tumor back. There is no real enlargement of 
 the inferior turbinated, but a reflex swelling due to obstruction elsewhere. 
 
 How are we to treat such a condition as this? We should not apply any destructive 
 agent to this part because we want it to remain intact. We might term this trouble re- 
 flex or irritative congestion due to the pressure of the septal spur against it. Rather 
 than destroy the mucous membrane which is useful in the man's nose, we might as a 
 compromise measure take a galvanic cautery point and insert it in the inferior turbinated 
 down near the floor. In that way you get a reaction of this tissue without destruction 
 of its mucous surface. 
 
 Now while this right nostril is a fairly roomy one, it is not quite as large as the 
 left, and as you look well in you see that the middle turbinated bone is in contact 
 with the septum. If a little of that middle turbinated was taken off, the anterior part 
 of the nose would be the better for it, and for that reason we will pass in between the 
 middle turbinated and the septum a pair of scissors and remove a small amount of the 
 tissue. Now as I do this you notice the retraction of the anterior swelling. 
 
 TREATMENT OF ACUTE AND CHRONIC ULCERS. 
 
 By JAMES OSBORNE DeCOURCY, M. A., M. D., St. Libory, III. 
 
 (Published by Louisville Medical Monthly, August, 1894.) 
 
 I have found no class of diseases yielding to treatment with greater reluctance than 
 "old sores," or chronic ulcers. Recently, however, I have adopted a plan of treatment 
 which is quite different from that laid down in the books, and my results have been 
 much better. 
 
 Almost without exception, internal, or constitutional, as well as local treatment, is 
 necessary. 
 
 The internal treatment should be directed to the seat of the malady, thus eradicat- 
 ing the general pathological condition, eliminating the poisons and disease germs from 
 the system. 
 
 To accomplish this object, absolute cleanliness internal and external, plenty of 
 pure air and sunshine, the religious observance of the laws of hygiene, and a wholesome 
 nutritious diet are more useful and restorative in many instances than are drugs. All 
 the secretory organs of the body should be required to perform, as nearly as possible, 
 their natural amount of work. 
 
 This once accomplished, and all nature's machinery kept lubricated and in good 
 working order, the local treatment and work of reconstruction will be comparatively 
 easy. 
 
 The sores must be kept clean. This is done very satisfactorily by the application 
 of hot water. If the parts can not be soaked in the hot water, an ordinary fountain 
 syringe can be filled with water (as hot as can be borne, without burning), elevated 
 high enough to give sufficient velocity to the stream which is played over the parts, by 
 the operator holding the nozzle of the syringe a short distance from the seat of the ap- 
 plication. The frequency of the washing will depend upon the nature of the case, but 
 should be repeated as often as necessary to keep it clean and free from offensive odors. 
 
148 
 
 To destroy pus and bacteria, and to aid nature in the work of rebuilding the parts 
 invaded, I have found Hydrozone and Glycozone superior to any and all other agents tried. 
 
 Hydrozone is first applied (after the hot water) by the use of an ordinary glass 
 dropper, or hard rubber syringe, slowly, all over the ulcer, until the pus is destroyed. 
 
 Chemical action with ebullition immediately follows and continues until the enemy 
 is quite dead, but no longer. One layer of absorbent cotton is saturated with Glycozone 
 and placed smoothly over the parts, and held in place by a cotton bandage, sufficiently 
 tight to hold the cotton in place. 
 
 Other local medication might do as well in some cases, but I have not so found it. 
 The result obtained in the case I report herewith seems to confirm the statement as 
 above made. 
 
 Edw. K., aged twenty-three, American, but German descent. A farmer by occu- 
 pation; unmarried. Rather small in stature, but well-built. Having taken sixteen 
 bottles of "Blood purifier" and a lot of "Anti-constipation pills" within the last eight 
 months for "Falling sickness," came to my office March 19th, with both legs most 
 frightfully ulcerated, from knees to ankles, with considerable discharge of pus from 
 various parts of the legs. Such a case should have been sent to a hospital or sanitarium, 
 for the best systematic treatment obtainable; but, unfortunately, he was so situated that 
 he could not be sent to such a place. In a most pleading way, he asked me if I could 
 do him any good, I told him I thought so, if he would mind me, and take the treat- 
 ment that I would advise. He promised, and the treatment was begun. 
 
 The legs were cleansed by soaking them for twenty minutes in hot water, twice 
 a day, after which Hydrozone was used freely all over the sores, to destroy the pus, 
 the pustules having been opened, and as much pus evacuated as possible. 
 
 After this application, morning and evening, the legs were powdered all over the 
 affected portion with a mixture of equal parts of alum, boric acid and aristol, then 
 covered with absorbent cotton, and bound up with an ordinary cotton gauze bandage, 
 
 This local treatment was kept up for two weeks. The improvement was slow, but 
 constant. The process of healing advanced from the knees downward, and from the 
 ankles upward, leaving the last part to heal about the middle of the leg, where the 
 ulceration formed a thick crust, extending two-thirds around each leg. 
 
 The constant discharge of pus from the sores caused the dressing to stick to the 
 parts, which could not be removed without difficulty. 
 
 The alum, boric acid and aristol powder was discontinued, and Glycozone used 
 as a reconstructive agent, from the end of the second week. The sores were washed 
 and the Hydrozone used as before mentioned, then the Glycozone was applied to the 
 whole affected parts. A layer of absorbent cotton was saturated with Glycozone, and 
 smoothly placed around the sores, and heid in place by a cotton bandage. 
 
 There was no further trouble about the bandage adhering to the sore. The gran- 
 ulation was much more rapid than at first. At the end of the second week after 
 Hydrozone and Glycozone were used as the sole local agents, the young man said he 
 was well and worked every day from that time. 
 
 The internal treatment was changed from time to time as the case required. 
 Opiates were given several times during the first two weeks of the treatment, to ameli- 
 orate the pain, which was very great at times. He was emaciated and melancholy when 
 he first came to me. His bowels would not move without cathartics. 
 
 Fluid extract of nux vomica was given morning and noon, seven drops before each 
 meal. Elixir lactopeptin, with bismuth, was given in drachm doses after each meal, 
 and, occasionally laxatives at night. Later on, tincture chloride of iron was given in 
 ten drop doses, after each meal, for one week. 
 
 After the third week no internal treatment was given, as the patient was in good 
 condition, and cheerful. 
 
 Hydrozone and Glycozone were left to complete the structure, and place upon it 
 the capstone of a beautiful new integument, which they did in a way gratifying both to 
 the patient and to myself. 
 
149 
 
 THE TREATMENT AND CURE OF CHANCRE WITH 
 PEROXIDE OF HYDROGEN. 
 
 By WILLARD PARKER WOOSTER, M. D., New York. 
 
 (Reprinted from the Journal of Cutaneous and Genito- Urinary Diseases, for February.) 
 
 The subject of the best treatment of the primary sore of syphilis has occupied the 
 minds of investigators of late years to such an extent that almost every surgeon has a 
 different method, and the general practitioner is somewhat at a loss to know which is the 
 best treatment to employ as the most expeditious means of relieving the anxiety of the 
 patient and curing the lesion. The special purpose of this paper is to draw attention to 
 a particular method of treatment, which not only relieves the anxiety of the patient and 
 places him in a delightful bouyancy of mind, but cures the chancre in the shortest pos- 
 sible time, without pain or detention from business, and with less scar and less destruc- 
 tion of tissue than any other method. 
 
 The chancres of the following cases, selected from a good many recorded, were of 
 the large Hunterian variety, embracing the worst fornix of sloughing and phagedena. 
 
 Case i. — Mr. K., aged 38 years, came to me, January 29, 1891, with a large 
 sloughing single chancre, situated on the right side and at the base of the glans-penis, 
 and at the junction of the prepuce and very deep; incubation about thirty days; penis 
 large and soft. Sprayed it with full strength solution (15 volumes) of Peroxide of 
 Hydrogen medicinal (Marchand's), at 60 pounds ^pressure, and dressed with iodol 
 powder, and continued the same treatment every morning at 7 o'clock. 
 
 February 20, sprayed it as above; sore now only skin deep, and continued till 
 February 23, sore healed; duration of treatment, twenty-five days. 
 
 Case 2. — Mr. W. B., came to me, September 6, 1892, with a single sloughing 
 chancre on left glans penis, and corresponding ulceration on prepuce; incubation about 
 thirty days; sprayed with Peroxide of Hydrogen full strength, 60 pounds pressure, and 
 dressed with iodol; continued same treatment every evening at 7:30 o'clock, for sixteen 
 days. 
 
 September 23, sore almost healed. 
 
 September 25, sprayed for the last time to-day; duration of treatment, nineteen 
 days. 
 
 Case 3. — Mr. L., aged 28 years, came to me, August 23, 1893, with a phage- 
 denic chancre, thirty-five days' incubation, situated immediately at meatus urinarious, 
 and sloughing its way very rapidly into the urethra; sprayed it with Peroxide of 
 Hydrogen, full strength; 60 pounds pressure, and dressed with iodol powder. Continued 
 the same treatment every evening at 7:30 o'clock. 
 
 August 30. Sore almost healed up, only some granulations left. Continued the 
 same treatment every evening till September 4. Sprayed it to-day for the last time; 
 there only being the surface of the sore about the size of a pin's head. Considered 
 himself cured and said he would not come again. Duration of treatment, eleven days. 
 
 The above cases selected from many recorded cases, on account of their possessing 
 the worst features of the initial lesion, serve as good examples of the treatment by the 
 Peroxide of Hydrogen method. 
 
 I treated Mr. K., of Case 1, on two different occcasions, for the same disease, in 
 exactly the same manner, and the two cases are about identical in regard to length 
 of time of treatment and as to details, and he got well in about the same manner. 
 
 The case of Mr. L. , presented the worst features of phagedena, which was so 
 virulent that I think he would have lost the greater part of the glans penis, if he had 
 been treated by the nitric acid or caustic method, and as it was, the ulcer healed with a 
 very small scar, scarcely noticeable. 
 
 The pressure of the spray (60 pounds), which is one of the most important factors 
 in the whole method, not only cleanses and produces thorough asepsis of it, killing the 
 
i 5 o 
 
 germs of the disease at the very bottom of the ulcer, but the oxygen of the peroxide 
 aerates the blood through the capillaries, and arrest the progress of the disease at the 
 nearest possible point, allowing the process of repair to commence as soon as possible, 
 according to the severity of the disease, with the least loss and destruction of tissue and 
 consequent scar. It must be particularly understood that in using this treatment, all 
 instruments, spray-tubes and bottles, must be made of either glass or hard rubber, 
 for the reason that metals, with one or two exceptions, coming in contact with the 
 peroxide of hydrogen will destroy its component parts and render it useless, and I have 
 found also a greater difference in the results if the peroxide is fresh or otherwise. The 
 first effect of a spray of peroxide upon the ulcer is to deposit upon it a thick film of albu- 
 men; this should be allowed to remain for about half a minute or less; then continue the 
 spraying till a large tubeful has been used (one ounce); as the sore progresses the spray- 
 ing causes a good flow of rich arterial blood upon it which merely shows returning 
 healthy conditions. 
 
 The treatment is entirely painless, and the patients do not experience any annoyance 
 or inconvenience whatever while carrying the disease, and freely express themselves 
 as well pleased with its effect. 
 
 No internal medication during this stage is given. The iodol powder is used only 
 as an antiseptic, to protect the sore from external influences until it is sprayed again the 
 next day, keeping the sore in as good a condition as it is left by the spraying, which 
 must be done once every day until the ulcer is healed. 
 
 This method of treatment of chancre has been in my hands, the best and most 
 successfull of all methods that I have heretofore adopted. 
 
 THE TREATMENT OF TYPHOID FEVER. 
 
 By M. A. CLARK, A. M., M. D., Macon, Ga. 
 (Published by The Food, June, 1894, also the Medical and Surgical Reporter, Phila- 
 delphia, Aug. 4, 1894.) 
 
 The first duty of the physician, in the treatment of any disease, is to pay strict 
 attention to prophylaxis and hygiene. This is especially applicable to the successful 
 management of typhoid fever. 
 
 With proper attention to these, the majority of cases of typhoid fever will recover 
 without any medicinal treatment. Hence, we should be very wary in making any 
 decided claims for medicines. We do know, however, that there are remedies which 
 will not only mitigate the symptoms but also shorten the disease itself. Such being 
 true, it is the duty of every physician to seek diligently for those remedies and to 
 judiciously and faithfully apply them. 
 
 In this paper I propose to set before you what seems to me to be the best of these 
 remedies. 
 
 Before referring to the subject proper allow me to say that I fully believe that this 
 disease is due to some powerful germ, no doubt the bacillus of Eberth, which produces 
 not only very marked lesions in the parts invaded but also very decided nervous phe- 
 nomena and great waste of the whole system. If we, then, can find some remedy that 
 will check this dread germ in its ravages and destroy the poison it produces, we have 
 found that remedy that will prove a most powerful adjuvant in the management of this 
 disease. Our hope, then, lies in the antiseptic treatment. In fact, it seems to me that 
 this plan of treatment is par excellence the one from which we may hope to derive any 
 decided results. 
 
 Henry claims best results from thymol; Rossbach and Wolff, from naphthalin; 
 Pepper, from nitrate of silver; Thistle, from salol; while calomel is urged by others. 
 All of these are, no doubt, good and well worthy of trial. Having had such good 
 results from the use of another most powerful antiseptic, I beg to offer it as the one for 
 
i5i 
 
 treatment of this disease, even though it falls short of the definition of an intestinal 
 antiseptic as given by Bouchard: "It should be more or less insoluble and exert no 
 toxic action on the organism." This remedy exerts no toxic action upon the system, 
 but it is soluble, being in itself a solution. 
 
 I refer to hydrogen peroxide, which all will admit is a most potent antiseptic when 
 locally applied. Seeing such excellent results from its local use, I ventured to test it as 
 an internal antiseptic, believing that it would prove most effective. Having been 
 rewarded with most wonderful results in the few cases in which I have used it, and 
 feeling so sure of its continued effectiveness, I offer it to you for your consideration on 
 this occasion. 
 
 If given at onset of the disease, it will not only mitigate the severe symptoms but 
 will also check the disease itself. The tongue will rapidly clean off; tympanites will 
 subside or not appear at all; the diarrhoea will diminish; no marked nervous phenomena 
 will ensue; and the disease will spend its force with but comparatively little wear upon 
 the system. 
 
 I give from 20 to 40 minims of some reliable 15-volume solution, preferably 
 Marchand's, well diluted, every two or three hours until slight nausea is produced, and 
 then every four or six hours till convalescence is fully established. 
 
 With its use from the beginning I find no necessity for antipyretics, the tempera- 
 ture never rising sufficiently high to authorize their use. If, however, it becomes 
 necessary to resort to some means of reducing the temperature, I prefer phenacetine in 
 5 grain doses every four or six hours. The Brand method may work well in hospital 
 practice, but it cannot be used effectively in ordinary private practice. If the phenace- 
 tine is followed by, or given with, a mild stimulant and used only to reduce high tem- 
 peratures, there will be no unpleasant effects at all. I cannot say so much for the other 
 coal tars, or ever! quinine. 
 
 I begin at the outset to attend carefully to the diet of my patients, striving to pre- 
 vent all the waste possible by giving proper nourishment. Milk is by far the best diet. 
 Given in small quantities and at frequent intervals, it is usually well borne. If not well 
 tolerated, it may be peptonized and then given without ill effects. Horlick's malted 
 milk, beef tea and some reliable beef extract are usually easily assimilated and are valu- 
 able aids to the milk. Solid food is rigidly withheld. 
 
 Water should be given, not only in connection with the medicines, but also at 
 frequent intervals, whether called for by the patient or not. It is cooling and refreshing 
 to the patient, aids in the elimination of poisons from the system by its diuretic effects 
 upon the kidneys, and keeps up the normal amount of body-fluids. It should be deemed 
 one of the important factors in the treatment of this disease. 
 
 The mineral acids, inasmuch as they are aids to digestion, should be given in small 
 doses well diluted three or four times daily. I prefer dilute nitro-hydrochloric in ten 
 minim doses three times a day. 
 
 Alcohol should no longer be considered routine treatment but should be used only 
 when the symptoms absolutely indicate. Properly treated, few patients will require the 
 frequent use of any alcohol. When used, it should be given most cautiously, as too 
 much will cause unfavorable symptoms and is worse than not using at all. 
 
 Turpentine stupes, or turpentine locally applied, may be used with benefit, when- 
 ever there is tympanites. I find it unnecessary when using Peroxide of Hydrogen. 
 
 If the diarrhoea is excessive, as many as six or eight stools in twenty-four hours, it 
 should be controlled by nitrate of silver, bismuth or some other astringent. I prefer 
 bismuth subnitrate in 15 to 20-grain doses or salicylate in 5 to 10-grain doses every two 
 or four hours. I have no trouble with the diarrhoea, but if it should become trouble- 
 some; I would employ in connection with the bismuth occasional enemata of weak 
 solutions of hydrogen peroxide, having found them very effective in the summer 
 diarrhoeas of children. 
 
 If the Peroxide of Hydrogen is given from the onset of the disease, the so-called 
 typhoid phenomena, low muttering delirium, subsultus tendinum, picking at the bed 
 
152 
 
 clothes and soon, will not occur. If, however, I should be so unfortunate as to have 
 to deal with them, I would rely solely on the sedative dose of calomel. It will quiet 
 such nervous phenomena when nothing else will, and, too, without any unpleasant 
 effects upon the organism. 
 
 Other complications must be treated according to the usual methods. I believe, 
 however, they will rarely occur, if this treatment is used from the beginning. 
 
 During convalescence, it is very essential that the patient be rigidly dieted. The 
 liquid diet, with a little broth, milk-toast, soft boiled eggs, should be given till the third 
 week of convalescence, and even then solid food should be used most cautiously. 
 
 I herewith submit two cases illustrative of the results of this treatment: 
 
 James R., age 10; family history good; previous health good. Had been sick 
 with typhoid fever ten or twelve weeks and was in the beginning of the second relapse, 
 so-called, when I was called in. Having been poorly nourished, he was anaemic and 
 much emaciated. Saw him first in the afternoon. Temperature 106 F., pulse 140, 
 weak and irregular, marked tympanites, pain and tenderness in right iliac region, very 
 restless, slight delirium at intervals. 
 
 Gave three grains of phenacetine, with four teaspoonfulsof brandy every four hours 
 to reduce high temperature. Gave Peroxide of Hydrogen one ounce during the twenty- 
 four hours. Milk at frequent intervals. In 36 hours temperature was under control, 
 tympanites rapidly disappearing, delirium absent, patient comfortable and begging for 
 bread. Continued* the Peroxide and nourishment. In one week the temperature was 
 normal and convalescence was well begun. Recovery was rapid and complete. 
 
 Annie L., age 9; family history good; previous health good. Had just returned 
 from a visit to a place where there was an epidemic of typhoid fever. Had been sick a 
 little more than a week when I first saw her. Symptoms showed a case of typhoid 
 fever of no mild type. 
 
 Began at once with 20 minims of hydrogen peroxide every three hours. Gave 5 
 minims of dilute nitro-hydrochloric acid three times daily. Milk in small quantities and 
 frequently repeated. Used phenacetine and salol i£ grains each to control restlessness 
 and produce sleep during the first two days. Afterward, continued the Peroxide and 
 nourishment. In less than three weeks temperature was normal and convalescence was 
 fully established. Recovery was rapid and complete, there having been comparatively 
 little exhaustion of strength and vitality. 
 
 PEROXIDE OF HYDROGEN (MEDICINAL). 
 By Dr. G. W. PICKERILL. 
 
 (Reprinted from the Medical Free Press, Indianapolis, Ind., June, 1894.) 
 
 He who does not avail himself of the superior benefit of Peroxide of Hydrogen 
 (Marchand) in the treatment of open wounds, ulcers, scrofulous and syphilitic abscess, 
 "sores," etc., as a corrector of morbid action and pus destroyer, is denying himself of 
 the most powerful agent yet introduced for such purposes. Its beneficial effects are 
 seen at once in the destruction of fetid pus and other morbid products when applied to 
 an old scrofulous or syphilitic sore. 
 
 Two cases of syphilis with large open sores will illustrate the rapid action of Per- 
 oxide of Hydrogen. The first was a most formidable affair of seven years' standing; 
 the open sore involving f-of the ankle joint — with the joint enlarged to twice its healthy 
 size. This sore had been dried, patched and healed over a number of times, but such a 
 healing proved of no permanent benefit, for the sore would soon open in a worse state 
 than before. There had been no effort to clean the morbid, dead products from the 
 base of the ulcer, thus "dried" and "scabbed" over became, as a matter of course, a 
 source of irritation and ulceration. Such procedure is very bad surgery for any kind of 
 ulcers. 
 
153 
 
 A few weeks' treatment with Peroxide of Hydrogen (Medicinal) dressing with Gly- 
 cozone, and the ulcer was as clean and healthy looking as need be, and proceeded to 
 heal from bottom and edges without further trouble. And remains healed and healthy. 
 Will keep patient under appropriate constitutional treatment for two years. 
 
 Case second was of more recent date. Knee involved. Although had had consti- 
 tutional syphilis, the action in the knee was more the character of tuberculosis of the 
 joint. Proceeded to suppuration, opening just below the patella. Treated with Per- 
 oxide of Hydrogen and Glycozone locally. 
 
 The recovery was all that could be desired. 
 
 Not so perplexed with these syphilitic and tuberculous ulcers and abscesses since 
 Peroxide of Hydrogen and Glycozone were handed to us. 
 
 HYDROZONE. 
 
 By W. C. WILE, A. M., M. D., LL. D., Danbury, Conn. 
 
 (Reprinted from The Prescription, July, 1894.) 
 
 It was that brilliant young surgeon, Dr. Robert T. Morris, of New York City who, 
 when he read his paper four years ago, entitled "The Necessary Peroxide of Hydro- 
 drogen," touched a key-note which echoed through the world. 
 
 Many indeed knew of its uses and value, of course, before this time, still the masses 
 of the profession were practically ignorant of its wide range of usefulness and the won- 
 derful, almost magical power it possessed, let alone the knowledge of the fact that such 
 a product existed. 
 
 Morris related his experience which started men thinking and active, while the re- 
 sult was great good to suffering humanity and a rapid stride toward exactness in the 
 science of medicine. 
 
 We feel quite confident that when he turns his attention to the new product of 
 Charles Marchand, Hydrozone, that he will be much more enthusiastic about it, as Hy- 
 drozone is stronger and superior to Peroxide of Hydrogen. 
 
 Hydrozone is twice as strong as Peroxide and twice as active. 
 
 It works with much greater rapidity, hence more effectively, for in every operation, 
 no matter how trivial, it is essential that it be performed as quickly as is consistent with 
 good and thorough work in order to lessen shock, and anything that will reduce the 
 time to a minimum, will be sure to attract the immediate attention of the conscientious 
 and progressive surgeon, and meet a hearty reception. 
 
 The point we mean to lay particular stress upon at this time, is the powerful haemo- 
 static action of Hydrozone. In this respect it excels anything else that we know of for 
 rapidity of action and effectiveness of work. 
 
 This is particularly true of the venous and capillary oozing. This form of hem- 
 orrhage is many times the most troublesome and difficult we have to deal with, especially 
 when it occurs in a cavity which it is necessary to dry well before closing and applying 
 dressings. 
 
 It is not, however, confined to this class of hemorrhage, as a recent case that came 
 under the editor's care will illustrate. A lad nine years old while attempting to chop 
 some kindlings, let the axe slip, and the heel of the instrument penetrated the instep of 
 the right foot, severing an artery. 
 
 There was no ether at hand and the office a long way off, while every effort made 
 to pick up the artery resulted in almost convulsions in the excited and nervous boy. A 
 pledget of cotton was saturated with Hydrozone, and well packed into the wound, dress- 
 ing the whole with gauze bandages in abundance. The hemorrhage ceased at once, 
 
154 
 
 and the dressings were allowed to remain in situ till the following morning when the 
 patient was put under an anaesthetic and the wound properly dressed. No ligation was 
 necessary and the case made an uninterrupted recovery. 
 
 Dr. Elmer Lee, of Chicago claims also that Hydrozone is better than the peroxide 
 for internal administration, he having given both in a large number of cases of typhoid 
 fever. 
 
 PEROXIDE OF HYDROGEN IN CONJUNCTIVITIS. 
 
 (Published by Medical Fortnightly, April 2, 1894.) 
 
 Lautenbach, Therapeutic Gazette, advocates the use of Peroxide of Hydrogen in 
 conjunctivitis. He has been quite successful in the treatment of this troublesome 
 disease by the following method: From 10 to 30 drops of the solution, full strength, is 
 instilled at the outer canthus of the eye, and with the fingers a degree of massage is 
 applied over the entire surface of both eyelids. A second, third or fourth application 
 can be made if necessary. In trachomatous cases the eyelids should be everted and 
 rubbed with the rubber end of the eye-dropper. A saturated solution of boric acid is 
 then used to irrigate conjunctival cul-de-sac. The inflamed surfaces are thus cleansed 
 and ready for whatever application is necessary. The treatment is not intrusted to the 
 patient, but is performed by the surgeon himself, once or twice a day, or a few times a 
 week, according to indications. Dr. Lautenbach says it is important to have peroxide 
 test beyond ten volumes, that it should not lose its oxygen on slight change of temper- 
 ature, and, most important of all, that it should not contain any free acid. Undue 
 amount of free acid causes pain and untoward effects. On account of the uncertainty 
 of preparations fit for use, Marchand's should always be procured. The lids should be 
 everted and thorough exposure of conjunctiva had; it is then cleansed by warm solution 
 of boric acid. 
 
 HYDROGEN DIOXIDE.— H 2 O g . 
 
 By L. D. KASTENBINE, A. M., M. D. 
 
 Professor Chemistry, Urinology, and Medical Jurisprudence Louisville Medical 
 College; Professor Chemistry Louisville College Pharmacy. 
 
 (Published by Louisville Medical Monthly, July 1894.) 
 
 This remarkable liquid which contains the greatest percentage of oxygen of any 
 compound known, was for some time, considered as a mere solution of oxygen in 
 water, and consequently was called oxygenated water. It was afterward obtained free 
 from water and found to be a definite chemical compound of hydrogen and oxygen, and 
 differing from water in containing twice as much oxygen. In this state it is a heavy, oily 
 liquid, readily decomposing at ordinary temperatures, but if heated, with explosive 
 violence, being converted into ordinary water and oxygen gas. When poured into 
 water it sinks, being nearly half again as heavy as that liquid, but is miscible in all 
 proportions with it. It has a somewhat bitter, astringent taste, and is colorless, trans- 
 parent and without odor. It contains 94 per cent, of oxygen gas by weight, and will 
 yield 475 times its volume of that gas. It bleaches the skin, hair, ivory and destroys 
 organic coloring matter, pus and all organisms with which it comes in contact by liber- 
 ating oxygen gas in a nascent or active state. It is resolved in oxygen and water by 
 certain metals, such as gold, platinum, silver and mercury in a state of fine subdivision, 
 although the metals themselves undergo no change whatever. If the oxides of these 
 
'55 
 
 same metals are brought in contact with it, not only does the hydrogen dioxide lose 
 oxygen and become vater, but the oxides lose their oxygen and are reduced to the 
 metallic state, thereby evolving an additional amount of oxygen. 
 
 Strange as it may appear, with all its energetic oxidizing action, it has no effect on 
 phosphorus, a substance which is so readily oxidized by the air. 
 
 The preparations found in commerce are only solutions of this compound in water, 
 and sold in different degrees of concentration or strength, rated by the number of vol- 
 umes of oxygen gas they can be made to yield. A fifteen volume solution is one that 
 will give off fifteen volumes of gas from one volume of the solution. A ten volume so- 
 lution will yield ten pints of oxygen gas from one pint of the solution, and so on. ■ 
 
 These solutions, although more stable than mere concentrated preparations, never- 
 theless decompose and lose their nascent oxygen on which its powerful antiseptic pow- 
 ers depend, and consequently we find the commercial brands varying considerably from 
 their reputed strengths. The solution I find containing the greatest percentage of 
 available oxygen, is the preparation known as Marchand's, which, when perfectly fresh, 
 is about a fifteen volume solution. 
 
 There are quite a number of different methods of preparing aqueous solutions of 
 this interesting compound besides the original method of Thenard, the discoverer. 
 Usually, however, barium dioxide in the hydrated state and purified from all foreign 
 matter, is decomposed by such acids as will make an insoluble compound with it. The 
 United States Pharmacopoeia has adopted this compound under the official title of Aqua 
 Hydrogenii Dioxidi, gives a process of preparing it and describes it as a slightly acid 
 aqueous solution of hydrogen dioxide, containing, when freshly made, about 3 per cent, 
 by weight of the pure anhydrous dioxide, corresponding to about 10 volumes of available 
 oxygen. It is made by the action of phosphoric acid upon barium peroxide. It must 
 be borne in mind that it is essential to employ a small amount of free acid to preserve 
 these solutious, but if too large a quantity it would be a source of irritation when applied 
 to denuded surfaces and inflamed mucous membranes, and consequently, officially, a 
 preparation requiring more than 0.5 c. c. of volumetric caustic potash solution to neu- 
 tralize .50 c. c. of it, does not come up to the U. S. P. standard. 
 
 Of the various brands of ccmmercial dioxides I have examined, I find Marchand's 
 to be the one which yields the largest amount of available oxygen under all conditions 
 of exposure, and the one which contains the minimum percentage of free acid. All the 
 marketable articles I have seen are free from barium compounds, but the majority do 
 not come up to the fifteen volume standard, but are 6, 8, 10 and 12 volume solutions. 
 
 In addition to its medicinal uses, hydrogen dioxide can be employed to detect blood, 
 in conduction with freshly prepared tincture of guaiac. Although tincture of guaiac 
 turns blue with a variety of substances, blood is not one of them. So in testing for a 
 stain — say on clothing — moisten the spot with water, and afterwards apply a piece of 
 white filter paper; the slightest straw-colored stain on the paper suffices. Now, add to 
 the spot on the paper a few drops of the guaiac tincture — no coloration. Add a few 
 drops of the solution of peroxide, when instantly the spot turns of a deep azure blue. 
 Of course if the spot turns blue by the guaiac alone, it can not be due to blood, yet it is 
 possible blood may be present in some other substance which has that property, and 
 hence the employment or peroxide, in that case, would be a source of fallacy. If there 
 is no bluing by guaiac and peroxide together, then absolutely no blood is present. 
 
 Hydrogen dioxide can be determined quantitatively by permanganate of potassium 
 solution acidified by sulphuric acid, and the quantity of oxygen gas evolved measured in 
 an instrument called a nitro-meter, and calculated for normal pressure and temperature. 
 One half the oxgen evolved comes from the dioxide and the other half from the perman- 
 ganate solution. 
 
 Another method and the one commonly employed, is to add a volumetric solution 
 of permanganate of potassium from a burette to a measured portion of the hydrogen 
 dioxide solution, diluted with water and acidulated with sulphuric acid, until the per- 
 manganate solution is rendered colorless, and then a few drops more of that re-agent 
 
156 
 
 employed till a permanent faint pink coloration is given to the dioxide solution to indi- 
 cate the completion of process. A slight calculation will give the strength of solution. 
 There are other methods but the two indicated are the best. 
 
 A solution of Peroxide of Hydrogen is usually tested by pouring a drachm of it 
 in a clean test tube, together with an equal quantity of ether, then pouring into the 
 tube a few drops of bichromate of potassium solution, and shaking the tube, when 
 the ethereal layer will become a beautiful azure blue color, due to the formation of per- 
 chromic acid which dissolves in the ether. 
 
 To a few drops of nitrate of silver solution, add aqua ammonia enough to precipi- 
 tate the oxide of silver, then add hydrogen peroxide when finely divided metallic silver 
 separates. A solution of titanic acid in oil ol vitriol and diluted will yield a yellow color 
 when added to solutions of the peroxide. 
 
 DISEASES OF THE ALIMENTARY CANAL.— TREATMENT. 
 
 INTERNAL AND EXTERNAL HYDROTHERAPY. MEDICATION. 
 
 By JAMES OSBORNE DeCOURCY., M. A., M. D., St. Libory, III. 
 (Read before the St. Clair Co., 111., Medical Society, June 7, 1894.) 
 
 Cleanliness is said to be next to godliness — a very old adage which I have found 
 to be no less true in the treatment of all diseases which have come under my observa- 
 tion. It is my custom to first make clean my patient, outside and inside so far as 
 practicable, by the free use of pure water and good soap. I have never seen or had 
 a bad result from the use of these agents. I am of the opinion that in many cases all 
 the medicine that is needed is the free, judicious use of water, abstinence from food, 
 plenty of pure air and sunshine. 
 
 These agents, together with a clear conception and observation of the laws of hy- 
 giene will figure very conspicuously in the future of medicine. 
 
 While I am a strong advocate of the free use of water in the practice of medicine, 
 I also have confidence in the therapeutics of drugs, and as I believe, have seen many 
 good results from the intelligent use of them. 
 
 In the treatment of diseases there are three distinct steps. They are: 1, correct 
 diagnosis — ascertaining the cause; 2, absolute cleanliness by irrigation internally and 
 the free use of water externally; and by the use of disinfecting agents; 3, repairing 
 the damage — healing the wound — or assisting nature in her work of reconstruction. 
 This should be done by the skillful use of the tools best adapted to the work to be done. 
 
 In treating diseases of the alimentary canal generally, and in the three following 
 cases which I report to you I have endeavored to follow the foregoing principles. 
 My results are all that could be desired. They have been both interesting and profit- 
 able to me, and I trust they may be of some interest to this society. 
 
 Case i. — Miss Mary; aged 29; American; Faun type; medium size and rather 
 stout; was taken at night with pain in the lower bowels, followed by watery stools. 
 
 I was called in the early morning, March 15. Found her excited and suffering 
 very much from pain in the bowels; also complained of severe headache. Temperature 
 was slightly elevated. Pulse regular, but rapid and weak. She gave history of having 
 had several severe attacks of ulcerative colitis, during one of which she came very 
 near to death's door. 
 
 There was some tenderness on palpation and percussion over the major part of 
 the abdomen and the bowel was very active in evacuating itself. The stools were thin, 
 and contained mucus with a little blood. When food was taken into the stomach, 
 especially milk, it was usually ejected in curdy masses within a few minutes. 
 
*57 
 
 The usual agents were used to abate the pain, to check the vomiting; also to restore 
 the bowel to its normal condition. 
 
 The pain was greatly reduced and the rebellious condition of the stomach almost 
 entirely overcome; but the bowel persisted in its active work of draining the system. 
 The stools became offensive, containing more blood and mucus. 
 
 A portion of the lining membrane of the intestine about eight inches in length was 
 passed with the feces the fourth day. Having a four ounce bottle of Glycozone, I 
 concluded to try it. So other internal agents were discontinued, and 2- drachm doses of 
 Glycozone given every four hours in a wineglassful of water. The bowel was washed 
 out morning and evening with warm soap water, followed by an ounce of tepid water 
 containing an half drachm tinct. opium. 
 
 At the end of the first day after beginning the last method of treatment there were 
 marked signs for the better; and the patient expressed herself as feeling less bad. 
 The treatment was continued with constant improvement in the case until the Glyco- 
 zone was all taken, at which time the bowel and stomach were under good control. 
 Pain was all gone; and after a few days of convalescence the patient made a perfect 
 recovery without any further treatment. 
 
 Case 2. — Ely, aged 32, medium-size man, general health uniformly good; black- 
 smith by trade. First saw the case at 3 P. M., March 30. 
 
 On arrival at bedside of patient, I found him in what seemed to be a semi-comatose 
 state. The odor of whiskey was very marked. Examination of the matter ejected 
 showed it to contain blood and mucus. 
 
 A few drops of chloroform with cold water was' given, and a cold pack placed over 
 the epigastrium to check the vomiting. The following preparation was given to quiet 
 the stomach and to move the bowel: 
 
 1$ Calomel, gr. viij. 
 Podophyllum, gr. ij. 
 Subnitrate of bismuth, gr. xij. 
 Bicarbonate of soda, gr. iv. 
 
 M. Pulvis, No. 4. Sig. Dose, one powder every hour. 
 
 The father, mother and wife of the patient gave the following history: 
 
 "For the last five years the patient has been drinking whiskey, and for the last two 
 years, in particular, he has been drinking too much. Last October he had an attack 
 somewhat iike this, but recovered in about one week. 
 
 "His general health has always been good. He has been drinking too much every 
 day for a week now — keeping his whiskey in the shop. He was well this morning. 
 Worked in the shop until noon. Ate a hearty dinner, but was taken sick soon after 
 eating and in a short time began to vomit." 
 
 Called again at 5 p. m. Found him quiet, but suffering. Left some Dover's 
 powders to be given during the night if necessary. 
 
 At 2 a. m., March 31, was called again. Found him excited and suffering very 
 much. Quick pulse and slight elevation of temperature. Gave him hypodermic 
 injection: 
 
 I£ Morph. sulph., gr. £. 
 Atropin, gr. 1-150. 
 
 His wife gave history of his vomiting at irregular periods until 10 P. m., after 
 which time nothing would pass either up or down. Impossible to swallow water. 
 Upon careful inspection the whole mucous membrane lining the mouth and throat as 
 far as could be seen was in a state of hypertrophy. Indeed it was simply cooked. 
 (Pardon the use of the word, cooked; but it expresses the condition.) The stomach, 
 also, was in a state of inflammation. What was to be done? 
 
 Internal medication and alimentation was out of the question. Recognizing the 
 emergency of the case, I determined, if posssble, to dissolve the mucus about the 
 affected parts, and to attempt to reduce the oedema of the membranes. 
 
 The nose and throat, therefore, vere sprayed every twenty minutes for awhile with 
 
"5§ 
 
 Hydrozone and a twenty per cent, solution of the same used as a gargle every hour, 
 until he could swallow water, which required forty hours. An enema of warm soap- 
 water was given and repeated, which produced a soft stool; and he expressed himself 
 as feeling better. 
 
 The spraying of nose and throat together with the gargle, also the enema, 
 were continued every day. The inability of the patient to swallow made alimentation 
 by the stomach impossible, to say nothing of the incapacity of the stomach to perform 
 the work of digestion. Boiled milk and warm soups were regularly given in small 
 quantities per rectum. 
 
 On the morning of April 7 the whole lining membrane of the esophagus was 
 expelled in the attempt to vomit. The membrane was neither broken nor perforated; 
 but was turned inside out. I have preserved the spicimen in an alcoholic solution; and 
 take pleasure in presenting it herewith for your examination . 
 
 "A" "B" 
 
 Photograph of the mucous membrane expelled from the esophagus of Ely. Cut "A" illustrates 
 the ragged surface of the membrane as torn from the muscular coat of the tube. 
 
 Cut "B" illustrates the smooth surface of the same membrane over which food was passed, the 
 membrane being turned inside out, just as when expelled. The size of thes* 1 cuts is two-thirds that of 
 the photograph of the esophagus. The cardiac end of the membrane being at the bottom of the cut 
 in each case. 
 
 There was some fever most of the time. The temperature running up as high as 
 102 F. The pulse varied from normal up to 90, and a few times went up to 100. 
 
 The general condition of the patient was fairly good — indeed much better than 
 could have been expected. 
 
 There was little headache, but a lancinating pain in the left hypogastric region 
 which was greatly accelerated by coughing; and there was more or less tendency to 
 cough during the first week. 
 
 I might state here parenthetically that, in my judgment, the trouble in the side 
 had no connection with the conditions of the mouth, throat and stomach; but on tha 
 contrary, was entirely and wholly independent of it. 
 
159 
 
 The history given of the case showed the last named trouble to have been produced 
 some five years ago by prolonged arduous labor in which the abdominal muscles were 
 in constant strain for hours. Since which time the trouble has returned at different 
 periods; and almost invariably following protracted, or great straining of the muscles 
 in that region. The treatment given was palliative. 
 
 The odor coming from the mouth of the patient was offensive from the first, and 
 continued to grow more and more offensive until after the expulsion of the membrane. 
 
 The kidneys performed their work fairly well. The stools which followed the 
 enema of warm water were rather soft and of a greenish color. 
 
 There were no hallucinations, no delirium; and for the most part sleep was good. 
 
 To prevent septicaemia, to assist nature in the work of reconstruction, as well as 
 to counteract any miasmatic influence that might be present the following solution was 
 given : 
 
 I£ Quininae sulphatis, 3ij. 
 
 Acidi sulphurici aromatici, 3 j- 
 Aquae camphorae, 
 Aquae destillatae, aa 3 ij. 
 
 M. Sig. One teaspoonful every two hours, being alternated by half drachm 
 doses of Hydrozone, 20 per cent, solution, given in a third of a glass of water. 
 
 Gradually, but slowly, the condition of the patient grew better, with the exception 
 of one day, at which time he had no Hydrozone. The other medicine "Would not 
 work without the gargle," as he expressed it; "But worked well together." 
 
 Immediately after resuming the use of Hydrozone he began to feel better. Saw 
 him April 9. Found him in good condition. ' Pulse and temperature normal. 
 Expressed himself as feeling very well. 
 
 He had been sitting up most of the time for several days. I recommended that 
 the treatment should be continued for some time. 
 
 A week later his wife called at my office stating that she thought he was doing 
 very well. Since which time I have had no official report from the case. 
 
 My candid opinion is, that of all the agents used, the one to which he owes the 
 preservation of his life during the first seven days of the attack, is Hydrozone. 
 
 Case 3. — Bennie, little boy, age 9 years, orphan, German, was brought to my 
 office May 20 Had diarrhoea which had become chronic. Also had intermittent fever 
 — mild form. He was very much emaciated. 
 
 Various and numerous agents from the list of ordinary remedies were used during 
 the four succeeding days; but the diarrhoea was growing worse rather than better. 
 The stools became very numerous, the actions amounting to ten or twelve at night with 
 as many more during the day. The malarial fever received appropriate treatment and 
 was readily subdued. 
 
 May 26 I planned a new treatment. The patient was thoroughly sponged from 
 head to foot once a day with tepid alkaline water. The bowel was washed out clean 
 morning and evening with soap-water, just warm enough to be comfortable to the 
 patient. After the bowel was washed out, two ounces of starch-water containing two 
 drachms of Glycozone was thrown into the rectum, and left to be absorbed. The 
 interna] treatment consisted of a milk diet, fresh water to drink, impregnated with 
 Hydrozone, and teaspoonful doses of Glycozone taken every two hours during the 
 day in a wineglassful of fresh water. 
 
 Improvement began with this treatment. The skin and bowel was kept thoroughly 
 cleansed every day as well as medicated, the bowel being irrigated twice each day. 
 June 4, the child was reported well. His general health is rapidly improving. 
 
 What effected the cure? My answer is this: 
 
 1. Removing the cause. This was done by abstinence from all solid food. 
 Aliment was restricted to small quantities of pure, fresh milk, beef and chicken 
 soups, given at regular periods. 
 
 2. By cleansing the affected parts, as before stated. 
 
i6o 
 
 3. By healing the wound. This was done by the use of Glycozone, which I have 
 found to be one of the most reliable and rapidly-healing agents that I have yet used. 
 The Hydrozone was used as a disinfecting agent 
 
 May we not reasonably expect that during the remainder of the present decade, 
 and for all time to come internal as well as external cleanliness will be to suffering 
 humanity a boon — an heavenly unction? 
 
 Note. — I have, for some time, substituted Hydrozone in my practice instead of 
 Peroxide of Hydrogen, as formerly used. 
 
 Hydrozone is "double strength" Hydrogen Peroxide — so to speak. In other 
 words it has twice the bactericide power, and, therefore,, requires only one-half the 
 quantity to accomplish the same results. 
 
 It is not disagreeable to the patient when taken internally, if well diluted with 
 pure, fresh water. 
 
 CHOLERA.— PREVENTION AND TREATMENT. 
 
 By ELMER LEE, A. M., M. D., Ph. B., New York, 
 (Reprjnt from The Chicago Clinical Review, for April, 1893.) 
 
 A mass meeting of physicians, for the consideration of the above subject, was held 
 at the Great Northern Hotel, Saturday evening, March 18, 1893, under the auspices of 
 the Practitioners' Club, of Chicago. There was a large attendance. 
 
 Dr. C. D. Wescott called the meeting to order at 8:20 p. m., and Dr. DeLaskie 
 Miller was chosen Chairman of the meeting in the absence of Dr. N. S. Davis. 
 
 Dr. Miller in his opening remarks said: This is an unexpected honor, to be 
 called upon to fill the place of the gentleman who is unavoidably absent; but as the 
 Chairman of this meeting is to belittle more than a figurehead, I will accept the honor 
 with thanks. This is an important meeting, and I trust that the attention and interest 
 of it will be given to the gentlemen who will occupy the time. Without further remarks 
 we will proceed to the business before the meeting. 
 
 After remarks made by several medical gentlemen on the different phases of the 
 subject of Cholera, Dr. Elmer Lee, of New York, read the following paper. 
 
 The leading proposition suggested and tried in the treatment of Asiatic cholera, 
 during the epidemic of 1892, in Europe, consisted of the following general plans. Early in 
 the epidemic, lactic acid treatment was proposed on the ground that it would neutral- 
 ize the alkaline accumulations in the bowel, and so stop the multiplication of the 
 bacilli. 
 
 An Englishman, residing in Paris, considered Cholera a hyperemia of the spinal 
 cord. His proposition was ice poultices continuously applied to the region of 
 the whole spinal column. A small pamphlet was published by the doctor in defense 
 of his conclusions, and to present testimonials in favor of his congestion theory. As 
 this system of management was not seriously considered by cholera physicians, its effi- 
 cacy cannot be stated. 
 
 The use of large doses of the Russian remedy, salol, the invention of Prof. Nenski, 
 of St. Petersburg, grew in favor as a new remedy during the epidemic. The average 
 result of cases so treated in St. Petersburg, and by my American colleague, Blackstein, 
 in Baku, and in other provinces in Southern Russia, could not be said to be satisfac- 
 tory. Finally, at the close of the epidemic, its influences had come to be considered 
 less and less valuable — this, however, can be said — it was in all and all more largely 
 used than any other remedy. Still it would not be safe to put too much trust in it. 
 
 Calomel was everywhere a remedy even more used than salol. Formerly this drug 
 was used in very large doses, but last year it was the very small doses that found favor. 
 Especially was this true in the treatment of cholera in Hamburg. 
 
i6i 
 
 Of the surgical measures, the infusion of solutions of salt were most practiced. 
 The solution consisted of distilled water in which was dissolved one-half of one per cent, 
 of common salt. This liquid was warmed to the temperature of the blood, and either 
 introduced directly into some large vein, or injected, with a long needle and a large 
 barrel syringe, beneath the integument of the abdomen. The amount of salt solution 
 used in either case would be from one pint to one quart each time. In one case treated 
 at Hamburg as much as thirteen quarts of salt water were used from first to last. The pa- 
 tient recovered. The subcutaneous injections were frequently followed by cysts and some- 
 times abcesses appeared. Intravenous injections sometimes proved a godsend, but more 
 frequently disappointment could be said to be the result. These injections were only used 
 in the third period of the disease, cr the stage of collapse, algidity or asphyxiation, at which 
 period, it would be rather unreasonable to expect recovery by virtue of any treatment. 
 
 The Italian treatment, as it was called in Russia, was much used and with frequent 
 gratifying success. The practice was introduced by Prof. Cantani. It consists of a 
 clyster composed of the following constituents. 
 
 Boiled water or infusion of chamomile (warm), 2 litres. 
 Tannin, 4 to 10 grammes. 
 Laudanum, 5 to 10 drops. 
 Powdered gum-arabic, 50 grammes. 
 
 This or some part of this solution is occasionally passed into the rectum, to be re- 
 tained if possible by the patient. In the experience of those who have followed this 
 method of treatment, almost every case taken at the beginning of the disease has lived. 
 It is certainly more reasonable in principle than simple drug management. 
 
 Of the experiments of Ferran, of Spain, and Hafikine of the Pasteur Institute, 
 much has been said, but what has been said has failed to bring conviction to my mind. 
 As cholera itself cannot be said to protect one who has had the disease and recovered,, 
 against a second attack, then that which is less than cholera in influence cannot be ex- 
 pected to do it. The seat of the disease is located in the intestines, and, so long as the 
 infectious juices are there, the lymph vessels, in the processes of physiological function, 
 will continue to infect the blood. Can we hope to thwart physiological action of ab- 
 sorbents by hypodermatic injection of cholera culture, made at some time, it may be 
 year,s previous to the date of the passing epidemic? The answer by my judgment, is 
 that such expectations are flimsy. The caprice of Stanhope at the Hamburg Hospital 
 cannot seriously pass for an argument in favor of anti-choleraic vaccination. His inter- 
 esting but widely exaggerated stories were the product of a newspaper's love for sensa- 
 tion, and profit of increased sales of newspapers. 
 
 My own personal thoughts concerning cholera and the method of treatment, as- 
 practiced by me both in Russia and at Hamburg, during the epidemic of 1892, will oc- 
 cupy the remaining time allotted to me. 
 
 It is now well known that cholera is a disease of the alimentary canal. Its inciting 
 cause is believed to be a germ taken into that canal through the medium of food and 
 drink. There its presence is protested against by the absorbent vessels, which elimi- 
 nate from the food the nutriment for the body. The first symptom produced by foreign 
 invasion in the intestines is a diarrhoea, which may preceed vomiting from one to three 
 or even four days. If this be true, the bowels must be the seat of disorder, and the 
 most direct method of reaching them by medication must be the best. If the stomach 
 could be emptied of the foul material before the poison has passed further, there might 
 be speedy relief and, indeed, no real cholera. After it has passed into the intestines, 
 medicine administered through the stomach may be slow in reaching the seat of the 
 disease, and even then can only mingle with the poison, holding out the hope that the 
 one will be neutralized by the other. This hope, in truth, is seldom realized. But if 
 the poison can be removed from below, the course is left clear for nature to recuperate 
 itself. The diarrhoea is an evidence of the great exertion put forth by the organism to 
 rid itself of the death-dealing agency, and probably it would be effectual in the great 
 majority of cases, were it not that the nervous forces of the system are exhausted by the 
 
162 
 
 terrible strain, before the required evacuation of the bowels is completed. A large 
 irrigation of hot water, made soapy, preferably by neutral liquid soap, introduced into 
 the colon through a suitable rubber tube, is the simplest, and I am prepared to say 
 further that it is a more satisfactory way of treating cholera than any other with which 
 I am acquainted. The time to begin the irrigation is at the very earliest possible mo- 
 ment. Save the blood every single moment of infection by immediate action even if 
 there is the faintest suspicion of cholera either with or without diarrhoea. In every post 
 mortem seen by me in cases of death in which there had been no marked diarrhoea, the 
 colon and intestines were filled with accumulations of choleraic matter, which swarmed 
 with coma bacilli. The rule from which there need never be deviation is to treat the 
 patient by irrigation of the bowels and rinsing of the stomach without waiting for con- 
 firmation of the diagnosis either with the microscope or by the culture- test. The best 
 part of the practice is always to save the patient, even at the expense of fine statistics. 
 The accompanying illustration explains the manner of using irrigation of the intestines. 
 Such apparatus is suitable for places of public treatment of the sick. In private prac- 
 tice the syringe would take the place of the irrigating apparatus. 
 
 The irrigation is accomplished by means of a soft rubber tube F, one meter in 
 length and of suitable size to be introduced into the rectum, in front of the promontory 
 of the sacrum, into and up through the sigmoid flexure and into the descending colon. 
 This tube which is connected with a glass reservoir E, should not be too small nor too 
 
 (Dr. Lee's apparatus for irrigating the intestines for the cure of cholera and other bowel diseases. 
 Used first in St. Petersburgh during the cholera epidemic of i8q2.) 
 
 large in order to facilitate its introduction through the folds of the sigmoid portion of the 
 lower bowel. In fact, the greatest difficulty to be encountered, is to successfully pass the 
 tube in front of the promontory of the sacrum, and enter into the sigmoid flexure. The 
 tube should be of proper firmness to prevent it from bending or buckling upon itself 
 when the end (which in all cases should be rounded) comes in contact with the obstruct- 
 ing folds of the intestine. 
 
163 
 
 For internal treatment my experience taught me that the medicinal Peroxide of Hy- 
 drogen of Mar c hand*, given in cupful doses of the strength of 4 per cent. , or even much 
 stronger, was a better antiseptic than any other drug heretofore known in the treatment 
 of cholera. Then the treatment would be, first, immediate irrigations of hot water and 
 soap, using from one to three gallons at a time twice a day for the first and second days. 
 Once a day afterwards, if required, which is seldom the case. At the same time cleanse 
 the stomach with medicinal Peroxide of Hydrogen* and hot water used freely — by urging 
 the patient to drink. The feeding and nursing are the same as would be required by 
 a patient suffering from septicaemia or other prostrating disease. My belief is based 
 upon personal experience, and the following surgical measures and medical treatment, 
 viz.: Irrigation of the bowels, always first with hot water made soapy with neutral 
 liquid soap or a good castile soap; second, cleansing and rinsing the stomach with 
 hot water and medicinal Peroxide of Hydrogen* , continuing till it is well washed; 
 third, food and nursing; fourth, medicinal Peroxide of Hydrogen of \ per cent, strength* 
 given in cupful doses at intervals of two hours during the sickness till convalescence; 
 fifth, meet the requirements as they come up, as would be done in any other grave dis- 
 ease, using whatever personal experience has taught us to believe is good. Cleanse the 
 bowels, wash the stomach, feed the sick, keep them warm if cold, and reduce excessive 
 heat by the cool bath rather than reliance upon drugs, using anything in an emergency 
 that is the easiest and the most accessible to procure. The cholera patient may be con- 
 valescent inside of the first few days, or if not convalescent and not dead, the case goes 
 into the typhoid state, after which convalescence may be deferred for several weeks, or 
 death may be the conclusion. The temperature prior to the fifth day is generally 
 subnormal or a little above, but on the fifth day marked exacerbation and elevation of 
 temperature indicates the typhoid condition. 
 
 The Chairman: It is a most fortunate circumstance that we are alive to-day. 
 We must all of us feel confident that we have passed from the old to the new dispensa- 
 tion, which cannot but strengthen our faith like the anchor cast within the vale. We 
 know what cholera is; we know that we can limit its spread in our city. This is a great 
 confidence, and will do much for the comfort of this community. This idea should be 
 spread throughout the length and breadth of this great city. 
 
 Note. — Since reading the foregoing paper, Hydrozone has been substituted by 
 Dr. Elmer Lee instead of Peroxide of Hydrogen for reasons given on page 39, article 
 headed Treatment of Typhoid Fever. 
 
 CHRONIC CERVICAL ENDOMETRITIS.— 
 OSMOTIC TREATMENT. 
 
 By Walter S. Wells, M. D., New York. 
 (Reprint from the Chicago Medical Times, July, 1894.) 
 
 Acute inflammation affecting the uterus, shows a marked tendency to invade the 
 entire organ, and to involve both the body and the cervix. 
 
 But chronic inflammation, being of a lower grade of intensity, is more apt to be 
 limited to the mucous membrane of the body of the organ, or of the neck. 
 
 There is, however, nothing absolute as to such limitation — sometimes subjacent 
 parts being more or less implicated, and in other cases the mucous membrane of the en- 
 tire organ may be simultaneously involved. 
 
 The term, chronic cervical endometritis, is here applied to chronic inflammation of 
 the mucous membrane extending from the os externum to the os internum. This con- 
 dition, like many others, has been described under various titles, and is known as Cer- 
 vical Catarrh, Cervical Leucorrhcea, and Endocervicitis. 
 
 *Hydrozonenow takes the place of Peroxide of Hydrogen, the strength is double, the dose one- 
 half. See note. 
 
164 
 
 It is regarded as the most frequent of all diseases of the female genital organs, and 
 although not itself a malady of dangerous character, may give origin to some of the 
 most serious and obstinate uterine disorders. 
 
 The cervix uteri being exposed to injury during coition, — to laceration during par- 
 turition, — and to irritation from walking, riding and lifting, it is not surprising that it 
 is frequently the seat of disease. 
 
 The chronic cervical inflammation is a frequent cause of menstrual derangements, 
 and frequently produces sterility — the tenacious, thick glairy discharge from the cervi- 
 cal glands preventing entrance of the spermatozoon. 
 
 The cavity of the cervix uteri is described in text books as a fusiform canal measur- 
 ing about one inch and a quarter, beginning at the os externum below and ending at 
 the os internum above. The mucous membrane lining this cavity is estimated to con- 
 tain in a well-developed virgin cervix, at least ten thousand mucous glands. 
 
 The mucous membrane in which these glands caleld the glands of Naboth are im- 
 bedded, is covered by cylindrical and ciliated epithelium and studded by villi, especially 
 in the larger rugae. 
 
 Occlusion of the ducts of these glands causes their distension with mucus, when 
 they form small translucent cysts, and if they are large enough to project like peas from 
 the surface are known as "ovula nabothi." 
 
 T he natural secretion of the cervical canal has been shown by M. Danne to be 
 alkaline — while that of the vagina is acid. Cervical endometritis consists of inflam- 
 mation of the structures named, the disease being one of glandular inflammation. The 
 glairy mucous, which is secreted in large amount as one of the symptoms, is the charac 
 teristic discharge in this disease. 
 
 In patients who have died from some other cause, but having this disease also, an 
 examination of the parts with a magnifying glass has disclosed the Nabothian glands 
 enlarged and elevated, with their mouths dilated. 
 
 In some cases there is granular degeneration, the villi or papillae being involved. 
 In time, an hypertrophy occurs in the villi, which increase in size, project like so many 
 hairs from the surface, and give to the os and cervix the appearance termed granular 
 degeneration. The condition affects the vaginal portion of the cervix principally, but 
 may extend up the canal. Another pathological state may be found; an eversion of the 
 os and lower portion of the canal to such an extent as to keep up inflammation there by 
 the friction of the membrane thus exposed against the floor of the pelvis, rendering the 
 case obstinate. The thick tenacious mucous which is poured forth is loaded with 
 epithelium, and may be tinged with blood. 
 
 The causes which predispose to this disease are impoverishment of the blood, fre- 
 quent parturition, subinvolution and tight lacing. The exciting causes are laceration 
 of the cervix, flexions of the uterus, excessive coition, endometritis, injury and efforts- 
 to produce abortion and prevent conception, and the use of intra-uterine pessaries. 
 
 Many of the causes mentioned would fail to produce it in a uterus which had not 
 been prepared for their action by depressed conditions of the general system. Cervical 
 endometritis may exist for a length of time before it is recognized, the patient not com- 
 plaining of the discharge. The first symptoms probably, which do attract attention, 
 will be dragging sensations about the pelvis, followed by pain in the back and loins,, 
 which will be aggravated by exercise. 
 
 In time the leucorrhoea will be noticed, the discharge having come to resemble boiled 
 starch or thick gum water, and often irritating the vulva and vagina to such an extent as to- 
 inflame them. Menstrual derangements may follow, the mense become too scanty or 
 too profuse, too frequent or too dilatory. Occasionally decided dysmenorrhcea exists. 
 Generally before the disease has continued long, the constitution of the patient becomes 
 affected. She becomes nervous, irascible, moody, and often hysterical. Her appetite 
 will diminish, and digestion grow feeble, causing impoverishment of the blood. 
 
 This condition may continue for some time before complications supervene, but 
 cystitis, cervical hyperplasia, and vaginitis may develop, proving very troublesome. 
 
«6S 
 
 Pain during sexual intercourse is regarded as indicative of the development of 
 cervical hyperplasia, rather than of the endometritis, the former becoming added 
 as a complication to the latter. Nausea and vomiting sometimes present themselves 
 as symptoms, aggravating the disgestive disorder mentioned, as well as deteriorating 
 the nutrition of the already impoverished blood. 
 
 Upon making physical exploration, the patient lying on her back, the finger of 
 the examiner will probably find the os uteri in its usual position in the pelvis, the weight 
 of the uterus is not increased, the connecting tissue not being involved. The os may 
 be somewhat enlarged, and its lips slightly puffed, or it may be roughened on account 
 of granular degeneration. Sometimes, however, severe cervical endometritis may ex- 
 ist without enlargement of the os or any trace of abrasion or granular degeneration. 
 
 If the finger be placed under the cervix and that part raised by it, pain will be com- 
 plained of, but it will be most marked opposite the os internum. 
 
 The speculum will disclose the cervix usually somewhat enlarged, its tissue swollen, 
 puffed, and intensely red if its investing epithelium is removed and there is hypertrophy 
 of the villi. But cervical endometritis may exist, affecting the glands of the canal, 
 without abrading the lips of the os, in which cases, without removing the plug of mucous, 
 the os is seen to be no larger than it should be, its tissue is not reddened, no degenera- 
 tion exists, nothing visible to explain the backache, nervousness and impaired nutrition, 
 except the profuse glairy, tenacious discharge. 
 
 The cervical cavity, in nulliparous women, may be found distended by the accu- 
 mulation of the thick cervical mucous which is prevented escaping by a small external 
 os. The cervix then has an elliptic form and is out of proportion to the size and shaeo. 
 of the body of the uterus. 
 
 Cervical endometritis is not a self-limiting disease, and if unchecked, frequently in 
 multiparous women, passes into cervical hyperplasia, with displacement, and other ills 
 which add to her annoyances. 
 
 If the mucous which marks inflammation of the glands be slight in amount and 
 not very tenacious in character, the prognosis is favorable, but if a considerable amount 
 of thick, yellowish, stringy mucous hangs from the cervical canal, the prognosis is dis- 
 couraging as to any definite time when a cure may be predicted, especially in a woman 
 whose general health is impaired. 
 
 Even in mild cases of some duration from four to six months or more will be re- 
 quired to effect a perfect cure and even then a relapse is likely to occur. General and 
 local treatment must go hand in hand in the management of these cases, as it is well 
 established that by improvement of general health and hygienic surroundings, the local 
 disease is benefited. 
 
 It will probably not be amiss at first to relieve torpidity of the liver and constipa- 
 tion by triturates of calomel, £ gr. at bedtime, followed in the morning by seidlitz salt 
 or Rochelle salt, repeated from day to day, pro re nata. The value of quite warm 
 water injections, 85 to 100 degrees F. or more, daily, and especially at bedtime, have 
 been recognized from time almost immemorial. 
 
 Great good is effected by suitably medicating the water for vaginal injections and 
 for this purpose one part of zymocide to four or five parts of water at 100 degrees F. 
 answers an excellent purpose, especially if we add half an ounce of boracic acid to each 
 quart of the above mixture, in the bag of the fountain syringe generally employed. 
 
 The tube (vaginal) should be of hard rubber, the central distal (uterine) opening 
 closed to avoid throwing the injection into the uterine cavity, and about five inches in 
 length. 
 
 The dorsal recumbent position is preferred. With the hips elevated, the shoulders 
 lying lower, the abdominal viscera gravitate toward the diaphragm by which the vagina 
 is lengthened and its whole cavity may be flooded with the injection, a portion of which 
 remains around the cervix until the erect posture is resumed. 
 
 The patient may be placed with her hips resting on the edge of the bed, with feet 
 
1 66 
 
 on two chairs, and a rubber sheet so folded and placed beneath to elevate the hips, and 
 its folds hanging over a tub below to catch the return fluid. 
 
 Or, the patient may be placed by her nurse and supported in the knee-chest posi- 
 tion, if it is thought desirable to further distend the vagina with hot water disinfecting 
 injections and to retain the same in longer contact with the os and cervix. 
 
 The position itself, through the influence of gravitation, materially aids the recti- 
 fying certain displacements of the uterus and diminishing pelvic congestions. 
 
 Having used these injections for a few days, both in the morning and at bed time, 
 the parts will be in condition to commence the Osmotic method of medication, which we 
 usually commence by inducing profuse exosmosis of serum from the capillaries, to further 
 unload the surrounding blood vessels and lymphatics and thus accomplish depletion 
 and reduction of congestion. 
 
 This has usually been accomplished by the topical application and retention around 
 the cervix and os of pledgets of antiseptic cotton saturated in glycerine. But since we 
 have used glycozone, which is glycerine subject to the action of ozone and made power- 
 fully antiseptic by the Marchand method, we prefer it to plain glycerine, although the 
 latter may be made antiseptic in a less degree by admixture with carbolic and boracic 
 acids. 
 
 In using glycoztme we prefer the prepared lamb's wool, a suitable sized pledget of 
 which is tied around with a string, for easy removal by the patient, and being saturated 
 with glycozone is seized with the dressing forceps and passed through a widely ex- 
 panded speculum and deposited directly to the os and cervix. 
 
 If pain, locally, is a prominent symptom, J to $ grain of morphine may be incor- 
 porated with the half ounce of glycozone used and the pledget is to remain in situ 
 twenty-four hours. 
 
 Belladonna or aqueous ext. opii may be substituted, the former being credited by 
 Trousseau and Ringer with properties, diminishing the secretion of the nabothian 
 follicles, as well as acting as an anodyne. 
 
 The pledget of glycozone will have exhausted its exosmotic influence by the end 
 of twenty-four hours and being removed may be followed by an injection as before. 
 
 The tamponade with glycozone may be repeated every third day, alternating with 
 the injections of hot water with zymocide until the parts have lost the appearance of 
 congestion, when the treatment may be extended within the cervical canal by means of 
 the cotton wrapped hard rubber probe applicator. The distal extremity of the probe 
 being coated with a thin film of prepared cotton, and the cervix having been cleaned 
 and dried with absorbent cotton, the wrapped probe is dipped into the selected fluid 
 and any excess pressed out against the walls of the vial and then gently passed into 
 the cervical canal to the os internum, and allowed to remain a few seconds before with- 
 drawal. 
 
 Any overflow from the os should be wiped away. Many combinations have been 
 tried. Iodine is preferred by some, it not being altered by the secretions of the cervix 
 as most medicaments are. The officinal tincture of iodine is too weak. Churchhill's 
 tincture (iodine gr. xxv; potassic iodide, 3 iss; to alcohol, § i.), very much stronger is 
 often to be preferred. 
 
 A good tincture is one from J)iiss to 3 i of iodine to § i of alcohol, with a small 
 quantity of potassic iodide to facilitate solution. This can be applied to the cervix and 
 canal once per week. 
 
 Iodo-tannin (tannin dissolved to saturation in the foregoing tincture of iodine, 
 may at times be beneficially substituted; also carbolic acid, liquefied crystals) used at the 
 same intervals acts as an anaesthetic locally rather than as a caustic, is a favorite with 
 some gynecologists. So also is iodized phenol (2 parts of iodine with eight parts of 
 carbolic acid.) In these obstinate cases the physician will need to have several com- 
 binations with which to alternate the local treatment. We have of late used with benefit 
 the medicinal Peroxide of Hydrogen. The probe applicator is wrapped at its distaL 
 end with a thin film of aseptic cotton and being dipped into a solution of equal parts of 
 
167 
 
 the Peroxide of Hydrogen and zymogen, the probe is gently passed up and down in 
 the cervical canal and renewed as long as the foamy discharge shows the presence of pus 
 or the canal is cleansed. 
 
 We then select a suitable sponge for osmotic treatment, one sterilized and bleached 
 by the Marchand method and with its string attachment for easy removal, saturate it 
 with equal parts of zymocide, Peroxide of Hydrogen and warm water, pass the same by 
 aid of dressing forceps up through a widely expanded speculum in contact with che os 
 and cervix, leaving it there for about twenty-four hours. 
 
 The patient then removes the sponge by its string and has it cleaned in warm, 
 weak ammonia water, and it is ready to be again medicated and adjusted as before. 
 
 Perhaps a more efficient method of bringing the Peroxide Hydrogen within the cer- 
 vix is by means of the cervical syringe, first devised, I believe, by Munde. This appli- 
 cator syringe with its distal end coated with a film of aseptic cotton and charged with 
 the Peroxide of Hydrogen and zymocide aa q. s., the end is passed within the cervix up 
 to the os internum. A slight depression of the piston forces out a small quantity of the 
 fluid which being retained in the enveloping cotton holds the liquid antiseptic in close 
 relation with the Nabothian follicles to be passed over them frequently, so as to bring 
 the peroxide thoroughly in contact while the foamy discharge indicates the presence of 
 pus in the cervix. 
 
 After this direct medication of the cerv'cal canal, the osmotic sponge saturated as 
 before, may be left in apposition with the os for the succeeding twenty-four hours. 
 During this local medication the general nourishment of the patient, it will be inferred 
 from what has been said, must not be neglected. 
 
 Profs. Thomas and Munde says that if they were restricted to a choice between local 
 and constitutional treatment in these cases, they would choose the constitutional, unless 
 the local treatment were a surgical operation to remove the entire lot of glands. 
 
 Having chosen a suitable bill of fare, digestion and assimilation may be promoted 
 by administering after each meal a tablespoonful of elixir of peptenzyme and one at 
 bedtime following a glass of milk, many patients, as well people, sleeping better after 
 taking a little light nourishment at bedtime. 
 
 This new digestant, peptenzyme, contains the concentrated extracts of all the diges- 
 tive secretions furnished by nature for the digestion of a mixed diet. 
 
 Its use with food, especially cream, which it rapidly digests, as well as prepares 
 fats for assimilation, will soon overcome the dyspeptic condition and impoverished blood. 
 
 Cases will occasionally be found in which nothing, not even both constitutional 
 and local treatment will put a stop to the discharge from the Nabothian glands and as a 
 dernier resort the late Dr. Sims in such obstinate cases dilated the cervix, and by means 
 of the sharp curette, scraped away completely from the canal the entire mucous lining 
 with its thousands of Nabothian glands. 
 
 In very obstinate cases of this disease there is occasionally some other redundant 
 growth besides the Nabothian follicles which may be improved by removal, as cervical 
 hypertrophy granulations around the os and mucous polypi. 
 
 After even such small operations the patient should be kept in bed and antiseptic 
 anodyne mixtures used upon the osmotic sponge as dressing to the wounds. It should 
 be remembered that in using the sponge to a raw surface that a cut surface of the sponge 
 should not be applied, or adhesion would occur. The natural surface of the sponge is 
 not liable to adhere. 
 
 LOCAL TREATMENT OFUTERINEANDVAGINAL DISEASES. 
 
 By WILLIAM C. WILE, A. M., M. D., LL. D., Danbtjry, Conn. 
 
 (Reprinted from the New England Medical Monthly, September, 1894.) 
 
 There is no class of cases that come under the doctor's care , that cause him so 
 
 much trouble as those called female complaints, and the more advanced we progress 
 
 towards civilization, the more frequent becomes the call to do this sort of work, and the 
 
i68 
 
 more obstinate they seem to cure. This condition of affairs is largely due to: I. 
 Corset wearing. 2. The desire to avoid child bearing, with its shifts and expedients, 
 hot water, cold water, medicinal washes, withdrawals, et al. 2. Uncleanliness, not 
 keeping these important parts in a sanitary condition. 3. Too rapid child bearing. 
 
 The gynecological surgeon has used his knife so recklessly about this neighborhood, 
 that the revolt has come and the cry is, halt! and in emphatic tones. The days of 
 pessaries are numbered, and only in exceptional cases are they used by any body novv- 
 a-days, while practical medication deducted from experience is in the van, with thera- 
 peutical local applications, which do more for diseased vaginal and uterine tissues than 
 all other methods combined. Chronic inflammations either simple or catarrhal of the 
 cervix, cervical canal, endometrium, and vagina are amongst the most obstinate of all of 
 this class of cases to treat, and give the patient and doctor both a deal of trouble. 
 
 My method of treatment for the last two years has been as follows: Correct what- 
 ever is out of gear in the general condition, hot water douches from 10 to 20 minutes 
 twice a day. Immediately after this douche with a glass or rubber syringe use one ounce 
 of Hydrozone and one ounce of water, allowing this to remain while the patient 
 lies in the recumbent position for ten minutes. Wash vagina out with water and 
 introduce clear up the cervix one of those indispensable little tablets, Micajah's 
 Medicated Uterine Wafers. These I have found simply invaluable in the treatment of 
 these cases. A cuse is readily affected and the patient and doctor alike delighted. 
 (See articles headed, "Treatment of Vaginitis by Peroxide of Hydrogen (Medicinal)," 
 by Herman L. Collyer, M. D., of New York, p. 126; "Peroxide of Hydrogen in 
 Gynecology and in Obstetrics," by Egbert H. Grandin, M. D., of New York, p. 79, 
 
 TUBERCULAR ADENITIS OF THE NECK. 
 
 HOSPITAL CASES. — FROM THE ST. LOUIS FEMALE HOSPITAL. 
 
 By R. M. Kirley, Superintendent. 
 
 (From the Courier of Medicine, St. Louis, Mo., July, 1894.) 
 
 L. I. single; age 20; occupation servant; admitted into Female Hospital June 17* 
 1893. History: Had given birth to a child sixteen months previous. The glands of 
 the neck began to enlarge two years previous. When admitted to hospital had an 
 itching dermatitis of flexor surfaces of both fore-arms, also of the neck. 
 
 The enlarged glands are very tender and painful, at times suffering intense. After 
 using anti-syphilitic remedies for one month without avail, extirpation was determined 
 upon. Operation: On July 21st the superficial chains were removed, six in number, 
 under chloroform. Incision was made along posterior border of sterno-mastoid down 
 to diseased tissues, which were then enucleated. Capillary oozing was quite free but no 
 vessel of importance was severed, although the sub-clavian could be plainly seen, pul- 
 sating in the lower angle of the cavity left by the removal of one of the deep glands. 
 As far as could be ascertained, no morbid tissue was left behind in the dissection, which 
 was tedious on account of adhesions to the glands. The wound was closed with inter- 
 rupted silk sutures, without drainage. The cavity soon filled with blood and the line 
 of incision was painted with iodoform-colodion and an ice-bag applied. Time required 
 for operation, one hour. Patient reacted well. 
 
 The removed glands were tuberculous in various stages of the disease, two of which 
 had undergone caseation, and two others had broken down and were apparently about 
 to suppurate through the adjacent parts at time of operation. 
 
 On July 26th the stitches were removed, union was perfect except at dependent 
 portion, where there was a superficial nidus of pus. Washed with Marchand's Peroxide 
 of Hydrogen and applied dressing — bichloride gauze. 
 
 August 2nd, wound healed. August 4th, patient discharged, well. 
 
169 
 
 THIERSCH'S GRAFTS IN EXTENSIVE DESTRUCTION OF 
 
 SOFT PARTS ABOUT LARGE JOINTS. 
 
 By Henry W. Coe, M. D., Portland, Ore. 
 
 Reprinted from the Medical Sentinel, of Portland, Oregon, September, 1894. 
 
 Read by title before the seventh annual convention of the National Association of Railway Surgeons 
 
 at Galveston, Texas, May, 1894.) 
 
 For a comparatively recent procedure and an operation producing; such satisfac- 
 tory results, Thiersch's method of skin grafting occupies very little space in medical 
 
 books and almost none in 
 medical journals. 
 
 It seems to the writer 
 that no method in surgery 
 has been brought forward 
 in recent years which, in a 
 small way always, and in 
 many instances in a larger 
 degree, produces results 
 which afford such general 
 satisfaction as those given 
 to us by the use of this pro- 
 cess of Thiersch. Espec- 
 ially is this true in relation 
 to the treatment of injuries 
 involving the destruction of 
 considerable areas about 
 the larger joints. 
 
 We often see the con- 
 torted results following the 
 older methods of treatment 
 in cases of destruction of 
 large portions of skin. 
 Especially deplorable have 
 been the results obtained 
 after any other methods of 
 treatment, when the loss of 
 integument has occurred 
 about large joints. 
 
 It has been my good 
 fortune to meet a number 
 of injuries in which the 
 integument and underlying 
 soft tissues about great 
 joints have been involved, 
 and in which I have, during 
 these late years, been glad to 
 Figure 1. find in Thiersch's method 
 
 a satisfactory treatment, 
 say "good fortune," for the results are so satisfactory that the keenest gratification 
 
170 
 
 must result from one's care of such cases. My excuse for this paper is the dearth 
 of literature upon this important division of modern surgery, and the desire to present 
 two cases in illustration. 
 
 Case i. A young man, 20 years of age, a kneader in cracker factory, on Oct. 
 16, 1893, in feeding the dough, had his hand and arm drawn between two rapidly 
 revolving rollers up to a point several inches above the elbow joint. His desperate 
 effort to withdraw his arm, with the crushing force of the machinery and suction of 
 the passing dough, severed the skin above the elbow, except a small shred upon the 
 inner aspect of the arm. At the time of the accident this isthmus was put upon the 
 stretch, the forearm being partially flexed, and the integument was drawn down over 
 the forearm and wrist much like an everted gauntlet. 
 
 The patient was taken to the hospital at once, where the grease and other dress- 
 ings, which had been applied by fellow workmen, were removed and the skin replaced 
 
 Figure 2. 
 
 as carefully as possible. The wound was kept clean, and after three weeks the tissues 
 destroyed by the force of the injury and loss of blood supply were removed, the gran- 
 ulations scraped down, and the raw surface, which at this time completely girdled the 
 arm at the elbow joint for a space of from three to six inches, was, at one sitting, com- 
 pletely covered with grafts taken from the inside of the patient's thigh. Although 
 only about two-thirds of the grafts "took," the adhering portions were so distributed 
 and so loosely applied that the natural contraction of the tissues, together with their 
 marginal growth, soon covered the wound with new skin. The contraction which 
 naturally took place where grafts did not adhere took the "slack" out of the loosely 
 placed grafts, so that the results were highly gratifying. As the grafts were ' applied 
 longitudinally upon the arm, any contraction the result of cicatricial tissue formation 
 was not so situated as to act as a band about the arm. 
 
 A wound of this nature under the ordinary methods formerly in vogue, and, for 
 that matter, under methods often employed even at the present time, would have left 
 an elbow joint covered with dense cicatricial tissue, to shrink, harden and crack, and 
 
i7i 
 
 seriously abridge the action of the joint, as well as to interfere with the blood supply- 
 to the parts below the seat of constriction. 
 
 At this time, six months after the operation, the young man has as free use of his 
 injured elbow joint as he has of its uninjured fellow. The skin over the region is 
 
 loose, and has quite a nat- 
 ural appearance, and the 
 circulation below the seat of 
 injury is not interfered with 
 in the least, and the man is 
 now working again at his 
 trade. 
 
 The first illustration 
 shows the wound as it was 
 three weeks after the injury, 
 and at a time when the 
 dead skin, drying up and 
 shrinking, was about ready 
 to fall away. The forearm 
 was still swollen, but the 
 tissues, up to the line of 
 demarcation, were otherwise 
 in a healthy condition. 
 
 The second view shows 
 the elbow flexed to a similar 
 degree as in the former view 
 of the arm, with the wound 
 all healed, excepting a small 
 portion of the outer aspect, 
 which is closing up by mar- 
 ginal skin extension. This 
 view was taken about three 
 weeks after the grafts had 
 been applied. 
 
 Case 2. A boy, 16 
 years of age, whose knee 
 came in contact with a set 
 of powerful cog-wheels, 
 and, as a result, a consider- 
 able amount of skin was 
 torn away. 
 
 The skin grafting in 
 this case was done upon the 
 superficial fascia four days 
 after the receipt of the 
 injury. The time between 
 the date of the injury and of the operation was consumed in attempting to remove the 
 oil with which it had been dressed, and otherwise make the wound aseptic, the wound 
 being dressed several times a day with peroxide of hydrogen. 
 
 The grafts took at once, and the entire surface was healed in about ten days, 
 excepting two spaces of about a square inch each, which required four weeks to cover 
 with cicatricial tissue by marginal extension, while fifty times as much surface adjoin- 
 ing had been covered with soft, pliable integument in a few days only. 
 
 The outcome in this case manifestly demonstrates again the happy results to be 
 obtained by the use of Thiersch's grafts after injuries about large joints, in permitting 
 free joint motion and circulation. 
 
 Figure 3. 
 
172 
 
 The views exhibited in this case, recently taken, eighteen months after the receipt 
 of the injury, show the new skin (cut 3), the leg being flexed upon the thigh at right 
 angles; and, again (cut 4), the new tissue picked up by the thumb and finger to 
 demonstrate its soft and pliable condition, even over a half-flexed knee — a procedure 
 which cannot as readily be demonstrated upon the normal skin of a flexed knee, as any 
 
 one can ascertain by at- 
 tempting to pick up the 
 tissues over his own knee. 
 I believe that my suc- 
 cess in the application of 
 Thiersch's grafts has been 
 largely due to the free use 
 of peroxide of hydrogen 
 (Marchand's) in dilute form, 
 used not only before the 
 grafts were placed upon the 
 broken surface but also 
 daily thereafter, to carry 
 away promptly any broken 
 down tissues and to remove 
 any discharge of a suspici- 
 ous nature. Even when 
 pus microbes have found 
 entrance to such a wound, 
 by the judicious use of this 
 dressing the greater portion 
 of the grafts may be saved 
 and the melting down pro- 
 cess aborted. 
 
 Later in the treatment 
 I have found the balsam of 
 tolu, upon lint, an excellent 
 dressing to strengthen the 
 graft, and- if any open por- 
 tions are present, as may 
 be even under favorable 
 circumstances, such a dress- 
 ing will hasten the process 
 of granulation. 
 
 One point that I desire 
 to emphasize is that the 
 grafts should be lain on 
 parallel with the long axis 
 of the limb, especially over 
 a joint. By this means, 
 even if but a portion of such 
 grafts become adherent, the 
 cicatricial tissue is broken by loose strips of skin up and down the limb, whereas, ii 
 placed over the joint, encircling the same, the failure of a single graft may result in 
 the formation of a band of cicatricial tissue, entirely or partially encircling the limb 
 and interfering more or less with its action and blood supply. 
 
 Figure 4. 
 
i73 
 
 SCARLET FEVER. 
 
 By JAMES S. KENNEDY M. D., Chambersburg, Pa. 
 
 (Reprinted from the New England Medical Monthly, December, 1894.) 
 
 So much has been written lately concerning "scarlet fever" that the busy prac~ 
 titioner passes to the next page when his eye meets with the above title but to those 
 who have the good of humanity at heart, I beg for a hearing. 
 
 This section of the state (Penn.) has, since May last, been cursed with an epidemic 
 of "scarlet fever," many cases being malignant in character. This contagious exan- 
 thema as exemplified here, has been remarkable for the length of time intervening be- 
 tween the subsidence of all symptoms and the desquamation. In some cases desqua- 
 mation did not commence until the twenty-first day and in others it was six weeks be- 
 fore it was completed. The Health Board (God save the mark) allowed the return of 
 all the scholars to the schools without respect to the symptoms in twenty-one days, and 
 in this way contagion was rapidly disseminated through the medium of the common or 
 public schools. 
 
 The forms of this dreaded disease, as generally accepted, are simple, anginose and 
 malignant, and in these authors differ widely in characteristics. Most of the cases 
 coming under my notice were of the pseudo-membranous anginose variety. The divisions 
 given above, are in my humble opinion, far from correct, nor are they consonant with 
 the nature of the disease. Scarlet fever is a single'and unvarying disease, differing 
 only in degree of severity, produced by one and the same species of bacteria, same in 
 course, requiring no more than does typhoid fever to be divided and semi-divided 
 simply because it differs in severity in different subjects. Look at the picture of the 
 bacteria. These are the germs that do the damage and there is no doubt that they are 
 found in every case of this specific disease, either simple or malignant. The essential 
 element of this affection is an inflammatory action of the mucous membrane alike in 
 each case and there never was a well authenticated case, where this inflammation was 
 not present to a greater or less extent. It may be so slight as to cause no uneasiness 
 to the patient or even escape the notice of the physician but it is there all the same, and 
 is always shown under the "microscope." 
 
 As to the anginose and malignant type, as they are usually called, the names are 
 of little value for in all grave cases in which death was not due to cerebral invasion, by 
 the third or fourth day, there developed a dangerous anginose inflammation, which 
 although of the anginose vaiiety still was malignant also in character. Its powers of 
 contagion are surpassed by none and its propagation and dissemination by air currents, 
 the physician, visitors, sewage, and a thousand and one other means cannot be success- 
 fully combated. There can be no doubt that the activity of its poison remains for an 
 indefinite period of time. For instance this case came under my observation: A cer- 
 tain church was preparing a box to be sent to a missionary in the South and for this 
 clothing, etc., etc., was requested of the congregation by its pastor. A mother who had 
 lost her only child by malignant scarlet fever, over a year ago, had preserved a doll and 
 some fine underclothing as mementoes. These articles were stored in a close fitting 
 cedar chest, in the garret. The touching appeal by the minister, influenced her to 
 donate these sacred treasures, and they were included in the box. The missionary's 
 child wore the clothes and played with the doll — contracted scarlet fever — died, and 
 strange to relate it was the only case, far or near, noi was there any further develop- 
 ment of the disease in that vicinity. 
 
 The exact duration of the septic influence is as yet unknown and no matter how 
 much care is taken, it can be carried away by visitors. No one realizes it more than 
 the writer who taking every precaulion, such as baths, change of clothing and disin- 
 fection yet carried it to one of his own children, who was too young to get it from any 
 other source. On the other hand we have known children constantly exposed to its 
 
174 
 
 dangers escape entirely. This part of the subject has not been as thoroughly inves- 
 tigated as its importance demands and if our scientists would give more of their 
 time to such practical questions as "public hygiene" and less to investigations that 
 will not do humanity one iota of good, better would it be for the public. Whatever 
 may be the activity of this virus it is an indisputable fact, that it can be disseminated 
 by the clothing of the physician and others, bedding, furniture, and desquamation. 
 As to its not attacking a person a second time, I believe it does so more frequently 
 than is supposed. I am attending a patient now, who one year ago had this disease 
 without one single symptom absent. Her sister who slept with her a year ago escaped 
 the infection at that time, and when this attack developed she was sent away and after 
 an absence of seven weeks she returned home only to contract scarlet fever in five days 
 afterwards. I believe that no matter how severe the disease is in a family the consti- 
 tution must be in a certain condition to receive, retain and develop the poison. 
 
 The age of five years and under, has in my experience produced the greatest 
 number of cases, and I have known of a death at thirty-eight years. Sex does not 
 seem to exert any influence, but most of my cases this summer and fall have been girls. 
 One thing I have never seen noticed is the fact that the person taking the greatest 
 inteiest and personal care of the patient is very prone to suffer from aggravated sore 
 throat, of a specific nature. Some others of the family may suffer the same way. 
 
 The symptoms of this disease are so familar to every practitioner that it would be 
 useless to mention them, but as to the treatment each has his favorite — mine is as 
 follows, nor do I claim anything to be strictly original: From the first rise of temperature 
 and the slightest flush of the fauces, I give aconite, gtt. ij-iv, either in tablet form or 
 tincture, every two hours, followed by belladonna the same dose, one hour after each 
 dose of aconite, until the rash is thoroughly out from head to foot — then the belladonna 
 is dropped and acid carbolici, § ss, olei olivoej^x. M. Sig. Anoint all the- body 
 except the face (on which pure olive oil is used), twice daily — followed at night by a 
 tepid bath — where the cerebral symptoms preponderate, I give in connection with that 
 above, a suppository containing ext. hyoscyami, gr. ss-j, ext. cannabis indica?, gr. 
 £-j. camphorse monobrom, gr. ii-v, lupulin, gr. v-xv. M. Sig. One night and 
 morning. This will allay to a remarkable extent the cerebral symptoms such as 
 delirium, wakefulness and low mutterin^s, and prevent any tendency to convulsions. 
 
 For any stomachial symptoms, Glycozone, 3 j, aq. distillata, § iij. Glycozone is a 
 powerful oxidizing agent and in contact with the germs destroy them. The above dose 
 may be given every three or four hours. It causes no action on the heart, kidneys or liver. 
 
 The local treatment is of the greatest importance, the fauces should at the first 
 indication be swathed externally by a large silk handkerchief saturated in cold water, 
 and over this a woolen bandage to prevent its too sudden evaporation, this is to be 
 repeated every two hours until amelioration of the inflammation is noticed. Besides its 
 local benefit, the temperature is also reduced — sponging over one portion of the body 
 at a time is beneficial. Next in order in importance are remedial applications, and to 
 these specially is this article directed. Hydrozone is by long odds the best local appli- 
 cation and constitutional remedy we have in the whole range of materia medica. It 
 has done wonders and will do wonders for you, my skeptical brethren, if I can only 
 persuade you to use it. The following is the proper strength, viz: Hydrozone, § ss, 
 aq. distillata, § iij-vj. M. Sig. Spray the throat, fauces and nasal passages thor- 
 oughly every two hours. In this last mentioned medicine we have a comparatively 
 recent addition to our weapons to combat this scourge, and as a germicide annihilator 
 it has no equal and in no disease is this so well shown as in the above named. It pos- 
 sesses virtues peculiar to itself, and no remedy will give the physician, and what is of 
 more importance, his patient, so rapid and beneficial a result as "Hydrozone." Caution 
 should be used in the manner of exhibiting this oxidizing agent, and only an apparatus 
 of glass or rubber should contain it. A glass spoon for internal medication and a glass 
 and rubber atomizer for the spray. No matter how severe the inflammatory process is 
 in the fauces, or how much mucus is thrown out, the spray in a short time will change 
 
i75 
 
 the character of the discharge and give a healthy tone to the membrane, and on the 
 second day of use the entire buccal cavity will present a clean healthy color with the 
 inflammation and breathing relieved, and temperature reduced. Saturate the fauces 
 with the spray, and the bacteria present and forming will certainly be destroyed. 1 ry 
 it once gentlemen, and I know the death rate will be reduced and this will not be written 
 in vain. 
 
 The action of hydrozone when brought into contact with bacteria of any description, 
 internal or external, destroys them by decomposition almost immediately. Nascent 
 oxygen is liberated, the albuminoids of the diseased part coagulated, the pus corpuscles 
 destroyed, and those in formation utterly routed out of existence. It is energetic, 
 destructive, with absolutely no toxic effect, but at the same time, on account of the 
 chemical action on the albumen, it should not be injected into the circulation. In a 
 voluminous table of bactericide potency, hydrozone stands first, the biniodide of mer- 
 cury second, glycozone third, with chloride of iron twenty-five on the list. It has been 
 found that lime water, soda bicarbonate, thymol, and eucalyptus have no action on the 
 microbes of pseudo-membranous anginose, when they are once developed, but may exert 
 a mild preventative action. Such articles as potash permanganate, hypochlorite of lime, 
 bichloride of mercury, carbolic acid and silver nitrate, do destroy the bacteria, but they 
 are dangerous to the life of the patient, whilst glycozone and hydrozone are perfectly 
 harmless. In the table of comparative strengths of the different germicides, it has been 
 shown that hydrozone is twice as strong as Marchand's Peroxide of Hydrogen (medicinal) ; 
 3 times as strong as bichloride of mercury; 5 times as strong as silver nitrate; 10 times 
 as strong as iodine; 28 times as strong as iodoform;, 128 times as strong as carbolic acid. 
 
 By glancing over the above you will see what a valuable adjuvant we have in the 
 treatment of scarlet fever. 
 
 REPORT OF A CASE OF EXTENSIVE GUNSHOT WOUND. 
 
 (Published by The Journal of the American Medical Association, December, 1894.) 
 By F. H. BROBST, M. D., Reading, Pa. 
 
 On Aug. 2, 1894, I was summoned in great haste to see Mr. G. B., who met with 
 a dangerous accident half an hour previous to my arrival at his residence, by a dis- 
 charge of a full shell, containing No. 8 shot, from a breech-loading shotgun, into his 
 leftside. Upon examination, after anesthetization by the assistant physician, I found 
 the whole contents of the shell, containing about two hundred and fifty shot, had entered 
 three and three-fourth inches to the left of mid-sternum, between the seventh and eighth 
 ribs, fracturing the ninth, eighth and part of the seventh ribs to minute pieces, tearing 
 and lacerating the pleural peritoneum and diaphragm ; lung and liver protruding, and 
 impregnated with several shot. 
 
 At first sight the case was thought and expected to be entirely hopeless. How- 
 ever, I was determined to do all that could be done, so I excised a great deal of lacerated 
 marginal tissue. I extracted all the pieces of bone obtainable, with numerous shot, 
 and shreds of clothing from lower left lobe of lung and liver; washed out the peritoneal 
 and pleural cavities with a warm bichlorid of mercury solution, 1 to 2500, but could 
 hardly control capillary oozing until, as a last resort, I applied hydrozone half diluted 
 with water, which admirably controlled all capillary oozing, and at the same time acted 
 as a strong disinfectant. 
 
 After a thorough cleaning and removal of lacerated tissue, I brought the edges 
 together and coaptated with silk sutures after inserting two drainage tubes; one under 
 the lower lobe of the left lung and the other under the liver from which I ascertained 
 there was absolute drainage. The external dressing was composed of iodoform gauze. 
 I prescribed internally brandy, belladonna and quinin and a bland but nutritious diet. 
 
176 
 
 On the third day, I found my patient restless and coughing with hematemesis and 
 fever. Upon this I removed the dressing and washed out the abdominal and thoracic 
 cavities with hydrozone in solution through the herein mentioned drainage tubes, and 
 reapplied another antiseptic dressing, from which time the case made a remarkable for- 
 ward progress until about the fifteenth day, when again the patient began to show some 
 internal disturbance that on the eighteenth day proved to be an abscess on a large scale 
 in left lower lobe of lung; this ruptured spontaneously three days later, leading to pro- 
 fuse purulent expectoration (undoubtedly a result of remaining shot, and small frag- 
 ments of bone) breaking down the patient's vitality very much for a time which, how- 
 ever, was soon repaired with quinin and iron, and now the patient is absolutely cured. 
 
 I merely report this remarkably unusual case to show what can be and often is 
 done to apparently hopeless cases. 
 
 NEW THERAPEUTICS IN HAY FEVER. 
 
 By ALEXANDER RIXA, M. D., of New York. 
 (Published by the Medical Summary of Philadelphia, Pa., for December, 1894.) 
 
 For a number of years I had the opportunity to pay particular attention to a case 
 of hay fever of the worst kind. The case was in my own family, a brother-in-law, who 
 is living in my house. He is forty-five* years of age, weight about 220 pounds, and is 
 a six footer. He contracted the disease about fifteen years ago, in Chicago, while 
 attending a camp meeting of the Knights of Pythias. Since then it has appeared every 
 year with the punctuality of good clock work, on the nineteenth of August. Early in 
 the morning, rain or shine, the sneezing commenced with the vehemence of a volcano 
 in full eruption, as the first symptoms of the disease. The eyes are usually swollen 
 and suffused in the inner canthus. There is a feverish, accelerated pulse, and a rise of 
 temperature to 101 5-10 or more. However, it is not my intention to give you the 
 etiology, pathology, symptoms, etc., of the disease; my object is to impart to you my 
 successful treatment. 
 
 I recollect my first experience with the case. I was called to the patient late in 
 the night, at the period of the hay-asthma. He returned from the White Mountains 
 where he used to spend the season, too soon, and got this attack. I found the gentle- 
 man standing at the foot of the bed holding on to the woodwork and breathing like an 
 aggravated bellows. Having no experience in the treatment of the disease, being my 
 first case I ordered a wash-bowl of hot water, in which I placed his hands. After a 
 short while the intense dyspnoea was relieved, the respiration easier, so that he could sit 
 down on the lounge. I now ordered a hot drink, hot water with brandy, almost half- 
 and-half, still keeping his hands in the warm water. After a while I had the hot drink 
 repeated, and in an hour he fell asleep on the lounge. The next morning he was sur- 
 prised at the efficacy of my remedy, which ga\e him several hours of rest. 
 
 Before I visited my patient I stormed all the hand-books on the subject, and took 
 along a vast amount of prescriptions, which were recommended by the great authors, 
 but they all failed to help the asthma. The paroxysmal attacks returned upon the 
 slightest change in the weather, and the asthma run its self-limited course, in spite of 
 all my remedies. That was six years ago. Since then I experimented with the good 
 man, who was a patient subject, with all available drugs and medicines. I cauterized 
 his nostrils, burned it with the thermo, and galvano cautery, brushed it, washed it, 
 pencilled it, and still the next year the hay fever returned with the same vehemence 
 and on the same day. Certainly I gave him relief, every year more, but to stop the 
 out-break of the disease, I succeeded but for the last tw r o years. 
 
177 
 
 My mode of treatment to prevent or abort the disease, consists of the following: 
 Three days before the onset of the disease, I commence to wash the inner nares with 
 a solution of Peroxide of Hydrogen (Marchand's), one part of hydrogen, and two parts 
 of boiled water. This year I used Hydrozone, a new preparation, which has the 
 double strength of the former, and is one of our best germ killers. I took one part 
 of Hydr ozone to three or four parts of water, according to the indication, three or four 
 times a day. I use a nasal douche holding one pint of the fluid. By this process I 
 suceeded to prevent the outset of the disease in all my cases. There is but very little 
 irritation of the nose present which causes the patient hardly any trouble. However, 
 for those most sensitive I have the following prescription: 
 
 1$ Acid, boracic, gr. viij. 
 
 Sol. cocaine hydrochlor, § ij. 
 
 (Five per cent.) 
 M. Sig. Use in atomizer. 
 
 The nasal symptoms, or the hay fever, proper, has a duration, according to my 
 observation, of about two weeks. After the expiration of this time, the hay asthma 
 sets in, and two days later the hay bronchitis follows. Up to the past year I have not 
 succeeded, in spite of all my efforts, to prevent this stage of the disease. Last year 
 and this season, however, I succeeded rationally with the following remedies: My 
 observations of former years taught me the lesson, that when this period approaches, 
 certain branches of the bronchial tubes get clogged up with tenacious mucous, which 
 none of our expectorants could dislodge in a hurry. ' I succeeded but once with a des- 
 perate dose of apomorphia to remove this obstruction and the asthma disappeared like 
 magic. However, in a short time it re-established itself and kept tight for some ten 
 days and sometimes to the end of the season, of course with more or less severity. 
 Considering this pathological condition, I started in right at the time when the hay 
 fever should appear with the administration of the following prescriptions: 
 
 "Bf Iodide of ammonia, 3 j. 
 
 Fl. ext. grindelia robusta, 3 iv, 
 
 Fl. ext. yerba santa, 3 iv. 
 
 Aq. q. s. ad., § ij. 
 M . Sig. A teaspoonful four or five times a day. 
 
 For the first week, while the second week I ordered to be taken every three hours 
 in teaspoonful doses adding yet the following medication: 
 
 3$ Terpin hydrate, 3 j. 
 M. Fiat capsule No. xii. Sig. Two capsules every two to four hours. 
 
 These medications acted like a charm and prevented the asthma during the entire 
 season. It seems to act in the way of preventing any accumulation of the discharges 
 in the bronchial tubes and branches. The last stage of the disease, or the period of the 
 bronchial catarrah, I have, thus far, not succeeded to avert, notwithstanding that there 
 is no accumulation of mucous. However, as it forms the mildest part of the disease, 
 the patient cares but little for the cough, which can easily be controlled by small doses 
 of codeine or morphia. Stimulating drinks are beneficial. Grogs and punches as well 
 as good wines are advisable, all through the different stages of the disease. The in- 
 testinal tract should be kept in order and late or heavy suppers prohibited. In some of 
 my milder cases patient attended to his business during the whole period, and was not 
 compelled to stay in the house like in former years. 
 
i 7 8 
 
 PELVIC PERITONITIS WITH RESULTING ABSCESS. 
 
 By F. P. LEFFERTS, M. D., Belvidere, N. J. 
 
 Read before the New Jersey Homoeopathic Medical Society, October, 1894. 
 
 (Published by The Hahnemannian Monthly, of Philadelphia, Pa., January, 1895.) 
 
 This case is presented not because of anything remarkable in the treatment or in 
 the results attained, but rather that pelvic abscess in not very common; to emphasize 
 the tediousness of such cases, and to refer to the local treatment which seemed of bene- 
 fit, and to see whether any can give suggestions in the way of an improved treatment. 
 
 Mrs. X , set. 43, the mother of one child twenty-three years ago. Has 
 
 been afflicted with endocervicitis with erosions of the os for years, for which a good deal 
 of local treatment has been used. This inflammation of the cervical canal has resulted 
 in thickening the body of cervix, and constriction of the external os. Has latterly had 
 thickening of right Fallopian tube and some enlargement of right ovary. 
 
 Suffered from the first attack of pelvic peritonitis five yeais ago, which came on 
 two weeks after a moderate dilatation of the cervix for the relief of the constriction of 
 the external os. Temperature was 103 during the course of this attack, and much 
 abdominal pain wa$ suffered, particularly in the right iliac region. This attack, lasting 
 four weeks ended in resolution. 
 
 Had a second attack of pelvic peritonitis two years ago, during which the symp- 
 toms were less severe and temperature more moderate, but attack was more tedious, 
 being confined to bed six weeks and terminating in resolution, but there remained peri- 
 toneal thickening posteriorly and more fixation of the uterus than after the first attack. 
 
 The last attack, which resulted in abscess, was ushered in on November 12th last, 
 after carriage rides on two successive days, when she was nearing her menstrual period. 
 Had two slight chills after retiring, followed by moderate fever and some pain in back. 
 
 Moderate fever continued until afternoon of November 15th, when she was seized 
 with a very hard and long continued chill, which was followed by a temperature of 
 104 1-5 . This temperature decreased in a few hours and perspiration was induced. 
 Temperature was 101 1-5 at 3 p. m. of the 16th. The temperature ranged from ioo° 
 to 101 for several days, accompanied by swelling and tenderness of the peritonaeum 
 surrounding the uterus, and fixation of uterus. As the inflammation increased the 
 uterus was pushed forward and formed a tumor above the pubes. The stomach was 
 very irritable, nausea coming on during sleep, which often resulted in vomiting. She 
 was fed on a liquid diet exclusively. There was very little pain in the abdomen. 
 Temperature did not rise above 102^° after the 15th of November. Pus formed and 
 fluctuation became apparent in the Douglas cul-de-sac and caused pain in lower part of 
 the back. There was considerable enlargement of the abdomen, showing the inflam- 
 mation to have extended over a large area. The accumulation of pus was so large that 
 fluctuation was not distinct. 
 
 On December 8th, while under the influence of ether, Dr. Seibert, of Easton, 
 evacuated the pus by an incision made as near to the rectum as possible per vagina. 
 The discharge of pus was very profuse and offensive. All went well for a few days, 
 when there was a rise of temperature and other symptoms indicating that the pus was 
 not having free exit. The operation was repeated on December 13th, and the incision 
 was made deeper and the opening made larger, when there was another profuse dis- 
 charge of offensive pus. The temperature decreased after this operation. Pus dis- 
 charged freely for a long while. Began using a weak solution of carbolic acid to wash 
 out cavity of abscess daily. The effect of this seemed to be very little judging from 
 the amount of discharge, but she grew stronger and improved in a general way. After 
 using injections of carbolized water for a month or more, began using a 25 per cent, 
 solution of Marchand's Peroxide of Hydrogen. This had more influence both in re- 
 ducing the amount of discharge and rendering it less offensive It was gradually used 
 
179 
 
 stronger until it was used full strength. It was found more effective used in this way. 
 The patieni continued to have some fever until four months had elapsed after the 
 operation, when she was allowed to be around her room some. Continued washing out 
 the pus cavity once daily for nearly five months, when the discharge was so moderate 
 that it was done only every second day, when we tried to hasten the healing by the use 
 of Glycozone, after first cleansing the cavity with Peroxide. The discharge became 
 more profuse while using this, consequently it was given up. 
 
 A solution of permanganate of potassium was also used for a time, but not with as 
 satisfactory results as from the Peroxide. Recourse was again had to the Peroxide, and 
 we began using it twice daily the latter part of May. Continued its use in full strength 
 twice daily for the next two months with the result of a gradual decrease of discharge 
 of pus and in the depth of pus cavity. During the latter part of July began using the 
 injections once daily, which was continued for two months, with the result of a grad- 
 ual decrease in the discharge. 
 
 Patient suffered a relapse on August 2ist owing to over-exertion, but was con- 
 valescent in ten days. We have tried again to see whether an injection every second 
 day -will not be sufficient, but find that the discharge increases. The cavity seems 
 about an inch in depth at this time and the discharge very moderate, but there are in- 
 dications that it will require weeks still before the cavity will be closed. Patient's men- 
 strual flow did not appear for three months after the beginning of the attack. For the 
 past four months she has been able to do light housework and take short walks, and a 
 few times has been in a carriage by driving on a walk. 
 
 A PRACTICAL THEORY AND TREATMENT OF 
 PULMONARY TUBERCULOSIS. 
 
 (Abstract from the Philadelphia Medical Times and Register of January 26, 1895.) 
 
 In a lengthy paper on the above subject, which doubtless marks a new era in the 
 study of tuberculosis, Dr. Frank S. Parsons, editor of the Medical Times and Register 
 of Philadelphia, Pa. , has shown that pulmonary tuberculosis is primarily due to a lym- 
 phatic stasis. That such stasis may be congenital or acquired. That the bacillus tuber- 
 culosis is to be regarded as a development, existing simply because a favorable medium 
 is presented, in the lymphatic stasis, for its cultivation. Bacilli may exert influence on 
 the disease as foreign bodies, similar to other foreign or waste elements, but are not 
 primarily causative. Their mere removal will not cure the disease, except as such removal 
 implies restoration of perfect excrementitial function and lymphatic circulation. That 
 tuberculosis implies atrophy of the pancreatic gland in the majority of cases, and the 
 dislike of fats by phthisical persons is the only symptom we can depend upon to show 
 that with the pancreas may lie the origin of this disease. 
 
 In the treatment of this affection Dr. Parsons calls attention first to the catarrhal 
 condition of the stomach, and considers that on the successful treatment of this condition 
 lies the curability of tuberculosis; for, only by removing chronic catarrhal inflamma- 
 tion of the stomach and intestines may the physician hope for proper assimilation of 
 food or medicines. 
 
 "To begin with," he says, "it will be found of advantage to insert a stomach tube 
 and thoroughly wash out that organ, teaching the patient the art of performing this 
 feat himself. The solution used for this lavage should be a 1 to 16 dilution of Hydro- 
 zone in warm water. I prefer the Hydrozone to the Peroxide of Hydrogen for the 
 following reasons: It is double the strength of the latter, its taste is not objectionable, 
 and it is more active in its therapeutic qualities. The solution should remain a few 
 minutes and then be syphoned out through the tube." 
 
i8o 
 
 : 'Hydrozone acts in two ways on the mucous membrane of the stomach chronically 
 inflamed, first, it clears the surface of excess of mucus, combining with the pus to form 
 carbon dioxide and nascent oxygen (both gases, and easily removed through the tube) ; 
 second, the oxygen of the preparation acts directly and favorably in stimulating the 
 mucous membrane and underlying glands, thereby favoring the circulation of the blood 
 and the performance of function." 
 
 Second to this method, for the treatment of catarrh of the stomach in tuberculosis, 
 is the internal administration of Hydrozone before meals. A dilution of one part to 
 thirty-two of water may be employed in this manner: a glassful of the mixture taken 
 half an hour before meals. If the dilution is too strong the gas generated will be dis- 
 tressing to the patient. On that account it will be frequently advisable to administer 
 Hydrozone diluted one part to sixty-four of water. Glycozone (c. p. glycerine treated 
 to fifteen times its own volume of ozone) may be used alternately with the Hydrozone 
 as a curative agent. 
 
 Then Dr. Parsons treats of the various methods necessary to build up the body, 
 the value of ozonized atmospheres and inhalations and the medicinal management of 
 tuberculosis, in a practical way. Anyone not having read this article should obtain it 
 from the publishers. It is now published in book form. 
 
 THE SUCCESSFUL TREATMENT OF RIGGS' DISEASE. 
 
 By H. E. LEWIS, M. D., of Burlington, Vt. 
 
 Published by The Vermont Medical Monthly, January, 1895. 
 
 A short time ago a member of my family, a gentleman of forty-five years of age, 
 was suffering with what was believed to be-Riggs' disease. There was no evidence of 
 ulceration, no swelling and little soreness to speak of, simply a very evident loosening 
 of the right incisors, and canine in the lower jaw. 
 
 Several dentists examined the teeth, confirmed the diagnosis, but declared that 
 there was not much to be done except to await developments. 
 
 A solution of Hydrozone was made in the proportion of one ounce of Hydrozone 
 to four of distilled water, and used as a wash. 
 
 The treatment commenced at 6:30 p. m., and the mouth was washed very thor- 
 oughly three times before retiring, some of the solution being retained in the mouth 
 each time for about a minute. The escape of gas showed plainly the presence of pus 
 though in small quantity. 
 
 In the morning there was a marked change; the teeth were much firmer, what sore- 
 ness had been present had entirely disappeared, and the test for pus gave no reaction 
 whatever. 
 
 A weaker solution (about one to twelve) was used every four hours all day, and at 
 night just twenty hours after commencing the use of the Hydrozone, the teeth were as 
 firm as ever and have been ever since. But in order to prevent a recurrence of the 
 trouble a weak solution of Hydrozone (about one to twenty-four) is used every morning 
 as a mouth wash. 
 
 From its great antiseptic qualities it is found to be an excellent wash for cleansing 
 the mouth of every bad taste, and rendering it pure and clean. 
 
i8i 
 
 THE PLASTER OF PARIS, WOOD, ALUMINUM, PAPER, 
 LEATHER AND STEEL SPINAL SUPPORTS. 
 
 By A. M. PHELPS, M. D., New York. 
 
 Professor of Orthopedic Surgery in the University of the City of New York and the 
 New York Post-Graduate Medical School and Hospital '; Professor of Surgery in 
 the University of Ver?nont; Surgeon to the City Hospital; President of the 
 American Orthopedic Association. 
 
 A discussion on Dr. L. A. Sayer's paper on the history of the plaster of Paris corsets, 
 read before the Academy of Medicine at the annual meeting-, January, 1895. 
 
 (Reprint from the New England Medical Monthly for March, 1894.) 
 
 I am exceedingly obliged for the courtesy which has been extended to me to dis- 
 cuss the paper of the evening. With nearly all of the points which have been raised in 
 this paper ] fully agree. And that the plaster or Paris corset, in my opinion, is one of 
 the best supports for Pott's disease of the spine ever devised, my experience verifies. 
 Without it, it would be difficult for me to conduct the, clinics and dispensaries of which 
 I now have charge. While it contains many defects and demerits, its good qualities 
 will more than over-balance the bad, because of this and because its application is 
 based upon accurate scientific principles I give it a most hearty endorsement. 
 
 I have used the plaster of Paris corset from its very first inception. I have watched 
 its growth from the time of its first application. I have seen it fail through bad ma- 
 terials and worse application. I have seen it bitterly fought against by its opponents, 
 receiving just and unjust criticisms. I have watched its methods of application gradu- 
 ally re-constructed, the materials from which it is made improved, and I am free to say, 
 after fourteen years of experience, that it is one of the best supports to be used in Pott's 
 disease of the spine the world has ever seen. The arguments which have been urged 
 against its use are most fallacious. That it does not support is argued by some of its 
 bitter adversaries. But when a patient is suspended in Pott's disease of the spine, and 
 a jacket properly adjusted, it is at once relieved from a condition of pain and suffering, 
 and to such an extent that any amount of pressure upon the shoulders does not produce 
 pain. I am convinced that something does support. If it is not the jacket, what is 
 it? A patient is suspended in lateral curvature of the spine. A plaster corset with 
 lacings is made to fit this suspended and straightened position. After the corset has 
 been adjusted the patient is three inches taller than before its application. If the corset 
 does not support, what makes him three inches taller? I have personally observed this 
 change in many cases, and no amount of argument advanced by the opponents of the 
 plaster of Paris corset can possibly disprove a clinical fact. One fact is worth more 
 than a thousand theories. The first book written on steam navigation by an English- 
 man, in which he attempted to prove that a steamship could not cross the Atlantic ocean, 
 was a failure, because after his book was printed, it was brought to this country by the 
 first steamship. And so it is with this argument — the patient is three inches taller with 
 the corset than he is without it. What makes him three inches taller? Support. It is 
 true that this corset becomes filthy; vermin invade it; but it is inexpensive, and can be 
 changed, if necessary, once a month. Much better this than the application of a steel 
 brace, that a mother and nurse can remove at liberty, handling the child in such a man- 
 ner as to produce trauma and injury to the diseased vertebra. The steel braces must 
 be frequently removed or else excoriations will occur. They excoriate and are uncom- 
 fortable if they give support, which is one of the strongest arguments against their use 
 in Pott's disease of the spine. 
 
l82 
 
 We are all agreed, I believe, that the best orthopaedic machine ever devised is the 
 human hand. Guided by an intelligence, it applies forces for the correction of defor- 
 mity, more delicately and perfectly than any inanimate object ever invented. Plas- 
 ter of Paris is applied to the deformity. While in the plastic state the hands mould 
 it to the correct position, and hold it there until hard or set. Can you not 
 see that now the plaster of Paris continues to uo the work exactly as the human 
 hand did it? In other words, plaster of Paris is effective as a brace of support 
 only in proportion to the amount of gray celcbral matter mixed up with it. 
 In the absence of the latter it is worthless. Proper materials must be used, else 
 the plaster will not set rapidly, H. B. Claflin & Company make a perfect hospital 
 crinoline, containing just the proper amount of sizing and no indigo. The White 
 Dental Mfg. Co., of New York, puts up the plaster in tin cans, hot from the oven. 
 These two materials make, when put together properly, a perfect bandage, that will set 
 in five minutes. This rapid setting of the plaster is necessary, because the hand holds 
 it to the corrected position of the deformity. This material, with the stockinet sold bv 
 Ford, completes the materials necessary to make a perfect corset. The crinoline costs 
 6c. a yard, the plaster of Paris 3c. a pound, and the stockinet 30c. a yard. A corset 
 for a child six years old should weigh not to exceed one and one-quarter pounds, and 
 for an adult two ajjd three-quarter pounds. This makes a support as light or lighter 
 than the steel brace, and it supports as the steel brace cannot. 
 
 What the profession wants is a proper brace, one that will apply extension and 
 relieve pressure, and also act as an anterior-posterior support when necessary trans- 
 mitting the weight of the body through the transverse and articular processes, thereby 
 relieving the bodies of the diseased vertebra, Such a support is to be found in the 
 plaster of Paris corset. It removes from the nurse or the mother the possibility of inter- 
 fering with the dressing. By its particularly broad, even surfaces, if properly applied, 
 it does not excoriate, ^nd can be worn for one cr two years with comfort. Springing 
 or bending the corset anterio-posteriorly m-kes it an anterio-posterior support. Thus 
 we see that 't combines the good qualities of all the steel braces that have ever been 
 devised, and one more, and that is extension for the relief of pressure. The corset 
 is heavy when improperly made, It is not so porous as we are led to believe. Its 
 thickness makes it bjectionable t' women. This has led me to substitute for it the 
 wooden corset, ihe paper corset, made from paper such as is used in making 
 paper boats, and the aluminum corset. These corsets combine all of the good 
 elements of the laster of Pari: corsets, and, in addition to these, lightness, durability 
 and thinness, which does not interfere with the clothing of women. 
 
 In clinical work and among the poor patients the plaster of Paris corset fills the 
 gap that nothing else can possibly fill. These patients, supported by steel braces, I am 
 informed, and I have observed almost invariably go on from bad to worse as regards 
 deformity. They certainly do in disease above the eighth dorsal vertebra. I feel sat- 
 isfied that in this class of patients the steel brace will be utterly abandoned in the very 
 near future. They certainly should be in lateral curvature o' the spine in any case. 
 Now, in private practice, I know of no better dressing for Pott's disease than a light 
 and thin plaster corset during the acute stage, * after which the corsets that I have 
 already mentioned, and which we use, will be found to be more comfortable and agree- 
 able to the patients. The difficulty with leather corsets is that they fail to support, 
 because they do not retain their shape — as a boot changes upon one's foot, so will a 
 leather corset change upon the body. The spinal support for Pott's disease of the 
 spine must be unyielding and firm. The paper corset first made by Vance is, in some 
 respects, a good one; but it is not desirable; it is difficult to make and it is somewhat 
 expensive. Since the time of Vance, other paper corsets have been made, according 
 to different formulae, but they are made of paper, and are, really, only modifications of 
 Vance's idea. The corset made by Weigel, of Rochester, N. Y., from the paper used 
 by printers in making their stereotypes, he claims, is durable and comfortable. The 
 corsets made for me by Horace Waters & Co., of Troy, N. Y., after the paper boat 
 
i »3 
 
 formula, have proved most satisfactory; but it is more bother to get tb~m than I care 
 to endure. Other corsets made in this city, similar to that made by Vance, are open to 
 the same criticisms as those mentioned. The Jurymast and corset, when adjusted so 
 as not to lift the head, but to draw it backwards, so as to transmit the weight of the 
 head through the transverse and articular processes, makes the most efficient dressing 
 that I know anything of, and particularly so in upper dorsal and cervical disease. So 
 far as I have observed the deformity does not increase, as is the case with p steel ap- 
 paratus, in diseases of the upper dorsal. 
 
 Dr. Say re has accomplished much by his constant and indefatigable hammering at 
 the profession towards introducing the idea of partial suspension and fixation in Pott's 
 disease of the spine, but the idea of parlial suspension and fixation in Pott's disease of 
 the spine carries us back almost to the traditions of medicine. Ambrose Pare, in 
 1579, used a fixation apparatus, made from steel, which is almost identical with the 
 aluminum corset which I am using. 
 
 In 1696, Von Nuck made a suspended apparatus which has been in almost con- 
 stant use in Europe since that time. It is very similar to that used to-day, bearing the 
 name of the distinguished author of the paper of the evening. In 1700, Heister 
 devised an anterio-posterior support, which, in principle, is the same as Taylor's brace 
 used to-day. It has been in use in England since that date. In 1754, Hauermann 
 made a modification of. Von Nuck's suspension apparatus, which seems, however, to 
 be more a change of material than principle. In 1764, Levacher devised the Jurymast, 
 which was attached to a corset made of steel and canVas, and was used precisely as the 
 Jurymast is used to-day. Portal, in 1772, slightly modified the Jurymast, but attached 
 it to a corset in the same manner. In 1825, De La Croix still further modified it by 
 adding the chin piece. Heine, in 1832, still further modified Levacher's Jurymast by 
 adding a chin piece and attaching it to a steel hip-band corset. These Jurymast sus- 
 pensions, taken together with the description of its use, are identical with those in use 
 at the present time. About sthe only thing that this generation can claim in regard to 
 spinal supporting is in the change of materials, using the principles laid down in the 
 last century and the beginning of the present. They have been in constant use since 
 then, and also the principles, as exemplified here to-night. I believe them to be correct. 
 
 I offer the aluminum corset, not as a substitute for many of the braces and corsets 
 now worn in the acute forms of Pott's disease and lateral curvature; I suggest it, 
 rather, to take the place of such braces in cases requiring permanent bracing, or in 
 individuals who are desirous of securing a support at any time which combines dura- 
 bility with lightness and comfort. So soon as a case of lateral curvature has been 
 arrested, or the greatest amount of benefit has been derived from treatment, the 
 aluminum corset will then be found a most agreeable, permanent support. The alumi- 
 num corset has these qualities to recommend it to the patient: 
 
 1. Lightness. 
 
 2. Durability. 
 
 3. It is thin and does not interfere with the form and clothing. 
 
 4. Being extensively perforated makes it the coolest and most agreeable of supports. 
 
 5. The patient can wear it during bathing. 
 
 An ordinary corset weighs from one to two pounds, depending upon the size. To 
 prevent cracking and to protect it from perspiration, it is covered with a waterproof 
 enamel, which is applied by heat. 
 
 The steps of its construction: Make a plaster form of the body; send this form 
 to the foundry and have a cast iron anvil made; polish this, and then at a certain tem- 
 perature the workmen will bend on to it two sheets of aluminum representing the two 
 lateral halves. The frequent heating and hammering together with the cylindrical 
 shape makes the corset almost as strong as steel. The two halves are hinged in the 
 back and closed with automatic clasps in front, which stop at any notch to accommo* 
 date itself to the body before and after eating. This corset completes my armamen- 
 tarium in cases requiring spinal supports, viz.: 
 
184 
 
 i . Plaster of Paris corsets for acute Pott's disease. 
 
 2. The Wood corset for lateral curvature, and cured or convalescent cases of 
 Pott's disease. 
 
 3. The Beely corset for mild forms of lateral curvature, particularly in girls. 
 
 4. The aluminum corset for permanent bracing; and, lastly, 
 
 5. The celluloid corset, which, in a way, takes the place of the aluminum. 
 
 I visited Dr. Waltuck, of Odessa, Russia, in 1888, and from him personally I 
 learned the details of making the Wood corset, after several days of hard work. I 
 found that Professor Lorenze, of Vienna, has been using the corset for some time 
 and was much pleased with it. At that time, however, many of the corsets proved 
 to be inefficient on account of errors in their construction. We have used the corset 
 constantly since that time, and with the modifications which we have made, it is one of 
 the most efficient, comfortable and suitable braces that I know of. 
 
 It has been with the greatest difficulty that we have succeeded in getting the proper 
 materials for constructing the corset, and even now it is cheaper and better to import 
 the wood from Vienna. The spruce timber which grows there makes a better shaving 
 than any timber that we have attempted to use which grows in America. It is tougher 
 and works better with the glue. 
 
 An impressioruis made of the body with plaster bandages. This mould is filled 
 with plaster of Paris, which makes a perfect cast of the body. The corset is now 
 made over this cast. The cast is changed somewhat in shape "to make the form even 
 straighter than the body in the suspended position. 
 
 Corsets made according to the method followed at the time I observed the process, 
 were not as perfect as they should be. The slightest excess of glue moistened by the 
 perspiration of the body coming in contact with the shirt or the skin, was exceedingly 
 disagreeable. The perforations in this corset weakened it, and allowed the glue to 
 exude during perspiration. 
 
 To obviate all this I had the corset perforated, in which perforations eyelets were 
 punched. A special machine facilitates the perforating and the punching of the 
 eyelets. The lacings are stitched on. Trim the top and bottom with kid. The entire 
 corset is shellaced inside and outside with two or three coats of shellac, which render 
 it impervious to moisture, the eyelets ventilating it perfectly. The improvements 
 which I have made in the corset consist in shellacing it on the inside and outside and 
 putting in the eyelet holes and eyelets, which add to the strength of the corset and 
 ventilate it perfectly. 
 
 An ordinary corset for an adult weighs from one to one and one-half pounds. 
 They are very durable, very comfortable to wear, and thus far I believe that they are 
 the best spinal braces yet devised. 
 
 I will add, by way of parenthesis, that the corsets, when completed, can be cov- 
 ered with silk or with stockinet, or they can be left in the linen finish. 
 
 A word or two in regard to abscesses occurring in Pott's disease of the spine. 
 The orthopsedist is inclined to trust them to nature, as he does in abscesses of joints. 
 Pus living in contact with the diseased vertebra destroys them, and what was at first a 
 small focus of disease, in a few weeks by this macerating process becomes an extensive 
 disease, involving frequently the entire body of the vertebra. 
 
 We never aspirate such abscesses. So soon as they are detected they are at once 
 incised and thoroughly irrigated with a solution of bi-chloride of mercury, I to 2,000, 
 after which they are washed thoroughly with Hydrozone until foaming ceases. They 
 are then either packed with gauze saturated with iodoform, § ss, glycern, § iv. Small 
 foci of diseases are curetted. Abscesses appearing at Poupart's ligament are incised 
 and treated the same as other abscesses, only a half-inch drainage tube is passed up to 
 the seat of disease on the end of a strong probe. This is the sewer through which pus 
 can discharge and not burrow through the tissues. All abscesses should be opened, 
 excepting when something communicates, then open them. 
 
i8 5 
 NATIONAL THERAPEUTICS OF CHOLERA INFANTUM. 
 
 By GUSTAVUS BLECH, M. D., St. Louis. 
 Published by The New York Medical Journal, March 2, 1895. 
 
 No strict rules can be given for the treatment of disease. It is for this reason 
 that so many physicians say we do not treat a disease, but we treat an individual. 
 True enough, we treat the individual, but what we have most of all to consider is the 
 disease. The individual will dictate us alterations and modifications in our treatment. 
 
 A general plan of treatment may be outlined, however, and I will try to do so in 
 regard to one of the most fatal diseases of babyhood — cholera infantum. 
 
 There is a certain philosophy in therapeutics which I would frame in the three 
 following rules: First, remove if possible the disturbing causes; second, treat symp- 
 toms which per se are liable to endanger the life of the patient; and third, sustain 
 vitality. 
 
 As said before, the therapeutics, which is based upon the aetiology and pathology 
 of a given case, is the only one to be employed. 
 
 Now, the aetiology of cholera infantum is not so obscure as asserted by a good 
 many authors. Whether or not of microbic origin, one thing is sure — it is due to a 
 chemical decomposition of food, causing an inflammatory condition of the digestive and 
 alimentary canal. 
 
 Clinical experience, furthermore, shows that this disease is of a grave character, 
 producing death in a large proportion. Heather se is not the immediate cause of this 
 disease, but it influences its course considerably. Therefore, gastric or intestinal dis- 
 turbances in summer demand a closer attention than those which occur during the 
 colder season. Cholera infantum is a disease met even in the palaces of the rich, 
 although not so often as in the tenement houses of the poor, which fact proves again 
 that bad air, filth, and lack of ventilation are also of a predisposing influence, as well 
 as an obstacle to a quick cure. The mortality in the tenement houses is larger than that 
 of the richer parts. 
 
 If we consider the aforesaid, we shall first of all, as regards the treatment of this 
 disease, have to restrict diet. 
 
 As soon as called to a case of cholera infantum, prohibit for the first day any food 
 whatever. Mothers have no right to nurse the little patient either. Strict instructions 
 must be given in that direction, because the timid mothers are often inclined to quiet 
 the crying babies by putting them to the breast. 
 
 Remedies are of very little value. Beginning with calomel, salol, and all the 
 newer antiseptics, finishing with subnitrate of bismuth — they have all proved a failure, 
 for none of them work quickly enough. 
 
 The treatment as outlined by Dr. Elmer Lee, of Chicago, in his cases of typhoid 
 fever, proved a success in my hands during last summer, and under this treatment I 
 have lost only one patient out of twenty-three, while the monuments of my skill exer- 
 cised during the year 1893 are decorating the cemeteries of the State of Connecticut. 
 
 So far as I knew, the best antiseptic (which has also a strong tendency to reduce 
 local inflammation) was peroxide of hydrogen (medicinal) until hydrozone was used by 
 me. Hydrozone being twice as strong as Marchand's peroxide of hydrogen (for eco- 
 nomical reasons), the latter drug is preferred by me. This remedy can be adminis- 
 tered internally as well as externally. 
 
 I add a tablespoonful of hydrozone to a pint of water for washing out the stomach. 
 The vomiting ceases after the first washing as a rule. If necessary, this procedure can 
 be repeated. If the vital power of the little patient is not too low it can produce no 
 harm. But in every case, no matter how far advanced, I do not omit an irrigation of 
 the bowels, for which purpose I use a soft rubber catheter attached to a common bulb 
 syringe. The catheter is introduced as high in the colon as possible. It is unneces- 
 
1 86 
 
 sary to say that the water must first be sterilized. I do not agree with Dr. Lee in 
 using hot soap water. On the contrary, I use cold water, and add to each quart about 
 two ounces of hydrozone. The improvement after the first or second irrigation is 
 marked. If necessary, these irrigations can be repeated every two hours. 
 
 Among other remedies there are only two to be employed, morphine and strych- 
 nine. Both ought to be administered hypodermically. Their indication is too well 
 known and they are about all we need. No antipyretics should be given. If the fever 
 is very high and if the irrigation of the bowels does not reduce it, the whole body 
 should be washed with alcohol. 
 
 The diet for the next twenty-four hours should be very light indeed. Sweet, 
 strong Russian tea is all I allow. 
 
 Each individual case will teach us when food can be allowed again. 
 
 Since the adoption of this mode of treatment I have met with the most remarkable 
 success, and no honest practitioner should refuse it a trial. 
 
 ii N. Broadway. 
 
 A GLANCE AT THE MANAGEMENT OF CAPILLARY 
 BRONCHITIS IN INFANTS. 
 
 By DOUGLAS H. STEWART, M. D., New York. 
 
 Physician to Harlem Dispensary. 
 
 Published by Times and Register, of Philadelphia, Pa., Feb. 17, 1894. 
 
 The treatment has for many years been emetics, ammon. carbonat. and ammon. 
 chlor. Of the emetics, syrup of ipecac is time-honored, and deservedly so; but have 
 you never ordered this valuable remedy and on returning found your patient worse, and 
 not a sign of vomiting ? My experience of this preparation as made or kept in the 
 average apothecary shop is far from comforting, one-half a teaspoonful of one sample, 
 acting as an emetic, while a teaspoonful of another only made the little child nauseated 
 and depressed. 
 
 It has seemed wise to me not to tell the nurse what I was giving at all, but to order 
 syr. ipecac, two ounces, a teaspoonful to be given every twenty minutes until vomiting 
 or purging, then stop; and I have generally gone back to smiling faces, instead of sol- 
 emn remarks about the medicine not acting. Whatever is given in excess of the re- 
 quirements will be either vomited or purged. 
 
 Children under three yeais of age do not expectorate, but we often notice quite an 
 amount of mucus or muco-pus unloaded from the bowels. The mother will often make 
 an anxious complaint that the child does not "raise anything," but a prompt statement 
 that little children never do, and an exhibition of the slimy passages contained in the 
 diaper, will go far to reassure her both as to her fears and your knowledge of the case. 
 
 The ammonium compounds I have discarded — as the only real effect I could ever 
 find from them in the acute stage was that they made my patient sick "at the stomach." 
 Of course, I am a heretic, and deserve boiling in oil for such a statement, when all the 
 prominent physicians of the early part of this century set the seal of approval on the 
 chloride and carbonate — still, this is a clinical paper, and I can only give the results of 
 experience, and not of a diffusible, stimulant, expectorant theory, and, after using them 
 till you have lost many cases, face about and give one teaspoonful every hour of the liq. 
 potassa citratis or mist. pot. citratis — a simple refrigerant diuretic — agreeable to child, 
 lowering the temperature and having a most soothing effect on any acute inflammation. 
 
i8 7 
 
 Let the expectorants alone. They only increase the activity and congestion of the 
 mucous membrane. 
 
 Externally, if the patient is strong, flaxseed poultices; if weak, no poulticing at all 
 — but turpentine "liniment" rubbed in thoroughly every three hours, from the chin to 
 the pubes in front and from neck to coccyx behind. 
 
 My patients have all their clothing removed; the bandage generally worn since 
 birth, especially. Have the abdomen free — this is the first commandment. Then a 
 loose cotton or muslin night gown put on, and over this a blanket — all very loose — 
 pinned at the neck and down the front, if necessary, with large safety pins. Don't put 
 the patient next the blanket; some skins will not stand wool next them. 
 
 The sick room should be kept at seventy-five degrees — a thermometer is indispen- 
 sable. On a stove, or over an alcohol flame, boiling water, and into the kettle a tea- 
 spoonful of turpentine poured on the steaming water every hour, so that the case is con- 
 stantly in an atmosphere of steam and the steam carries minute particles of turpentine. 
 
 Should a case prove a bad one, or not making the progress I could wish, the 
 blanket is opened and handkerchiefs wet with dilute alcohol or whisky, are spread over 
 the chest and abdomen every fifteen minutes. 
 
 The parents will not permit cold water packing, because they fear the child will 
 "take cold." Alcohol or whisky is quite a different thing in their eyes from water, and 
 they know that heat destroys the strength and virtue of spirits, and they approve of 
 spirits, externally at least, if not in every other way; therefore they will usually gladly 
 second cold liquor compresses. 
 
 Keep up the packing until you find a very decided improvement — as you will if it is 
 not too late. An improvement in breathing, in cyanosis and dyspnea, and a fall of from 
 one-half to one degree in rectal temperature. 
 
 Then rub the child well with dry towels and replace blanket and gown. 
 
 Should any signs of collapse appear, dry heat or a hot bag will offset them. 
 
 The alcohol or whisky acts in four ways. First, some is absorbed by skin, and 
 breathed in as a vapor. This stimulates. Second, the reaction from the cold brings 
 the blood to the surface and away from the lungs. This relieves congestion. Third, 
 the cold stimulates the heart and makes the patient take deeper inspirations. Fourth, 
 it lowers the temperature. 
 
 After this I give from ten to twenty minims hourly of peroxide of hydrogen in the 
 following non-oxidizable mixture: * 
 
 1$ Marchand's sol. Hydrogen Peroxide, 3 v-x according to age. 
 
 Glycerine § j . 
 
 Aq. q. s. ad. § iv. 
 M. Sig. One teaspoonful every hour as directed. 
 
 This is supposed to supply some of the lacking oxygen to the blood and it does 
 seem, from its effect, as if the stomach did take it up. 
 
 It will be noticed that I have written "Marchand's Solution" — well, if your have 
 used any other kind for this purpose, I am sure you don't need my arguments to con- 
 vince you that you were disappointed. Also please remark that there is nothing to 
 spoil the peroxide in the above mixture. 
 
 In conclusion watch the urine carefully, especially look out for suppression. You 
 will scarcely find it when giving potassium citratis — otherwise you may, and when you 
 relieve the suppressed urine you will often relieve the dyspnea. 
 
 * A mixture of glycerine with Peroxide of Hydrogen will not keep for more than three days. Con- 
 sequently, it must be made fresh every three days. 
 
 See article headed "The Therapeutics of Glycozone" by Dr. Cyrus Edson, page n. 
 
i88 
 
 After the fever is nearly or quite gone and the cough only is left, I generally start 
 my expectorants, and have found the following commonplace mixture served me well — 
 combined with our standby oleum morrhuae emulsion q. s. ad. lib. 
 
 1$ Ammon. Carb., gr. xx. 
 Yin, Ipecac, 3 j, 
 Syr. Senegce, 3 iv. 
 Glycerini. 3 iv. 
 Vini Xerici, 3 iv. 
 Syr. Tolu, § j. 
 Aq., q. s. ad., § iv. 
 M. Sig. A teaspoonful every two or three hours until cough is relieved. 
 
 I£ Syr. Hypophos. Co., § ij. 
 Syr. Calc. Lactophos., § ij. 
 M. Sig. A teaspoonful foUr times a day until relieved. 
 
 NOTES ON THE TREATMENT OF DIPHTHERIA. 
 
 Read before the Orleans Parish Medical Society, January 13, 1894. 
 
 By. ARTHUR WEBER, M. I)., New Orleans, La. 
 
 (Reprinted from the New Or leans Medical and Surgical Journal, February. 1S94.) 
 
 This brief report of the following eighteen cases of diphtheria may be of some 
 interest on account of the treatment adopted in each being almost identical. The 
 majority of them occurred in poor and ignorant families whose sanitary surroundings 
 were abominable. A few of the parents were hardly endowed with sufficient intel- 
 ligence to properly carry out the instructions of the attending physician. These cases 
 were the longest under treatment. 
 
 Having had- a belief that diphtheria was a local disease, with constitutional symp- 
 toms produced by the absorption of toxic material, it has been my aim to combat it at 
 the point of infection, and by destroying the nest of the bacilli to remove the source of 
 the poison. 
 
 • This theory has, to my mind, been proven in the success attending these cases. 
 For as soon as there was an improvement in the local development of the disease there 
 was a corresponding improvement of constitutional symptoms. By this I do not mean 
 to say that we should depend entirely on local treatment, for no cases ever come under 
 our care where the effect of the absorption of the poisonous tox-albumen is not notice- 
 able, and it is necessary to adopt some general plan of treatment to destroy the effect 
 of this effete material in the blood. 
 
 The following is the treatment adhered to in all cases coming under my attention. 
 The throat is sprayed every twenty minutes during the day and every hour at night 
 with pure Peroxide of Hydrogen (Marchand's) until the membrane has disappeared. 
 After the removal of the membrane has taken place the spray is continued every two or 
 three hours for several days, when the patient is discharged. Whenever the pure per- 
 oxide causes too great irritation of the throat it should be diluted with water and slightly 
 alkalinized. One to three is about the weakest solution I have found useful. 
 
 At each sitting it is necessary that the parts involved should be well attended to; 
 never introduce the nozzle only two or three times, but continue it for a minute or two, 
 permitting the child to breathe after each application. Under such treatment you will 
 be gratified to find the membrane dissolve, and often come off in pieces. 
 
 For systematic treatment at the commencement one-twentieth grain doses of calo- 
 mel, combined with a grain of bicarbonate of soda, is given until there is an increase in 
 
189 
 
 the salivary secretion and production of four or five characteristic calomel stools, which 
 usually takes place in twenty-four to forty-eight hours. The following prescription, a 
 teaspoonful every two or three hours, is given after the action of the calomel. 
 
 R- Tinct. ferri chloride, 3 iss. 
 Glycerine. 3 iv. 
 Aq.,lij. 
 If at any time during the attack there is any indication of heart failure, very small 
 doses of strychnia and digitalis are given. 
 
 For food, brandy, milk, milk toddies, egg-nog, white of egg beaten up in water, 
 the juice of meat broiled very rare, cocoa and Ducro's elixir are ordered at regular inter- 
 vals, 
 
 The results of the above treatment can be seen in the following eighteen cases: 
 
 1. Ada W., 3 years; membrane disappeared in five days; under treatment twelve 
 days; recovered, 
 
 2. Edna D., 2 years; recovered in twenty days; membrane disappeared on fifth 
 and reappeared on the eighth day. Slight paralysis. 
 
 3. Ralph E. D., 2 years; recovered; membrane lasted seven days. 
 
 4 and 5. Mrs. R. E. D., and baby, recovered; membrane three days. 
 
 6. Annie E. W., 6 years; recovered nineteen days; membrane in throat and nose; 
 a very severe case; followed by paralysis of palate. 
 
 7. Mary W., 9 years; recovered in twenty days; membrane twelve days; paralysis 
 of palate. 
 
 8. Tillie M., 10 years; died on the ninth day; there was sloughing of the palate. 
 The child was given a glass of cold beer and died thirty minutes after. 
 
 9. Alfred M., 3 years; recovered twenty-five days. 
 
 10. Henry M., 1 year; recovered twenty-two days. 
 
 Ho Bertha W., 8 years; recovered twelve days, paralysis of palate. 
 
 12. Baby W., 1 year; recovered six days. 
 
 13. William W., 3 years; recovered twelve days; membrane seven days. 
 
 14. Thomas W., 5 years; recovered fourteen days; membrane six days. 
 
 15. Lizzie S., 7 years; recovered ten days; membrane four days. 
 
 16. Louis M., 6 years; recovered thirty-two days; thrice the membrane disappeared; 
 paralysis of palate. 
 
 17. Daniel R., 5 years; recovered seventeen days. 
 
 18. Charles H., 3 years; recovered eight days. 
 
 In none of the patients, with the exception of case 8th, did the temperature rise 
 above 103 ° nor last longer than five days. In case 8th the temperature rose to 106 °. 
 There was gangrene of the throat at the first visit; sloughing of the uvula and parts of 
 the palate occurred on the fourth day. 
 
 Cases 7th, 8th, 9th, 5 10th, nth and 13th were covered with a diffuse erythema, 
 which I at once thought was measles. 
 
 SCARLET FEVER. 
 
 By A. G. CALDWELL, M. D., of Ballardville, Ky. 
 
 (Published by the Louisville Medical Monthly, May, 1895.) 
 
 During the spring and summer of 1894, I treated twenty-nine cases of scarlet fever, 
 without a death or a serious sequela. These cases ranged in severity from mild to 
 malignant. 
 
 Treatment: For the mild cases 1 gave a simple fever mixture; kept the bowels and 
 kidneys active and anointed the entire body with "sweet oil," three times a day, to 
 
190 
 
 allay itching, and to prevent drying up and diffusion of scales. Kept patient on a light 
 diet. 
 
 When the fever arose above 103° I put patient in bath of temperature ioo°, and 
 gradually reduced water to 75 . This promptly brought down the fever, quieted ner- 
 vous symptoms, and refreshing sleep followed; anointed the entire body three times a 
 day with carbolized sweet oil; this allays the intense itching, prevents scales from drying 
 up, and reduces the danger of contagion to a great extent; gave whiskey and strychnia 
 to support the heart; cascara sagrada to keep the bowels open; infusion of digitalis 
 leaves and acetate of potash to keep kidneys active and prevent nephritis. Kept the 
 patient on exclusive milk diet, and during convalescence gave elix. gentian and tincture 
 chloride iron. For throat and nasal passages, sprayed three times a day with Peroxide 
 of Hydrogen (Marchand's). 
 
 CHOLERA INFANTUM. 
 
 By I. N. LOVE, M. D., St. Louis. 
 
 (Published by The Medical Mirror, June, 1895.) 
 
 It is well for us to remember that every case of cholera infantum has prior to the 
 initiation of serious and dangerous symptoms, a history of one or more days of general 
 indigestion, manifested by diarrhoea and sometimes occasional vomiting. We should 
 emphasize in the most positive way upon the minds of mothers the importance of giving 
 attention to these primary deviations from good digestion to the babe. After the 
 advanced state or definite state of cholera infantum has arrived, the conditions are des- 
 perate and often but little can be done. 
 
 To be brief, the best way to cure cholera infantum is to prevent it or check it in 
 the first stage. Given an artificially fed child with a considerable degree of summer 
 heat and the chances of fermentative changes occurring in utensils for feeding or the 
 food supply, we have the conditions favorable to the development of cholera infantum. 
 If the child be teething, its nervous system on edge, as it were, all sorts of reflex dis- 
 turbances present in consequence, the conditions are doubly favorable for the disease. 
 
 It goes without saying that the gums cannot safely be ignored. While we have 
 escaped from the old time slavish thought that every deviation from health in the teeth- 
 ing child was due to the teething yet we should not go to the extreme of ignoring the 
 thought which is the correct one that an erupting tooth renders the child more susceptible 
 to all kinds and conditions of disease, particularly those connected with the digestive tract. 
 The condition of the tongue as expressive of the state of the stomach should be grasped. 
 
 Every evacuation from the bowels should be carefully scrutinized with a view to the 
 determining of the condition of the alimentary canal. 
 
 All the newer remedies may pass before us in review but we can find among them 
 none that will equal the old time calomel in very small doses. Prolonged trituration of 
 calomel unquestionably emphasizes its effect. The twentieth of a grain together with 
 one grain of the bicarbonate of soda, is usually sufficient, and this should be given as 
 often as once in two hours on the first appearance of indigestion whether diarrhoea be 
 present or not. Frequent vomiting with marked evidence of a fermentative stomach can 
 be relieved more promptly by washing out of the same than in any other way. The use 
 of a large size male catheter attached to a fountain syringe, using a pint of water prefer- 
 ably at the temperature of the body, to which has been added four tablespoon fuls of 
 hydrozone. I have repeatedly found after this procedure nothing further required to 
 calm the riotous stomach. A diarrhoea accompanied by much tenesmus, great fre- 
 quency in evacuation, small unsatisfactory stools mingled with mucus and blood can 
 be relieved in a very satisfactory manner by the flushing out of the bowel. The large 
 
I 9 I 
 
 size, soft rubber catheter referred to above, is ample. A pint to a pint and a half of 
 water, the temperature dependent upon the temperature of the child. If there be a very 
 pronounced fever present, cool water may be very satisfactorily used. I find a pint to 
 a pint and a half usually sufficient and add thereto about two ounces or four table 
 spoonfuls of hydrozone. 
 
 It is my custom to introduce the catheter about two-thirds of its length into the 
 bowel and in this connection permit me to suggest that every household syringe should 
 have accompanying it a large soft rubber male catheter for use in the enema. The hard 
 rubber nozzle on the end of the average syringe is harsh and unsatisfactory. It does 
 not reach in many instances, on account of the timidity of the mother and the difficutly 
 of its introduction, beyond the sphincter and this accounts for the frequent failures in 
 giving injections into the bowels. The soft rubber catheter referred to, can be intro- 
 duced much more readily, can do no harm and from its length the fluid can be intro- 
 duced high up in a manner to give satisfaction. The in jections described above, of pure 
 water (and I prefer distilled water for this purpose whether washing out the bowels or 
 the stomach. The Crystal Water Co., of St. Louis, furnishes a double distilled water 
 which is now in general use in this city and this is especially acceptable) with the addi- 
 tion of one or two ounces of Hydrozone to each pint, I have repeatedly found after such 
 washing out of the bowel a complete rest from frequently repeated or straining actions, 
 the patient often going the entire night without being disturbed by a movement from 
 the bowels. 
 
 ACUTE GLOSSITIS. 
 By MORTIMER H. BROWN, M. D., Holcomb, III. 
 (Published by The Alkaloidal Clinic, of Chicago, 111. July, 18.95.) 
 
 May 26th I was called to see W. B., German, aged 50 — worker among sheep — 
 with the following history: General health good except that last winter he had several 
 boils; does not drink or use tobacco to any extent. On the 24th day of May he noticed 
 a small pimple on the left side of his tongue; on the 25th he had a violent headache, a 
 profuse sweat and pain and dryness in the throat and tongue — pimple slightly larger 
 and painful. Towards evening he placed a small piece of alum on his tongue and went 
 to bed. In the morning, the 26th, his wife noticed that he could not speak and that his 
 tongue was greatly swollen and protruded from his mouth interfering with res- 
 piration. 
 
 I was at once summoned and found his tongue filling his mouth and protruding 
 about two inches out of it, of a dark purple color, very offensive odor, glands about the 
 jaw and neck swollen, and his temperature 104, with profuse sweats and chills. As the 
 dyspnea was increasing rapidly, I at once made a free incision into the tongue and let 
 out about six ounces of very dark blood, and started the following treatment: Ice bags 
 to neck and throat, pieces of ice on tongue and a spray of Marchand's Peroxide of Hydro- 
 gen medicinal every half hour, with veratrine for the fever. At my evening visit the tongue 
 was about the same, temperature 102, sweats and chills worse. ] thought, after obtain- 
 ing the above history, that there was probably infection from the sheep and so adopted 
 means to prevent general septicemia from absorption, giving calcium sulphide in full 
 doses with tincture of chloride of iron — ten drops in a teaspoonful of glycerine every 
 four hours — with alcohol baths and veratrine for the fever. On the 27th there was 
 marked improvement; tongue was less swollen, temperature 99, glands not so large and 
 he could speak some. He complained of the left side of the tongue; had an ulcer on it 
 the size of a bean. I scraped it and dressed it antiseptically every half hour. On the 
 following day his temperature was 103, with some sweats and chills and same headache 
 
19 2 
 
 with diarrhea, but the next day the above symptoms had left him and he was better in 
 all respects. On the 30th improvement still continued. The ulcer was healing, the 
 glands were not so large but still very tender. Up to this time he was fed through a 
 rubber catheter attached to a funnel, but on the following day he could take food 
 naturally. The tongue rapidly returned to its natural size, the ulcer granulated over, 
 the glands increased in size and the tenderness was relieved by a fifty per cent, iodine 
 cerate with iodide of lime internally, and on June 4th he was discharged. 
 
 What do you think caused the rapid swelling of the tongue? Was it the alum or 
 is there a disease among sheep of that nature? He has worked among from ten to fifteen 
 thousand sheep annually for several years. I think the calcium sulphide prevented 
 general suppuration as he was on a fair road to septicemia. 
 
 POISON IVY. 
 
 By R! M. CLARK, M. D., of Ada, Ottawa Co., Kas. 
 (Published by the Medical Arena, of Kansas City, Mo., August, 1895). 
 
 A boy, Woods, ret. 12 years, had been fishing along the banks of 
 
 a small stream in May, and became severely poisoned about the head and face. When 
 brought to me for treatment, a couple of days later, the case presented the following 
 symptoms. 
 
 Head and face covered with large vesicles which broke and oozed a watery and, in 
 some places, as around the eyes and ears, a yellowish muco-purulent substance. The 
 left side of the head and face had been the worst poisoned and the eye of that side was 
 swollen completely shut and highly inflamed. The nose discharged a yellow, offensive 
 matter and the pain and itching about the head and face was intense. In her anxiety 
 to relieve the boy's suffering the mother had made an application of moist baking 
 soda, which, from its strong caustic properties of course, only increased the itching and 
 aggravated the matter. 
 
 I had in previous years treated other members of this family and knew them to be 
 highly susceptible to the influence of poison ivy (rhus radicans) so much so that one be- 
 came poisoned a distance of 200 feet, while passing timber in the spring, with the wind 
 blowing from the woods. On learning this circumstance I had cautioned the parents 
 and warned them not to allow their children around the woods, especially in spring time, 
 when the sap flows most freely in the vine and the poison is easiest of communication. 
 The caution had not been heeded. 
 
 Treatment: I bathed the face with Marchand's medicinal Peroxide of Hydrogen dil- 
 uted with three parts of warm water, until the itching had almost subsided and the alka- 
 line application was thoroughly removed; thenl carefully sprayed the nostrils, removing 
 considerable yellowish, offensive matter and instilled a few drops of atropine in the 
 congested eye. I gave the mother a half-pound bottle of the medicinal peroxide 
 (Marchand's) with instructions to bathe her boy's head and face every hour with a solu- 
 tion prepared three parts of warm water to one part H 2 O s (medicinal) and internally 
 I ordered given every hour, five or six drops of sanguinaria 3X. The result was a com- 
 plete cure in two days. 
 
 I am of the opinion that the small percentage of acid necessary to prevent decom- 
 posure of the hydrogen peroxide (Marchand) was sufficient to neutralize the caustic 
 effects of the alkaline application and materially aided in the cure. 
 
193 
 TREATMENT OF ASIATIC CHOLERA. 
 
 By ELMER LEE, A. M., M. D., Ph. B., New York. 
 
 Read in the Section on Practice of Medicine, at the Forty-sixth Annual Meeting of the 
 American Medical Association, at Baltimore, Md., May 7-10, 1895. 
 
 (Reprinted from the Journal of the American Medical Association, June 22, 1895.) 
 
 Spasmodic cholera — called also malignant, epidemic, Asiatic, Indian, blue, and 
 pestilential cholera — is generally epidemic, though not contagious. The first symptoms 
 are generally experienced during the night, sometimes beginning with a light general 
 uneasiness and moderate diarrhea; at other times the symptoms come on violently and 
 follow each other rapidly. In fatal cases death usually occurs at some period be- 
 tween six and twenty-four hours; in a few fatal cases the patient lingers two or three 
 days. The ordinary course of symptoms are more or less diarrhea; the discharges at 
 first feculent, but soon presenting the appearance of rice-water or gruel; there are flying 
 pains, or sense of coldness in the abdomen, as if purgative medicine were about to 
 operate; the countenance is pale; there is nausea, vomiting, prostration of muscular 
 power and nervous agitation; cramps in the legs, arms, loins and abdominal muscles, 
 more or less severe; small, weak pulse, intense thirst, and urgent desire for cold water; 
 in most cases cold, clammy skin; all these symptoms may appear successively or almost 
 simultaneously. In some cases the premonitory symptoms exist for eight or ten days; 
 and sometimes the patient is prostrated at once. When the disease comes on suddenly 
 the cramps usually begin in the fingers and toes, rapidly extending to the trunk; the 
 eyes are sunken and surrounded by a dark circle; there is vomiting and purging of 
 white matters mixed with flocculi; the features are sharp and contracted; the expres- 
 sion of the countenance wild and confused. The face, extremities, and often the whole 
 surface of the body manifest a varying intensity of a leaden, bluish or purplish hue; the 
 extremities sunken, the nails blue, the pulse thready or wholly imperceptible at the 
 wrist, arm, axilla, temple or neck; there is great restlessness, incessant jactitation, 
 severe pain in the epigastrium, loud moaning or groaning, difficult and oppressed 
 breathing; difficult inspiration, with short and convulsive expiration; voice hoarse, 
 whispering, or nearly suppressed and plaintive; the tongue is white, cold and flabby, 
 and the external temperature often sinks below 80 degrees; convulsions recur at short 
 intervals, or a constant tremor exists; The secretions of bile, saliva, tears and urine 
 are entirely suppressed, and a cadaverous odor exhales from the body. The patient 
 retains his faculties to the last. 
 
 Some of the symptoms may be disproportionately severe, or may be entirely absent. 
 Those usually regarded as pathognomonic are: watery dejections, blue appearance of 
 the countenance of surface, thirst, coldness of the tongue, and pulselessness at the wrist. 
 
 The foregoing description of the symptoms of cholera is indicative of the nature of 
 the disease calling for human aid. The time in which to treat the patient sick with 
 cholera is exceedingly limited. What is to be done must be executed with rapidity. 
 There is not a moment to lose between the time when the patient is first seen and the 
 accomplishment of severely practical efforts. Many wise theories may be promulgated, 
 but there are few practical measures that will avail against Asiatic cholera. The ex- 
 periences during the cholera epidemic of 1892 in Europe, both in Russia and Germany, 
 produced in me a profound conviction that, for the most part, remedial agencies that 
 have been used are of questionable utility. Nearly every prominent remedy proposed 
 and tried has been found to end in greater or less disappointment. Years ago, great 
 reliance was placed upon the far-famed "mild chlorid of mercury." Twenty and ten 
 years ago this remedy was given in large doses. Three years ago, during the latest 
 epidemic, small doses prevailed. Next to this, the synthetic drug salol, the product of 
 the laboratory of the Imperial Institute of Experimental Medicine in St. Petersburg, 
 
194 
 
 was the most widely used and the most favorably received. Professor Nenski, the 
 originator of salol, personally informed me that the value of the drug could not be seri- 
 ously recommended as of much importance, but that it perhaps answered the require- 
 ments as far as any drug could answer, in the hands of his colleagues. Widely 
 circulated and various reports, enthusiastically commending and moderately commend- 
 ing this remedy were received by the Professor in St. Petersburg, but he himself was 
 silent as to its efficacy. The far-famed and seemingly unmatched drug, quinin, has 
 been used, and has been held as a dazzling gem before the eyes of the profession by 
 some of our best men, who believe that cholera is analogous to malarial disorders, and 
 consequently the medicine which occupies the position of keystone in the arch, for ma- 
 larial treatment, is a remedy suitable to contend with the rapid and desperate symptoms 
 of Asiatic cholera. Quinin has a stout advocate in our own country, in the person of a 
 well-known professor in one of the Ohio medical colleges. It was not used, to my 
 knowledge, in the treatment of cholera during the last epidemic in Europe. 
 
 A remedy was brought to Hamburg during the latter part of the epidemic of 1892 
 by the representative of an English syndicate, who posed as a chemist, not a physician. 
 His remedy was a preparation of iodin, to be administered through the mouth. He 
 called the medicine a periodate, and made some experiments upon patients in one of the 
 cholera hospitals in Hamburg. His remedy, however, was not favorably entertained 
 by the medical authorities in charge of the cholera patients, and whatever claims were 
 reported came through the interest of a friendly correspondent of one of the Hamburg 
 weekly secular papers. To show how misleading some of our supposedly authentic infor- 
 mation often is, it is only necessary for me to refer to the report given in the ' 'Year Book 
 of Medical Progress," published in Philadelphia. Of all the progress made, of all the 
 combined investigations during the entire epidemic of cholera throughout Europe in 
 1892, and there was an immense amount of original investigation and great effort made 
 to discover a remedy, the curious spectacle in the Year Book, which alone refers to the 
 remedies brought by an agent of a syndicate from London to Hamburg, at the closing 
 of the epidemic of cholera, shows that there are some things in our profoundest medi- 
 cal publications that are to be taken cum grano salis. Uretin was extensively used 
 hypodermically for its alleged influence upon the secretions of the kidneys, upon the 
 ground that the kidneys were to be aided by irritating them to greater functional activity 
 to eliminate morbid elements through the urine. The result of many investigations 
 recorded in Russian practice show that this drug is not to be commended. Digitalis 
 was used, supposedly to benefit a weak heart. This remedy, if at all useful, could be 
 little more than palliative. The use of acidulated water was extensively employed in 
 different hospitals in Europe as a drink, but not prescribed as a remedy. The water 
 was acidulated with HC1 and H 2 S0 4 . Subcutaneous injections of salt water were 
 made. The proportion of salt was one-half of I per cent., and the amount of saltwater 
 injected subcutaneously was sometimes as much as a quart at a single injection. In one 
 instance, during an illness of several days, as much as thirteen quarts were subcutaneously 
 injected into the cellular tissue, principally that of the abdominal wall. This process 
 of subcutaneous injection was known as hypodermaclysis. The purpose of the hypo- 
 dermaclysis was to maintain the volume of the blood. The diminished volume of the 
 blood is directly the result of the waste Of its liquid portion or serum into the alimentary 
 canal. In this serous discharge, flakes of intestinal mucous gave the name of "rice-water 
 discharges" to the bowel evacuations, the particles having a resemblance to grains of rice. 
 The general inflammatory state of the intestinal mucous membrane, throughout its en- 
 tirety, drains the blood of its liquid portion rapidly, and collapse due to stagnation of 
 circulation quickly ensues. 
 
 The remedies mentioned are only a portion of those tried; but there is no living 
 advocate who to-day can point with unerring certainty to one single organic or inorganic 
 substance, howsoever administered, that can be safely depended upon in the treatment 
 ,of Asiatic cholera. Both botany and mineralogy have been searched in vain for a cure 
 for this disease. 
 
IQ 5 
 
 The cause of this disease is perhaps accurately stated to be due to invasion of the 
 blood and, secondarily, of all the tissues of the living organism, by toxines or ptomaines, 
 which originate in the upper portion of the small intestine at the early stages of cholera. 
 These products of organic activity, whether of animal or vegetable organisms it is here 
 unnecessary to debate ; but these noxious products enter the circulation through the 
 villi of the intestine and rapidly and desperately poison the blood. It is clearly proved 
 that the disease is the result of general blood poisoning from an intestinal origin. 
 Whatever the chemic nature of the poison may ultimately be found to be, maybe safely 
 left to the bacteriological laboratory. The practical and intensely important part that 
 remains for physicians seeking to cure patients in times of this disease is to realize how 
 much, as well as how little, it is within human power to do. The human organism is 
 prostrated by a fierce and deadly poison. This poison is in the blood and in the cells 
 of the tissues, and its work of destruction is quickly and effectually accomplished. Re- 
 flectively, to say nothing of experimental research, it would seem to me that the rational 
 and only course that could be advocated with scientific assurance of relief is to, as far as 
 possible, literally cause to be removed these products which are death-dealing to the 
 body in which they happen to be found. Now in the same reflective mood, think for a 
 moment and try with me to determine whether it is possible in such conditions as pro- 
 duce the symptoms of Asiatic cholera, it is safer to introduce other poisonous products 
 to neutralize the noxious elements in the blood and cells, or whether it is a better pro- 
 cess to, without the introduction of additional foreign substances, remove what we 
 already find in the blood. To make this proposition clearer, it could be stated in an- 
 other way, namely, the body is already bearing a crushing burden; shall we add other 
 foreign substances as an additional burden to the load already carried ? The principle 
 seems to me to be at fault. The principle is the principle of allopathy, but in the light 
 of facts is it a safe principle to follow ? It is reasonably scientific to produce in the 
 laboratory, definite results in vessels of glass by the use of fixed reagents; in the organic 
 laboratory of the living body, no such definite results can be demonstrated. The vital 
 principle is an entity which enters into the formula and may be represented by the un- 
 known quantity x in algebraic equations. Great and laudable efforts have been made 
 to prevent as well as to cure this disease by inoculation. 
 
 Ferran, of Valencia, Spain, thrilled the world ten years ago with his proposition of 
 a universal cure for this disease. His glory was then at its zenith. His fame has long 
 since faded. So obnoxious became his proposition to the government of Spain that laws 
 were adopted to suppress Ferran's cholera inoculations. 
 
 A worthy colleague and laborious investigator, Professor Haffkin, of Pasteur Lab- 
 oratory fame, proposed a modified inoculation for the prevention and cure of cholera in 
 1892. A reporter of the New York Herald was inoculated at the Pasteur Institute, and 
 with credentials sent to expose himself to Asiatic cholera at Hamburg in September, 
 1892. The same reporter had been similarly inoculated by Ferran in 1886 and had the 
 courage to make further exploits in behalf of his newspaper, at Hamburg. A very 
 widespread opinion prevails in America that the exploit of the New York Herald reporter 
 during the ten days' stay as a nurse in the Hamburg hospital, constitutes a proof of the 
 validity of Haffkin's claim, but the scientific world of Europe knows differently. En 
 passant, it may be interesting to state at this place that further experiments have been 
 made by Professor Haffkin in India with the cholera inoculations and, unfortunately for 
 the proposition, reports have recently come to me from reliable medical sources, that a 
 greater percentage are attacked with cholera who have been previously inoculated than 
 of those who have not been inoculated. This subject of prevention, however, is to be 
 discussed by me in a paper to be read before the Section on State Medicine. 
 
 The result of prolonged recollection, covering many years, and the observations 
 resulting from personal experience in the cholera epidemic in Europe of 1892, is the con- 
 viction that there is provided in the laboratory of the universe a remedy which surpasses the 
 results of human ingenuity as much as does the sun surpass in brilliancy the light of the 
 artificial lamp. The all-prevailing and all-wide remedy, the greatest product of omnis- 
 
196 
 
 cient nature's laboratory, which alone can cope with this pestilential disease of the human 
 race, is nothing more and nothing less than the unmatched, unmatchable H2 O. Pure 
 water is absolutely the only trustworthy cure for cholera, and if it came at a great price it 
 would probably be more greatly valued. The human organism is so constituted that if 
 it is assisted by H2 O, every morbid element may be eliminated out of its domain. 
 The acutely poisoned body quickly recovers its equilibrium and its harmony of action as 
 soon as the processes of elimination can remove the invading poison. In the construc- 
 tion of the mucous lining of all the accessible cavities and channels it is prepared by an 
 undiscernable law to successfully resist the entrance of every form of organism. The 
 products of organic action alone are able to pass into the blood. If sufficient quantities 
 of pure water, of a suitable temperature, are introduced into the body through the 
 natural channels, it is actually possible to wash morbid products as well as organic 
 forms of life, out of the human body. The mouth gives entrance to the causative germs 
 in Asiatic cholera. This is quite conclusively established. The locality of the develop- 
 ment and formation of the toxin in the earlier stages is determined to be in the upper 
 end of the small intestine; and from experience, as well as from the powers of reflec- 
 tive analogy, there is no doubt that the system can be saved from death if the morbid 
 entity, the germ, is literally deluged away from the alimentary canal by the copious use 
 of a remedy that cannot be of the slightest danger to the victim. The amount of water 
 to be used varies in different cases. It is impossible to use too much; it is possible to 
 use too little. From the earliest moment that the patient is seen, the propositions 
 should be, first, wash the whole alimentary canal with pure water; wash the lower por-. 
 tion by introducing irrigations of warm soapsuds or merely warm water into the colon 
 sufficiently frequent and sufficient in quantity to cleanse that portion of the bowel 
 effectually. The frequency of washing that portion of the bowel which is accessible from 
 the rectum should be one, or two, or three, or four times a day, according to circum- 
 stances. At the same time from one to ten quarts of warm pure water mildly medicated 
 with Peroxide of Hydrogen or Hydrozone should be administered at regular intervals, 
 during the day, as the prescribed remedy by the mouth. If the patient vomits, very 
 well. Immediately re-introduce the quantity of water that was vomited. No harm can 
 be done in any case, and if it is possible to save life it is possible to save it through this 
 method. It is the quickest and' surest method of exciting the activity of the kidneys, 
 and it is the safest. It is the rational and effective measure for maintaining the 
 volume of the blood. It is the scientific process by which to establish cutaneous circu- 
 lation in the capillaries. 
 
 The use of simple and useful hygienic measures are the same as in other prostrat- 
 ing diseases. Patients should be fed with regularity at not too frequent intervals, giving 
 the proper time, between administrations of simple food, for its digestion. The use 
 of appliances for maintaining the heat of the body are not to be neglected. 
 
 The precise details of the method of treatment indicated at this time will be forth- 
 coming in a subsequent paper. 
 
 WATERY ULCER. 
 
 By M. F. Richards, M. D., of Toledo, O. 
 
 (Abstract from the Homoeopathic News, of St. Louis, Mo.) 
 Editor Homcepathic News: 
 
 About two months ago I treated a lady for a small, watery ulcer, on her neck near 
 the shoulder. It had troubled her for years, and largely because it would be chafed by 
 the collar or neck band of her dress. It would scab over and heal for a short time 
 and then it would break out again. I made one application of Hydrozone, full strength, 
 until the scab was entirely eaten off and the ulcer thoroughly clean. Then pineoline 
 was applied on a piece of cloth and kept renewed once or twice a day. In two weeks 
 the ulcer healed over nicely, and has remained well ever since. She has taken no extra 
 precaution about chafing of collar or neck band, either. 
 
i97 
 
 SHORT NOTES ON THE VALUE OF HYDROZONE IN 
 
 VARIOUS DISEASES. 
 
 By S. J. Wimmer, M. D., and F. S. Parsons, M. D. 
 
 (Taken from The Physicians' Vade Mecum.) 
 
 (Published by The Medical Publishing Co., 718 Betz Building, Philadelphia, Pa.) 
 
 The quotations extracted from this work are taken from paragraphs on the treat- 
 ment of the various diseases enumerated, from the midst of much material of value 
 to the general practitioner. 
 
 " Stomatitis. — Wash out the mouth frequently with one part Hydrozone in six parts 
 of water and administer glycozone internally after each meal to subdue inflammatory 
 conditions of the stomach." p. 178. 
 
 "Retro-P /laryngeal Abscess. — When the abscess has been opened pus should be 
 destroyed by spraying the pharynx with a mixture of Hydrozone one part and water 
 three parts," p. 180. 
 
 "Oesophagitis. — One tumblerful of ozonized water made of Hydrozone one ounce, 
 water two quarts, as a drink three times a day and one teaspoonful of Glycozone after each 
 meal will accomplish a cure," p. 181. 
 
 "Chronic Gastritis. — A tumbler full of ozonized water made of one ounce of 
 Hydrozone to two quarts of water administered as a drink three times a day; Glycozone 
 two teaspoonfuls before each meal," p. 183. 
 
 "Membranous Enteritis. — Wash out the intestines every morning with ozonized 
 water made of one ounce of Hydrozone to one quart of lukewarm water. Do not 
 mind the momentarily distressing symptom which accompanies this enema. Every 
 evening administer an enema of Glycozone one ounce water twelve ounces," p. 192. 
 
 "Dysentery. — Irrigation with warm water and Hydrozone as practiced by Dr. 
 Lee is well recommended. The same treatment is also recommended in cancer of the 
 intestines," p. 194-6. 
 
 "Cholera. — Cholera Infantum. — Large irrigations of hot water made soapy is 
 introduced into the colon through a suitable rubber tube and the stomach cleansed with 
 Hydrozone given in half cupful doses together with hot water freely. This is a perfect 
 antiseptic and should be continued until convalescence is established," p. 225 and 321. 
 
 "Diphtheria. — Hydrozone to disinfect the discharges and destroy the germs and 
 remove false membrane, it is thorough, quick and effective," p. 234. 
 
 " Typhoid Fever. — Hydrozone one ounce, water twenty-four ounces as a beverage 
 to disinfect the alimentary canal," p. 256. 
 
 "Measles. — Inflammatory condition of the mucous membrane of the throat and air 
 passages will be promptly subdued by spraying with Hydrozone one part, water eight 
 parts," p. 60. 
 
 RATIONAL TREATMENT OF PERTUSSIS. 
 
 By FRANCIS T. B. FEST, M. D., Plank Road, Mich. 
 (Published by The Journal 'of 'the American Medical Association, Chicago, Aug.17, 1895.) 
 
 With every disease its etiology shows us the way for its treatment. Therefore it is 
 necessary to recapitulate the etiology of every disease for which we wish to outline the 
 therapeutics. 
 
 Pertussis or whooping cough is a contagious disease, which manifests itself in spas- 
 modic cough. Although some bacteriologists have found in the sputum -bacilli, we are 
 unable so far to determine their role, whether causing, accompanying or only accidental* 
 
198 
 
 It is a local disease of the larynx, acting upon the nerve supply, and causing spasms of 
 this organ. The course of the disease shows three distinct phases, the catarrhal, par- 
 oxysmal and declining. 
 
 The first stage shows only symptoms of mild catarrh of the bronchi, nose or con- 
 junctiva. Pathognostic for pertussis is only the excessive watery secretion from the 
 affected regions. This phase lasts from two to seven weeks, with infants often a few 
 days only. 
 
 The paroxysmal stage affirms the diagnosis by its characteristic "whoops." The 
 expectoration is watery, sometimes bloody. In many cases vomiting follows the par- 
 oxysms by mechanical irritation. The vomiting in return can cause disorders of the 
 digestive apparatus. The whoops at times occur as often as every half hour, and as 
 thereby the cyanotic condition which accompanies the whoops occurs too frequently, 
 they lead to asphyxial convulsions and even death. 
 
 In the respiratory apparatus the irritation causes, in many instances, capillary bron- 
 chitis and catarrhal pneumonia. After duration up to ten weeks the paroxysms are 
 less severe, show themselves more rarely and the disease goes over into the declining 
 stage. At this time the sequelae or secondary lesions mainly demand our attention. 
 
 As we have seen, the disease is a local one. It primarily affects only the larynx; 
 all other symptom* are secondary. The circumstance forms the basis of our treatment. 
 The disease is local — ergo, we treat it locally; it is of neurotic character — ergo, we give 
 a drug that acts upon the nerves. 
 
 With contagious local diseases, rational local treatment consists in destruction of 
 the contagion by antiseptics — the most powerful is the most rational. Therefore every 
 local application of any antiseptic improves to a certain degree pertussis. If we cast a 
 glance at the literature, nearly everything was tried; phenol, boracic acid, thymol, 
 resorcin, naphthalin, creosote, benzol, bromoform, mercurials, etc., but they all more 
 or less are of irritating action upon the surface they are brought in contact with, or if 
 not irritating their action is so mild that their therapeutic effect is as mild too. The 
 experience of the last few years proved the superiority of Peroxide of Hydrogen over 
 all other antiseptics, except when we have to handle metallic instruments. An excep- 
 tion which interferes not in pertussis. 
 
 In pertussis, I used the Peroxide with great success for local applications in this 
 way: the child's head is leaned backward and held firmly, another person pulis out and 
 depresses the tongue to bring the glottis into good view; then by means of a bulb ato- 
 mizer consisting of glass and rubber only, I direct a spray of Peroxide of Hydrogen 
 solution towards the larynx and if possible through the glottis. This is much facilitated 
 if the child is old enough to pronounce the sound a. 
 
 I always prefer the 30 volume Peroxide of Hydrogen (Hydrozone) and dilute it in 
 the following manner: Hydrozone, one part; distilled water, ten parts; glycerine, one 
 and one-half parts. 
 
 If the parents are docile they can be instructed to repeat the application twice or 
 thrice a day. If the physician has a chance to apply it himself, he does well to make 
 the solution fresh every time. At all events it should be made fresh every other day on 
 account of this mixture being unstable. 
 
 Of all drugs only one has a really aborting influence upon pertussis, the old reli- 
 able, often abolished and always restored belladonna. The only secret of its right 
 administration is the circumstance that we have to give such doses to get the belladonna 
 action; the flushes, (Jacobi); otherwise the administration is without value. 
 
 A child of 2 years requires 6 drops of the tincture, three times a day; with the age 
 the dose has to be increased to the proportion of 1 .00 as a maximum single dose for an 
 adult (gtt. xxv). 
 
 The root, the extractum alcoholicum fluidum can be given to infants of six to eight 
 months in doses of 0.01 U i. d., children of 3 to 4 years require of thesame 0.3. Atro- 
 pin may take the place of belladonna, beginning in a child of two years with 0.0006s 
 t. i. d. and increase proportionately. 
 
i 9 9 
 
 All complications must be abated in time, else our patient will be emaciated. If 
 vomiting occurs at the paroxysms, give menthol. If there be gastritis and catarrh of 
 the bowels, give calomel, bismuth, or still better Glycozone. Often we meetgastralgia; 
 then I prescribe for a child over 2 years: 
 
 1$ Belladonna? tinct. 2.00 
 Mentholis 2.05 
 Spir. frumenti 10.00 
 Glycerini 20.00. 
 M. D. S. Teaspoonful every two hours. 
 
 Glycozone administered in the proportion of two teaspoonfuls, diluted in a wine- 
 glassful of water, gave me the most gratifying results in acute cases. 
 
 Are the paroxysms severe, we can easily control the spasm by an application of 
 cocain to the larynx. 
 
 For the general treatment we shall advise fresh air, good nourishment, tonics and 
 inhalations of ozone. With such treatment the disease can be cut off to a period of 
 only a few weeks. 
 
 Editor of New York State Medical Reporter, of Rochester, N, Y. : 
 
 In your July number you call the attention of the profession to a report from your 
 issue of January, 1895, to a reprint of the Times and Register, Philadelphia, of an 
 article by Dr. Endemann, chemist, of the relative value of the Medicinal Peroxide of 
 Hydrogen preparations found on the market. In it he condemns No. 8, Oakland. In 
 a subsequent examination he states that he did not discover any traces of baryta, and that 
 it is in strength equal to all claimed by them. The experience of the Williamsport Hos- 
 pital is large in the use of the Peroxides of Hydrogen. Comparing Oakland, Squibb's and 
 Marchand's, we find that Marchand's is cheaper at a larger price than either Oakland 
 No. 8), or Squibb's, as a smaller amount produces a larger oxidation.* 
 
 Respectfully, 
 
 B. H. Detwiler,M. D., 
 Aug. 5, 1895. Williamsport, Pa. 
 
 MEDICINAL TREATMENT OF TYPHOID FEVER. 
 
 By GUSTAVUS BLECH, A. B., M. D., Detroit, Mich. 
 
 (Read before the Meeting of the Mississippi Valley Medical Association , Sept. 6th, 1895.) 
 
 We have no specific treatment for typhoid fever. Hygienic and dietetic treatment 
 alone are not sufficient, and although the so-called abortive treatment of this malady is 
 nothing else but an illusion of a few optimistic physicians, there are a good many reme- 
 dies known which will influence considerably this disease. 
 
 As late as twelve or fifteen years ago the treatment was symptomatic only, the 
 attention being directed especially to the high fever. At that time patients died with a 
 low temperature. 
 
 To-day our treatment is more rational. We have investigated into the cause of this 
 disease, found it to be of microbic origin, hence we treat typhoid fever antiseptically. 
 The germs are found principally in the intestines, hence we will employ intestinal anti- 
 septics. I will speak of it later. 
 
 * See p. p. I to V,also p. 154, Reports by Dr. H. Endemann, Prof. L. D. Kastenbine and Dr. J. P. 
 Parker. These reports establish the relative value of the different brands of Peroxide of Hydrogen 
 which are found in the market. 
 
200 
 
 As an antipyretic, quinine was a favorite about fifteen years ago. At present its 
 use is considerably reduced and modern antiseptics (phenacetine, antifebrine, antipy- 
 rine) have been substituted. Hydropathy has a great many friends. On the other hand 
 the number of opponents cannot be underrated. Medicinal antipyretics in infectious 
 diseases are dangerous, as they oppress the heart. I treat the fever if it reaches a high 
 degree internally with alcohol (wine, cognac) externally sponging with a twenty per 
 cent, aqueous solution of alcohol. 
 
 Now to the antiseptic treatment. Intestinal antisepsis is the parole. My previous 
 experience with Hydrozone in gastric and intestinal affections in both adults and chil- 
 dren induced me to try it in typhoid fever. See my report headed "The Rational 
 Treatment of Cholera Infantum," published by the New York Medical Journal, (March 
 2d, 1895). I note with pleasure, that the editor of the Mirror, Dr. I. N. Love, of 
 St. Louis, the well known teacher of Paediatrics, in an editorial in the June issue of his 
 valuable monthly, fully agrees with my methods. 
 
 I found Hydrozone not only to be a good antiseptic but a splendid remedy against 
 the stupor, in which all of my patients were laying and which clearly proves that the 
 cases that I had to deal with were serious. 
 
 Soon after a few doses of Hydrozone (diluted with water 1 to 32) were adminis- 
 tered, they felt comfortable, the semi-unconsciousness ceasing. I think the blood and 
 blood corpuscles become saturated with oxygen and thus the brain is kept in activity. I 
 alternate the internal treatment between Hydrozone, hydrochloric acid and alcohol. 
 
 Hydrozone has proved to be in my hands, more powerful than any other antiseptic, 
 and yet it is harmless. As a direct medication I irrigate the bowels of every typhoid 
 fever patient with four quarts of clear water to which two ounces of Hydrozone are 
 added. I would repeat this procedure twice daily. Depending on the temperature of 
 the body, I would use cold water in high fever, otherwise lukewarm water will be more 
 agreeable, and accomplish the same purpose. Irrigation of the bowels with cold water 
 has also an antipyretic effect. Such irrigations will also check the diarrhoea and en- 
 courage a natural catharsis. They also reduce the hyperaemia and inflammation of the 
 intestinal mucous membrane, annihilate the bacilli and if ulceration be present, will 
 stimulate granulation and produce a healthy surface. This irrigation with diluted Hy- 
 drozone is the best remedy to prevent perforation of the bowel. 
 
 In order to obtain the desired results from irrigation, we must introduce the rectal 
 tube beyond the sigmoid flexure. The tube which should be neither too flexible nor too 
 stiff, must be well oiled and carefully introduced. In this way, the fluid will enter even 
 the caecum and reach the seat of the disease. 
 
 The treatment as I have outlined in this paper will not only have a curative effect 
 but will also prevent the usual complications. Of course, symptoms, which per se are 
 liable to influence the disease or endanger life itself, must be treated accordingly. 
 In conclusion I beg to submit a short report of six cases in which the above treatment 
 was successful. 
 
 Case i. — Otto S., German, shoemaker, aged 24. Saw him first August 14, 1894. 
 Has been actually sick but a few days, although as he said, he felt ill for over a week. 
 Headache, slight chills, thirsty, constipated, temperature 102.5 slight cough. Physical 
 examination of chest and abdomen gives negative result. Could make no definite diag- 
 nosis. Prescribed calomel and bicarbonate of soda. Saw him again on the 16th. 
 Temperature almost 104. Could feel swelling of the spleen. Tympanites. Sleeps bad 
 in night time. Diagnosis. Typhoid fever. I ordered at once diet and sponged the body 
 with diluted alcohol. Temperature taken five minutes after sponging 102. On the same 
 evening I made an irrigation of the colon. A good deal of fecal matter was evacuated. 
 
 August 17, Fever 104 degrees. Arrhythmia of the heart. Headache intense. No 
 appetite. Sponging of the body by nurse. Irrigation whenever fever high was 
 ordered. Hydrochloric acid. 
 
 August 18, same symptoms. Stupor. Has been delirious all night and appeared 
 apathic when visited. Same treatment. 
 
201 
 
 August 19. Same symptom-?. Roseola. Prescribed Hydrozone diluted. Rested 
 well this night. Old treatment continued. 
 
 August 20. Appears brighter. Asks many questions as to his disease. Wants 
 to know whether his disease, the character of which was not disclosed to him, is infec- 
 tious, and if so, wishes his younger sister removed. 
 
 August 25. Slight haemorrhage from the bowel followed by a state of semi-collapse. 
 Was called in a hurry. A hypodermic injection of sulphuric ether was administered 
 which improved his condition ?oon. Irrigation of the bowels with diluted Hydrozone 
 was now made twice daily. 
 
 Patient was discharged September 2, and advised to observe diet and to remain in 
 bed for a week. Complete recovery. 
 
 Case 2. — Miss Agnes T., Irish- American, actress, age 21, of a nervous tempera- 
 ment. Saw her first, August 25. Patient looked pale and emaciated. She described 
 her condition as due to over- work and mental strain. Has been sick for over a week and 
 was treated by an Eclectic physician. Had all marked symptoms of typhoid fever which 
 diagnosis was confirmed on the next day. The treatment in this case was similar to the 
 former with the exception that I had to resort to the wet pack on the 30th as the tem- 
 perature, 104.5, was not reduced by the sponging. Although the dry tongue and lips 
 indicated a grave disease, the patient was always conscious and able to talk, which I 
 attributed to the administration of Hydrozone. She made a good recovery after an ill- 
 ness of four weeks, three weeks being under my care. Patient left town to join a com- 
 pany in October, 1894. , 
 
 Case 3, was that of a robust smith, Peter R., aged 30, married, father of four 
 children. He was first seen by a Senior student, now a physician, practicing for a 
 living at that time under my supervision. He did not make a definite diagnosis attrib- 
 uting his fever to a cold, and prescribing pilocarpine and antipyretics. He called me 
 in consultation August 20, fearing death of the patient. Temperature 105, pulse no. 
 Arrhythmia, stupor, swelling of the spleen was rather difficult to be determined, but I 
 could feel an increase of its volume by palpation. Tympanites. No roseola, dry lips, 
 dry tongue. 
 
 I advised sponging which reduced the temperature at once to 103. Hydrozone 
 was given, one ounce to a quart of water as a drink. Irrigation of the colon with cold 
 water and Hydrozone was practiced, and the patient's general condition improved the 
 very evening. Mr. K., the medical student, continued the treatment, with irrigations 
 and sponging and prescribed internally, digitalis, strychnine and Hydrozone. Patient 
 made a good recovery. I cannot say when he was discharged, but Mr. K. informed 
 me that he never saw him in such a grave condition any more. With moderate symp- 
 toms, he recovered after two or three weeks. 
 
 Case 4. — Joseph S., waiter, born in Polish Russia, aged 19, eight years in this 
 country, was never sick during that time. He complained of general weakness, chilly 
 feeling, headache, etc., and thought the "Indian summer," as the warm fall of St. 
 Louis is called, were obnoxious to his health, and that he contracted malaria. There 
 were no chills, however, only a slight rise of the temperature. I saw him first, Sep- 
 tember 19, but did not think much of his trouble. I prescribed Mariani wine and 
 patient really felt better. Was called again September 24th and found patient in bed. 
 He told me he sometimes felt cold, sometimes warm. Temperature 10 1.5, pulse 90. 
 Is thirsty and desires no food. Thinking of malaria, I prescribed 10 grains of quinine 
 ter per diem. Conditions the next day worse. I made a different diagnosis when I 
 visited him the next day, namely, typhoid fever. Patient was treated on the same prin- 
 ciples as the former, but got pneumonia during the state of convalescence. After an 
 illness of four weeks however, he completely recovered. 
 
 Patient contracted in November, gonorrhceal urethritis, which proves that the 
 double malady left very little impression on him. 
 
 Cases 5 and 6, were sisters living in one house. A widow Mrs. L. aged 32, and 
 Mrs. B., married one year. Both had no children. Mrs. L. took sick September 
 
202 
 
 24, and called me the next day. Mrs. B., took sick September 29, and both sisters 
 made a good recovery. Whether one infected the other, or whether the infection 
 came from a general source, I do not know. There was nothing unusual in the course 
 of their diseases, the same being of rather a moderate character. After two week's 
 treatment both were discharged well. 
 
 The characteristic fever curve, the swelling of the spleen, tenderness in the iliac 
 region and roseola, left no doubt as to the diagnosis. 
 
 The younger sister was treated by me until March for anaemia with iron and 
 maltine. She was not anaemic before, and this condition must be regarded as due to 
 and following the attack of typhoid fever. When I left St. Louis (in March) the 
 anaemia was much improved. She felt stronger and objected to be treated by a physi- 
 cian declaring that she feels the maltine and iron preparations will bring her back to 
 full health. 
 
 MALIGNANT SORE THROAT AND ITS TREATMENT. 
 
 By JAMES OSBORNE DeCOURCY, A. M., M. D., St. Libory, III. 
 
 (Read before the twenty-first annual meeting of the Southern Illinois Medical Associa- 
 tion, held at Carbondale, 111., May 9 and 10, 1895.) 
 
 (Published by the Courier of Medicine, for July and August Issues, 1895.) 
 
 It is in compliance with special request from your distinguished president that the 
 author ventures to add a word upon a subject which for several months past has 
 received more scientific thought, perhaps, than any other one subject which concerns 
 the profession from a pathologico-scientific standpoint. There are various forms of 
 sore throat which may be called malignant; but the attention of this Association is 
 directed by this paper to that acute, specific, contagious disease, beginning by an 
 infection of the throat, characterized by local exudation, glandular enlargements, sys- 
 temic poisoning,and having various paralyses for its sequelae. The technical name by which 
 it is generally called (derived, as it is, from the Greek diphthera, leather, and dipho, 
 soften) at once portrays the peculiar nature of the pathological condition, and when 
 the soft, leathery-like membrane has been formed and observed by the physician, a 
 picture that cannot be erased is engraved on his mind. This malady has ever been a 
 terror to the faculty, as well as to the laity, whenever and wherever it has made its 
 appearance. Since the profession has had so much literature upon this subject from 
 so many different standpoints, through the medical press during the past year, it seems 
 that any lengthy scientific exegesis of the subject at this time could scarcely be expected. 
 
 The more salient points, therefore, will be touched, some personal observations 
 given along the line, the gate set ajar, that the members present may enter the field, 
 unveil the materies morbi, and discuss their modus operandi, ad libitum. As to the 
 cause of the disease, the opinions of authors and pathologists of eminence have been at 
 variance, and may yet be said to be divergent. Hueter, Oertel and Virchow were 
 among the first to advance the opinion that micrococci produce the pathological condi- 
 tion, and, therefore comprise the primary cause of the disease. On the other hand, in 
 concord with various dissenting voices, by certain filtration experiments made by Bur- 
 don-Sanderson, serious doubts were cast on micrococci as the immediate agency; but 
 they are found to be necessary from either standpoint, and a secondary role named by 
 the experimenter as being consequent upon their functional activity. More recently it 
 has been scientifically demonstrated by a number of German pathologists, to the satis- 
 faction of a portion of the profession, that this belongs to the list of bacteriological dis- 
 eases. 
 
203 
 
 The reasons and demonstrations set forth to establish the germ theory, so far as 
 this disease is concerned — to the author, at least — seem conclusive; other opinions, 
 possibly that of some of you, to the contrary notwithstanding. In regard to the con- 
 tagious infectious nature, the sporadic, endemic and epidemic prevalence of the dis- 
 ease, it is scarcely necessary to make mention; neither its seeming alliance with scarlet 
 fever, nor yet of its simultaneous appearance during epidemics of small-pox, measles, 
 puerperal and typhus fevers. The contagion in the poisonous exudations and secre- 
 tions of the fauces is, without doubt, the chief cause of its spread. The author be- 
 lieves the variation in the period of incubation to be due to several causes, among 
 which may be mentioned the physiological or pathological condition, the age and sur- 
 roundings of those exposed to and infected by the germs. From the standpoint of 
 pathological anatomy, the first perceptible change, is the infection of the mucous mem- 
 brane of the fauces, quickly followed by hyperemia of the tonsils. At the end of 
 thirty hours or so a grayish pellicle appears on the tongue, and soon is visible elsewhere 
 on the soft palate, uvula or tonsils. At first these patches are thin and scattered, 
 but in a very short time coalesce. Very soon the army of micrococci marshall their 
 forces and press their way through the mucous membrane at whatever point may be 
 the least strongly fortified. At and around this point the forces assemble as they pass 
 through the broken wall, and at once proceed to throw up a very singular fortification 
 — the false membrane. The constituent parts of this membrane, its office, extension 
 into the nares and air passages, its various changes, together with the special forms of 
 the disease, are intentionally omitted, with the h6pe that the more important points 
 may be brought out by the discussion. Little opportunity is offered the general prac- 
 titioner, outside of hospitals, for accurate observations of the inroads made by the dis- 
 ease on the various organs of the body. 
 
 Symptomatology. — In the mild, or catarrhal form, the symptoms are similar to 
 those of acute pharyngitis or tonsilitis; soreness, pain and irritation are felt in the 
 throat, especially on attempting to swallow and general malaise may follow. In other 
 subjects of a nervous excitability; or those who are laboring under some pathological 
 condition at the time infected, the symptoms may be much more severe. Nausea and 
 vomiting may follow, marked headache, fever and sore throat. On ocular examina- 
 tion the tonsils are found cedematous, the mucous membrane of the fauces infiltrated, 
 and membranous patches are present. So great may be the oedema of the tonsils that 
 a fatal climax may be reached before the false membrane is produced. A thick white 
 coating soon covers the tongue. In two or three days the false membrane appears in 
 one or more places, spreading over a considerable space in a few hours. The mem- 
 brane, at first thin, constantly grows thicker the longer it remains undisturbed. The 
 color, ■ at first a creamy yellow or a grayish white, gradually changes to a dark red as 
 the disease advances. About the fifth day the disease may take on the more severe 
 form and violent symptoms follow, the temperature rising from 103 ° to 105 ° Fahren- 
 heit. The soreness on attempting to swallow is very acute, and in a few hours the 
 membrane appears either on the palate, uvula or tonsils. In removing the tenacious 
 membrane the mucous is peeled off with it and a raw surface left through which the 
 blood percolates. Should no attempt be made to remove the false membrane and to 
 arrest its reproduction, it will spread rapidly, passing up the nares and down the tubes 
 penetrating the air passage. Thus the blood constantly taking on poisons from the 
 debris of the fungosus, the whole system is saturated with the infection, and a septic, 
 or even gangrenous condition produced. Possibly this condition of things may be 
 spared by earlier termination of the case, by spasm of the glottis, occlusion of the 
 bronchi, pneumonia, or carbonic acid gas poisoning. 1 1 is during the septicsemic stage that 
 the membranes take on the darker color, that the odor from the breath and discharges 
 becomes foul and offensive. At this time, as a rule, there is but little elevation of tempera- 
 ture, if any at all; slow and irregular pulse. Next grangrene sets up, and a fatal termina- 
 tion ushered in by paralysis of the heart. Numerous are the causes which influence 
 the behavior, course, duration and termination of malignant sore throat. The mortal- 
 
204 
 
 • 
 
 ity is great, though no precise statement of mortality rates has yet been made. The 
 prognosis should be very guarded, and is usually grave; is augmented the more viru- 
 lent the case from which the infection was obtained. For obvious reasons, the mortal- 
 ity is greater in infants and young children. Good nursing has a decided influence 
 upon the course of the disease, and should always be considered in estimating possible 
 results. Extension into the nares and larynx is an alarming symptom; likewise bleed- 
 ing, vomiting, purging, low temperature, cold and clammy skin and slow and inter- 
 mitting pulse are premonitors of evil. 
 
 Cases apparently favorable have suddenly ended by paralysis of the heart. As 
 regards the hopefulness of recovery from the various forms of this disease, the catarrhal 
 stands first, the croupous second and lastly the septic or gangrenous. 
 
 Paralyses of various parts and organs of the body are prominent among the 
 sequelae which often follow the ravages of this disease. It may come on at once, be 
 delayed for several days, or even some weeks. Fortunately, however, this paralysis is 
 quite amenable to treatment. It is hoped that the discussion will bring out the pathologi- 
 cal condition thus produced upon the nervous system, organs of circulation and respira- 
 tion. To make a prompt and positive diagnosis in all cases is a most difficult task. At 
 present eminent authorities in bacteriology teach that the only actual scientific diag- 
 nosis that can be madfe is by use of the culture fluid or microscope. A portion of the 
 suspected exudate is immersed in the Klebs-LoefHer fluid, which is furnished in sealed 
 glass tubes. After the fluid has been inoculated it is set away in a warm, dark place 
 (98. 6° Fahrenheit is about the required temperature) for the space of twelve or eighteen 
 hours. If the micrococci of diphtheria are present they will by that time have pro- 
 duced a growth in the fluid which will be perceptible to the unaided eye. This method 
 is not accepted by all. The microscope is regarded as the most accurate method by 
 which to make a scientific diagnosis. The author has never yet seen two cases that 
 were exactly alike, either in symptoms or in local manifestations. Before the false 
 membrane has been formed it is easy to confound the catarrhal variety with acute fol- 
 licular ulceration of the tonsils, or amygdalitis, owing principally, in the last case, to 
 the intense cedema of the tonsils. Especially is this true when there are no other cases 
 of the malady in the neighborhood, and when, so far as known, the patient has not 
 been exposed to the contagion from any source. That it has been confounded with 
 croup there is little room for reasonable doubt. 
 
 Since croup is simply a local affection, non-contagious and not infectious, is with- 
 out the characteristic general symptoms of malignant sore throat ; for these reasons the 
 non-identity of the two diseases seems perfectly patent. There is some analogy 
 between malignant and scarlatinal sore throat, but the whole mucous membrane of the 
 fauces is intensely red in scarlet fever, while in malignant sore throat the redness is 
 limited to the infected area; in scarlet fever the exudation is soft like curds, and usually 
 scattered over both tonsils and the palate. In malignant sore throat the membrane 
 begins at one point (sometimes more), adheres closely to the epithelium, and has a 
 characteristic color. In scarlatina the symptoms are much more severe; high fever, 
 with vomiting, delirium, or convulsions, commonly inaugurate the disease, which are 
 wanting in malignant sore throat. At the expiration of twenty-four hours the rash 
 appears in scarlatina, but is absent in malignant sore throat. 
 
 Treatment. — -Believing that local infection is the true cause of the disease, the fol- 
 lowing treatment is suggested, being based upon the validity of the germ theory. 
 Rational treatment necessarily resolves itself into two distinct divisions: preventive 
 and active therapeutics. In every case where preventive medicine is timely, faithfully 
 and scientifically applied, the mortality should be zero. Unfortunately, however, this 
 mode of treatment is at present impracticable in very many cases. In t!:e application 
 of preventive measures, the establishment and maintenance of normal physiological 
 condition is of primary import. 
 
 Abundance of sunshine, the greatest of all purifying agents and germicides; good 
 hygienic surroundings, absolute cleanliness indoors and out, internal and external, are 
 
205 
 
 axioms, so to speak, which should form the basis of treatment in all cases. When the 
 disease has appeared in any locality, the whole population should be informed at the 
 earliest possible moment, so that suitable precautionary steps may be taken to suppress 
 the outbreak. The mouths and throats of all children who are under fifteen years of 
 age and living in the infected district should be carefully examined from day to day. 
 
 Mouth washes, gargles and sprays of trustworthy germicide agents, should be 
 freely used in every family where there are children, and especially among the young 
 children, as well as all those who may be exposed to the poison. There are many ger- 
 micides in active use, but the author has obtained the most satisfactory results from the 
 use of Hydrozone. No ill effects are consequent upon the extensive use of Hydro- 
 zone; and when diluted can be given internally to the new-born infant. Immunity of 
 children produced by the new and very popular agent, antitoxic serum, before, or at 
 least as soon as exposed to the infection, is already regarded by some as the best 
 known preventive and active treatment. There are many things which conspire to in- 
 fluence the active treatment — the age of the patient, his physiological or pathological 
 condition at the time he is infected, the length of time the poison has been in the sys- 
 tem when the physician first sees the case, the particular form of the disease and the 
 general surroundings of the patient are all to be noted, and are worthy of careful con- 
 sideration. The earlier the disease is recognized and the sooner the treatment is 
 begun the better will it be for all concerned, and the greater the chances for recovery. 
 As venom by the sharp fang implanted beneath the skin quickly ramifies every part of 
 the living organism, producing general toxic effects, so it is in this disease; the infection 
 from a single spot migrates into every nook and corner of the system. For complica- 
 tions that may arise during the course of special cases no prescribed plan of treatment 
 would apply. The physician in charge is at the helm; wisdom and good judgment 
 must be brought into play as compass and needle to direct him in the skillful management 
 of the case, so that, as the vessel advances through the tempest, the rocks and sand-bars 
 lying concealed along the way may be avoided. Solutions of silver nitrate, iron chloride tr. 
 perchloride and glycerine, acids (salicylic and carbolic), potash chlorate, borax, etc., have 
 been in use as local applications for a long time; but some of them are dangerous and I 
 do not use them. I have found nothing superior to Hydrozone. It accom- 
 plishes all the good that can be obtained from any local application, routes the enemies 
 from their strongholds, kills the invaders and destroys their fortifications. It is quite 
 safe and free from all untoward after-effects which often follow the use of some of the 
 other therapeutic agents; can be used in full strength, or diluted as a spray, gargle, 
 taken internally, or used on cotton probang to mop up the " beasts." It should be 
 used every hour, day and night, until the false membrane ceases to be reproduced, and 
 every particle of the membrane destroyed at each seance. If the fungosus be removed 
 early and kept removed hourly it is very quickly destroyed by Hydrozone, when ap- 
 plied in full strength. When the growth extends into the nares diluted Hydrozone 
 should be sniffed up the nose, or the nasal douche and spray thoroughly and frequently 
 used. 
 
 After the poison has become general the systemic treatment is quite as important 
 as the local. The treatment should be directed against the malady from a double 
 standpoint, to limit spreading of the local disease and to prevent, as far as possible, 
 systemic infection. Ammonia bromide, iodine (used singly and combined), iodine 
 comp. liqr. and acid carbolic, quinine and alcohol have been extensively used as con- 
 stitutional antidotes to the poison of malignant sore throat. Since the appearance of 
 antitoxic serum in therapeutics the mortality of this disease has been so much reduced 
 in the various hospitals and infirmaries where it has been used, it has supplanted other 
 agents or reduced hem to places of subordination, at least for the time being. 
 
 The author's experience with antitoxin is quite limited, having used it in three 
 cases only; but in each case the results were all that could have been expected by the 
 most sanguine. The results following its use, as reported by the institutions and 
 physicians who have experimented with it are very gratifying; and unless "it is possible 
 
2o6 
 
 that the very elect are deceived" the antitoxic serum therapy is a success. The 
 immunizing dose is from c. c. i. toe. c. vii, depending upon the age and condition of 
 the patient. The medicinal dose is from c. c. v. to c. c. xxv, given at one injection, 
 repeated one or more times should it be deemed necessary. The earlier the injection 
 is given the less will be the quantity of serum required in any given case. Stimulants 
 and quinine may perform beneficial functions, but nourishing aliments are necessary 
 from the beginning. Beef extract, eggs, egg-nog, pure milk and malted milk are suit- 
 able articles of food for diet. They can be changed and interchanged from time to 
 time throughout the course of the disease. Nourishment should be given at short in- 
 tervals in order, if possible, to prevent collapse. 
 
 It is scarcely necessary to add that every precaution should be taken by physicians 
 and nurses to ward off infection. The clothes of the patient and nurses, the bed, bedding, 
 furniture, and appartments occupied, should be thoroughly disinfected. The judicious 
 use of quinine, iron, strychnine and electricity will generally subdue paralysis that may 
 follow or result from an attack of malignant sore throat. 
 
 THE THERAPEUTICS OF SPECIFIC URETHRITIS. 
 
 By CHARLES P. WAGAR, M. D., 
 
 (Read before the Toledo Medical Association, November 9, 1894.) 
 
 (Abstract from the Toledo Medical and Surgical Reporter for December, 1894.) 
 
 A great many cases of gonorrhoea are supposed to be cured, while there still 
 remains in the epithelial covering of the urethra, or the pockets and glands far back in 
 the prostatic portion, a quantity of the gonococci which are not yet in active, irrita- 
 tive and aggressive condition, yet they are present and may become dislodged, and 
 pass oat with the urine or with the semen in sexual intercourse, and in the latter case 
 they are injected into the female vagina and may be productive of serious trouble. At 
 the onset of the disease, in order to render the urine as bland as possible I order fifteen 
 grains of bicarbonate of soda, well diluted, every three hours, a brisk saline cathartic 
 at bedtime, a sitz bath in 1 to 5,000 bichloride of mercury solution hot as can be borne, 
 three times a day. Painful erections at night are benefited by half grain morphine 
 suppositories, being preferable to the bromides. 
 
 I do not permit a patient to u^e a syringe at any stage of the disease if I can help 
 it. As a rule putting a syringe into the hands of a patient is crude and unscientific. 
 They will not use the injection regularly, and frequently insert the syringe in an im- 
 proper manner. If I see a patient before the inflammatory stage has set in I have him 
 come to the office morning and evening and then proceed to thoroughly irrigate the 
 urethra with two quarts of bichloride solution (hot) 1.15,000. 
 
 Liberal and frequent irrigations of Peroxide of Hydrogen (Marchand's)* half 
 strength, at the onset of the disease has frequently been attended with the best of 
 results. If I do not see patients early, injections are not used until after the inflamma- 
 tory stage has subsided. Another remedy that has given good results is a capsule 
 (Merz Compound Sandalwood No. 128) composed of sandalwood oil, balsam copaiba, 
 haarlem oil and oil cassia. This combination gives better results than either of the 
 drugs administered alone. I have not had enough experience with any remedy for 
 gonorrhoea to claim for it a "sure cure." 
 
 ♦When Hydrozone is used instead of Marchand's H2 O2 medicinal it should be diluted in the 
 proportion of 1 part Hydrozone for 4 to 16 parts of water, according to the degree of sensitiveness of 
 the mucous membrane of the urethra. 
 
207 
 
 THE DIAGNOSIS AND TREATMENT OF THE DISEASES 
 OF THE ACCESSORY SINUSES OF THE NOSE. 
 
 By WM. ELLERY BRIGGS, M. D., Sacramento, Cal. 
 
 Read before the California Northern District Medical Society. 
 {Abstract from the Occidental Medical Times, of Scramento, Cal., for September, 1895.) 
 
 * * * The following case is one of Empyema of the Ethmoidal and Erontal 
 Sinuses. A. M., aged 68, farmer, had been suffering intense pain located in the 
 frontal region, and below the eyes, for five weeks. He had been obliged to resort to 
 anodynes several times daily to lessen the severe pain. The conjunctivae of both eyes 
 were greatly inflamed; the right lids were edematous. A hard tumor could be felt in the 
 swollen cellular tissue in the upper part of the right orbital cavity which displaced the 
 eye downward and outward. There was considerable hypertrophic rhinitis and some 
 polypoid growths in the vicinity of the infundibulum. An incision was made into the 
 orbital tumor, the cavity washed out with Peroxide of Hydrogen (Marchand's) and the 
 wound packed with iodoform gauze. The nasal polypi were removed and the nasal 
 hypertrophy reduced to some extent, but on account of the patient's dread of operative 
 treatment, the natural drainage was not established nor the discharge through the orbital 
 sinus cured. The relief from pain being complete and the few drops of glairy mucus 
 which continued to discharge through the orbital sinus, causing the patient little incon- 
 venience, he declined further operative treatment. 'The slight secretion from the orbital 
 •opening has persisted during the past two years, and is likely to continue indefinitely 
 unless better drainage is established through the nose or the sinuses are opened and the 
 pyogenic lining to the cavities curetted out. * * * 
 
 * * * The following case is one of Trau??iatic Empyema of the Erontal Sinus: 
 J. L. R., set. 30, carpenter, was struck on the right brow by a falling hammer. He 
 had occasional pains in that region, but no urgent symptoms until he presented himself 
 for treatment about six months after the injury. He had been suffering intense pain in 
 the region affected for two weeks. A hard tumor, about the size of a small hazelnut, 
 could be felt just internal to the middle of the roof of the orbit. The lid was edematous 
 and could not be raised; the conjunctiva was inflamed; the eye was pressed downward 
 and outward. There was some pus discharged into the right nasal cavity. The nasal 
 cavity was healthy, with the exception of inflammation in the vicinity irritated by the 
 pus. An incision was made into the tumor, and about a half drachm of pus was dis- 
 charged. The cavity was washed out with Peroxide of Hydrogen (Marchand's) and 
 packed with iodoform gauze. It was dressed daily, and at the end of five weeks, the 
 secretion from the sinus and into the nose, had ceased, and the patient was discharged. 
 About four months later the patient returned with all of his previous symptoms, pain, 
 tumor, edema, etc. An incision was made down to the bone beneath the superciliary 
 ridge, and considerable pus was discharged. A probe could be passed into the frontal 
 sinus through an opening in the skull. With a sharp spoon and chisel, the diseased 
 "bone was removed, the cavity washed out with Peroxide of Hydrogen packed with 
 gauze and dressed daily, as before. The peroxide flowed freely into the nasal cavity. 
 After two months' treatment, the patient was discharged cured. 
 
 TREATMENT OF THE NEURALGIC VARIETY OF 
 
 DYSMENORRHEA. 
 
 (Abstract from an American Text Book of Gynecology, pp. 11 7- 11 8.) 
 
 Published by Dr. S. M. Baldy, Prof, of Gynecology, Philadelphia Polyclinic. 
 
 The treatment of this form may be subdivided into general and specific treatment. 
 In the beginning of the treatment the physician must carefully ascertain the general 
 state of the patient. If it is of the rheumatic, gouty, or syphilitic diathesis, this must 
 
208 
 
 be met by the usual remedies; in other words, the physician must treat assiduously the 
 systemic condition which seems to predispose to the development of this neuralgia. The 
 daily free administration of laxatives and diuretics is advisable. Should a local cause 
 for the constipation be found in the anus or rectum, it should be removed by surgery 
 or otherwise. Free daily evacuation of the bowels are indispensable to the restoration 
 of the physiological balance of these patients. Constipation may lead to fecal anemia. 
 In women thus affected neuralgic dysmenorrhea is extremely common. Rheumatism 
 should be treated with colchicum, guaiac,the salicylates, and the preparations of potash. 
 Gout requires the administration of minute doses of calomel, as one-twentieth of a grain 
 three times a day, and with the citrate of potash or lithia. wSyphilis calls for mercury 
 and iodides. An anaemia demands tonics. An indulging' fermentative dyspepsia 
 which ?nay be one source of degenerated general health, requires gastric lavalion, creo- 
 sote, glycozone and other antiseptic treatment. 
 
 ELECTROLYSIS FOR THE SURGICAL TREATMENT OF 
 
 STRICTURES.* 
 
 By J. A. FORT, M. D., 
 
 Professor of Anatomy in the Kcole Pratique of the Paris Faculte de Medecine. 
 Published by the New York Medical Journal, November 16, 1895. 
 
 It affords me great pleasure to have the honor of being allowed through the kind- 
 ness of your president to present to you a new instrument which I have devised and 
 called "electrolyser," for the surgical treatment of strictures by the "linear electrol- 
 ysis" method. 
 
 It is a well-known fact that electrolysis has been discarded on account of the im- 
 perfect instruments which were used. My electrolyser has all the advantages of the 
 urethrotome and none of its inconveniences. It looks like a small whip of which the 
 handle contains a metallic wire projecting from the end which connects with the flexible 
 part. This instrument, being first introduced into the urethra, is connected with the 
 negative pole of a continuous current battery, and the positive pole is connected near 
 the affected part, on the front of the thigh or over the pubes; then the current is turned 
 on. 
 
 The operation, which is almost painless, requires thirty seconds (on an average), 
 with a current of a strength of at least ten milliamperes, as indicated by means of a 
 galvanometer. The electrolyser remains perfectly cool during the operation. In 
 nearly all cases there is no bleeding, or but very little. The urethra is made aseptic 
 before and after the operation, in order to prevent fever. I never allow a sound to re- 
 main permanently in the urethra for any length of time after the operation. 
 
 Usually the wound resulting from electrolysis heals quickly without any local 
 treatment whatever, and often the patient can attend to business immediately after the 
 operation. \ In nearly all cases I pass a sound the third day after the operation, also 
 the day after. I instruct a patient to pass a sound, No. 22 or No. 24 F., every month 
 and every other month. 
 
 *Read before the Section in Genito-urinary Surgery of the New York Academy of Medicine, 
 Tuesday, November 72, 1895. 
 
 tWhen the wound does not heal, I merely prescribe injections morning and evening with a mixture 
 of one part of hydrozone to twenty parts of water. 
 
209 
 
 With the urethrotome, which cuts blindly, the surgeon can not ascertain the degree 
 of density of the tissue of a stricture. On the contrary, by means of electrolysis, which 
 
 
 The electrolyzer, shown in two parts, on account of its length, i, i, the shaft; 2, the conducting por- 
 tion; 3, the platinum blade; 4, point of connection with the negative \ 
 pole; 5, screw-head for fixing the conducting 
 cord; 6, ivory push-button. 
 
 merely produces a molecular destruction of the stricture, although the instrument re- 
 mains cool, I have been able to demonstrate that there are two classes of strictures — 
 "soft and hard." Hard strictures are in the proportion of one against five soft ones. 
 The time required to perform the operation varies with the density of the stricture. 
 Some strictures are so hard that they cannot be successfully operated upon by electrol- 
 ysis. 
 
2IO 
 
 If my American colleagues who are familiar with the French language are willing 
 to refer to one of my books entitled Traitement des ritre'cissetnents par V electrolyse 
 Unfair e (this book can be procured at the library of the Academy of Medicine), they 
 may find it quite interesting, as it will enable them to understand the improvements 
 which have gradually been introduced in the applications of electrolysis to surgery dur- 
 ing the last fifteen years. They will also understand how I have applied electrolysis 
 to the treatment of strictures of the urethra, uterus, rectum, and oesophagus. 
 
 Up to date, I have performed in Europe a hundred and thirty-five operations on 
 strictures of the oesophagus (recorded in my book), and with the exception of those 
 which were caused by malignant growths of the wall of the oesophagus all recovered. 
 
 It has been my good fortune to meet here some leading surgeons who are author- 
 ities in the treatment of strictures, and I am very grateful to them for their kindness in 
 giving me the opportunity to demonstrate the advantages of my method in operating 
 upon some of their patients. 
 
 CAN ANTITOXIN STATISTICS BE P.ELIKI) UPON? 
 By GUSTAVUS BLECH, A. B. , M. D., 
 
 Surgeon to the German Free Dispensary, Detroit, Mich. 
 Published by The Journal of the American Medical Association, for Jauuary 25, 1S95 
 
 The many fiascoes in modern medicine have taught me a lesson, viz.: Never to 
 be the first and never to be the last one, to adopt a new remedy. Liberality is one 
 of the first conditions for progress and success in medicine; conservatism, the prevent- 
 ative of poetic illusions and errors, undiscovered on account of the blinding effect of 
 enthusiasm. 
 
 I have quietly watched the reports of cures of diphtheria with antitoxin, and have 
 wondered how easy it is to catch the masses, even if one knows next to nothing about 
 the modus operandi of a remedy. Besides, its origin and composition is mystery as yet, 
 its preparation being controlled entirely by a few enterprising chemists. But neither 
 this nor the fact of its introduction into the human system is apt to cause a good many 
 dangers like leucocythemia, shall be brought as an argument against its value; even 
 the fact that a good many eminent and thoroughly reliable physicians have reported 
 their experiments with it as failures shall not be mentioned, and only one modest ques- 
 tion shall be asked: Can antitoxin statistics be relied upon ? I dare answer, no, not 
 always. 
 
 I do not doubt for one moment the honesty of the reporters and their noble inten- 
 tions; for the sake of the honor of the profession I will say that "figurers will not lie," 
 but I cannot help asserting that " figures will." The fact is, that every case reported 
 as diphtheria, is indeed, not always true diphtheria. In some cases the microscopic 
 examination alone was sufficient for a diagnosis, and that was false. In other cases, 
 the physical signs, the clinical picture was the medium, and that was false also. Both 
 together, microscope and thermometer, eye and hand, must be employed to obtain a 
 correct diagnosis. 
 
 Diphtheria, true diphtheria, in spite of horse, jackass or any other quadruped 
 serum, is a grave, constitutional disease, the prognosis of which is always doubtful. It 
 is exaggerated when one of my fiiends asserts, that he makes a diagnosis of true diph- 
 theria post mortem only; but there is some truth in that intended joke. There are 
 plenty of poor children running around the streets with sore throats, follicular tonsilitis, 
 rhinitis fibrinosa and never take a drop of medicine and get well. And in some of 
 these a physician is called in, and a few hours later the health inspector is placarding 
 the house. If, by chance, the parents are smart enough to call in a more experienced 
 physician, off goes the red sign. 
 
211 
 
 I had quite a number of such cases in my practice, but in one of my last ones I 
 had an encounter with our local board of health, which ended in my victory. 
 
 The case I refer to is that of a little boy, R. S. , aged 4 years. He was taken sick with 
 sore throat, and nose, the latter bleeding on touch, membranes being expelled on sneezing. 
 A reputable physician was called who pronounced it diphtheria. He sent a culture to 
 the local board of health where Klebs-Lceffler bacilli were found. For some unknown 
 reason to me, the parents discharged the physician and called me in to attend the case. 
 I made a careful examination of the nose and throat, found a somewhat accelerated 
 pulse and a temperature below 100 degrees F. The boy ran from one room to another 
 and would not agree to be confined to bed. While the mucous membrane appeared to 
 be, on the first look, diphtheria, a closer examination revealed the do.uble malady of 
 follicular tonsilitis and rhinitis fibrinosa. Both affections simulate diphtheria almost 
 to delusion. The clinical picture of a grave constitutional disease, high fever, etc., 
 which symptoms are a conditio sine qua non for a diagnosis of true diphtheria, were 
 absent. On the other hand some authors have lately classified rhinitis fibrinosa with 
 diphtheria, but the best authorities in the old and new world strongly object to such 
 classification. The argument that if the Klebs-Lceffler bacillus be found, the case 
 must necessarily be one of true diphtheria, does not always hold good, as Baginsky and 
 others have found the same bacillus in different forms of rhinitis and pharyngitis. 
 While I must admit that not every case of diphtheria is associated with a high temper- 
 ature, constitutional depression, etc., such is the rule without any exception in nasal 
 diphtheria. After nose and throat have been sprayed with hydrozone there could be 
 found no microbe in the culture taken the other day. 
 
 The number of cases of this kind which I have successfully treated approaches 
 closely to one hundred. If, according to the Board of Health of New York, Chicago 
 and other institutions, they ought to be styled diphtheria, well then what is the use of 
 injecting blood serum taken from some animal ? We have in hydrozone (30 volumes 
 aqueous solution of anhydrous peroxide of hydrogen) a remedy which not only kills 
 instantaneously the Lceffler bacilli, but also changes chemically the soil in which their 
 spores can develop. Its deadly action is limited to vegetable cells (pathogenic germs) 
 and it is the most powerful stimulant to healthy granulations, having no injurious action 
 upon healthy animal cells. In fact, my experiment taught me that hydrozone is a Safe 
 and most reliable remedy to use in the treatment of diphtheria. On the contrary, I 
 will say: 
 
 How can we rely upon antitoxin ? 
 
 203 E. Columbia Street. 
 
 HYDROZONE IN PURULENT OTITIS MEDIA. 
 
 By WM. CLARENCE BOTELER, M. D., of Kansas City, Mo. 
 
 A Report of a Case Supposed to Involve Inflammation of the Mastoid. 
 
 Published by the Medical Bulletin, of Philadelphia, Pa., February, 1896. 
 
 On November 4, 1895, I was consulted at my office by Robert P , aged 24 
 
 years; occupation, laborer in the Armour Packing^ Company. The patient complained 
 that for about four weeks he had been suffering from intense pain in his left ear, making 
 it impossible for him to sleep at night, or rest during the day. The pain was so severe 
 that at times he apparently lost consciousness and it seemed to extend through his entire 
 brain. Upon inspection, the man's face was found terribly deformed; an edematous 
 swelling the size of one half of an ordinary loaf of baker's bread occupied the usual 
 location of the ear and the surrounding muscles. The auricle of the ear was almost 
 buried in edematous tissue; upon palpation, the part w T as found intensely tender and 
 
212 
 
 deep pressure invoked expressions of excruciating pain. The integument and sub- 
 cutaneous tissue were thoroughly infiltrated. Ichorous, fetid pus was slowly exuding 
 from an almost imperceptible meatus. The patient expressed feelings of chilliness, 
 showing a possible septic contamination of his system. Every indication and sign pointed 
 to possible suppuration of the mastoid cells — tenderness upon pressure over the mastoid 
 being very marked. Efforts to localize the tenderness, whether in external meatus or 
 mastoid, for discriminating diagnosis, were unsatisfactory. I concluded to withhold a 
 positive diagnosis as to whether the condition was purulent otitis media or suppurative 
 inflammation of the mastoid, and used tentative treatment for a short while. I imme- 
 diately placed the patient under heroic doses of elixir of the six iodides internally. After 
 laborious effort I succeeded in separating the edematous tissue sufficient to admit the 
 introduction of a small Eustachian catheter into the external meatus. Through this, 
 with a small hard rubber syringe, I injected four times daily about one-half an ounce of 
 hydrozone, allowing it later to drain away, advising hot fomentations. The patient was 
 confined to his bed and the best possible hygienic surroundings provided. In twenty-four 
 hours after the treatment was commenced, the intensuy of the odor, amount and char- 
 acter of the discharge had manifestly lessened, the swelling was reducing and the patient 
 feeling better. The edema being lessened, the aperture was enlarged. I now recom- 
 mended the injectiorf of hydrozone through a catheter of larger calibre, every hour, 
 requiring the head to be kept turned to the opposite side for ten minutes to allow the 
 percolation of the hydrozone as deeplvas possible into the middle ear, before reversins 
 the position to allow drainage. I continued this treatment for a week, the man'g 
 recovery progressing with remarkable rapidity, his pain and the constitutional symp- 
 toms having disappeared about the third day. At the end of eight days the swelling had 
 entirely disappeared, his features were again normal, and he expressed himself as per- 
 fectly well. An examination showed a circular perforation in the ear drum the size of 
 a shot, proving that the case had been one of purulent otitis media, with septic con- 
 tamination of the patient's system, and infiltration of the surrounding cutaneous tissues. 
 Small incisions were made at two different places to permit the exit of pus from the 
 integument. The mastoid was found not involved. The rapidity with which the dis- 
 ease yielded after the introduction of hydrozone through the catheter into the middle 
 ear impressed me with the wonderful value of the preparation; for struggling with such 
 cases during a practice of seventeen years, I have never seen its efficiency equalled by 
 any medicinal or operative procedures. 
 
 PEROXIDE OF HYDROGEN. 
 
 By WARREN BROWN, M. D., Tacoma, Wash. 
 
 Published by The Medical Sentinel, of Portland Ore., February, 1896. 
 
 (Read before the Washington State Medical Society, May 1895.) 
 
 This is usually made by the decomposition of hydrated peroxide of barium by sul- 
 phuric acid. It is employed in the arts for bleaching. The usual commercial article 
 yields about ten volumes of oxygen. 
 
 Dr. Benjamin Ward Richardson, the famous London ptrysician, who in 1893 
 received knighthood from Queen Victoria, first experimented with Peroxide of Hydrogen 
 in 1857. It was regarded then as a curiosity, and was soon forgotten. Thirty years 
 later, Dr. Squibb, of Brooklyn, brought it prominently before the profession, and since 
 that time it has been used more and more each year, until its consumption has reached 
 enormous proportions. 
 
 In order to preserve hydrogen peroxide it must be slightly acid; on this account, a 
 disagreeable irritation and smarting may be caused by its use on mucous membranes. 
 
213 
 
 This can be avoided by mixing it fresh at the time it is to be used with equal parts of 
 lime water, or spraying with lime water first. 
 
 It effervesces not only with pus, but with blood, serum, mucus and cerumen: It 
 is one of our best antiseptics, and it is of the greatest value in removing septic clots 
 and enveloping fluids before making applications of other drugs. 
 
 As a bleaching agent, in skin practice, it is constantly used in removing pigmen- 
 tary stains, and may always be tried before resorting to bichloride of mercury in the 
 treatment of freckles and chloasma. Discolorations of the skin and nails caused by the 
 aniline dyes, chrysarobin, pyrogallol, sulphur, and permanganate of potash will yield to 
 this excellent bleaching agent. Nearly all of the patent hair bleaches on the market 
 contain peroxide of hydrogen. 
 
 Gonorrhoea may often be aborted by using a full strength hydrogen dioxide injec- 
 tion immediately on the very first appearance of discharge. The meatus should be 
 closed and the solution retained for five minutes. The injection should be used four to 
 six times in twenty-four hours. This drug is only of value in the incipient stage. 
 
 Cystitis, where pus is voided with the urine, often yields rapidly to injections of a 
 solution containing two ounces to the pint. 
 
 Otitis media is treated by hydrogen dioxide solutions in various strengths from 6 
 per cent, upward. It is an almost indispensable agent in these cases. 
 
 Eye diseases, where there is a purulent external inflammation, are constantly being 
 benefited by this agent. The Wills Eye Hospital, Philadelphia, uses a 50 per cent, 
 strength of the so-called 15 volume solution. Blepharitis marginalis is quickly cured 
 by touching the edges of the lids once or twice daily with a strong solution, care being 
 taken to avoid getting it into the eye. 
 
 Ulcers of all kinds improve rapidly under its use, granulations are stimulated and 
 surfaces freshened. For treating and cleansing venereal sores, as chancroids, etc., it 
 is of great service. 
 
 Empyema, especially where there is from the first a stinking, sanious exudation 
 following incision, is very satisfactorily treated by washing out the cavity with a solu- 
 tion from one-half to full strength. 
 
 Dr. Noble, of Philadelphia, commends this agent for cleansing the hands prepara- 
 tory to abdominal operations when the skin about the nails has become horny and rough 
 from frequent contact with antiseptic solutions. 
 
 In appendicitis, the abscess cavity is cleansed with this solution by many operators, 
 in preference to any other antiseptic. Dr. Robert T. Morris, of New York, has laid 
 special stress on the value of the peroxide in these cases. 
 
 In follicular tonsilitis, the use of a spray, diluted just enough to prevent the 
 smarting sensation, and alternating with this, one of the alkaline antiseptic sprays, or 
 gargles, is a very satisfactory procedure. 
 
 Diphtheria and all naso-pharyngeal inflammations where there is a pseudo-mem- 
 branous and septic condition, have been treated very widely by means of this agent. I 
 like the plan of Jennings, in Detroit, who uses an irrigation of an aqueous solution of 
 one eighth each of hydrogen dioxide and listerine. He throws the solution into the 
 pharynx with an all-soft rubber syringe every one, two or three hours. The plan is an 
 admirable one for treating children, and the combination is pleasant and effective. 
 
 Atrophic rhinitis is benefited remarkably by the use of a 40 per cent, spray. It 
 should be used a few minutes before the employment of the usual alkaline, stimulating 
 spray, and the powder insufflations. In this way the scabs are loosened, muco-puru- 
 lent secretions are dissolved, and a stinking breath is converted into one that is pure 
 and sweet. 
 
 In acute cases of eczema of the leg, we find this agent of the utmost value. The 
 tissues are inflamed, hot, swollen and oozing, the itching is almost unendurable, the 
 odor is offensive. To secure the best results the limb is elevated, and a diluted solu- 
 tion of the peroxide is applied frequently, with cheese-cloth, gauze or an atomizer. 
 In two or three days a marked change for the better will be apparent, the pruritus i s 
 
214 
 
 allayed, the purulent exudation is checked, and all inflammatory symptoms are sub- 
 siding. At this stage we begin the use of a soothing ointment, such as the boracic 
 acid or zinc oxide, using lime liniment to wash the parts instead of water. Under this 
 treatment, combined 'with rest, we will see our patient rapidly cured. 
 
 Eczema of the anus will rapidly improve if the fissures are touched twice a day 
 with this solution, then dried gently with cotton, and a glycerite of lead application 
 made. In nearly every form of acute eczema in the first and second stages the per- 
 oxide will give us the keenest satisfaction. The regular solution is diluted with two or 
 more parts of water. Hydrogen peroxide is an excellent anti-pruritic, and for this pur- 
 pose it is widely used. 
 
 The haemostatic value of this drug, as pointed out by Dr. Emerson Brewer, of 
 New York, I can endorse. In operations on the nose and throat I have upon two 
 occasions been enabled to check a persistent hemorrhage, when Monsel's solution and 
 plugging had failed. At present I am in the habit of applying the full strength hydro- 
 gen dioxide after every operation on these parts. It is of special value after sawing out 
 a deviated septum. 
 
 For flushing out a mammary abscess cavity this agent is invaluable. 
 
 Applied to ce&vix uteri, adherent mucus is removed and our medications can be 
 applied. 
 
 Where it is inadvisable or impossible to make a complete opening of a fissure or 
 abscess, irrigation with the peroxide will be found superior to all other antiseptics. 
 
 We have in Peroxide of Hydrogen a prompt, safe and efficient germicide. By its 
 oxidizing power it rapidly decomposes pus, diphtheritic membranes, and other morbid 
 putrifying material. It is a thorough deodorizer, and as a cleansing agent for foul 
 wounds, abscesses, etc., it has no equal. 
 
 Of the different preparations of peroxide, Marchand's has been most uniformly 
 
 satisfactory. 
 
 Bibliography.— Piffard, Jennings, J. Lewis Smith, Noble, Morris and others, as well as the cur- 
 rent medical journals. 
 
 Since writing the foregoing paper my attention has been called 
 to Hydrozone, a stronger solution of Peroxide of Hydrogen, which 
 for some months I have been using with much satisfaction. 
 
 CHRONIC GASTRITIS OF LONG STANDING, WITH 
 PERIODIC ATTACKS OF MIGRAINE. 
 
 By GEO. A. CURRIDEN, M. D., of Chambersburg, Pa. 
 Published by the Medical Summary, of Philadelphia, Pa., March, 1896. 
 
 The herewith reported case is one of double interest inasmuch as the patient has 
 been under my care for a number of years, and previous to the commencement of the 
 present treatment, I have been unsuccessful in affording much relief or preventing the 
 recurrence of the frequent and periodic attacks of migraine, to which she had been 
 more or less subject to since early womanhood. The cause of which I could not 
 account for more that "a habit long continued," aggravated by gastric catarrh. 
 
 The history of the case is briefly as follows: Mrs. A., aged 55, since early 
 womanhood has been subject to periodic attacks of migraine at intervals of two, three 
 or four weeks, but seldom free from them for longer intervals. 
 
 An attack comes on by general malaise of usually a day's duration, repugnance of 
 food or drink, marked drowsiness, much depression with request for rest and quiet, 
 followed by complete physical prostration, dull frontal headache, which the least noise 
 
215 
 
 or disturbance makes the more intense, invariably accompanied by violent and frequent 
 attacks of vomiting and retching, inability to retain any food or nourishment of any 
 kind, retention of bowels, often cold sweats, pulse somewhat slow and weak and small 
 in volume. This condition lasting usually two days, followed by gradual cessation of 
 symptoms. 
 
 During the whole period of usually four or five day's duration, she is unable to 
 take nourishment of any kind, remains constantly in bed, and desires only complete 
 rest and quiet. The previous treatment has been so varied and on so many different 
 plans, that I refrain from mentioning them. 
 
 Two years ago I was able to prevent an attack for over two months by the use of 
 strychnine in 1-20 grain doses t. i. d. with careful diet and artificial digestives. 
 
 In May, 1895, I put her on Charles Marchand's "Glycozone" treatment in teaspoon- 
 ful doses well diluted t. i. d. using this as all other previous remedies experimentally; 
 she commenced to improve much in general health, an unusually good appetite, without 
 the previous distressing symptoms following, a more regular movement of the bowels, 
 freedom from headache and in every way a decided improvement; this improvement 
 and enjoyment of good health lasted during continuation of above treatment for over 
 three months. Unknown to me she stopped taking the Glycozone, thinking herself 
 perfectly well. In a few weeks had a return attack, milder and devoid of gastric dis- 
 tress. A similar attack two months later, both of which occured some weeks after 
 stopping of the above described treatment, and I might say caused by imprudence in diet. 
 
 The conclusion come to, in this case, is that the headache is sympathetic, that the 
 stomach becomes acutely inflamed by its inability to naturally and properly perform its 
 functions, and responds to the call of nature to unload itself, and thus secure for a time 
 rest, that the use of Glycozone has corrected the existing gastritis, and by so doing has 
 removed the primary causes of these many years of suffering. 
 
 DISEASES OF THE EAR. 
 
 By ALBERT H. BUCK, M. D., of New York City. 
 (Abstract from The Journal of Medicine and Science, of Portland, Me., March, 1896. 
 
 When it was announced that Dr. Buck would write on "Diseases of the Ear," in 
 the Twentieth Century Practice of Medicine, it was a guarantee that affections of the 
 ear would receive the attention their importance merits, for he has been long and favor- 
 ably known as a writer and teacher of the highest attainments in the department of 
 otology which he has made his life study. 
 
 We are pleased to notice Dr. Buck's reference to the value of peroxide of hydrogen* 
 in the treatment, particularly of chronic suppurative inflammation of the middle ear. 
 He says: "To this drug more than to any other is due the credit for scores of cures 
 which nothing short of a radical operation could otherwise have effected," which cer- 
 tainly is of the highest importance for every physician to know, especially if he can learn 
 to use a drug the proper use of which will do away with an operation that he can not 
 do. 
 
 In the selection of such a valuable remedy it is of the highest importance to obtain 
 
 a reliable one and in this respect while there may be the product of other manufacturers 
 
 in the market that is reliable, we have come to think of Marchand's, when ordering it, 
 
 the same as we do of Squibb's ether when ordering an anaesthetic. 
 
 *Hydrozone (30 volumes H2 O2 aqueous solution) will give better results in all cases, on account 
 of its healing and bactericide properties which are far superior. See article headed: "Hydrozone in 
 Purulent Otitis Media," p. 210. 
 
2l6 
 
 HYDROZONE IN GASTRIC AND INTESTINAL DISORDERS. 
 
 By JOHN AULDE, M. D., Philadelphia, Pa. 
 
 (Published by the New York Medical Journal, August 15th, 1896.) 
 
 A period of nearly twelve years has elapsed since I first began the clinical use of 
 hydrogen dioxide, generally referred to at the time as the peroxide of hydrogen. In 
 1887 I published a paper giving a detailed account of several cases in which it had been 
 employed by inhalation, but even then I was thirty years behind the report of Dr. (now 
 Sir) Benjamin Ward Richardson, of London, who had made a thorough investigation of 
 its antiseptic, detergent, and healing properties. Notwithstanding the fact that this 
 preparation has been known to the medical profession for that length of time it had 
 achieved little or no reputation. This, however, may be explained by the fact that the 
 discovery preceded the dawn of bacteriology. Indeed, I was one of the early contribu- 
 tors to medical literature relating to the clinical value of this product, and since that 
 time I have published a number of articles, embracing practically every application, 
 both medical and surgical, to which hydrogen dioxide is adapted. 
 
 In the present communication it is my object to direct the attention of the profes- 
 sion to its special value in the treatment of gastric and intestinal disorders. In gastritis, 
 for example, there is no antiseptic which can be given with so much benefit as this rem- 
 edy, because its effect is immediate, and even in considerable doses it is absolutely harm- 
 less. The same is true in regard to itsemployment in typhoid fever, cholera infantum, 
 and Asiatic cholera. In the latter disease its efficacy has been thoroughly demonstrated 
 by a number of well-known physicians, and its applicability in cholera infantum is well- 
 known to those physicians who have given careful attention to the most modern 
 methods in the treatment of this class of cases. 
 
 The following brief notes will be sufficient to indicate the availability of this rem- 
 edy in the treatment of the disorders already mentioned, although, in view of the fact 
 that hydrozone is a more concentrated product, and withall a permanent solution, this 
 latter remedy should have the preference. It contains at least double the volume of 
 nascent oxygen which has heretofore been the standard for the medicinal peroxide of 
 hydrogen. 
 
 In gastritis, either acute, subacute, or chronic, we have to deal with an unhealthy 
 condition of the lining membrane of the stomach. The inflammation is attended with 
 an increased output of mucus, which seriously interferes with the normal functions of 
 the peptic glands. By the introduction of a small quantity of hydrozone, in the strength 
 of one part to thirty-two parts of boiled or sterilized water, this objectionable mucus 
 is at once destroyed by the action of the oxygen which is released, and the contents of 
 the stomach remaining are promptly discharged into the small intestine. A patient suf- 
 fering from gastritis should take at least half an hour before meals from two to four 
 ounces of diluted hydrozone (one to thirty-two) and lie on the right side so as to 
 facilitate the action of the stomach in discharging its contents*. The antiseptic prop- 
 erties of hydrozone thus used are sufficient to destroy the micro-organisms and leave 
 the stomach in a healthy condition for the absorption of nutritive pabulum. All forms 
 of fermentation are promptly subdued by the active oxidation resulting from the libera- 
 tion of nascent oxygen. The patient is then in a condition to take suitable food, which 
 should be nutritious and easily digested, liquids being preferred until the active symp- 
 toms have subsided. Later small portions of solid food can be ingested, but all food 
 
 * In chronic cases with a large output of gastric mucous, and particularly in gastric 
 ulcer concentrated solutions are not well borne at first, owing to the formation of oxy- 
 gen gas, but this difficulty disappears with the continuous use of the remedy, and no 
 treatment of gastric ulcer can be regarded as complete without the local employment of 
 hydrozone. 
 
217 
 
 stuffs of a starchy character must be thoroughly masticated, in order to secure the action 
 of the salivary secretion upon the starch granules, breaking them up, and lessening the 
 tendency to fermentation in the stomach. After taking a meal, a patient with gastritis 
 should follow it with medicinal doses of glycozone, which contain, in addition to the 
 nascent oxygen contained in hydrozone, a percentage of glycerin, which favors osmosis 
 and assists in re-establishing the functional activity of both the peptic and mucous glands 
 of the organ. 
 
 In the treatment of cholera infantum, typhoid fever, and Asiatic cholera, the same 
 general plan should be adopted in dealing with the stomach, always bearing in 
 mind the necessity for having the patient remain in the recumbent position and on the 
 right side for at least half an hour after the ingestion of the solution. In addition, how- 
 ever, to the preliminary treatment of the stomach, the same solution (one to thirty- 
 two) is used as an injection into the lower bowel, care being exercised to insure its intro- 
 duction as high up as possible. This can be managed by having the patient, lie on the 
 left side, with the hips well elevated, and the employment of along, flexible rectal tube. 
 In this manner we secure and maintain an antiseptic condition in both the stomach and 
 large intestine, the importance of which will be understood when we consider the large 
 number of micro organisms which grow under these favorable conditions with such 
 remarkable rapidity. 
 
 When deemed advisable, the solution introduced into the lower bowel may be com- 
 bined with large quantities of either hot or cold ,water, which enables us to obtain the 
 benefits of irrigation in addition to antiseptic effects. These irrigations may be em- 
 ployed as frequently as deemed advisable by the medical attendant, but they will 
 •usually prove satisfactory if administered at intervals of four hours. 
 
 Although brief, it is believed this communication will prove serviceable to a large 
 number of practitioners who have hitherto found seVious difficulties in counteracting the 
 mephitic influences of bacteria in this class of disorders, and the clinical virtues of the 
 remedy being now so fully recognized, no one will hesitate to adopt the methods 
 suggested, which may be conveniently carried out in addition to the usual routine 
 treatment. 
 
 TREATMENT OF INFLAMMATORY DISEASES OF THE 
 
 STOMACH.* 
 
 By GUSTAVUS M. BLECH A. B., M. D., Detroit, Mich. 
 
 Published by The Mathews 1 Quarterly, October, 1896. 
 
 For several years I have had under my care quite a number of patients afflicted 
 with acute or chronic inflammatory diseases of the gastro-intestinal tract. The records 
 of my clinic (143 of such cases) show that stomach diseases are to my knowledge the 
 most distressing ailments which may afflict human beings. When the stomach is out 
 of order life is a burden and everything seems to go wrong. 
 
 The majority of general practitioners, as far as I could learn, still adhere to the 
 old-fashioned treatment of gastric disorders, and I confess that during the first years of 
 my practicing medicine I have, like others, used remedies which every one of us have 
 'prescribed, in order to relieve their patients, and to my great disappointment I never 
 was fortunate enough to cure chronic gastritis by treating the symptoms, although I 
 have occasionally relieved my patients, but only when the disease was not chronic. 
 
 You have — as well as myself — prescribed menthol, cocaine, opium, ice, and other 
 remedies to relieve nausea and to stop vomiting ; you have cleansed the stomach by 
 
 *Read before the Mississippi Valley Medical Association at St. Paul, Minn., September 16, i8g6. 
 
2l8 
 
 lavage and purgatives, and subsequently irrigated the lining membrane of that much 
 abused viscus with modern antiseptics; you have called to assistance pepsin and 
 innumerable drugs, but have you cured your patient ? No. You have merely lost track 
 of him. The patient did not call again, because the treatment did not do him any 
 good, and frequently because it aggravated his trouble. 
 
 So the world goes on and the poor creature afflicted with chronic gastritis goes oa 
 suffering more and more. Why did you fail to cure catarrh of the stomach? It is 
 because you merely attempted to relieve the symptoms instead of prescribing remedies 
 to subdue the existing pathological condition, the inflammation of the lining membrane 
 of the stomach, which condition prevents the digestive process from being normal. 
 
 In order to subdue this abnormal inflammatory condition of the wall of the stom- 
 ach antiseptics are indicated, but you know as well as I do that powerful antiseptics 
 have the same destructive action upon both vegetable cells (germs) and animal cells. 
 Consequently, they will in all cases aggravate the disease. 
 
 I am much opposed to the use of strong drugs in my practice on account of sad 
 results which I have witnessed, and I put more stress on harmless, although most 
 powerful antiseptics, than I ever did since I successfully treated hopeless cases of 
 cholera infantum w,ith hydrozone (30 vols. H 8 3 , aqueous solution). 
 
 Therefore my method of treatment of all inflammatory diseases of the stomach may 
 be summed up as follows: First destroy the morbid element which is present in the 
 stomach, so as to thoroughly cleanse the mucous membrane; second, heal the diseased 
 surface after it has been made aseptic. 
 
 As a cleansing agent which acts both mechanically and chemically, I know of 
 nothing as powerful as hydrozone. Therefore I prescribe one tumblerful of lukewarm 
 water containing two per cent, of hydrozone, half an hour or so before meals. 
 
 The nascent oxygen which is set* free in the stomach by its oxydizing action destroys 
 the morbid element and cleanses the mucous membrane more thoroughly than anything 
 I know of. This being done, the patient should wait. for at least fifteen minutes before 
 taking his meal. 
 
 As a healing agent I prescribe one to two teaspoonfuls of glycozone diluted in 
 water to be taken immediately after meals. 
 
 The results which I obtained in submitting my patients to the above rational treat- 
 ment are so gratifying that I do not hesitate to say here that the great majority of 
 cases of stomach disorders may be cured or at least much relieved in a very short time 
 by this treatment, which is already indorsed and used by some of our most skillful 
 practitioners. 
 
 On this occasion I wish to state that I cured a well-defined case of gastric ulcer, 
 at least all the characteristic symptoms, like circumscribed pain, indigestion, and hema- 
 temesis have disappeared for fifteen months under the above treatment, save lavage, 
 which when practiced once caused an alarming hemorrhage. I wrote to the patient, 
 who lives in St. Louis, and he informs me that neither of his symptoms have appeared 
 since I left that city, which was about fifteen months ago. The patient has been 
 instructed to resume the treatment as soon as even the mildest symptoms reappear, but 
 he wrote me that he needed to use no medicine whatever. 
 
 While my experience with gastric ulcer is but limited, I could suggest no better 
 treatment; first, because all usual remedies do not influence the ulcer itself, and second, 
 because I have seen healed the most stubborn cases of ulceration of the cervix and. 
 chronic ulcers of the leg under the same method of treatment. 
 
 During the discussion which followed the reading of this paper, Dr. Larrabee, of 
 Louisvilie, had this to say: Almost any condition found in the stomach may come 
 from the causes mentioned by those who have spoken, but I am convinced that the 
 portal circulation is a most important factor in these cases; and one, too, which is often 
 overlooked. Exercise is of paramount importance, in all cases of chronic gastritis. In 
 arresting putrefactive changes in the stomach glycozone has proven in my hands most 
 excellent, but do not neglect to stimulate the liver when indicated. 
 
219 
 
 TREATMENT IN DIPHTHERIA. 
 
 By E. LAWRENCE LINDER, M. D., Blackfoot, Tex, 
 
 (Published by the Medical Brief, St. Louis, Mo., October, 1896.) 
 
 Much has been written about diphtheria and its treatment in the Brief, but I will 
 add my mite, thinking it will be of some benefit to my professional brothers. 
 
 In the beginning, I will state that I have used antitoxin in three cases, and two 
 proved fatal. I will never use it again, unless forced to through the solicitation of the 
 patient's family, 
 
 I will give my experience in the treatment of three cases of diphtheria: 
 Case i. — In June 16, I was called to see H. R., a girl eight years old, and found 
 her suffering with diphtheria. I at once prescribed mild chloride of mercury in two 
 grain doses every two hours, until the bowels moved freely. At the same time I painted 
 throat externally and internally with tincture iodine. I also ordered the throat to be 
 sprayed with the following every two hours: 
 
 1$ Peroxide of hydrogen (Marchand's,) § j. 
 Aquas dest., § vij. 
 On the 17th, I found patient about the same as on the previous day; the bowels 
 having acted well, but not too much. I then put the patient upon following treatment: 
 
 I£ Potassii chloratis', 3 j. 
 Aquae dest., § j. 
 Mix and give one drachm every two hours, also adding to each dose five drops of 
 the tincture of iron. 
 
 For the throat, I used Ihe following solution with an atomizer: 
 
 I£ Peroxide of Hydrogen, (Marchand's,) § j. 
 A^uae dest., § vij. 
 M. Use every two hours with atomizer. 
 Also; 
 
 1$ Potassii permanganate, gr. viij. 
 Aquae dest., \ j. 
 M. Use every two hours with atomizer. 
 I used the above solutions alternately every hour. 
 
 I continued the above treatment, and on June 22d, I discharged the patient, 
 prescribing the following, however, as a tonic to be taken for a week or two. 
 
 I£ Strychnia sulph., gr. j. 
 Quiniae sulph., gr. xxxj. 
 Tinct. ferri chlor., § j. 
 Aquae dest., q. s. ad. § iv. 
 M. Sig. One drachm every six hours. 
 
 Case 2. — On June 19th, three days after case one was taken, I was asked to pre- 
 scribe for O. R., six years old, a brother of case one. I found the little fellow suffer- 
 ing also with diphtheria, and put him on the same treatment as in case one except the 
 doses were diminished. The fever being higher than in case one. I gave a few doses 
 of acetanilid and aconite, until fever was reduced. With the same treatment this child 
 recovered also, and on June 27th, I discharged him, leaving the same tonic that I gave 
 his sister. 
 
 Case 3. — On July 3d, I was again called to Mr. R.'s, this time to see little G., 
 three years old, and a brother to cases one and two. I began treatment as I had 
 in the two previous cases. On the 4th and 5th there was little or no change. Mr. R., 
 the child's father, having read of antitoxin and its wonderful (?) cures, asked me to use 
 it. I at first refused and called in Dr. D. in consultation. After consulting, we agreed 
 to use antitoxin; both of us, however, did not wish to use it. On the 6th, the condition 
 of the patient unchanged. On the 7th, patient worse, and on the 8th, Dr. D. told the 
 
220 
 
 family that the patient would die, and discontinued his visits. After much pleading, 
 I got the father to permit me to discontinue the antitoxin. I at once resumed former 
 treatment, adding to treatment the cauterization of membrane with nitrate of silver, and 
 controlling fever with aconite and gelsemium solution, and acetanilid and antikamnia 
 powders per rectum. 
 
 On the following day, the gth, patient was resting easier, breathing freer, and 
 condition somewhat improved. This improvement continued until the 16th, when I 
 discharged the patient, leaving the following tonic to be taken for two or three weeks: 
 
 1$ Quiniae bisulph., gr. x. 
 Strychnia, sulph., gr. £. 
 Nitro-hydrochloric acid, gr. xxx. 
 Tinct. iron, 3 iiss. 
 Aquae dest., q. s. ad § viij. 
 M. Sig. One teaspoonful every six hours. 
 
 The patient continued to improve, and on July 27th, came into my office with 
 his father, looking well and healthy. 
 
 From my experience with these three cases, and especially the last one, I must 
 confess that I have no faith whatever in this new fad called antitoxin. I will never 
 use it again. 
 
 A CASE OF PROTRACTED LABOR. 
 
 Rupture of the Uterine Wall — Co?icealed Hazmorrhage — Subsequent 
 Extensive Sepsis and Mural Abscess , etc., Ending in Recovery. 
 
 By J. N. UPSHUR, M. D., Richmond, Va. 
 
 Professor Practice of Medicine, Medical College of Virginia. 
 
 Read before the Richmond Academy of Medicine and Surgery at a meeting held 
 
 October 13, 1896. 
 
 Dr. LANDON B. EDWARDS, President, in the Chair. 
 
 Dr. MARK W. PEYSER, Secretary and Reporter. 
 
 Published by the Virginia Medical Semi-Monthly of Richmond, Va., for Oct. 23, 180,6. 
 
 Mrs. H., get. 40, of good health prior to two months before delivery, when she 
 had an attack of dysentery. I saw her at that time. She had a recurrence of the 
 attack twice, but treated herself with the same remedies prescribed by me during the 
 first attack. With this exception, her pregnancy had been an uneventful one. 
 
 Labor came on suddenly at 7 p. m., September nth — pains so active and strong 
 that I was twice sent for within an hour. When I reached my patient at 8 P. M., she 
 looked pallid and showed evidence of extreme suffering — pains were strong and regu- 
 lar, coming on every few minutes. Digital examination revealed a cervix very rigid, 
 
221 
 
 thick, and about two inches long, through which could be felt the vertex presenting in 
 the first position. The pains, though violent and causing much suffering, made little 
 impression in dilating the rigid cervix. To procure rest and relaxation of the cervix, 
 about 12 p. M. I administered a hypodermic of sulphate morphia grain one-fourth, 
 sulphate atropiae, grain T ^. This procured her some respite from suffering for three 
 hours, when pains again became active. Cervix had slightly softened. She was now 
 given chloroform, but only with the effect of stopping pains. A second hypodermic 
 was given at 7 A. M., and I left the patient for three hours. 
 
 On my return at 11 A. m., I found cervix relaxed and dilatable, and pains active 
 and regular. Patient looked pallid, with feeble pulse, and had clammy skin. But 
 that she had had three exhaustive attacks of bowel trouble and a wearing labor from 
 the beginning, I should have suspected concealed haemorrhage. Chloroform was again 
 administered, and she was normally delivered at 12:45 of a still-born male infant weigh- 
 ing nine pounds. She had last felt the motion of the child just prior to the onset of 
 labor. There was delay in the delivery of the placenta, and the uterus was in a state 
 of complete inertia. Examination showed the placenta detached, and it was easily 
 removed; introduction of the hand being followed on delivery by a double handful of 
 coagula. It was evident that partial detachment of the placenta had taken place prior 
 to the birth of the child. 
 
 The uterus remaining obstinately relaxed, the hand was passed into the cavity, 
 which presented a feeling of a ragged bag, while on the right of the uterine wall, half 
 way between its anterior and lateral portion, could be felt an incomplete rupture of the 
 uterine wall in its long diameter about three inches long, and extending four-fifths of 
 the thickness of the uterine wall, so that a narrow escape had been made from opening 
 the peritoneal cavity. After administration of sulphate strychnia grains ^, and fluid 
 extract ergot (Squibbs) 3 v, with introduction of ice into the cavity, the womb was 
 induced to contract finally. I would have preferred a hot salt solution, but it was not 
 available, and only a septic syringe with which to use it, if it had been. The patient 
 reacted well. Having always had a free secretion of milk, tincture of camphor was 
 ordered applied to the breasts, beginning a few days after delivery, extending its appli- 
 cation well into the axillae. This proved efficient, and no milk was secreted. 
 
 On the second and third days after delivery, temperature only rose to 99. 4° F. 
 On fourth day it reached ioo° F. Lochia profuse, offensive, of the color of dirty dish 
 water. Free hot douche of hot water and borax was ordered thrice daily. 
 
 But on the morning of the fifth day, finding no improvement except temperature 
 slightly subnormal (98 F.), the uterus was washed out freely with hot salt solution. 
 Uterus was found above the pubis, and spongy. Ordered tincture chloride iron, ergot 
 and nux vomica in full doses every four hours. 
 
 On sixth day found little change in lochia, and that seventeen napkins had been 
 used in previous twenty-four hours; pulse fair at 90-100; temperature as on day 
 before. Curette (sharp) was used, and a number of dirty shreds of sloughing tissue 
 were removed. 
 
 On seventh day, patient expressed herself as feeling better; pulse and temperature 
 same as on day previous. Curette was again used, and large pieces of sloughing tissue 
 were removed; curette gave way suddenly, giving sensation of entering a cavity, and 
 was followed by a discharge of an ounce or more of thick, dirty-colored stinking pus. 
 I believe the rupture had healed on the surface, and an abscess had developed at the 
 bottom. The curette was freely used until discharge was slightly stained with blood. 
 Half gallon of salt solution was run through the uterine cavity till it came away clear 
 and odorless; patient expressed herself as feeling much more comfortable. 
 
 On eighth day, pulse and temperature same; ten napkins used; curette again 
 applied; no shreds. Washed out with Peroxide of Hydrogen, followed by salt solution, 
 and lightly packed with iodoform gauze. 
 
 ^ Twenty-four hours after delivery, the patient complained of severe headache, 
 located chiefly in the occiput. This was relieved by two doses of phenacetin of gr. v. 
 
222 
 
 each, but returned when the drug wore off. Subsequently benefited by sodii bromidi 
 gr. xx, and caffeine gr. ss. Patient had a comfortable night, has some appetite, 
 expressed herself as free from headache, and feeling much better; said headache 
 returned after treatment of womb. She has taken on two days full doses of quinine, 
 but I could detect no benefit from its exhibition. Bowels have been moved on alternate 
 days by exhibition of compound senna powder. Tongue has been clean, but pallid 
 from beginning. 
 
 On ninth day, eleven napkins in last twenty-four hours; temperature, ioo° F.; 
 pulse, 108; had a good night, but sweated freely; appetite fair; discharge very little 
 offensive; curette used; § j of pus discharged from uterine cavity; came from site of 
 rupture; uterus reduced decidedly in size; washed out freely with Peroxide of Hydro- 
 gen, one-fourth to three-fourths hot water, followed by salt solution. Patient complained 
 of violent frontal headache during the dressing, which passed off when completed; 
 light packing of iodoform gauze applied. 
 
 Tenth day, eight napkins; pulse, ioo; temperature, 99.4°; no odor in discharge; on 
 removing gauze, ^ ss pus flowed away; uterus cannot be felt above pubis; measured 
 three inches with probe; swabbed out with pure peroxide and replaced with gauze; com- 
 plained of severe frontal headache during the dressing, which subsided when it was 
 completed. 
 
 Eleventh day, five napkins; temperature, 99. 2°; pulse, 100; on removing gauze 3 ss 
 pus; no sweating. 
 
 Thirteenth day, temperature, 99.4. pulse 100; no sweating. 
 
 Fourteenth day, pulse, 96; temperature, 99°F,; no flow. 
 
 Sixteenth day, pulse, 100; temperature 97. 05 ; convalescence established; patient 
 sat up an hour and a quarter. 
 
 Twenty-eighth day, patient dressed and moving about her room; says she is abso- 
 lutely comfortable; no pain or weakness in back or elsewhere, except a little unsteady 
 on her feet. 
 
 Remarks. — The above case presents first in interest, the condition of the cervix at 
 the beginning of labor, so hard and resistant as to give the impression of previous dis- 
 ease, which had not been the case, except a slight cervical catarrh, for which I had 
 treated her prior to her sixth confinement, which had been rapid and uneventful. Pains 
 seemed absolutely inefficient in producing dilatation until after the administration of 
 morphine — the resistance in spite of such strong contractions being responsible for the 
 subsequent complications. I am sure that the patient's pallor was due to concealed 
 haemorrhage from premature partial separation of the placenta, not appreciated at the 
 time because of my knowledge of three attacks of dysentery in the previous two months 
 and the suffering she had borne incident to the violent uterine action, ineffective and 
 depressant. The inertia of the womb was simply muscular tire. 
 
 The rupture of the uterine wall in its long axis is of interest, because the almost 
 invariable rule is that when rupture occurs, it is in the transverse direction. "Boudl 
 reported nineteen cases in 40,614 labors occurring in nine years in the Lying-in Hos- 
 pital in Vienna. Jolly, in Paris, found 230 cases in 782,741, excluding from his list 
 lacerations of the cervix. Harris estimated one case in 4,000 labors. Lusk found 
 forty-seven deaths from this cause in New York between 18C7 and 1875, inclusive, or 
 one death in six thousand labors." — (Lush's Obstetrics, page 603.) I had a case of 
 complete rupture due to after-coming hydrocephalic head — patient dying five hours 
 after delivery. 
 
 Hagenberger estimated the mortality at 95 per cent. ; C. Braun at 89 per cent. (Lush, 
 page 603.) The above facts show how rare is this complication, even though incomplete. 
 
 Another point of interest is the prevention absolutely of the milk formation by the 
 early and repeated use of tincture of camphor in a woman who had in six previous con- 
 finements had an abundance. A long experience has proven no remedy better than the 
 camphor in my hands. The fact that only twice did the temperature reach roo° F. in a 
 uterus so septic as I have described, is remarkable, and the efficient action in the direc- 
 
223 
 
 tion of cure of free curettage, douching with salt solution and application of Hydrogen 
 Peroxide in stopping suppuration, evidences the great value of this therapeutic method. 
 The violent reflex headache coming on during the dressing and disappearing when it 
 was completed, is of interest, and shows plainly that the violent headache coming on 
 twenty-four hours after labor, was also reflex in character. 
 
 I deem myself most fortunate to have had such a satisfactory result in this case, 
 and place it on record for the instruction and encouragement of my professional 
 brethren. 
 
 DISCUSSION. 
 
 Dr. Paulus A. Irving thought it remarkable that there was no hemorrhage from 
 the site of the uterine tear. Another striking feature of the case was the low tempera- 
 ture in spite of the large amount of pus dammed back — the more remarkable when 
 we consider how a little excoriation or tear of the os, or cervix is so often followed by 
 a rise of temperature — sometimes even to 104 F. He commended Dr. Upshur for his 
 most admirable treatment and successful issue, especially in the employment of Hydro- 
 gen Peroxide. Nothing could be added to it. 
 
 Dr. Lewis M. Cowardin called attention to the fact that Hydrogen Peroxide 
 affects not only pus, but all organic fluids. Where a blood-clot was to be dissolved, he 
 knew of nothing more efficacious. 
 
 Dr. J. S. Wellford thought Hydrogen Peroxide a better disinfecting agent than 
 all others, because it produces super-oxidation of all effete matters, liberating, in the 
 body, ozone. In employing it, we imitate the processes of Nature, changing the specific 
 character of the ptomaines. 
 
 He asked Dr. Upshur the positions of the placenta and abscess in relation to the 
 tear. 
 
 Dr. Arthur Jordan spoke of a case in which he had successfully used creatin, 
 bichloride of mercury solution, Hydrogen Dioxide, and Hydrozone. Hydrogen Dioxide 
 had given better results than the first two, but pus was more diminished with two injec- 
 tions daily of Hydrozone than three of Hydrogen Dioxide. 
 
 The President stated that in his practice a vaginal douche of Hydrozone (Marchand) 
 prevented the third day fever of the puerperal state. His experience with that of Drs. 
 Irving, H. M. Taylor, Edward McGuire, and others, in some cases of puerperal sepsis, 
 had shown the great value of intra uterine injections of Hydrogen Peroxide and Hydro- 
 zone — simply keeping the os uteri well dilated so as to give free egress to the foaming 
 -pus, etc., that pours out. He uses a half pint to a pint each injection — diluted or not 
 with water. Marchand's preparations are those upon which he relies. 
 
 Dr. Upshur, in closing the discussion, said the placenta was above and posterior 
 to the rupture, the abscess being seated in the bottom of it. 
 
 He has firm convictions with regard to the value of Hydrogen Dioxide. Often the 
 -efficiency of applications to the cervix, externally, and canal, is lessened by a skin of 
 mucus that cannot be wiped away by cotton. In cases of this kind, the dioxide on an 
 applicator will dissolve the mucus, allowing the application to come in contact with the 
 tissues. 
 
 For cleansing purposes, he preferred a simple solution of Hydrozone or Hydrogen 
 Peroxide to the chemical agents, such as bichloride of mercury, carbolic acid, perman- 
 ganate of potassium, etc. 
 
 The Secretary, Dr. Mark W. Peyser, reported a case of horse-shoe fistula success- 
 fully treated with Hydrozone. Girl, aged 16 years. An abscess developed on either 
 side and above the anus, which were on the point of rupturing. Both were incised, 
 and afterward injected with Hydrozone until the discharges came away clear. The 
 solution made its way from one opening to the other, demonstrating the presence of a 
 horse-shoe fistula. In a week it was in a fair way to recovery. 
 
224 
 
 THE USE OF PEROXIDE OF HYDROGEN IN DISEASES OF 
 THE NOSE, THROAT AND EAR.* 
 
 By W. SCHEPPEGRELL, A. M., M D., New Orleans, La. 
 
 Professor of the Ear, Nose and Throat Department of the National College of Electro- 
 Therapeutics ; Vice-President of the American Laryngo logical. Rhinological 
 
 and Otologic al Society, etc. 
 
 Published by Medical Record, Aug. 8, 1896. 
 
 Peroxide of Hydrogen is one of the most useful agents which *we have in the treat- 
 ment of diseases of the nose, throat and ear; its germicidal and antiseptic properties, 
 and its capacity for destroying pus and decaying organic matter, without injurious 
 effect on healthy tissues, renders it almost indispensable in many cases. It has always 
 been a source of surprise to me, that so little reference to this valuable agent is found 
 in the foreign periodicals. 
 
 Peroxide of Hyjdrogen is not toxic, in fact it is used for internal medication, and 
 the amount which may be taken without injurious effect, is well illustrated by a case 
 recently reported, in a course of discussion on diphtheria, by Dr. Rudolph Matas. In this 
 case, in which Dr. Matas had occasion to prescribe it for a man suffering from asthma, 
 the patient, from a misunderstanding of the directions, took six or eight four ounce 
 bottles of Peroxide of Hydrogen during one night, and was not only not injured by 
 this excessive amount, but actually believed that he had been benefited. 
 
 In the disease of the nose, Peroxide of Hydrogen is an important therapeutic agent. 
 In ozena awash of a 25 per cent, solution is useful; or, after washing the nostrils with 
 an alkaline or the normal physiological salt solution, the Hydrogen Peroxide, pure or 
 mixed with an equal quantity of glycerine, may be applied locally by means of an 
 atomizer or applicator with cotton, to remove or destroy any scabs or secretion which 
 may be left. In this way the nostrils can be kept clean, and the offensive odor which 
 is one of the most unpleasant features of this disease, may be prevented. In purulent 
 rhinitis, a 5 per cent, solution, to which an alkaline has been added, is useful. It is also 
 said to be very serviceable in controlling nasal and pharyngeal hemorrhage. 
 
 In membranous rhinitis, whether due to Klebs-Loeffler bacillus or to micro-cocci, 
 the spraying of the nostrils with a 20 to 50 per cent, solution is indicated, and has given 
 me excellent results. My experience in diphtheritic rhinitis with this agent has been 
 so satisfactory that I have not deemed it necessary to use the antitoxin in these cases, 
 as this does not seem to prevent the post-diphtheritic paralysis, which would be the 
 only reason for my using it in diphtheritic rhinitis. 
 
 In the specific necrosis in the nostrils, Peroxide of Hydrogen is an important agent, 
 not only for its disinfecting properties, but also for controlling the horrible odor that is 
 present in these cases. In diseases of the accessoiy sinuses of the nose. Peroxide of 
 Hydrogen is so beneficial that I use it in all cases, whether of a maxillary, frontal, ethy- 
 moidal or sphenoidal sinus. In my opinion it cleans and disinfects the infractuosities 
 of these cavities more effectively than any other agent that we have. 
 
 In diseases of the throat, Peroxide of Hydrogen is used in follicular and other 
 forms of tonsillitis, and in specific affections, and is a sheet anchor in diphtheritic pro- 
 cesses in this region. Long before the introduction of antitoxin, I have had excellent 
 results from Hydrogen Peroxide in diphtheria, and even since the use of this serum, I 
 never fail to use the peroxide as a valuable adjunct; and I believe it to have had an 
 important bearing on the results obtained. It attacks the membrane, disinfects the 
 parts, and has no injurious effects when swallowed, which is more than can be said of 
 
 The Peroxide of Hydrogen which I use, is made by Charles Marchand, New York, 
 and this is the preparation which gave such excellent results in the above case. 
 
225 
 
 many other antiseptics used for this purpose. In a recent case of laryngeal diphtheria, 
 to which I was called in consultation, the stridor and dyspnoea were so marked that I 
 was compelled at once to introduce an intubation tube. The tube, however, was 
 repeatedly coughed out, and I then made use of a procedure, which I had found bene- 
 ficial in former cases, — the injection of a 75 per cent, alkaline solution of Peroxide of 
 Hydrogen, directly into the larynx by means of a laryngeal syringe. The relief given 
 by this injection was so great, that I was not compelled to intubate again, but simply 
 to make these injections every four hours. The patient also received three injections of 
 diphtheria antitoxin serum, which I made at intervals of 24 hours, and the child made 
 a good recovery. 
 
 Recently a German author called attention to the irritating effects of Peroxide of 
 Hydrogen on the mucous membrane; this effect I have found in none of my cases, 
 although this may be due to the fact, that in employing this agent, I make use of 
 a small addition of bicarbonate of soda, and that I adjust the strength of the solution 
 to the requirements of the case. 
 
 Diseases of the ear offer a good field for the use of Peroxide of Hydrogen. As a 
 non-irritating antiseptic wash it is invaluable, as in the various forms of suppuration, 
 especially where they are accompanied with a disagreeable odor. In diffuse or circum- 
 scribed inflammation of the external canal, Peroxide of Hydrogen is useful after an 
 incision has been made, and in suppurative otitis media, especially in neglected cases, 
 at 5 to 15 per cent, solution is of great assistance. 
 
 In cases complicated by inflammation of the mastoid cells, especially in the sup- 
 purative form, the indication of Peroxide of Hydrogen is clear, although this does not 
 prevent the use of iodoform, aristol, and other antiseptic agents. 
 
 In acute cases of purulent otitis media, a 5 per cent, alkaline solution should be 
 used, as strong solutions are not necessary, and may be injurious. 
 
 Medical Building. 
 
 PEROXIDE OF HYDROGEN AS A HEMOSTATIC* • 
 By M. F. COOMES, A. M., M. D. 
 
 Professor Physiology, Ophthalmology, Otology and Larynjology in tne Kentucky School of Medicine. 
 Abstract from Louisville Medical Monthly, for September, 1896. 
 
 It is probably not generally known to the profession that Peroxide of Hydrogen is 
 a valuable haemostatic. Its contact with blood results in the almost immediate coagu- 
 lation, or rather, production of fibrin. Of course this is desirable, • as the clot thus 
 formed is nature's clot, and not such as produced by the union of blood and Monsell's 
 solution, or other preparations of iron. 
 
 The clot in this instance is one that will be easily tolerated while that produced by 
 the iron always acts as a foreign body, and is an ugly thing to contend with, to say the 
 least of it; as the removal of the iron clot often results from secondary hemorrhage, 
 whereas, the clot resulting from Peroxide of Hydrogen is tough, and capable of being- 
 absorbed to a very great extent; or to say the least of it, its mechanical separation from 
 the surrounding parts is much more easily accomplished than that of the iron clot. 
 
 One point in particular must be remembered in the use of Peroxide of Hydrogen, 
 that it must not be pent up. Its injection into the tissues always results in great pain, 
 because of the undue distension produced by the gases. Hence, its injection into cav- 
 ities where it can not have perfect freedom, may result disastrously in the production 
 of great pain, to say nothing of what else might occur. 
 
 * I have found none better than Marchand's. 
 
226 
 
 In ordinary nose bleed, I know of no more valuable remedy than this agent. And 
 indeed, in nose bleed, where there is rapid dripping or a small stream it arrests hem- 
 orrhage within an incredibly short length of time. 
 
 It should be used pure, or if it is desirable, first try it with equal parts of water. 
 The best way to use it is to inject it with a small syringe, throwing in as much as half 
 an ounce of the mixture at a time, directing it upwards at an angle of about forty-five 
 degrees from the floor of the nose. This will insure it to reach almost every part of the 
 interior surface of the nose. 
 
 The patient's head should be inclined well forward so as to prevent any of the 
 overflow going back into the larynx, which under ordinary circumstances would not be 
 dangerous, but would be very unpleasant to the patient. 
 
 The contact of the Peroxide of Hydrogen with blood results in immediate and rapid 
 effervescence, just as it does when it comes in contact with pus. In using it for the pur- 
 pose of arresting epistaxis, no attention need be paid to effervescence; just as soon as 
 one syringe full has been discharged into the nose, follow it up immediately with 
 a second and third syringe full. At this time it may be well to grasp the nose with the 
 fingers and hold it for a moment, so as to give time for the perfect formation of the 
 clot. 
 
 If the bleeding surface is low down, and can be reached with a mop or cotton wool 
 saturated with the peroxide, all the better. I rely upon it largely in office practice to 
 arrest all ordinary nasal hemorrhage, and indeed I have arrested many cases of what 
 may be termed extraordinary bleeding from the nose. It is reliable and safe, and far 
 superior to any haemostatic that I know of, in arresting all forms of oozing hemorrhage 
 from open surfaces. 
 
 NOTES ON THE TREATMENT OF F^CAL FISTULA. 
 By FREDERICK HOLME WIGGIN, M. D., 
 
 * Visiting Gynecologist to the New York City. Hospital, and Visiting Surgeon to St. Elizabeth's 
 
 Hospital. 
 
 Abstract from the New York Medical Record, Oct. 14, 1896. 
 
 At the thirteenth annual meeting of the New York State Medical Association, 
 which was recently held in New York City, Dr. Frederick Holme Wiggin, of New 
 York county, presented a paper with the above title. The chief cause of the occur- 
 rence of faecal fistulas was stated to be the delay in resorting to operative measures to 
 which patients suffering from typhloenteritis, or strangulated hernia were frequently 
 subjected while their ailment was carefully diagnosticated. The view recently advanced 
 by a writer on the subject under consideration, that the best treatment for this con- 
 dition consisted in its prevention, was concurred in. But in the case in which this 
 mishap had occurred, it was pointed out that if the opening was of small size, was 
 located near or below the ileo-caecal valve and no obstruction to the faecal current existed, 
 operative measures might be deferred, as in most instances the opening would close in 
 a short time spontaneously. On the other hand, if the bowel opening was of large size, 
 was situated laterally, or some distance above the ileo-caecal valve, and was accom- 
 panied by the escape of a large proportion of the contents of the bowel, operative pro- 
 cedure for the closure of the opening should be speedily undertaken. 
 
 The histories of three cases, successfully treated by surgical measures were cited. 
 In two instances, the patients were inmates of the Hartford (Connecticut) Hospital, 
 and w r ere operated upon by Dr. Wiggin, by reason of an invitation which was extended 
 to him by the medical board of that institution, after several previous unsuccessful 
 efforts to close the bowel openings had been made. The occurrence of the fistulous 
 
227 
 
 •opening was due in the first case to failure, and in the second case, to delay in resort- 
 ing to surgical treatment of typhlcenteritis, from which disease both patients originally 
 suffered. In the third case, the bowel opening was caused either by the pressure of 
 the gauze used to drain the abscess cavity, or by an ulcerative process which originated 
 from within the gut. In the first case, as the opening in the bowel was of large size, 
 irregular in shape, and the gut was thickened and friable, the diseased portion of the 
 bowel containing the opening, about four inches in length, was excised, and the divided 
 ends joined by the suture method of Maunsell. In the second and third cases, the 
 bowel openings were situated in the head of the colon, and were in both instances closed 
 by means of several rows of sutures, after which the omentum was drawn over the 
 former site of the fistula, and retained in position by sutures. 
 
 In describing the technic employed, the writer laid much stress upon the follow- 
 ing points, viz. : the thorough disinfection of the parts, including the interior of the 
 "bowel, with Hydrozone, the closing of the intestinal opening, when possible, before the 
 breaking up of the peritoneal adhesions, and the opening of the general cavity, the 
 removal of any existing obstruction to the faecal current, the disinfection of the bowel 
 surface with a solution of Hydrozone, before and after the placing of the sutures, the 
 •control of oozing from the cicatricial tissue by the same means and the closure by a 
 single row of silk- worm gut sutures without drainage of the abdominal wound after the 
 washing of the peritoneal cavity with saline solution, some of which is allowed to remain. 
 
 In concluding, the writer stated that ever since September, 1893, when he had 
 proved the value of Hydrogen Dioxide as an effective antiseptic, which in proper solu- 
 tion did not unduly irritate the peritoneum, when followed by a six-tenths per cent, 
 saline solution, he had had little reason to fear the danger of causing septic peritonitis 
 from the accidental escape of pus or faecal matter while operating, and that when this 
 complication had occurred , it had been invariably successfully met by the use of Hydrogen 
 Dioxide in the manner described in the paper. He advised the excision of the diseased 
 portion of the gut in those instances where it had become much thickened and friable, 
 and expressed the belief that with a clearer understanding of the objects to be attained 
 "by operation — i. e., the restoration of the integrity of the intestinal canal, as well as the 
 •closure of the opening in the bowel — future operations for the cure of faecal fistulae would 
 more frequently result successfully than they had in the past. 
 
 The paper was discussed at some length by Dr. H. O. Marcy, of Boston, and Dr. 
 Joseph D. Bryant, of New York county, who commended it and in the main, endorsed 
 the writer's views. 
 
 MAMMARY ABSCESS. 
 By A. G. CALDWELL, M. D., of Ballard, Ky. 
 
 Published by Louisville Medical Monthly, for November, 1896. 
 
 One of the most troublesome complications of lactation is the formation of abscess 
 in the breast; an occurrence we often meet, and which, if improperly treated, may by 
 long continued suppuration and the formation of numerous sinuses in and about the 
 "breast produce very serious effects upon the general health, and even death by blood 
 poisoning. The causes of breast abscesses are numerous, the most common being 
 fissures or erosions of the nipples, hence those very common affections about the nipples 
 should be promptly treated. The abscess may form in any part of the breast, or in the 
 areolar tissue beneath it. Abscess is usually ushered in by a slight chill and general 
 constitutional symptoms. These symptoms vary according to the severity of the inflam- 
 mation. Fever is always present with rapid pulse and general malaise; rigors and 
 sweats follow suppuration, and if not promptly treated at this stage it leads on to fistu- 
 
228 
 
 lous tracts which in time completely riddle the breast. The general health soon suffers; 
 to a marked degree, and if it be left to suppurate for months the patient becomes 
 reduced to profound and even dangerous debility. 
 
 Treatment. — In many cases it may be aborted by removing the engorgement of 
 the lacteal vessels by hand friction and saline cathartics, and giving the affected parts 
 complete rest. When the general symptoms indicate the formation of pus, cleanse the 
 breast thoroughly with antiseptics, and make a free incision at the most dependent part, 
 parallel with the lacteal ducts to avoid injury to them. Avoid the admission of air, 
 press out all the pus, then irrigate thoroughly with Hydrozone (Marchand's) and boiled 
 water, equal parts, until foaming ceases; then inject the cavity thoroughly with a 5 
 percent, solution of carbolic acid, and if well done it seldom has to be repeated in acute 
 cases. 
 
 In chronic cases the same treatment suffices. When all sinuses and pus pockets 
 are broken up so the Hydrozone can reach all parts, keep incision covered with anti- 
 septic adhesive plaster and provide capillary drainage by inserting a strip of iodoform 
 gauze. For the pain give opium, gentle salines for the bowels, and tonics for the 
 general health. For high fever give large doses of quinine, and cactine to support the 
 heart. 
 
 PEROXIDE OF HYDROGEN IN DIPHTHERIA. 
 
 By A. B. CLAY, M. D., Rutherford, Tenn. 
 (Abstract of a paper read before the Gibson County Medical Society.) 
 
 Diphtheria is a highly infectious disease, frequently assuming a severe epidemic 
 form. Characterized by local fibrinous exudate, usually, though not always, upon a 
 mucous membrane. There is strong reasons to believe that the infection is given off in 
 the breath and various discharges. The sick should be isolated from the well ones, dis- 
 infection of everything that has come in contact with the patient? when a death occurs- 
 from the disease the body should be thoroughly saturated with some powerful disin- 
 fectant and placed in a coffin closely sealed, and the physician in attendance should 
 request the family to have a private funeral. The infection lasts for an uncertain time 
 after convalescence. 
 
 This peculiar inflammation of the fauces is attended with the deposit of exudation 
 which may locate at any one or more points, extend and coalesce so as to form extensive 
 patches or cover the entire surface. The organs may suffer from considerable ulcera- 
 tion or sloughing. Abscesses may form on any of the glands. In color the lymph 
 may be gray, white, slightly yellowish, dark or dirty looking, greenish or gangrenous, 
 and it may form in the throat from twelve to forty-eight hours after inflammation sets 
 up. Should it be removed, a raw, bleeding surface is left, which is again speedily cov- 
 ered by a fresh deposit, the exudation forming in the substance of, as well as upon, 
 the mucous membrane, thus causing superficial destruction of the parts. There is 
 constitutional disturbance which may become more or less severe, followed by nervous 
 disorders. The patient whispers or cries with a husky voice, has a dirty-looking, 
 opaque complexion, and the skin generally may assume a dirty, yellowish tint. There 
 is an ordinary febrile attack. The temperature may rise to 103 or 104 . The pulse 
 is rapid and feeble and the respiration hurried. ' The respiratory passage maybe 
 involved. The invasion is generally gradual, there being a feeling of languor and ill- 
 ness, more or less depression and weakness, often with chilliness, anorexia, nausea, 
 diarrhoea, drowsiness, asthenic condition, dyspnoea, pulmonary complications, disten- 
 tion of lungs, scanty or albuminous urine. Diphtheria is liable to occur in any season 
 but prevails more in hot and dry seasons, when it often becomes epidemic, especially in. 
 
229 
 
 3arge centers of population. Now and then a sporadic form is met with. The con- 
 tagion has not diminished in cities within the past few years like many other contagious 
 -diseases, although it frequently prevails with great severity in country districts. Prog- 
 nosis, always grave, is worse in children than adults. The chief signs of danger are: 
 Repeated vomiting or diarrhoea, epistaxis, great discharge from nares, implication of 
 larynx, with consequent interference with respiration, a very rapid, feeble or infre- 
 quent pulse, delirium, adynamia, suppression of secretion, prostration, cyanosis. There 
 is no specific remedy for the disease. Lowering measures are not well borne, a support- 
 ing treatment being always indicated. All hygienic conditions should be observed, the 
 patient's room kept in a uniform temperature — 65 ° to 70 — and the air kept moist with 
 steam. A generous diet — milk, eggs, soups, with stimulation, whiskey, brandy, 
 ammonia — should be prescribed. Disinfectants should be freely used about the apart- 
 ments. Mild purges, such as sulphate magnesia, seidlitz or phosphate soda, might be 
 given beneficially. 
 
 The use of drastic purgatives is to be deprecated. Calomel is highly recom- 
 mended. Local treatment should be actively used. A great number of astringent and 
 antiseptic preparations — such as nitrate of silver, tincture perchloride of iron, dilute 
 hydrochloric acid, glycerine and carbolic acid, papoid in listerine — have been used with 
 advantage. Spraying nose and throat by means of the atomizer is very efficacious. 
 For this purpose the Peroxide of Hydrogen, or Hydrozone (Marchand) diluted 
 sufficiently or full strength, is very advantageously used. Two cases of the number 
 reported were in an extreme condition and resisted the usual treatment. From the 
 time the Hydrozone was used, the patients began to improve, and were soon in a state 
 of convalescence. 
 
 HYDROZONE 
 
 FOR DISORDERS OF THE GENITO-URINARY TRACT. 
 
 By JOHN AULDE, M. D., Philadelphia, Pa. 
 
 Abstract from the Medical Times and Register, of Philadelphia, December 5, 1896. 
 
 About eight years ago I was very forcibly impressed with the clinical properties of 
 hydrogen dioxide through its prompt action in a case of protracted gonorrhea. The 
 patient had suffered for about three months, and notwithstanding the most earnest solici- 
 tations of several attendants the discharge had persisted. In addition to this, there 
 was an orchitis present, the left testicle being about the size of a baseball. Treatment 
 consisted of the local use of injections of equal parts of hydrogen dioxide and moderately 
 warm water, used at intervals of four hours, these injections being followed by a solution 
 of arsenite of copper containing one milligram (one 65th grain) to the drachm, diluted 
 with an equal quantity of hot water.* The object of these injections was twofold: 
 First, to cleanse the urethra by the destruction of micro-organisms, and second, to 
 stimulate the functional activity of the epithelial cells, thus enabling them to resist the 
 absorption of poisonous products. For the relief of the orchitis a suitable suspensory 
 bandage was supplied, together with the local application of a stimulating ointment 
 composed of mercury biniodide and lard, one part to ten. The ointment was applied 
 at intervals of twenty-four hours for two or three times, when the swelling had percep- 
 tibly diminished and convalescence had begun. 
 
 In the course of a week this patient, who lived in a distant State, had so far recov- 
 ered that he was able to return to his home, although he remained under treatment for 
 a period of ten days, during which time the ointment was reapplied once. The dis- 
 charge from the urethra had entirely ceased, pain had subsided and chordee had disap- 
 peared. 
 
 *See page 72. — When the urethra is very tender, Dr. Robert T. Morris recommends, that each 
 injection should be preceded by cocaine or ether for the purpose of quieting the smarting. 
 
230 
 
 The same method of treatment is equally efficacious in the treatment of non-specific 
 urethritis and ordinary forms of gleet, but as hydrozone is so much more concentrated 
 and perfectly harmless, it should be given the preference over medicinal hydrogen 
 dioxide. This will be understood when the advantages of using hot solutions are taken 
 into consideration. Hot solutions of either hydrogen dioxide or hydrozone quickly 
 liberate the nascent oxygen and thus diminish the activity of our medication. 
 
 The value of this remedy is to be commended in the treatment of vaginitis 
 and vaginismus; where hot solutions are especially indicated. Heretofore it has been 
 the practice of physicians to recommend the employment of a hot vaginal douche, 
 with or without some alkaline substance, such as sodium bicarbonate or boric acid, 
 to be followed by a small quantity of medicinal Peroxide of Hydrogen combined with 
 either warm or cold water; but with the increased volume of nascent oxygen con- 
 tained in hydrozone a single application of the hot solution, one part to eight, will be 
 found quite as effective. The patient should be taught how to employ the douche in order 
 to obtain the best results. She should have a fountain syringe, in which the medicated 
 solution is placed; it is then hung upon the wall at a distance of six feet from the lloor 
 and the patient sits upon a suitable vessel. The rubber tip of the hose is then introduced 
 well back into the vaginal cavity, so as to avoid introducing the solution into the uterine 
 cavity, and with the fingers of the disengaged hand the patient compresses the labia?, 
 allowing the medicated solution to distend the vaginal cavity, by which it is brought 
 into contact with every portion of the diseased tissues. This plan should be repeated 
 at least twice in twenty-four hours. 
 
 In the treatment of uterine disorders, where it is necessary to bring the medicated 
 solution into contact with the lining membrane of the uterus, the patient should be 
 placed in the recumbent position, with the hips well elevated as in the case of other 
 uterine applications. An ordinary dilatation is then employed to distend the cervix, so 
 as to permit the introduction of the nozzle of the syringe. The distension should be 
 sufficient to permit the exit of the injected solution, or a suitable return-flow tube can 
 be used instead. Certain precautions are necessary in making these applications, espec- 
 ially in chronic cases, because the effervescence attending the destruction of unhealthy 
 mucus in the uterine cavity may be sufficient to drive a small portion of the debris into 
 the Fallopian tubes. This danger, however, can be reduced to a minimum by the 
 liberal use of the hot medicated solution and afterwards instructing the patient to sit 
 up in bed. The pressure thus brought upon the uterus is sufficient to cause the dis- 
 charge of all debris resulting from this application. 
 
 In this class of cases it is of the utmost importance that none of the vaginal secre- 
 tions should be permitted to enter the uterine cavity, which can be avoided by having 
 the patient take a preliminary vaginal douche, using the medicated solution. Where 
 this cannot be accomplished, or seems unnecessary, the vaginal tract should be cleansed 
 by the local use of the medicated solution after introducing the speculum. 
 
 A word of caution should be added in regard to the vaginal douche. Where the 
 cervix is patulous and the patient takes the vaginal douche in the recumbent posture, 
 using the precaution above described to insure the full distension of the vaginal cavity, 
 a portion of the debris would almost certainly find its way into the cavity of the uterus, 
 and with it probably more or less of the poison, and thus we have uterine disease super- 
 added to the vaginal affection. Undoubtedly many cases of uterine disease have resulted 
 from a failure to observe this precaution. 
 
 Diluted hydrozone will be found an efficient remedy for the relief of cystitis occur- 
 ring either in the male or female. In chronic cases the amount of the solution (1 to 8) 
 must be limited, owing to the thickening of the walls of the bladder and the pain result- 
 ing from the muscular contractions after the withdrawal of the solution. Gradually how- 
 ever, the amount of the solution can be increased. In addition to the local treatment 
 of cystitis and gleet, and sometimes in chronic cases of gonorrhea, much benefit will be 
 derived from the internal administration of calcium sulphide, about one-tenth grain, at 
 intervals of two hours. 
 
231 
 
 SYPHILIS SUCCESSFULLY TREATED BY HYDRIATICS. 
 
 By ELMER LEE, A. M., M. D., Ph. B., New York. 
 
 Read in the Section on Dermatology and Syphilography at the Forty-seventh Annual 
 Meeting of the American Medical Association, at Atlanta, Ga., May 5-8, 1896. 
 
 (Reprinted from the Journal of the American Medical Association^ December 12, 1896.) 
 
 There is, perhaps, no disease whose character is so black, and whose ravages ar e 
 so universally distressing as that under consideration. The name syphilis strikes terro r 
 into the soul of its victim, and measureless uncertainty in the mind of the professional 
 attendant upon whose shoulders the responsibility of treatment is placed. 
 
 The exact origin of syphilis is uncertain. The records do not clearly establish by 
 whom or at what time in the history of the world the disease was first discovered. There 
 has been much discussion concerning this point, but little satisfaction has resulted. It 
 is the common habit of the Europeans to associate the disease with the return of the 
 followers of Columbus, in 1493, from their discoveries of the West Indies. However, 
 this may be, without the shadow of a doubt, the same disease must have existed 
 centuries before among the races of the Orient. The first record of syphilis in France 
 dates only to the siege of Naples, in 1494. 
 
 Syphilis is spread by direct contagion upon an abraded surface or a breach in an 
 exposed membrane or tissue, and thereby, contaminating virus enters the system. A 
 period of variable duration between the inception by contact and the lesion follows. It 
 may be a few days, or it may be weeks before the systemic exhibitions appear. Two 
 reasons may be assigned for the variability of incubation, viz.; the virility of the poison 
 and the susceptibility of the individual. As in other diseases, there are some people 
 insusceptible to syphilitic virus. 
 
 The precise nature of the infecting virus has eluded the researches of scientific 
 processes of determination. It is an open question whether the serious poisoning which 
 results is caused by a direct entrance of the contagion into the circulation, or whether 
 it is by reason of the secondary absorption of the product of the initial ulcer. For my 
 part it is not possible to decide the question, but fortunately the practical treatment of 
 the disease does not depend upon this mooted point. The answer to the problem is, 
 probably, that both influences together produce the result. 
 
 The first manifestation of syphilis appears in the form of macule or papule upon 
 some mucous or skin surface. The lesion may extend quickly to the deeper tissues and 
 viscera. During the period of healing of the initial lesion, the disease is regarded as in 
 the first stage. The subsequent appearance of surface and other lesions constitute the 
 second period of syphilis. If there are still subsequent exhibitions at some later time, 
 usually measured by years, such a manifestation establishes the third period of the dis- 
 ease. 
 
 One invasion of the body generally precludes a second. The disease may be 
 transmitted by the secretions of a sore upon any part of the body within and during the 
 earlier stages. The power of transmission during the third period of the disease is 
 regarded as unlikely, although there are some differences of opinion on this matter. It 
 is, further, reasonably decided that the normal secretions of the body, such as saliva, 
 mucus and other fluids do not transmit the disease. But in the first stage of syphilis 
 the blood as well as the material from the initial lesion may infect another person. 
 
 Some investigators have asserted that a germ has been found constantly associated 
 with the blood during the earlier stages of this disease, and that the microphite destroys 
 both the white and red corpuscles. As in some other diseases, the symptoms 
 of this are similar to those of certain other forms of toxemia. But it is undoubtedly 
 true that syphilis is due to a definite and specific contagion. The blood is poisoned 
 thereby, and a series of mild or severe disturbances of the health ensue in a somewhat 
 regular order. The principal changes that occur, according to Virchow, begin by the 
 production of a small-celled solid growth, which at first resembles granulation tissue, but 
 
232 
 
 which soon shows a vesicular occlusion with consequent degeneration. This statement 
 is, to me, one of the most important in the pathology of syphilis. If studied, according 
 to the light of experience and analogy, it has the significant indication pointing out the 
 requirements for treatment. 
 
 Variation in the caliber of the minutest channels through which the circulation is 
 carried, forms the earliest pathologic manifestations in internal diseases. The recog- 
 nition of this fact is of the greatest significance in the direction of a correct under- 
 standing of the truth concerning pathologic conditions. Alterations in the size of the 
 vesicular spaces produce either congestion or hyperemia, either state producing destruc- 
 tive changes in the delicate cell structures. Should the disturbance in the circulation 
 occur in the cells of a vital organ, the influence upon the whole body will be proportion- 
 ately serious. If at the same time, the resisting power of the general system as well as 
 the special locality in which the lesion occurs, should be of low vitality, great struc- 
 tural changes necessarily follow within short periods of time. 
 
 In the treatment of syphilis there is always one imperative indication, namely, sus- 
 taining the natural resisting forces against auto-infection. Upon the weakened and 
 demoralized system, disease preys rapidly and furiously. It is more important to pre- 
 serve the integrity of the individual cell, by supplying it with natural nutrition, and 
 relieving it of the occlusions in its neighborhood, than it is to attempt to overwhelm the 
 circulation by some extraneous and poisonous material with the view of neutralizing a 
 virus of disease. It is a serious question whether an organic or inorganic chemic sub- 
 stance, pervading any part of the living tissue structures, is able to be neutralized by the 
 introduction of another chemic agent. The various organic and inorganic drugs used 
 for the treatment of syphilis are based upon the supposed property of a matter to destroy 
 or antagonize another. It is easy to produce a definite reaction under favorable con- 
 ditions in a physiologic or chemic laboratory when we know the exact nature of the 
 materials with which the experiment is conducted; definite reactions, however, in living 
 structures are not possible. 
 
 The influence upon the contagion which enters the circulation from without, by the 
 fluids and solid elements of organized living tissues, cannot be definitely determined by 
 scientific methods. Moreover, when a given mineral or vegetable reagent enters the 
 stomach, and during its passage through the system, it is lost to the senses cf the 
 scientist, consequently whatever reactions there may be are determined by no reliable 
 data. It was recently stated by a clinician who gives nearly all his time to the treat- 
 ment of syphilitic manifestations, that up to the present moment, the materia medica 
 offered but two agents with which to control the symptoms of this disease. 
 
 Fortunately, indeed, it would be did the materia medica possess so many as two 
 remedies, which could, in truth, cure syphilis. Every physician whose experience has 
 been even moderate, knows that mercury and iodid of potassium are not able to cure 
 syphilis, all that may be said to the contrary notwithstanding. The philosophy of a 
 cure of the impaired tissues, by further impairment of that tissue is allopathy, but it is 
 not true to nature. It is necessary to do more than conform to a theory included within 
 the confines of a name. Syphilis is not curable by the alleged principles of "allopathy," 
 •or the infinitesimal folly of "homeopathy," or by the vagaries of the "eclectics." If 
 the disease is curable, the remedial forces of that inherent tendency for good which 
 resides in every vegetable and animal cell are able, when properly aided, to conquer 
 against its enemies. 
 
 By reference to one of the most recent reviews concerning the latest improved 
 treatment of syphilis, the following remedies are advocated as essential: The list com- 
 prises blue pill, gray powder, gentian, quinin, iron, opium, alum, chlorate of potash, jalap, 
 gamboge, epsom salts, green iodid of mercury, perchlorid of mercury, iodid of potas- 
 sium, perchlorid of iron, red iodid of mercury, tannate of mercury, sarsaparilla, anti- 
 mony, aromatics, iodid of sodium, iodid of ammonium, carbonate of ammonia, tartar- 
 ated iron, bitter infusions, arsenic, iodid of mercury, iodoform, bromid of potassium, 
 bromid of sodium, bromid of ammonium, strychnin, cod liver oil, mineral acids, vege- 
 
233 
 
 table bitters, sulphur, -calomel, black wash, carbolic acid, ointment of ammoniated mer- 
 cury, ointment of oxid of zinc, mercurial ointment, mercurial vapor bath, borax, chromic 
 .acid, permanganate of potash, iodoform ointment and atropin. 
 
 Of this bewildering array of anti-syphilitic soldiers, how is the young doctor to dis- 
 cover who is general and which are privates? The life of a physician is too short to exam- 
 ine each remedy and calculate its value. The numerous remedies really constitute a 
 ■disadvantage to the patient as well as the doctor. The choice of the materia medica will 
 .be determined very largely by the number of years since the date of graduation. The 
 lectures emphatically encourage the necessary use of mercurials, and with this recom- 
 mendation in mind, the young medical man feels consciously strong in his ability to treat 
 syphilis. He is encouraged to think that while there is difference of opinion concern- 
 ing the use of medicines in the treatment of whooping cough and measles, that the pro- 
 fession is a unity in its approval of mercurial treatment of syphilis. When a few cases 
 have been entrusted by chance or some other influence to his care, doubts will come 
 into his mind and his security will be sadly disturbed. 
 
 In what way is syphilis pathologically and radically different from other functional 
 and organic diseases, that it may not be cured? There are conditions which we fre- 
 quently see that are quite incurable, both in this and in other diseases. When the degen- 
 erate tendency becomes stronger than the resistance of the cells can endure, the natural 
 termination of such cases is fatal. Other cases are incurable because of the utter wil- 
 fulness and disregard of reason by the patient. 
 
 The experiences of the profession clearly show that the natural termination of 
 syphilis is toward recovery. The disease may be light or otherwise and in either case 
 complete restoration often takes place, either with or without professional treatment. 
 It would seem to show that if a single case of either mild or severe syphilis recovers with- 
 out treatment, that the restoration is solely due to the principle of inherent preservation of 
 cell integrity through a natural agency. My line of experience has taught forcibly the 
 lesson that vitality maintained through physiologic and hygienic management is a scientific, 
 a safe and satisfactory treatment of syphilis in the earlier stages. In the last stages, and 
 when the forces of life are sadly weak and declining, it is worse than useless to hope for 
 honest relief through the administration of organic and inororganic substances. 
 
 It is, perhaps, rash to controvert the position of the general profession in its atti- 
 tude favoring the use of mercurials in the treatment of syphilis, and it would have been 
 unnatural to an orthodox medical education, prior to the last third of my medical career. 
 But it matters not, rash or otherwise, the only concern of the physician is to know the 
 truth, and if syphilis can be successfully treated by hydriatics, is it not a worthy triumph? 
 The treatment of syphilis by water as the principal remedial agent, is not so simple or 
 so well known as the agent itself would seem to indicate. Neither is the method 
 mysterious or devious. But it must be mastered, and experience will teach more than 
 may be learned from a study of the brief literature on this subject. 
 
 My attention became attracted to hydriatics, as a successful method of treating 
 syphilis, through the necessity of personal responsibility in the treatment of this disease. 
 My position has been gained by actual clinical experience. 
 
 There came to my office in the spring of 1895", a negro, George F., age 25, single, 
 waiter, who applied for relief on account of phimosis. The symptom which lead him 
 to consult me was inordinate accumulation of smegma. Circumcision was done and the 
 case disappeared from my observation. Perhaps a month later, the patient appeared 
 again to exhibit an ulcer located on the dorsum, at the point where the division had 
 been made. This ulcer was enormous before it healed and was characteristic in every 
 particular. Finally it healed, and some weeks subsequent to its cicatrization, the 
 negro returned with unmistakable secondary symptoms of syphilis. The rash was 
 typical, the knees and ankles were swollen and painful, and the indications upon the 
 exposed mucous membranes were indicative of contagion poisoning. 
 
 The treatment was instituted from the inception of the diagnosis. The case was 
 seen by several experienced confreres, and the plan of management as outlined, was 
 
234 
 
 watched by them as well as by myself. The agreement in diagnosis was emphatic 
 Water was the remedy prescribed in regulated doses to the extent of between two and! 
 three liters per day during a period of between eight and ten months. In each glassful 
 of water some harmless dose of medicine was incorporated for the purpose of producing; 
 the desired mental effect upon the patient. The agent used for this purpose consisted, 
 for the most part, of one or two drops of carbolic acid to six or eight ounces of water, 
 which was altered in color each time the prescription was refilled. The dose from the 
 bottle was a teaspoonful, to be mixed with the portion of water which was to be taken 
 at definite intervals during the day. There was a period of two weeks, during the 
 second month of the treatment of the disease, when the young man was unable to work 
 on account of the unsightly appearance of his face and hands, as well as the general 
 discomfort from which he suffered. The symptom which remained the longest was 
 edema of the ankles. It has, however, entirely disappeared at this time. The symp- 
 tom of next longest duration was the raised patches, some of which broke down, 
 covering the unexposed surface of the body. The negro at this time is free from any 
 discoverable lesion or symptom of syphilitic sequelae. The skin is smooth and the 
 discolorations have practically disappeared. The case has frequently been observed by 
 several physicians, and at the last visit to my office, he was pronounced cured so far as 
 symptoms could be discovered. 
 
 During the winter of 1894-95, a woman, Lizzie B., singles 26 years old, fair, a 
 stenographer, presented an ulcerated throat. The case was not suspicious, and the 
 ulceration was considered benign; simple treatment was begun. A few weeks later she 
 complained of vesical hemorrhage. Examination revealed erosion of, and an ulcer upon 
 the inner surface of the anterior lip of the cervix. The case was immediately suspected 
 to be a contagious disease. At that time, no personal interrogation of her previous con- 
 duct took place; for a period of several weeks the case was observed and the diag- 
 nosis gradually and emphatically determined to be syphilitic. Soon after this deter- 
 mination, she was confined to her bed with fever, and during this time secondary, erup- 
 tions manifested themselves in the form of papules. They broadened and extended 
 over the whole body. The hair fell out in considerable quantity. 
 
 Her treatment, with the exception of local applications to the cervix, was directed 
 in the same general line as in the preceding case. The patient, however, during all 
 this period of treatment, which covered perhaps ten months, regularly added tea- 
 spoonful doses of the scented and colored water from the druggist's prescription bottle 
 to the doses of water which were given her at stated intervals, and insufficient quantity, 
 during each day of the ten months. 
 
 In addition to internal hydriatics, the bowels were irrigated daily during a period 
 of the first three months of treatment. Subsequent to that time, irrigation was per- 
 formed at intervals of once each week. The recovery of this woman is satisfactory to. 
 herself, and no physical symptoms of syphilis can be found. 
 
 The local treatment consisted, principally, of Hydrozone applied in full strength 
 to the chancres in each case. Hydrozone is selected amongst antiseptics, for the 
 reason that it exceeds all others in rapid oxidation, with veritable destruction of micro- 
 phites and putrid matter. In syphilitic treatment, the strongest antiseptic is most 
 desirable, if at the same time, it is safe and effective. The surface eruptions on the 
 body were anointed with Elixo, a liquid soap, which was rubbed in till it was dry, and 
 allowed to remain until washed off at the bath the following day,, to be again rubbed in 
 as before; a substitute for blue ointment. 
 
 In conclusion, the heralded treatment of syphilis at water cures, such as Hot 
 Springs, Ark., and other places of the same character, are, in my opinion, dependent 
 upon the quantity of water which is used, internally and externally, and not upon the 
 quality. Furthermore, the relief of the symptoms is dependent upon the large and 
 regularly used internal hydriatics, and not upon the morbid effects produced by the 
 mineral and vegetable materials which are administered in enormous and destructive 
 doses. By reason of the preservation of the functions of the vital organs, through the; 
 
235 
 
 internal use of water and the external baths, nature withstands and permits the awful 
 abuse to which it is subjected by the mercury and iodid of potassium that are imposed 
 upon credulous patients. 
 103 State Street. 
 
 PATHOLOGY AND TREATMENT OF INDOLENT ULCERS. 
 
 By DRS. P. N. RUSSELL, G. H. AIKEN and A. J. PEDLAR, 
 
 of Fresno, Cal. 
 
 Published by the Occidental Medical Times, of Sacramento, Cal., for December, 1896. 
 
 Read before the San Joaquin Valley Medical Society, October 28, 1896. 
 
 Anything which produces injury, irritation, or friction, may cause these ulcers. 
 They are frequently associated with varicose veins. In treating the ulcer, the first 
 requirement necessary to induce healing is to arrest the disintegration, and next, 
 to make the ulcer assume a clean and healthy granulating surface. Support of the cir- 
 culation was an important point. For this purpose he frequently curetted the surface 
 and sometimes made radiating incisions through the indurated edges. After thoroughly 
 cleansing the surface he next disinfected the cavity and then applied a simple ointment 
 to the skin for a considerable distance around the ulcer, filling the excavation with 
 iodoform. Over this he applied a piece of gutapercha tissue, in which numerous holes 
 had been punched, and then a rubber bandage. This he regarded as the most important 
 part of the treatment. It was applied carefully, including the foot, and going above the 
 ulcer. Each case should be dressed, according to its condition, from every day to twice 
 a week. The rubber bandage was removed on going to bed and reapplied on rising. 
 The treatment was sometimes supplemented with an occasional mopping out of the 
 ulcerated surface with hydrogen peroxide (Marchand's). In addition to local measures, 
 the general condition should carefully be looked after, constitutional treatment being 
 given if necessary. 
 
 Dr. G. H. Aiken, of Fresno: The general outline of the author's treatment is. 
 excellent. What we have to do is to convert the unhealthy, diseased condition to that 
 of healthy tissue. Aside from that, when accomplished, we may have a large denuded 
 surface requiring epithelium and new skin. How shall we best achieve this? I have 
 tried several methods with bandaging and antiseptic dressings, but recently, with a 
 severe and indolent ulcer from varicose veins, I adopted the following plan: The ulcer 
 was about the size of a silver dollar, of a gray, dirty color, with indurated edges. I 
 cleansed the parts with Peroxide of Hydrogen (Marchand's), which I find to be most 
 effectual in destroying these necrosed conditions, and then dusted the surface with iodo- 
 form until it became a healthy granulating surface. How shall we heal these ulcers 
 rapidly? I have found pyoktannin to be very effectual. I touch the whole surface 
 with it, then apply white vaseline with campho-phenique; and over that iodoform gauze, 
 and perhaps a little absorbent cotton, then bandage from the foot to the knee with an 
 ordinary bandage. I allow the dressing to remain three or four days. It is astonish- 
 ing to see the rapidity of cicatrization under the treatment. Each time when dressing, 
 I apply the blue pencil. 
 
 Dr. A. J. Pedlar, of Fresno: I do not think I have found any one remedy that 
 can be relied upon in these ulcers. In some cases I would get good results, and with 
 the same treatment, fail in others. I have used protonuclein with benefit in chronic 
 ulcers. Last summer, during the extreme heat, I treated a woman upwards of 60 years 
 of age, and weighing about 200 pounds. She was doing her own house work, and in the 
 almost incredible short time of two weeks I healed a large ulcer of the leg, which was 
 troubling her for about two years. I cleansed the surface with Peroxide of Hydrogen 
 (Marchand's) and applied protonuclein and absorbent cotton and bandaged above the. 
 swell of the calf. I have used it since, in the office, with good results. 
 
236 
 
 *LOCAL TREATMENT OF CHRONIC GASTRIC CATARRH— 
 
 A CLINICAL LECTURE. 
 By J.M. G. CARTER, M. D., Sc. D., Ph. D., 
 
 Professor of Clinical and Preventive Medicine in the College of Physicians and Surgeons, Chicago 
 
 Fellow of the American Academy of Medicine, etc. 
 
 (Reprint from the American Therapist, January, 1897.) 
 
 Local treatment may be applied in any stage of chronic gastric catarrh; but it must 
 be varied somewhat in the different stages. The grade of inflammation, its character 
 and persistence, likewise may require some modification of the treatment. 
 
 First stage. — During the insipiency of chronic gastritis, local treatment is not so 
 essential, except in bacterial cases, but is beneficial. It serves to modify the congestion 
 when that is increased, and often allays dyspeptic symptoms even when they are more 
 marked than usual. The use of warm water (105) with bicarbonate of sodium (three per 
 cent.) for washing out the stomach is frequently very valuable to remove the tenacious 
 mucus usually adhering to the gastric mucous membrane, in this condition, and interfering 
 with the proper mixing of peptic fluid with the food. The patient may drink a glassful 
 of the solution before meals or it may be introduced into the stomach through the tube. 
 If the tube is used, the stomach should be filled before allowing any reflow. The cold 
 douche with water 9t 8o° to 6o° is sometimes more grateful and helpful than the hot 
 douche (no°to 125 .) A continuous effect may be secured by using a double tube 
 and permitting the inflow and outflow to progress simultaneously; but care should be 
 taken to keep the stomach distended sufficiently to have the solution come in contact with 
 the entire gastric surface. The soda solution dissolves the mucus and the stream 
 washes it away. Weak soap-suds may be used with the tube for the same purpose. 
 More satisfactory in many instances is the use of a solution of Hydrozone. A glass- 
 ful (fl 3 viii) of a two or three per cent, solution may be given half an hour before meals. 
 If used as a douche with the tube a five or six per cent, solution is not too strong, and 
 two quarts the minimum amount. These douchings may be given one to six or seven 
 times a week, according to the requirements of the case, and are frequently all the treat- 
 ment this stage of chronic gastritis demands, except what changes are necessary in the 
 diet. 
 
 Second stage . — The inflammatory process is fully developed in the second stage and 
 while there may be weeks or months when there is little if any suffering, the treatment 
 should be persistent. The cleansing of the gastric mucous membrane must be system- 
 atic and thorough. This is best accomplished with a solution of green soap or a five 
 or eight per cent, solution of Hydrozone, introduced with the double tube. After first 
 filling the stomach, inflowing and outflowing streams ought to remain about equal or 
 the outflow may exceed the inflow, the distention of the stomach may be maintained by 
 retarding the reflow when necessary. This process can be beneficially accomplished by 
 driving the solution into the stomach under increased air pressure; but when the proper 
 apparatus for this method is not at hand the siphoning method with the single rube 
 does very well. For home treatment or when the tube cannot for any reason be used 
 a solution may be made for drinking. For this purpose a 2 or 3 per cent, solution of 
 Hydrozone is prepared. The patient may take a glassful (8 oz.) half an hour before 
 meal time. He should lie down at once, remain five minutes on the back, then turn on 
 tha right side where he must remain during the remainder of the half hour. While the 
 patient is on the back the solution comes in contact with every portion of the gastric 
 mucous membrane and turning to the right side facilitates the emptying of the stomach. 
 By this process the offending mucus is dissolved and carried away and the organ is put 
 into a proper condition to digest food. The use of Hydrozone has the additional 
 advantage of checking the growth of the bacteria, and probably exhibits greater anti- 
 •septic properties than any other agent that can be used in the stomach with the same 
 .degree of safety. In obstinate cases this cleansing ought to precede every meal. 
 
237 
 
 After the stomach is cleansed it should be treated with- soothing, stimulating and. 
 healing- applications. There are many preparations which can be so used, some, of the^ 
 best of which are glycerole of bismuth and eucalyptol, the essential oils and Glycozone. 
 Boric acid in 2 or 3 per cent, solution as a wash with the tube is sometimes very valu- 
 able. The other agents mentioned may be used with a nebulizer by means of which 
 a vapor impregnated with the medicines can be passed into the stomach through a 
 tube, the double tube being preferable. If it is not convenient to use a nebulizing appa- 
 ratus, the glycerole mentioned, and especially Glycozone, may be administered by the 
 mouth. In many cases, in fact, the latter mode of administering these agents is more 
 desirable. These remedies encourage healing and materially enhance the patient's 
 prospects of recovery. This is especially true in bacterial cases. When Hydrozone 
 has been given before meals as already suggested for cleansing purposes, Glycozone 
 may be administered in teaspoonful doses after meals with very satisfactory results. 
 This line of treatment is frequently so successful that cases are temporarily relieved 
 and possibly often a cure effected, particularly if the general treatment has been judici- 
 ously carried out. 
 
 If, for any reason, Glycozone cannot be employed the essential oils may be used. 
 The oils of anise, peppermint, cubebs, and tar may be combined and used with a 
 nebulizer as previously suggested. Although benefit may be derived from the admin- 
 istration of this combination, I prefer Glycozone treatment. The use of hot water, 120 
 or more, and the employment of cold water, 8o° to 40° (F.) may give very happy results, 
 in certain severe cases. 
 
 Third stage. — The condition referred to here is one of atrophy. The functions 
 of absorption and motion may be fairly well performed. The chief difficulty then is 
 with the digestion of proteids. The local treatment has two objects mainly, although 
 a third is sometimes in mind. The first object is the removal of debris and foreign 
 material. The second is the cleansing of the mucous membrane and the destruction of 
 micro-organisms and their removal in order that the intestines may not receive bacterial 
 products from the stomach. The third object sometimes kept in view in the local 
 treatment by douching is a degree of stimulation of the functions of motion and absorp- 
 tion and the tonic effect to the gastric walls which follow those washings. The first 
 object is accomplished by the use of sterilized water or a 3 per cent solution of sodium 
 bicarbonate. Either tube may be used. The second object is effected by douching 
 the walls with a green soap solution or a solution of Hydrozone. The latter agent in 
 5 per cent, solution as directed above gives very pleasing results. The third object, 
 may be secured by using hot or cold water for the douche. 
 
 100 State Street, Chicago. 
 
 MECHANICAL FEEDING IN THE INSANE. 
 
 By FRANK C. HOYT, M. D., Clarinda, Iowa. 
 
 Superintendent Iowa Hospital for the Insane. 
 
 Published by The Medical Herald, of St. Joseph, Mo., January, 1897. ' 
 
 In many forms of insanity, but particularly in cases of stuporous melancholia, and 
 melancholia with extreme agitation, we find our patients suffering, with gastric dis- 
 orders, which require prompt and methodical treatment. These gastric derangements 
 are usually to be classed as atonic dyspepsia, with hypersecretion,, or chronic mucus- 
 gastritis, also attended by hypersecretion. In the latter condition we find that decom- 
 position, with a consequent formation of gas, takes place; the decomposing food acts 
 as a powerful irritant to the mucosa of the stomach, there is a corresponding increase 
 of the muscular action of the sphincters; the resulting, contraction- causes- aretention of- 
 
2 3 8 
 
 the decomposing food, while the gaseous distension seems to distend and paralyze the 
 walls of the stomach. Patients so afflicted usually refuse food, not alone on account of 
 their mental apathy, but because the ingestion of food causes pain and discomfort. 
 
 Where in ordinary cases we could safely treat the gastric disturbances systematically, 
 and, to a certain extent, leisurely, yet in cases of alienation the destructive metabolism 
 is so great as to force us to secure a restoration of the functions of the stomach as 
 rapidly as possible. Rectal alimentation may be used in these cases, but for obvious 
 reasons is very unsatisfactory. In common practice it has been the rule to permit the 
 patients to take food — predigested, it is true — whenever they could be induced to do so, 
 resorting to mechanical feeding only when necessary to introduce food. 
 
 This practice is erroneous, however, in my opinion, and I wish to advocate the use 
 of the lavage tube and mechanical alimentation in all cases of insanity, in which there 
 is established a diagnosis of atonic dyspepsia, or in fact any form of gastritis in which 
 there is a retention of mucus or food, with consequent decomposition. 
 
 The plan of treatment I would outline as follows: Twice or three times daily the 
 stomach should be thoroughly cleansed by a large volume of warm ozonized water, pre- 
 pared by adding three ounces of Hydrozone (Marchand's) to one gallon of water. This 
 should be poured into the stomach slowly, giving time for escape of gas through the 
 tube, until the stomach is about one-third filled. The fluid, decomposing food, mucus, 
 etc., should then be permitted to escape, and the same procedure repeated, until the 
 fluid comes away cleajr and free from gas bubbles. Then empty the stomach com- 
 pletely, and introduce a proper amount of prepared food, such as malted milk. The 
 opportunity may also be taken to administer such therapeutic agents as may be indi- 
 cated, small doses of Glycozone seeming to favor a restoration of the normal function 
 of the stomach. 
 
 In this connection, however, I wish to say that no greater mistake can be made in 
 the treatment of these eases, than to crowd an already disabled stomach with food and 
 medicine, before it is cleansed of its foul load of decomposing matter, and its mucosa 
 put in a condition favorable to digestion and absorption. And I would also say that 
 I know of no agent that equals Hydrozone for cleansing purposes. 
 
 A CASE OF TRAUMATIC SYNOVITIS OF THE KNEE— 
 OPERATI ON— RECOVERY. > 
 
 By H. C. DALTON, M. D., St. Louis. 
 
 Reprinted from the Medical Review, of St. Louis, Mo., January 23, 1897. 
 
 September 27, 1894, I was called to see J. N. White, male, aged 7 years. Four 
 days before my first visit, while running, he had fallen, striking his knee upon a rusty 
 nail; a few hours after the injury, his knee became swollen and painful. Prior to my 
 first visit, he was treated at home by a liberal use of Mustang liniment. 
 
 He had chills at irregular intervals; the mother thought that he had had fever for 
 two or three days; the joint was excessively painful. 
 
 My patient was well nourished, but was very restless; face flushed and anxious; 
 temperature 103. 5 F.; pulse 112. He complained of constant pain in the knee, 
 
 1 Read before the Missouri State Medical Association, Sedalia, Mo., May, 1896. 
 
239 
 
 greatly aggravated by attempt at movement. The joint was swollen, red, and edema- 
 tous, measuring four inches more in circumference than its fellow; the patella was "float- 
 ing," and over its middle point there was a small punctured wound, where the rusty 
 nail had entered. 
 
 The leg was partly flexed upon the thigh, and it was evident that the joint con 
 tained a considerable quantity of fluid, which both the history and symptoms showed 
 to be septic. 
 
 The patient was anesthetized, and under strict antiseptic precaution the joint was 
 opened by making two vertical incisions, one on either side of the patella; these in- 
 cisions were each i£ inches in length, and opened the capsules throughout their extent. 
 A large amount of pus, mixed with masses of flocculent lymph, was evacuated, and the 
 cavity throughout washed out with warm sterilized water, followed by a 3 per cent 
 solution of boric acid, and this by Peroxide of Hydrogen (Marchand's) full strength. 
 
 The synovial membrane was intensely congested, and there were numerous masses 
 of lymph adherent to it. Upon attempting to remove some of these, slight bleeding 
 was provoked. On the articular surface of the patella I could feel the roughened point 
 where the nail had entered the joint. The patella had been pierced just about its 
 middle point. 
 
 After a thorough cleansing, the joint was rather tightly packed with 10 per cent, 
 iodoform gauze. The attempt was made to so place the gauze that the articular sur- 
 faces would be separated as much as possible. The ends of the gauze were brought 
 out at the incisions, and an antiseptic dressing applied, after which the limb, slightly 
 flexed at the knee, was put upon a long posterior splint; this was confined by a cotton 
 bandage, and the whole covered by a crinoline bandage, snugly applied. 
 
 During the next 24 hours, the patient complained of the bandage being too tight, 
 but as the foot did not swell, and the pain and discomfort were not very great, I did 
 not remove it until the end of that time. His temperature was now 99. 8 P F , pulse 
 100. The pain and discomfort had now disappeared. The dressing being removed, 
 the same method of irrigatioji was employed as above. There was a considerable 
 amount of thin purulent discharge. A gauze drain was inserted into the joint through 
 each opening, but no attempt was made to pack the joint. 
 
 The next day the discharge was very scanty, and had lost its purulent character. 
 The joint was irrigated as before, but in dressing the wounds, gauze was placed in the 
 external wounds only; 24 hours later there was no discharge, and no water could be 
 forced into the joint, when an attempt was made to irrigate. 
 
 The dressing was changed daily for one week from date of operation, when an 
 attempt at passive motion was carefully made. Movement of the joint was very pain- 
 ful, and the manipulation was followed by considerable pain and some swelling. This 
 "was treated with an evaporating lotion, composed of: 
 
 1$ Ether sulph., § iij. 
 Liq. plumb, dil., § xij. 
 
 The limb was again put upon the splint, and left at rest for three days, when a 
 second attempt at motion was less painful, and was not followed by marked inflam- 
 matory reaction. 
 
 After this (10 days from date of operation) daily, careful and gentle, but persistent 
 passive motion was kept up. Adhesions were numerous and pretty firm. On two or 
 three occasions an anaesthetic was administered, in order to break them up thoroughly. 
 
 At the end of six weeks, the joint seemed to be well. Flexion and extension were 
 perfect, and no pain or roughness could be elicited even upon rather rough handling. 
 The joint now measured the same as its fellow, and the only evidence of former trouble 
 -was found in the scars. 
 
 I have given the history of this case somewhat in detail; not because of any novelty 
 in the case itself, nor in its treatment. Punctured wounds of the knee-joints are not 
 fare, and the principles underlying the treatment pursued are well known to all of you. 
 
240 
 
 The fact that the wound was directly through the patella marks the only unusual feature- 
 of this case. In an older patient in whom ossification would be more advanced, the 
 joint would probably have escaped altogether, or the bone would have been broken. 
 
 This case, and the result, show that thorough cleansing, followed by careful and 
 persistent after treatment, offers a fair chance of perfect restoration, even in suppurat- 
 ing joints. The presence of a large amount of pus and an abundant exudation of 
 fibrinous lymph did not interfere with the result in the case under consideration. 
 
 The essentials for success in these cases seem to me to be about as follows: 
 
 1. Early operation; this should not be delayed until the joint is widely distended 
 with pus and probably partly disorganized. I think my patient would have made a more 
 rapid recovery, and would certainly have given me less anxiety, had the operation been 
 done 24. or 36 hours earlier. When I was called the joint was already fully distended, 
 and must have been on the point of rupture. Rupture of the capsule, with extension 
 of the suppuration into the periarticular structures, or among the deep muscles of the 
 thigh, would probably have endangered his life, and certainly would have destroyed 
 his chance for a useful joint. 
 
 2. Thorough irrigation and drainage. These are best obtained through large 
 parallel incisions on either side of the patella, unless the process has extended beyond 
 the joint, when counter-openings at dependent points may be desirable or necessary. 
 
 The choice of an irrigating fluid is not without importance, when we remember- 
 that the synovial membrane is less tolerant of irritation, either mechanical or chemical, 
 than even the peritoneum. This fact prompted me to use only pure water and a boric 
 acid solution for irrigation, depending upon the Peroxide of Hydrogen (Marchand's) 
 for any needed antiseptic action. This agent in my hands has given excellent results 
 in all abscess cavities, and I have never seen any bad effects, even when used upon the 
 most delicate tissues. 
 
 After thorough cleansing, the question of drainage must be considered. In the 
 case under discussion, iodoform gauze, tightly packed into the joint seems to have met 
 the indications. The packing was done firmly and a^ thoroughly as possible. The 
 object was twofold: 
 
 (a.) To make sure that no pockets were left to fill up with and retain septic 
 material. 
 
 {b.) To separate as much as possible, the articular surfaces, and prevent the for- 
 mation of adhesions at least to some extent. Of course, I knew that a complete separa- 
 tion of the synovial membrane at every point could not be accomplished, but I desired^ 
 to do so, as far as possible. 
 
 3. The next essential to success, and of not less importance than the others ins 
 preserving the function of the joint, is early, persistent, but gentle passive motion. 
 Passive motion should be begun early, but not persisted in, if gentle efforts in this- 
 direction cause much inflammatory action. In such cases, the limb should be left at 
 rest for several days (the length of time to be determined by the severity of the symp- 
 toms), and the attempt again made. As soon as this tendency to reaction has disap- 
 peared we should be persistent in our efforts to break up existing adhesions, and to pre- 
 vent the formation of fresh ones. Pain alone, at the time of making the movements, 
 should not deter us. If necessary we should give an anaesthetic, as was done two or 
 three times in this case. 
 
 It has not been very long since our text-books told us that a suppurating joint was- 
 a destroyed joint, and that the best plan was to open it freely, drain thoroughly, and, 
 place the limb in such position as would be most useful after anchylosis had occurred. 
 
 This case, and others which doubtless you can recall, show that the time has come- 
 in which we can hold out hope for a better result. Not every suppurating knee-joint, 
 even if operated upon early and treated intelligently, can yet be saved in perfection of 
 form and function; but the time is probably not far distant in which we shall be able to* 
 say that the great majority of such cases will recover with a functionally perfect limb. 
 
241 
 
 CHRONIC GASTRITIS. 
 
 By PROF. H. T. WEBSTER, M. D., Oakland, Cal. 
 
 Professor of Theory and Practice of Medicine in the California Medical College, 
 Resident Physician of the MacLean Hospital in San Francisco, Cal. 
 
 (Reprinted from The Eclectic Medical Journal, of Cincinnati, April, 1897.) 
 
 Chronic gastritis, known also as gastric catarrh and chronic dyspepsia, is a disturb- 
 ance of digestion depending upon alterations in the character of the gastric secretion. 
 
 The causes are numerous and varied in character, but all tend to one result — diffi- 
 cult and protracted digestion and formation of fermentative products. It may result 
 from acute gastritis, though it is more liable to arise from indiscretions in diet, exces- 
 sive addiction to tea, coffee, tobacco, or alcohol, irreguiar and hasty eating with insuffi- 
 cient insalivation and mastication, or from the habit of drinking ice-water or the use 
 of iced foods during meals. It may occasionally arise as a reflex from rectal, prostatic 
 or uterine irritation. Certain constitutional diseases as anaemia, chlorosis, tuberculosis, 
 gout, nephritis, diabetes, and malarial cachexia may be attended or preceded by it. 
 Frequently pulmonary phthisis or chronic interstitial nephritis may be heralded for 
 months by gastric catarrh, long before the impending causal disease has been declared 
 by its symptoms. Slow and inadequate digestion of food encourage the growth of 
 the yeast plant, sarcina, and other elements of fermentation in the stomach, and thus 
 give rise to irritation of the gastric mucosa. Portal' obstruction, by causing engorge- 
 ment of the gastric capillaries may retard digestion, and finally, through disturbance 
 of the functions of the gastric tubules and resultant slow and feeble digestion permit 
 the accumulation of sufficient provoking cause to bring on a chronic catarrh. It may 
 be associated with certain local diseases of the stomach, such as cancer, ulceration and 
 dilatation. 
 
 Pathologists recognize two forms of the disease: (1) the simple $r common, and (2) 
 the sclerotic. The simple form is attended by hypertrophy of the intertubular mucous 
 membrane, while the second is attended by atrophy of the entire mucous membrane as 
 well as of the secreting structures. The first is marked by profuse secretion of mucus, 
 with restriction of the normal amount of gastric juice, the lining of the stomach being 
 covered with a tenacious coating which mechanically and chemically interferes with 
 normal chylification ; while the second is characterized by dryness or lack of secretion 
 not only. of gastric juice, but of mucus, the organ being dilated, its walls thinned and 
 atrophied, with fatty degeneration of its glandular elements. In another sclerotic form 
 (which is exceedingly rare) there is fibrous degeneration of the gastric walls, the mus- 
 cular structure being thickened with fibrous growth. 
 
 In the common form removal of the tenacious gray mucous covering the interior 
 surface of the stomach will reveal more or less alteration of structure in the mucous 
 membrane, the amount and character depending upon the duration and severity of the 
 disease. CEdematous spots, covered with granulations, ecchymoses, and more or less 
 extensive areas of pigmentation are distributed over the surface. Thickening of the 
 mucous membrane is prominent, especially about the pylorus, and this maybe so exten- 
 sive as to obstruct the opening, the stenosis resulting in gradual dilatation-gastrectasia. 
 In some cases the submucous tissue is implicated, the thickening being attended by 
 infiltration of the structure with migrating connective tissue cells and the development 
 of adventitious fibrous growth which renders the walls firm and unwieldy, and inter- 
 feres greatly with normal peristaltic action. 
 
 In long-standing cases, the mucous membrane of the pylorus and its immediate vicin- 
 ity may be the seat of abrasions or superficial ulcers of circular shape, varying from half 
 an inch to an inch in diameter, the intervening mucous membrane being reddened and 
 cedematous. Minute plants of ulceration may appear scattered about over the entire 
 
242 
 
 mucous surface, marking the location of similarly affected solitary and lenticular glands. 
 The inflammation usually extends to the duodenal mucous membrane. Dilatation of 
 the stomach may attend some cases, and contraction of its walls others, as varying 
 pathological changes predominate. Amyloid degeneration of the walls of the stomach 
 may occur in advanced cases, secondary to waxy changes in the liver and spleen. Fatty 
 infiltration of the tubules is sometimes detected under the microscope, and occasionally 
 fatty degeneration of the intertubular structures. 
 
 Symptoms. — The symptoms are those of indigestion. Heartburn, associated with 
 weight and fullness in the epigastric region follows eating, and continues for hours. 
 Later on, there is actual pain, of a burning nature, attended by eructations of gases and 
 fluids, and tenderness on pressure over the epigastrium. Darting pains radiate from 
 the stomach into the pectoral region or backward toward the scapulae, which may be 
 aggravated by pressure. The tongue is often red, the papillre being elevated and the tip 
 pointed, though in other cases the general appearance of the organ may be normal. 
 Craving for food (boulimnia) is a frequent symptom, this amounting to an almost con- 
 stant, unsatisfied gnawing sensation in the epigastrium, though a small portion of food 
 may satisfy it for a short time, during which the torments of difficult and painful 
 digestion are experienced. A metallic taste is frequently present between periods of 
 eating. 
 
 In aggravated cases vomiting is a frequent symptom, the material ejected consist- 
 ing of partially digested food mixed with a large quantity of mucus containing sarcinae 
 ventriculi, torukt, and varieties of bacilli and micrococci. The gastric juice is deficient 
 and there are present lactic, butyric, or acetic acid, though in rare cases there may be 
 excessive secretion of hydrochloric acid. 
 
 The boweis are usually constipated, though the reverse may be the case, undi- 
 gested food then passing through the intestinal canal soon after it is swallowed (lientery). 
 
 Cardiac palpitation frequently attends the digestive process and the tumultuous 
 throbbing may seem to be communicated to the sensitive stomach where the accumu- 
 lated gases aggravate the difficulty, eructation affording only temporary relief. 
 Stitching pains ii»the cardiac region may be present, and vertigo is not unfrequently 
 associated with it. 
 
 A dry cough, termed "stomach cough," is often present, this probably being due 
 to pharyngeal irritation, and partly to voluntary efforts on the part of the patient in 
 seeking relief from precordial oppression and epigastric discomfort. 
 
 Among the general symptoms are headache, languor, melancholia, and emaciation. 
 Where atrophic conditions of the gastric tubules are present, anaemia is a prominent 
 symptom. 
 
 Diagnosis. — The use of the stomach-tube will afford the best means of diagnosis. 
 If siphonage be practised an hour or so after eating, hydrochloric acid will usually be 
 absent, and lactic acid, associated with fatty acids are present with a large quantity of 
 mucus. If siphonage be practised seven hours after eating, undigested food will be 
 found still remaining in the stomach while in cases of functional dyspepsia it will 
 have disappeared. Malignant disease will be excluded by lack of cachexia, absence 
 of perceptible tumor upon palpation, and by the character of the material vomited, coffee- 
 ground material soon appearing in cancer. In gastric ulcer, a diagnostic feature is fre- 
 quent hematemesis. 
 
 Prognosis. — Chronic gastritis will usually improve readily under rational treatment 
 unless there be associated with it gastric ulcer, cancer, gastrectasia, or organic, hepatic, 
 renal, or pulmonary disease. When neglected it may continue for years and eventu- 
 ally terminate in ulcer or pyloric stenosis with resultant perforation or dilatation. A 
 sympathetic disease of the supra-renal capsules is not an unfrequent complication, the 
 supra-renal bodies seeming to sustain a peculiar relation to gastric irritation. The 
 marked emaciation which attends long-continued cases renders the patient susceptible 
 to attacks of acute disease and he is liable to succumb suddenly to some attack of this 
 kind, to hematemesis, or to the immediate results of pyloric stricture. 
 
243 
 
 Treatment. — An important part of treatment is the abandonment, so far as possible, 
 of all exciting or perpetuating causes. If the subject has been in the habit of using 
 alcoholic liquors, he should dp away with them at once and forever. As a substitute, 
 three parts of Howe's viburnum cordial and one part of specific avena sativa should be 
 combined and resource be had to the mixture in acceptable doses repeated until all de- 
 pression and craving for the accustomed stimulant have passed away. Ice-water or 
 iced drinks, or foods should be dispensed with warm, foods and drinks of bland- and 
 digestible character being indicated, and over eating and the use of objectionable food 
 should be avoided. The patient should restrict himself to small quantities of judici- 
 ously selected foods, taken at more frequent periods than in health and masticated 
 slowly. Fats and carbo-hydrates should be generally avoided, and complete abstinence 
 from pastries, griddle-cakes, fried foods, cheese, pickles, and tea and coffee should be 
 observed. 
 
 Sometimes, when there is nephritic or cardiac complication (and even in severe 
 cases without complication), a milk diet adhered to strictly for several weeks will afford 
 the best results. In order to prevent the formation of hard curds the milk should be 
 diluted with soda-water, lime-water, or other alkaline fluids. If the stomach is very 
 weak, the cream should be removed from the milk before it is taken. Buttermilk is 
 allowable, and from one to three quarts of this or milk may be taken during the twenty- 
 four hours, but given in small quantities and frequently. 
 
 When milk does not sustain the strength (though such cases will be rare), under- 
 done beef, or, what is better, raw, scraped beef, may be allowed in connection with it, 
 one or two ounces at a time, two or three times a day being sufficient, though the 
 amount may be increased as the patient's ability to digest food improves. Broths and 
 soups should be avoided, and tea, coffee, and cocoa should be taken sparingly and with- 
 out milk or sugar. Oysters, raw, broiled or panned are allowable and also stale bread 
 with but little butter. Where there is an excessive amount of hydrochloric acid secreted 
 rare roast beef, rare steaks, or the breast of chicken eaten with stale bread are best. Eggs 
 should be thoroughly cooked for such persons, and will then be well tolerated. If an egg 
 be boiled for an hour, the yolk, with a little salt added, will agree with the most delicate 
 stomach. Where there is a strong tendency for food to undergo decomposition in the 
 stomach, salted and smoked meats and fish may sometimes agree better than other 
 articles of diet. Here, cream-codfish, dried beef, jerked venison, caviare, etc., maybe 
 carefully tried in succession, in small quantities, that the diet may be varied. Cured 
 meats may be employed for the manufacture of cream gravy to be eaten on toast or stale 
 bread, the solid part being rejected. 
 
 Saccharine, starchy, and farinaceous foods are almost certain to undergo lactic and 
 butyric acid fermentation in the stomach before their digestion can be completed, pro- 
 ducing flatulency. A person afflicted with chronic gastritis should endeavor to live 
 carefully and abstemiously after recovery, throughout his life, as it is not a difficult 
 matter to provoke a return of the disease. During treatment, business cares and all 
 other responsibilities should be avoided, that no expenditure of energy may be made 
 in an unnecessary direction, neither physical nor mental exertion being conducive to 
 improvement. The case of Louis Cornaro, the Venetian, is not to be forgotten in this 
 connection, for it illustrates the remarkable effect of careful living upon those almost 
 hopelessly afflicted. 
 
 Though my information does not justify me in asserting that he was a sufferer from 
 chronic gastritis, the narrative at least suggests such a condition. Possessed of the 
 means, he abandoned himself to high and prodigal living but a weak constitution, 
 broken down at the age of thirty-five, from excess, rendered life a burden to him. The 
 next five years were passed in almost constant misery, and at the age of forty, his phy- 
 sician informed him that nothing could prolong his life more than two or three years 
 and temperate habits were advised as the means to relieve his suffering during that time. 
 He now began to gradually reduce his amount of food, both liquid and solid, until he at 
 length only took what nature absolutely required. This, according to his own state- 
 
244 
 
 ment, was a difficult course to pursue, and he often relapsed to over-eating; but he finally- 
 succeeded (within a year) in adopting permanently a spare and moderate system, and 
 was already restored to perfect health. 
 
 Being now an enthusiast, he proceeded from moderation to abstemiousness, and 
 diminished his daily allowance until the yolk of an egg sufficed him for a meal. Health 
 and spirits improved, and he soon became able to derive more pleasure from a small 
 meal of dry bread than the most tempting viands of a richly laden table had afforded 
 him in his days of excesses. Such a course, persevered in, with the avoidance of ex- 
 tremes of heat and cold, enabled him, after almost ending his life at thirty-five, to re- 
 cuperate and become a centenarian. 
 
 The constant and prolonged fermentation is the principal cause of perpetuation of 
 the disease and the cleansing of the stomach of mucus and fermentative products is the 
 direct way out of the difficulty. Modern times have afforded us superior advantages in 
 this respect and there is now little difficulty in curing uncomplicated cases of chronic 
 gastritis, even of long standing. If complications exist they should be removed if pos- 
 sible, and the problem then becomes clear. The tenacious mucus, which serves as a 
 nidus for fermentative products must be removed and the interior of the stomach kept 
 cleansed, when little other treatment, except a proper regime, is required. We possess 
 two effective measures for this purpose, which may be employed singly or combined. 
 I refer to (i) lavage and (2) disinfection and cleansing with hydrozone. 
 
 Lavage is an efficient means of cleansing the stomachal cavity. It is performed by 
 the aid of an elongated soft-rubber tube to one extremity of which is attached a glass 
 funnel. Dealers in rubber goods furnish these tubes upon application with open 
 lower end, fenestrated sides, and raised ridge to indicate the point of sufficient intro- 
 duction, this being at the lips when the tube is in situ. In order to introduce the tube, 
 it is first coiled in a bowl containing cold or warm milk according to the preference of the 
 patient, and the fenestrated extremity is then passed over the protruded tongue into the 
 lower part of the pharynx, the patient assisting its onward motion by efforts at swallow- 
 ing accompanied by deep inspirations. Steady pushing will now carry the instrument 
 into the oesophagus and it will glide easily along until the lower end passes into 
 the stomach, when the funnel should be affixed. It may be necessary for the physi- 
 cian to assist in the introduction for four or five times, after which the patient will be 
 able to attend to it for himself. After initiation, the patient holds the funnel in the left 
 hand and a flask of the fluid to be used in the right, fills the funnel and raises it above 
 his head, when the contents flow into the stomach (irrigation). The funnel is immedi- 
 ately depressed below the level of the stomach, when the principle of siphonage oper- 
 ates to withdraw the liquid contents, which are allowed to flow into a pail placed between 
 the patient's feet. Lavage is therefore divided into two stages, viz. , irrigation and siphon- 
 age. 
 
 Reflex irritation producing nausea and vomiting with dyspnoea, which may attend 
 the beginning of this measure, may usually be quieted by the administration of a single 
 dose of twenty grains of bromide of potassium, taken an hour or so beforehand. Where 
 the presence of the tube in the stomach provokes vomiting, the immediate introduction 
 of a little fluid to remove the gastric surface from contact with the extremity of the tube 
 will be sufficient, usually, to quiet the reflex. 
 
 The amount of fluid to be used at a time should be small at first, as vomiting is 
 easily excited, and until the stomach becomes used to the measure, a pint will be suffi- 
 cient. As treatment progresses, however, one, two, or three quarts may be used at a 
 time without inconvenience, and this should be repeated each morning before eating. 
 
 The solutions should be warm (98.5 F. or thereabout), and consist of simple 
 alkaline solutions, a drachm and a half of Glauber's salt to a quart of water constituting 
 a popular fluid for the purpose. I find weak solutions of asepsin excellent, and have 
 used boracic acid as a medicament with satisfaction. Long-standing cases of uncom- 
 plicated chronic gastritis recover completely in a few months on this treatment without 
 the assistance of other measures except proper attention to dieting. Mucus and re- 
 
245 
 
 tained fermentative elements and products are thus removed, and the mucous mem- 
 brane is aroused to normal action, the hyperemia subsides, and the irritated surface 
 returns to a healthy condition. 
 
 The introduction of hydrozone as a remedy in this condition was an 
 innovation of remarkable value. A drachm of Hydrozone, added 
 to four ounces of boiled water, and drunk while the stomach is 
 empty exerts a powerful influence in dissolving and removing the 
 tenacious mucus, destroying microbic elements of fermentation and 
 stimulating normal action in the diseased mucous surface. The best 
 results follow its use in the morning before breakfast, the patient 
 taking it while in bed and remaining on the left side for ten minutes 
 before rising. It may be taken oftener but once a day will suffice 
 and it may be advantageously used in this manner after the practice 
 of lavage. 
 
 The Hydrozone may at first produce acrid sensations in the 
 stomach and the patient may complain of an unpleasant taste follow- 
 ing its action, but as the irritated gastric surface improves in tone 
 under its influence, this will pass away, and sensitiveness to its action 
 will subside. Where necessary the amount of Hydrozone may be 
 reduced, until the stomach becomes more tolerant to it. 
 
 The important step in chronic gastric catarrh, as in catarrh of all 
 other mucous cavities, is the cleansing of the part from the ropy mucus, 
 which clogs the glandular organs, and serves as a nidus for the opera- 
 tion of agents of fermentation. Glycozone may sometimes be pre- 
 ferred, glycerine possessing individual virtue in certain cases of indi- 
 gestion with fermentation. 
 
 With attention to such details, little more is necessary in the treatment of this dis- 
 ease. Some advise, in the absence or lack of the normal amount of hydrochloric acid, 
 that this drug be given in suitable doses, well diluted with water. Benefit may some- 
 times follow this measure, but with the removal of morbid accumulations a normal 
 amount of hydrochloric acid will soon be provided by nature. The efficiency of bitter 
 tonics is doubtful, though some of them may specifically improve the recuperative forces 
 of the gastric mucous membrane, and aid in a restoration to normal conditions. I believe 
 berberis aquifolium to be one of these, its beneficial influence in catarrh of the mucous 
 membrane generally adapting it here, while it is an acknowledged stomachic of supe- 
 rior virtue. Ten-drop doses of a reliable fluid preparation, repeated thrice daily, will 
 often assist materially in restoring a normal condition of the gastric mucous membrane 
 and digestive glands, aiding digestion, banishing boulimnia, and promoting a normal 
 appetite. 
 
 When the catarrhal accumulation is a marked feature and there is a yellow coat- 
 ing on the tongue, bichromate of potassium in minute doses (two or three grains of the 
 3x), repeated three or four times daily, will usually assist the local treatment. Nux 
 vomica may relieve some of the local unpleasantness, and there are those who assert that 
 it specifically ameliorates the catarrhal condition. The dose should be minute. Hydras- 
 tis, Pulsatilla, robinia, antimonium, bismuth, both the subnitrate and the liquor, and 
 many other remedies, have their advocates. 
 
 In anaemic persons, where catarrhal tendencies are strong, calcium phos. 3x, in two 
 or three grain doses repeated three or four times a day will lessen the ropy secretion. 
 Protonuclein is another drug which promises much as a restorative. 
 
246 
 
 Where chronic gastritis attends malarial cachexia that group of remedies which 
 tends toward lessening the pressure in the radicals of the portal vein, will be efficient 
 in relieving the congestion of the gastric mucosa. Of the four principal ones — 
 polymnia, ceanothus, carduus, and grindelia squarrosa-grindelia squarrosa is my favorite. 
 Improvement in digestion, under favorable circumstances, almost invariably follows its 
 use. From five to ten drops of a satuarated tincture of the genuine plant, administered 
 in a swallow of water, and repeated three times a day, insures marked benefit within a 
 few days. 
 
 Sometimes we may be urged to administer agents for the relief of cardiac palpitation 
 and associate gastric distress. Cactus grandiflorus and pulsatilla established a reputa- 
 tion with us for this purpose, before our old-school friends discovered their virtues, and 
 they will occasionally answer us still. The best remedy I have ever tried, however, is a 
 saturated tincture of aplopappus laricifolius, in from two to ten drop doses, one or two 
 doses sufficing at a time. It calms erythism of the sympathetic nervous system, promotes 
 rest, strengthens cardiac action, and lessens pain, relieves precordial oppression, pro- 
 motes evacuation of the bowels, and favors digestion. Minute doses of aconite and rhus 
 tox are not to be despised for this condition, this reliable gastric sedative combination 
 being very serviceable in some cases of chronic irritation. 
 
 Where constipation is present, enemata will be found preferable to laxative medi- 
 cines, the salt-wateiigalvanic enema being an excellent aid in stubborn cases, it not be- 
 ing necessary to repeat it more than once or twice a week. The positive pole should 
 be applied with a moistened sponge over the espigastrium. 
 
 Local applications over the espigastrium are sometimes of service, and should be 
 tried in intractable cases. The compound tar plaster of our forefathers, worn over the 
 espigastrium until pustulation begins, then removed for a few days and its use repeated 
 again and again, to perpetuate a superficial irritation, has many able advocates, and I 
 have known it to effect most excellent results. A vinegar pack or girdle worn upon the 
 epigastrium is hardly less effective. Equal parts of strong vinegar and water may be 
 employed to moisten an epigastric pad which should be wrung as dry as possible two or 
 three times within the twenty-four hours and worn constantly, the clothing. being pro- 
 tected by an oiled silk covering. 
 
 As this disease is a long time in becoming established, it must be expected that 
 several months will be required to effect a cure. 
 
 A CASE OF LUPUS OF SIX YEARS' STANDING. 
 
 By TRUMAN SEXSMITH, M. D.. 
 
 Surgeon Golden Cross Mining Company, Yuma, A. T. 
 
 (Reprinted from The Medical Brief, for April, 1897.) 
 
 The patient is a male, aged fifty-eight years. When he applied for treatment he 
 was completely run down both mentally and physically. The ulcer, which was situated 
 at the corner of the left eye (involving both upper and lower lid), was a little larger than 
 a dime. He had consulted several physicians, and the only encouragement was the 
 knife. 
 
 By the advice of Dr. Geo. Monroe, of San Francisco, Cal., I concluded to try chro- 
 mic acid, which was applied, the eye being protected by vaseline. On the third day 
 it was again applied with cocaine to relieve pain. This application was attended with 
 greatly increased inflammation and swelling of the whole side of the face. The acid 
 was re-applied on the fifth day. In the meantime, the ulcer was washed out four times 
 daily with Marchand's Hydrozone, full strength, and a compress of carbolized cotton 
 soaked with Glycozone was applied each night. The patient was given Arsenauro in 
 
247 
 
 six-drop doses in a wine-glass of water, half hour after eating. In two weeks the 
 dose was increased to ten drops. This treatment was continued for six months. 
 In one month the ulcer healed, leaving a soft, flexible cicatrix with only slight inver- 
 sion of the under lid. 
 
 It is now more than a year, and the patient has increased in weight from one hun- 
 dred and twenty pounds to one hundred and fifty-six pounds; general health seems 
 perfect. Only slight weakness of the eye complained of, caused partly by intense sun- 
 shine of this climate. 
 
 ESSENTIAL REQUIREMENTS OF A MODERN ANTISEPTIC. 
 
 By ROBERT C. KENNER, A. M., M. D., Louisville, Ky. 
 
 (Reprinted from The New Albany Medical Herald, for April, 1897.) 
 
 Seventeen years ago the entire world was aglow wilh the strides made in the domain 
 of surgery by the introduction of antiseptics. It caused many good surgeons to believe 
 that surgery would have an entirely new future. But now, after a thorough trial, anti- 
 septics have come to be considered in their true light. We have come to regard anti- 
 septics as indispensable, and their field of usefulness is clearly understood by the pro- 
 fession. When antiseptic surgery first was advocated by Sir Joseph Lister, he held 
 many views which he soon abandoned as worthless. He operated under a carbolic acid 
 spray. This he soon found to be useless, and he did not long depend upon carbolic acid 
 as an antiseptic. In order to bring out the central idea of this paper — the requirements 
 of a modern antiseptic — let me go over the most prominent antiseptics which have 
 claimed the attention of the profession. The first antiseptic which in recent times 
 gained the confidence of the profession was carbolic acid. This agent, from the fact 
 that it was the one used by Lister, came to be depended upon all over the world. Its 
 reign of favor however did not last long, as it soon came to be found to be an irritant and 
 a poison, capable of doing a great deal of harm. When large surfaces were treated 
 with carbolic solutions often patients died of carbolic acid intoxication. It is impossible, 
 in many cases, to prevent a result like this, and many surgeons can give some sad 
 experience along this line. Again, when all danger of causing carbolic acid poisoning 
 was rendered impossible, it has been found that the agent was an irritant to such a degree 
 that wounds were rendered unhealthy or made to heal more slowly than when they 
 received no antiseptic at all. Again, it was demonstrated by a great many investigators 
 that carbolic acid was not fatal to many pathogenic bacteria, and, therefore, the agent 
 has come to be laid aside as far as any of the purposes of a modern surgical antiseptic 
 are concerned. After carbolic acid had come to occupy this place, we find corrosive 
 sublimate to have gained a most widespread acceptance at the hands of the profession. 
 This widespread acceptance is due to the fact that corrosive sublimate is positively fatal 
 to many and most all of pathogenic bacteria. Over a hundred years ago Pringle, in an 
 array of tests to demonstrate the value of antiseptics, found that carbolic acid would 
 more quickly prevent or deter sepsis than any other agent. Pringle's work, however, was 
 on other lines than ours. Yet he found out much that has since his day been rediscovered. 
 Corrosive sublimate to-day may be said to be on the decline. In fact, few well informed 
 surgeons will now employ it at all. The reason for the decline of carbolic acid in favor 
 is that it is very poisonous and a most potent irritant. Possibly no drug is a greater 
 irritant. One of the first things which caused corrosive sublimate to begin to decline 
 was the fact that one of the leading surgeons pointed out that it would, when brought 
 in contact with divided tissue, form an albuminate over all the surface of the wound, 
 and that this would prevent the healing by the first intention, and very often it would 
 cause suppuration in certain places where, if no antiseptic was employed at all, we need 
 have care, too, in using corrosive sublimate that we do not allow it to be used over 
 
248 
 
 extensive surfaces. If there is but a small amount absorbed, we shall find our patient 
 with symptoms of poisoning. Again, in employing corrosive sublimate, it is necessary 
 to bear in mind that it is easy to get it too strong. Many serious accidents occur from 
 this cause. Again, when we use corrosive sublimate, we will find that it cannot be used 
 with safety as a spray. For these reasons corrosive sublimate is a most dangerous anti- 
 septic, and its going into disuse is for the good of the profession. 
 
 Iodoform has been long popular, but is now being relegated to the shades of disuse. 
 This is so because this drug has a most disagreeable and a most reproachful odor, and 
 it also produces many cases of poisoning. For these reasons iodoform has gone prac- 
 tically out of employment. But iodoform is a powder, and cannot be brought into a 
 solution, and, therefore, should it be non-poisonous, it would not be applicable in a 
 large number of cases. 
 
 But the requirements of the modern medical man for an antiseptic is not supplied, 
 as we have seen, in any of the agents of which we have spoken. We have in Hydro- 
 zone the strongest antiseptic known to the medical profession, and it is now employed 
 extensively by the profession. It is three times the strength of Peroxide of Hydrogen, 
 the U. S. P. officinal, and it is in no sense an irritant or a poison. It can be taken 
 internally, as in cases of gastric catarrh and dyspepsia due to fermentation, and as an 
 intestinal antiseptic without the slightest danger of producing poisonous results, or with- 
 out the least danger of producing irritation. One of the greatest sources of benefit 
 which we derive from this agent is the antiseptic effect which it produces in throat dis- 
 eases. Hydrozone, diluted with half its quantity of water, we find the best remedy for 
 tonsillitis. This sprayed against the tonsils when an attack is in its incipiency will in 
 every case abort it. It should be sprayed thoroughly against the tonsils every 
 fifteen minutes or half an hour until the pain and difficulty of swallowing has been 
 dissipated. But this need not be continued longer than four hours with this frequency. 
 After that every two hours will suffice, and generally not more than six or eight 
 hours are necessary to effect a cure of tonsillitis. But the best effects of Hydrozone 
 will be seen in diphtheria. Here its employment will bring us good results by render- 
 ing the parts antiseptic and limiting the affection. It is claimed by the best observers 
 that if the nose is sprayed in attacks of diphtheria we will have no faise membrane in 
 the nose. 
 
 But this is not all. As an injection in the strength given above, it is the best injec- 
 tion in leucorrhea and gonorrhea in females. It is above all remedies for the cleansing 
 out of abscess cavities. It will never cease to bubble as long as there is any pus in the 
 cavity. In nasal catarrh, in ozena and all inflammation of the mucous membranes its 
 action is that of a pure antiseptic. In other words, it begets absolute cleanliness, and 
 destroys all pathogenic germs, and renders in the diseased structure an absolutely 
 healthy condition. 
 
 No remedy equals it in carbuncles. Here it destroys the pus and core, and causes 
 the diseased structure to take on a healthy action. 
 
 We may, therefore, not hesitate to claim that this antiseptic meets the demands of 
 the physician and surgeon more nearly than any other agent of its class at their disposal. 
 
 GLYCOZONE IN CHRONIC CATARRH OF THE STOMACH. 
 
 By J. W. STARR, M. D., of Chariton, Ia. 
 
 (Reprinted from the Lancet, April, 1897.) 
 
 In October, 1896, my attention was called to the value of Glycozone in chronic 
 catarrh of the stomach. Having at that time three typical cases (two males and one 
 female) I began the use of Glycozone, giving it in the proportion of one teaspoonful 
 in a wineglassful of water. At first one of the patients experienced a peculiar uneasy 
 sensation in the stomach directly after taking the remedy, but this was of short duration 
 
249 
 
 with no particularly unpleasant nor bad effects in any manner. The appetite became 
 more regular, the feeling of distress so common in such cases gradually subsided and 
 the pains became of trifling severity. 
 
 The cardialgia in a short time was entirely relieved in two cases and greatly bene- 
 fited in the third. The eructations of gas and gaseous distention of the intestines were 
 relieved in a short time. In all the cases digestion appeared to become more energetic 
 and a general improvement was very noticeable. The results obtained with the remedy 
 have been most satisfactory to me and I consider it worthy of a still more careful and 
 extended trial. 
 
 The reason so many fail to cure catarrh of the stomach is because they only pre- 
 scribe to relieve the distressing symptoms instead of trying to reduce the inflammation 
 in the stomach and subdue the existing pathological conditions. In order to accom- 
 plish the desired end the stomach must be treated with antiseptic remedies, themajorily 
 of which are too strong and in many cases they only tend to aggravate the disease. 
 
 The first indication then would be to destroy the morbid elements of the stomach, 
 and second to heal the inflamed lining membrane after the first was accomplished. 
 
 If the antiseptic theory be correct, we would then begin to look about for an anti- 
 septic remedy that would not act as a chemical irritant to the stomach, and at the same 
 time secure one that would be a good cleansing agent, if possible to do so, and to meet 
 this end I look upon Glycozone as being the best available remedy at the present time 
 to meet all the demands of such an agent, for by prescribing it diluted with water we 
 may get the mechanical as well as the chemical effect of the remedy on the lining mem- 
 brane of the stomach. 
 
 In treating nasal catarrh, pharyngitis, and like diseases of the mucous membrane, 
 I look upon Hydrozone and Glycozone as being indispensable. 
 
 THE TREATMENT OF CHRONIC SUPPURATION OF THE 
 
 MIDDLE EAR. 
 
 By SETH SCOTT BISHOP, M. D., LL. D., of Chicago, III. 
 
 Professor in the Post-Graduate Medical School and Hospital of Chicago; Professor of Diseases of the 
 Nose, Throat and Ear in the Illinois Medical College, etc. 
 
 (Abstract from Louisville Medical Monthly, June, 1897.) 
 
 The diversity of opinion relative to the advisability of irrigating the ear in suppu- 
 rative conditions of the tympanic cavity is something worthy of remark. Some very 
 excellent otologists disapprove of the practice. With others it is the common practice 
 to syringe suppurating ears with the solution of bichloride of mercury — 1 to 5,000 — in 
 the beginning of treatment, at least, and even during the course of treatment. 
 
 Believing that the most thorough cleanliness is absolutely essential to a cure of 
 suppurating ears, we begin the treatment by having them syringed with the sublimate 
 solution as warm as can be borne with comfort, using at least a quart at a time with a 
 continuous flow syringe. 
 
 Inflation is then practiced with antiseptic vapors like camphor-menthol in a 10 per 
 cent, solution. The discharges that inflation may project into the meatus are then 
 removed with cotton. 
 
 The next step is to fill the ear with warmed Peroxide of Hydrogen. I have seen 
 it claimed that warming this remedy would deprive it of its potency, but I have 
 employed it in this manner for years without observing such a result. In a private 
 letter from so eminent an authority as Charles Marchand, he says: 
 
25° 
 
 "I received a letter from Dr. J. F. Burkholder a few days ago, in which he states 
 that you had an argument with some doctors who claimed that when Hydrozone is 
 heated at a temperature of 102 to no° F. it loses its strength. This is perfectly 
 absurd. When Hydrozone is heated at that temperature in a glass container it does 
 not lose any of its strength, and that is the proper way to use it in case of mastoid 
 abscess and suppurative conditions of the middle ear." 
 
 The Peroxide is left in the ear as long as effervescence continues. This decomposes 
 pus, liberates oxygen, destroys bacteria and effectually cleanses the cavity. * * * 
 
 THE CARE OF THE INSANE IN PRIVATE PRACTICE. 
 
 By DR. HENRY W. COE. Portland. Ore. 
 
 (Abstract from The Journal of the A?nerican Medical Association, March 6, 1897.) 
 
 Dr. H. W. Coe says: "There is no more prolific source of insanity than auto- 
 infection, and to meet this condition, Bouchard calls attention to the necessity of a 
 carefully selected diet and the free operation of all the emunctories. Salines he espec- 
 ially recommends, and I can testify as to their value. Intestinal antisepsis should be 
 a feature in nearly everf case, and the agent employed for this purpose should be such 
 as shall not interfere with normal digestion and yet be powerful enough to destroy the 
 micro-organisms which are doing the mischief and to neutralize the ptomaines already 
 present in the tract. My own experience accords with that of Dr. John Aulde and Dr. G. 
 M. Blech,the Peroxide of Hydrogen is a most satisfactory agent for intestinal disinfection. 
 Dr. Aulde uses a three per cent, and Dr. Blech a two per cent, solution of Hydrozone 
 in water, from two to eight ounces of this mixture being taken a half hour before 
 meals. I have made use of this method with pleasant results, and in cases where 
 there has been much gastric fermentation I have employed an additional ozonized solu- 
 tion, Glycozone, a teaspoonful immediately following meals. The glyc erine which is the 
 menstruum in this latter solution, acts as a mild stimulant to theointestinal glands, 
 thereby accelerating the excretory functions of the tract. I have w ndered if a little 
 of the good effects from the use of a powerful static machine, which I have noticed in 
 several cases of mental trouble was not due to the general effect from the inhalation of 
 liberal quantities of ozone from the atmosphere in which the patient has been envel- 
 oped during the use of the breeze. Dr. Riggs and many other writers are enthusiastic 
 over the use of the static current in the treatment of insanity. Dr. Gray believes that 
 the ozone from the static breeze accounts for much of its benefits in hysteria, and why 
 not also in insanity?" 
 
 ENTERO-COLITIS OF INFANCY.* 
 
 By M. A. CLARK, A. M., M. D., Macon, Ga. 
 
 (Abstract from The Atlanta Medical and Surgical Journal, June, 1897.) 
 
 * * * Bismuth is the remedy par excellence when there is much tympanites. 
 With regard to bismuth let me remark that we are often disappointed in its results 
 because we give too small doses. I do not hesitate to give to a child of six months grains 
 xx of the subnitrate every two hours when the stools are frequent and the bowels are 
 tympanitic. The salicylate is recommended by some as being more antiseptic. I pre- 
 fer the subnitrate, as I get better results from its use. 
 
 ♦Read before the Georgia Medical Association at Macon, April 21, 1807. 
 
251 
 
 When the tannigen is pushed, it is rarely necessary to resort to the bismuth. Give it 
 till the bowels are checked and then every four or six hours till the stools have resumed 
 their natural color. Tannigen is both astringent and antiseptic, and will not only 
 check the diarrhoea, but will also destroy the fermentative changes taking place in the 
 bowels. I do not claim that it will cure every case, but I do claim thac, if properly 
 used, it will cure much more promptly than any other medicine. 
 
 If there is great pain, I add a little deodorized tincture of opium; but all opiates 
 should be avoided if possible. It is better to allow the patient to suffer some pain than 
 to be stupefied by opiates. 
 
 In connection with the foregoing medicines I wash out the bowels thoroughly two 
 or three times daily with Hydrozone, i to 32 or 40. I use a fountain syringe with a 
 soft rubber catheter, No 23 or 24 or even larger may be used. Hold the syringe just 
 high enough above the patient to allow a gentle flow. If the fever is high, I use the 
 water barely tepid, sometimes cool water is better, as it reduces the temperature more 
 rapidly. For general use I have the water comfortably warm. 
 
 In irrigating the bowels do not be afraid to use plenty of water. Use it freely not 
 only till the bowels move, but till the water returns clear, showing that the bowels are 
 well cleansed. The water removes all faecal matter and unhealthy mucus, and the 
 Hydrozone destroys all sepsis and stimulates the intestine to a rapid return to its nor- 
 mal condition. 
 
 When there is constant griping and much tympanites, I use the irrigation oftener, 
 every two or three hours, if necessary, to keep the patient comfortable. 
 
 Thus with tannigen, the ideal intestinal astringent; bismuth the reliable antacid; 
 water, the great cleanser, and Hydrozone, the most potent antiseptic, with strict 
 attention to diet and clothing, we may reasonably expect a majority of our cases to 
 recover. 
 
 HYDROZONE AND GLYCOZONE 
 
 IN 
 
 GASTRIC CATARRH WITH NERVOUS SYMPTOMS. 
 
 By WARREN E. DAY, M. D., Prescott, Ariz. 
 
 (Reprinted from The New England Medical Monthly, August, 1897.) 
 
 Gastric catarrh with nervous complications is one of the most stubborn ailments 
 that I know of. I may confess here, that as long as I used injurious or worthless 
 drugs which are usually prescribed in order to subdue this disease, I never accom- 
 plished more than giving temporary relief to my patients. 
 
 Two years ago (although I am quite skeptical about new remedies) a hopeless case 
 of gastric catarrh came under my care, and instead of resorting to the ordinary reme- 
 dial agents, I gave up the routine and concluded to try Hydrozone and Glycozone, 
 excluding all other drugs 
 
 The results were so gratifying, that since that time I have used these remedies 
 with wonderful results in not less than forty cases of gastric and intestinal diseases. 
 Many of these cases were thought incurable, and I was called in as a last resort par- 
 ticularly in the case of Mr. L., who had given up all hope and nearly all desire to 
 live. He could not eat or retain food on his stomach. He had great difficulty in 
 breathing, and had paroxysms of asthma, lasting for hours, did not dare to sleep, fear- 
 ing death, kidneys and bowels deranged, legs and feet badly swollen, urine scant, fecal 
 matter light color, bullet form and hard. 
 
252 
 
 I lis relatives came in from Utah to see him for the last Lime, bury him of course, 
 lie had n<> wife Or children. I was called ill by his orders as he had known me for 
 twenty years, and my opinion of his case was needed to satisfy him. If I gave liini 
 no hope of relief, then he must go as he said. Physicians who had treated him before, 
 had been paid and dismissed with his presumed blessing. 
 
 Alter a thorough examination the internal treatment prescribed was ozonized 
 water and (llycozone with injections. No other dru^s permitted. Bowels soon 
 opened, and old accumulations gotten rid of; such food as his appetite craved for day 
 and nighl was provided. for weeks prior to my being called, he had not laid in bed, 
 but was propped up in a sitting posture with his clothing on and a nurse in constant 
 attendance. After a few days treatment all the natural functions were greatly 
 improved. 1 lis sleep returned naturally; he reclined in bed in proper position, the 
 swelling decreasing in his limbs. 
 
 lie had no difficulty in breathing and after live weeks treatment, he now goes 
 about attending to his business, looking after his real estate and putting in no little 
 time in giving me credit for his life. 
 
 The above is only one out of a score of bad cases, the cure of which was entirely 
 due to the judicious use of Ilydrozone and (llycozone prescribed as follows: 
 
 Fifteen minutes before meals, the patient took one tumblerful of ozonized water 
 made of two per cent, of llydro/.one diluted with clear water (boiled water to be pre- 
 ferred). Immediately after meals two teaspoonfuls of ( ilycozone well diluted with 
 water was given to the patient for three weeks, then reduced the dose to one tea- 
 spoonful. 
 
 In order to subdue the catarrhal inllammation of the bowels, I prescribed an 
 enema to be taken every morning with 12 ounces of lukewarm water containing one 
 ounce of Glycozone. 
 
 The results I obtained in prescribing the above are such, that I feel fully justified 
 to recommend it as being the treatment "par excellence" in gastric and intestinal dis- 
 orders. 
 
 l'KROXIDE OF HYDROGEN IN MASTOID COMPLICATIONS. 
 
 By M. F. WEYMANN, M. I)., St. Joseph, Mo. 
 
 Professor of Ophthalmology and Otology, Central Medical College. 
 (Reprinted from the Medical Herald, of St. Joseph, Mo., for July, 1897.) 
 
 Two years ago I was consulted by a little girl, of American parentage, about 14 
 years old, and to all appearances of good health, for an ear trouble. The parents were 
 both strong and robust country people, and stated that the child had been equally 
 fortunate in matters of physical well-being. There were traces of previous scrofulous 
 trouble, such as Hutchison teeth, some enlargement of the submaxillary and cervical 
 glands, and a tendency toward chronic catarrh. It was also remembered by the parents 
 that she used to be in the habit, in her younger age, of breathing through her mouth. 
 
 Inspection at the time showed an acute pharyngitis in the stages of decline, but 
 there were no adenoids perceptible, and both nares were free. There had been for 
 some time discharge from the ears, but within a week it had ceased, shortly after the 
 onset of the "cold in her head." The latter had come on with a great deal of fever 
 and torturing ear-aches. Sedative instillations were ordered by the local physicians, 
 but without success. The family finally became frightened by the appearance of mas- 
 toid swelling, and came to see me. 
 
2 53 
 
 There was a doughy swelling, over both mastoids, with tenderness on pressure. 
 The auricles were pushed away from the head, and the tissues of the neck below the 
 mastoid were thickly infiltrated and sensitive to palpation. This was the case on both 
 sides. The auditory canal was very much narrowed through inflammatory swelling, 
 although there was little discharge. The surfaces were dry, hot and red. Pressure 
 over the tragus was unbearable; in fact, handling of the auricle caused intense suffer- 
 ing. The child was flushed in the face, the expression sleepy and stupor-like. There 
 had also been vomiting on the preceding day. The case certainly looked serious and 
 alarming, and I informed the mother that perhaps mastoid operations might become 
 necessary, although I told them that I would wait another twenty-four hours. I 
 ordered immediately 
 
 1$ Olei tiglii, gtt. j. 
 
 Sig. Take at once on a lump of sugar. 
 
 This was given both for the purpose of moving the bowels and as a revulsive, but 
 especially for the latter purpose; and I must say that in many instances such revulsion 
 has done better for me than actual bleeding. I also ordered some antipyretic, to at 
 least somewhat reduce the fever, and finally I ordered hot cataplasms over both mas- 
 toids thirty minutes out of every hour, the surface to be so covered to be large, and 
 the temperature of the cloths to be as hot as possibly could be borne without actually 
 burning the skin. 
 
 Before allowing them to go from the office I syringed out the ears with warm 
 boric acid lotion, and then instilled Peroxide of Hydrogen, full strength. Although 
 there seemed to be no discharge, I could plainly hear the bubbling by laying my head 
 upon the patient's ear. After thoroughly cleansing in this manner, I dismissed the 
 patient with instructions to put on hot compresses thirty minutes, then keep Peroxide 
 of Hydrogen in the ears for the other half hour, and so alternate without cessation 
 during the whole night. There were perforations in both drums, and I should have 
 ordered Valsalva inflations with the peroxide, if it had not been for the pain caused by 
 the effort. 
 
 The next day my patient returned a different girl. Her fever was much lower, 
 her expression was lively, she showed interest in things and persons, and the pain in 
 the "head" had subsided. Even the mastoid swelling was reduced considerably. Of 
 course, I now took a more hopeful view of the case, but continued the measures 
 mentioned, and within five days every trace of mastoid swelling, cervical induration 
 and tragus tenderness was gone. The discharge was more copious, but disappeared in 
 about a month under ordinary treatment. 
 
 The correction of the mastoid complications was rather a surprise to me, and while 
 I attributed it mainly to the peroxide, still I could not help thinking that revulsion and 
 moist heat had their share. I made up my mind to find out for certain in the next 
 case where the glory belonged. 
 
 Since then I have had quite a number of cases, and my observations have con- 
 vinced me that Peroxide of Hydrogen is the most reliable of all remedies in mastoid 
 trouble. I do not mean that it will cure any case, but I do mean to assert, that at the 
 beginning and in the early stages of mastoiditis it will work wonders. Whenever 
 there is, at the same time, evidence of tympanic trouble, as shown by tenderness over 
 the tragus, it will abort mastoid complications almost with a certainty. This goes to 
 show that retained discharge may cause mastoidal swelling without, however, causing 
 permanent mischief. The moment the offensive secretions are removed the inflamma- 
 tory tumefaction rights itself. I believe the timely use of H 2 2 would prevent 
 periosteal complications to such an extent that surgical work would be needed in very 
 few instances. 
 
 In closing, I wish to state that care must be used in selecting the Peroxide of 
 Hydrogen, there being many inferior commercial brands on the market. I invariably 
 prescribe Marchand's medicinal Peroxide of Hydrogen or Hydrozone, both of these 
 preparations being thoroughly stable and reliable. 
 
254 
 
 AN ULCER RESULTING FROM ANTHRAX, 
 
 TREATMENT. 
 
 AND ITS 
 
 By J. OSBORNE DeCOURCY, M. D., St. Libory, III. 
 
 Secretary Southern Illinois Medical Association. 
 (Reprinted from the New York Polyclinic for August, 1897.) 
 
 The case came under my care July 26, 1895, with the following history. 
 
 Mrs. H. B., married, previous health good, family history negative. 
 
 Patient complained of not having been well for two weeks; back of the neck sore, 
 red, swollen with a "hard cake" extending over the back of the neck from base to occi- 
 put and from ear to ear, very painful and constantly growing worse. To this trouble 
 was added a profuse diarrhoea with fever. Had been dosed with wines, "family rem- 
 edies," and patent nostrums, with various local applications. 
 
 Cut No. 1. 
 
 When first seen patient was excited, pulse quick and strong, temperature ioi° F. 
 
 The fever behaved as the ordinary intermitting, and was so treated. 
 
 The usual agents were used to control the pain, to render the patient as comfort- 
 able as possible. 
 
 After two days, a great number of small pustules appeared over the swollen sur- 
 face which were opened and through which there came a flow of pus. 
 
 The line of demarkation having been formed, the integument together with the 
 underlying tissue was removed ; the wound made clean and packed with boric acid and 
 dressed, oiled silk being applied next to the surface. 
 
 Before the removal of the integument the discharge of pus was so constant and 
 profuse that the wound was dressed two to three times a day. 
 
2 55 
 
 It was indeed a ghastly sight as shown by Cut No. i which was not made until 
 the beginning of granulation. 
 
 Hydrozone was used freely from the first appearance of pus and at each subsequent 
 dressing, in sufficient quantity to destroy the pus and leave a clean surface. 
 
 In the meantime the fever was subdued and the pain which at first was so great, 
 had come to be much less severe and the lady expressed herself as feeling fairly com- 
 fortable after the wound was dressed. 
 
 Skin grafting was done at three different times, but as the patient most of the time 
 slept in the supine position, the grafts failed to take. 
 
 From the end of the third week Glycozone and Hydrozone were used alone as the 
 local agents. The ulcer was then washed and dressed twice each day for four weeks. 
 
 Cut No. 2. 
 
 Lukewarm water was used per fountain syringe to wash the parts; Hydrozone 
 then applied by means of a hard rubber syringe followed by Glycozone with a camel's 
 hair pencil. A layer of surgical lint was saturated with Glycozone and applied to the 
 parts, then one ply of dry lint extending well over the surface bound down by a 
 gauze bandage. 
 
 A nutritious diet was recommended and the patient well fed during the following 
 sixty days, at the end of which time the wound was practically well. 
 
 Granulations advanced rapidly from below upwards making slow progress from the 
 occiput, and from either side. The result was a beautiful white skin wi:h a very nar- 
 row cicatricial thickening extending across the neck just below the occiput as shown in 
 Cut No. 2, which was made the ist of November, about the ninety-fifth day after I first 
 saw the case. 
 
 Convalescence was steady and uneventful from the first. 
 and enjoying good health. 
 
 The lady is still living 
 
256 
 
 SUPPURATIVE NEPHRITIS. 
 
 REPORT OF A CASE. 
 
 By WILSON PETERSON, M. D., New York. 
 
 (Published by the North American Journal of Homoeopathy, for September, 1897.) 
 
 Mrs. B applied to me for treatment about three years ago for what I diag- 
 nosed as suppurative nephritis; all the symptoms pointing to this condition and the 
 urine containing albumen, pus and blood. Her condition was very serious, and I had 
 little if any hope of her recovery from the ordinary medication, but decided to try the 
 effects of Peroxide of Hydrogen, believing that by its beneficial action upon the diges- 
 tive organs, it might relieve the kidneys and soon help them to accomplish their 
 functions. 
 
 I began by giving Peroxide of Hydrogen (medicinal) 15 volumes, in teaspoonful 
 doses, diluted in a wineglassful of water every three hours, and kept it up day and 
 night for two weeks. I then changed to Glycozone same amount in a wineglassful of 
 water every three hours. 
 
 I examined the urine from time to time and found that in ten days there was less 
 albumen, pus and blood. In three weeks time, no albumen, pus, or blood could be 
 found, and the patient improved in every way, and considered herself a well woman 
 again. 
 
 About one year after, she had a similar attack but not so severe, and for which I 
 gave her only the Glycozone in the same amount as before. By the time she had taken 
 two pound bottles of the Glycozone, the albumen had entirely disappeared, and she has 
 remained as in her usual health. 
 
 On examination of the urine some months since, no trace of albumen or unnatural 
 condition of urine could be found. I consider the woman's life was saved by the in- 
 ternal use of Peroxide of Hydrogen (medicinal), and I would like to hear that others 
 have used the same in acute suppurative nephritis and with as good results. 
 
 I am now using Hydrozone instead of the medicinal Peroxide in my practice, ow- 
 ing to the fact that it is considerably stronger and more powerful in its healing properties. 
 
 HYDROZONE AND GLYCOZONE IN THE TREATMENT OF 
 
 GONORRHOEA. 
 
 (Reprint from the New York Medical Journal, for Sept. 4, 1897.) 
 
 To the Editor of the New York Medical Journal: 
 
 Sir: — My attention has been attracted to an article published in your journal for 
 July 3d, by Dr. J. A. Silverman, of Butte, Montana. The writer states that no anti- 
 septic has been discovered that will destroy the gonococcus without doing injury to the 
 mucous membrane. As I presume that he is open to conviction, I submit to you for 
 publication the following report of three cases which I have successfully treated during 
 the last few months with Hydrozone and Glycozone, which I consider not only harm- 
 less but the most powerful healing agents that I have ever used in my practice of thirty- 
 five years. 
 
 Case 1. — A man called on me on June 20th, with gonorrhoea of four weeks' dura- 
 tion, with profuse discharge, micturition painful, and an acute burning sensation along the 
 entire urethral tract. Pus sacs had formed in the canal, the meatus was inflamed, and the 
 gonococcus was active, as determined by microscopical examination. I prescribed in- 
 fections of one part of Hydrozone and ten parts sterilized lukewarm water, an ounce 
 
257 
 
 for each injection, four times daily. After two days I reduced the proportion to one 
 part of Hydrozone and fifteen parts lukewarm water, and I directed Glycozone mixed 
 with an equal amount of glycerine pure to be injected on his going to bed. The diet 
 was not restricted, but no stimulants were permitted. In two days no gonococcus could 
 be detected. The discharge was lessened, the pain and difficulty in micturition had 
 ceased, and in twelve days the patient was well. Continence was imposed for two 
 weeks. Doses of bromide of potassium and bicarbonate of sodium were administered 
 from time to time in order to make the urine alkaline and quiet the patient. 
 
 Case 2. — A married man who had contracted blenorrhcea from a woman who had 
 the whites. The same treatment was ordered, and with such satisfaction that the 
 woman also was brought for examination and treatment. Result, a cure in each case 
 within three weeks. 
 
 Case 3. — A man, fifty years old, contracted gonorrhoea from a woman of the town. 
 As the patient lived in the country, twenty miles out, no treatment was given until ten 
 days after infection. Aggravated symptoms of gonorrhoea were present, and there 
 was chordee every night; the patient, to use his own expression, was "plumb wild." 
 The Hydrozone injections were ordered, one part to twenty, owing to the great sensi- 
 tiveness of the urethra and the possibility of orchitis if a stronger injection was used, 
 as there was a slight swelling of the testicles. The Glycozone, diluted with equal parts 
 of pure glycerine, was ordered at night. I also gave Glycozone internally in medicinal 
 doses, to allay a gastric disturbance due to nervousness. In this case the treatment 
 was continued for twenty-five days. I sent my patient to his cattle ranch happy. 
 
 Warren E. Day, M. D. 
 
 Prescott, Arizona, August 16, 1897. 
 
PRICE LIST. 
 
 One Outfit for the Treatment of Catarrh, Hay~Fever, Influenza, and all 
 Diseases of the Respiratory Organs : 
 
 INCLUDING 
 
 i-i lb. Bottle Marchand's Peroxide 
 
 of Hydrogen (Medicinal), 
 i-i lb. Bottle C. P. Glycerine, 
 i-Hand Atomizer and Ozonizer, 
 
 $5.00. 
 
 INCLUDING 
 
 x-Large Size Bottle Hydrozone, 
 i-i lb. Bottle C. P. Glycerine, 
 i-Hand Atomizer and Ozonizer, 
 
 $5.25- 
 
 MARCHAND'S MEDICINAL PREPARATIONS. 
 
 ( Smallest size for Dentists,perbottle,$o 25 
 
 PEROXIDE of HYDROGEN J 1-4 lb " " 050 
 
 (Medicinal) 15 Volumes H 8 3 . j 1-2 lb " " 075 
 
 I ilb " " 1 00 
 
 (1-4 lb ■■* " 1 00 
 
 GLYCOZONE i 1-2 lb " " 1 75 
 
 ( 1 lb " " 3 00 
 
 { Ext. Small size for Dentists " " o 25 
 
 HYDROZONE (30 Volumes H2 O2) j Sum ske! '. \ " ! \ ". .* '. '. ! » " o 75 
 
 ( Large size " " 1 25 
 
 EYE BALSAM Per Bottle " " o 50 
 
 HAND ATOMIZER AND OZONIZER Each 3 50 
 
 LABORATORY. 
 28 Prince Street, New York. 
 
 When you cannot procure the above medicinal preparations in their 
 original unbroken packages at your druggist, send money order to 
 CHARLES MARCHAND, at the above address and shipment will be 
 made by express. 
 
 Once a bottle has been opened by a druggist, I decline to guarantee either 
 one or the other of these remedies as being genuine. 
 
 NOTE. — One extra small size bottle of Hydrozone will be sent by mail 
 on receipt of money order for 25 cents. 
 
 One 4 oz. bottle of Glycozone will be sent by mail on receipt of money 
 order for $1.00. 
 
 One bottle of Marchand's Eye Balsam will be sent by mail on receipt of 
 money order for 50 cents. 
 
 Should you have been imposed upon by any one who substituted spuri- 
 ous preparations instead of the genuine article, please report to me, so that 
 I may expose and prosecute such fraudulent dealers. 
 
 Agents: F. A. Beckett, 220 Sutter Street, San Francisco, Cat. 
 
 Leeming, Miles &-' Co., 53 St. Sulpice Street, Montreal, P. Q. 
 

<n^y** 
 
 & 
 
£V 
 
 cc 
 CC 
 
 cc 
 
 c c CX 
 
 
 v.c«: ^v \ 
 
 
 c ci S c f 
 
 Cc 
 
 % £S 2 
 
 Cc 
 
 s4(\^ « 
 
 J-C 
 
 r ( 
 
 etc S* 
 
 ccc «S 
 
 ^ 
 
 c c 
 c < 
 
 c c 
 
 &€ 
 
 
 
 
 <XCC v£ 
 
 etc . 
 
 
 & 5- ■ c- 
 
 ^6S 
 
 2 ?c^v 
 
 , CC c, 
 
 : |< I 
 
 ( c C r v C C 
 
 -f c£ \ fc 
 
 C c c CC ' 
 
 c < C.( 1C<; 
 
 CC V <( 
 
 cc, :& c o 
 
 - <CC_< r C <j 
 
 CO c ci 
 
 £ CCCc 
 
 : t cc,-, 
 
 2 > c> - ; 
 
 .< ( Cc 
 
 C CC tj 
 r < c CC i 
 
 :c. ccc, 
 
 ' % c £< 
 £ 5 ' << 
 
 Cc 
 
 cc XA « 
 C <€ c ,5 c 
 
 . r crv< C< 
 
 CC cr> >i < C <T rc 
 
 -*^ vc #^ r > ^ V 
 
 S C «CC <'c ^S- <J C' c 
 
 r-> CC C C « . c 5 
 
 CC c V/ c c 
 
 ■ct ^cc 
 
 CC CC ^ C C 
 
 = / -c c V 
 
 Av 
 
 1 
 
 c « 
 
 C c 
 c , 
 
 ac 
 
c 
 
 cc 
 
 c 
 c 
 
 CC 
 C ( 
 
 (V; 
 
 <^^ 
 
 ■c c 
 
 <c 
 
 C c 
 
 CC 
 
 c c 
 
 CC 
 
 c c 
 
 CC 
 
 c c 
 
 CC 
 
 Cc 
 
 CC 
 
 c 
 
 CC 
 
 c< 
 
 cC 
 
 c 
 
 CCC ex 
 
 c cc ' 
 
 C CC 
 
 - ; c c cc 
 
 C C C CC 
 
 C C C CC 
 
 C C C CC 
 
 C C C CC 
 
 C C C k v cc 
 
 < c c c < i ct 
 
 < o c C CI 
 
 Co cc v r 
 c c ac 
 
 c ■ c C C 
 Cc cc 
 C c c <c- 
 
 Cc < C c 
 C CC Cc c<c 
 
 c cC c c c< cc 
 
 ccc . 
 c« 
 e<< 
 
 cc Cv 
 cC 
 
 CC CC 
 c'C CC 
 CC cc 
 
 c v. ' C! 
 
 ■ C C < C 
 
 cc xac 
 
 ccccc 
 ccoxc 
 
 cc •< en 
 «Cc . CCO 
 
 CO cc 
 CCcC 
 
 «. c C c 
 
 v cC <C 
 
 <L C C 
 
 *v i c c >*c^^ ■ <C C< 
 
 I CC c OS C «0 ., « <3 
 
 (CC cCCc CO < - Cc i 
 
 : ccc ^c c*c cc <~ 
 
 cc CCCC C ( C CC cc CCC cC O cv cv c C( 
 
 > accc c C C^c -c c cC c cC. CC cc c cC cc 
 
 <X COOCC C cc < ccc V cc c C Cc cC % cc C 
 
 , c cCCC C C( C a cc cc C C C-cC Cv c\ cc cc C 
 
 cCCC CC cC ( CcCC CC C< C <C o cc CC cc CcCC < 
 
 ^CC C C ,c C CC C< cv <T«: < 'CC O. Cc c CC < 
 
 c ccCcc x c c c c cc cc cccC o CC CvCC c 
 
 c >>>«- c \ < c ' <- v c *~ cc cccc c cc cc cc 
 
 c (c cc C c* cccc cc cc <tr cc 
 C cc cc i CC < CC c C >S 
 
 O c v C_ *«> v v 
 
 ^ C c< c cc 
 
 C C wc cc C V c 
 ,*- * <r. (( C • C C 
 
 c c cc c <c 
 (CCC C < 
 < CC CC c 
 
 CC cc c a ccrco C c c c^ <C CC c CC 
 
 rCCC C C< c/:vc C C ,« C CO OL CC C CC 
 
 c ) > VV c • c «^ c C C C C C c C C.CO.<'C« 
 
 c CC C^ C c ^'^ ( cc c cc 
 
 cccc c cc Cc CC c cc; i 
 
 e S V c c c cc fe < CCC C C 
 
 '■' CC( ( ca -Cc CCcCC 
 
 CC CCC Cc <<L ( CC CC C 
 
 > , c < cc cc< c cc c c c 
 
 C^ CC c CccC C CCCC C: t 
 C «2C CCC-. CCCCI C CXCC C 
 
 c CC Cc - Cc cCc c CCCCC 
 
 <CiC<p CcfiC/CCCO 
 
 <LCv c CX c CC CCX C CC C c * 
 CCC CC <L CCC C <XC C 
 
 cCC v C( C c CC <jCCc ^ 
 
 cVc i C < C C C CC C < 
 
 c C c c Cc C c <L C CCC C C. 
 
 :c c c c cv ^ 
 
 ;c c cc c^ cv y 
 
 c c c - c c c c< c 
 
 c C Cc c c w c 
 
 CC c CC c: CC C 
 
 c c i 5 5 r (( 
 
 CC < C C c, c 
 
 vC C c ( C 
 
 c C C c ccc 
 
 c c O '^ c 
 
 tCv c 
 
 C C < > C^ 
 
 cCC< c Cc 
 . CCi^C CC 
 
 C cv c cc c c 
 
 ;£j c ct c cc ccccc 
 ^c c C Cl <f£<^ 
 
 cc c c c c Cc CCCC c 
 
 O c cccc cc c Ccc c <^- 
 
 c r o ccc C C S?cV c 
 
 < cc cccc 
 c V. c<c ccc ex: 
 
 c< 
 
 ccc CcCC C < 
 ccc CC CCC c 
 
 CCCC ccCCCC 
 
 lece -vCcClCC 
 
 xcc v ' c. cc 
 
 lece C r. cCl_C < 
 
 j-c.CC CcjCC Cc 
 
 \CC C CC Cc 
 
 • ccc c>.(C c 
 
 ^ t cr C i c (C < 
 
 dcrc cv'CC c 
 
 CvCC v< CC v 
 
 C <- 
 
 CC 
 
 'ScS 
 
 (V c ; CCC < CC ccxCc Cccc cc CC. 
 
 'c c'c^C C C CCCC CCCCCccCC C:-CC CcC 
 v CCc cC C C C CC^CCCCCc cc CCv cccc 
 ^S c-< c c c ^ cc cccc.ee -<c S c 
 '5 . c CC <_ CC CCCCC C cc Cc c C C 
 
 c > cc c c CC C CC CCXCC c CC C CcC^C 
 
 -L CC cccccc cc oc c v ' 
 CC CCCCC C Cc CC C.CC 
 -CCCCC C CC CiA C C C 
 ^>CCCC CC c ccc 
 
 C C CCCCC CC Ceo c c C_ 
 
 ^ C CCCCC C CC Cv c c C 
 
 C c 
 C X 
 
 C ex C CC 
 V cc < c v C c. c 
 
 c C c c c cc 
 c c c c c c c 
 ex c c c c cc 
 
 7 li C C cccc 
 C C C C CCC 
 C, c C c CCC 
 
 c c c c c ccc 
 
 - c < cccc ccc 
 
 r V cc CcC Ccc 
 
 c C 
 
 c c C 
 
 C c 
 
 *- < 
 
 7 C'c ( 
 
 C Ccc 
 
 C Cc c. 
 C CCC 
 C Ccc 
 
 S < "c i" 
 
 c CcccC c 
 C CccfC.. c 
 C Ccc ' 
 < C. CCCC 
 C c 
 
 C c 
 
 v <: ccc c 
 
 C cccC C 
 \ CcC C cc 
 
 r <rccc 
 
 c c C 
 
 <3C C u c C ■<' 
 C3C__ Cccc < < 
 
 
 c C 
 
 v*^ 
 
 
 X 
 
 C€ 
 
 
 C C 
 
 « cc^ 
 
 c <■ 
 
 C c 
 
 
 
 < c 
 
 
 
 c C 
 
 i 
 
 
 c C 
 
 CC 
 
 '^c 
 
 c c 
 
 CCC 
 

 LIBRARY OF CONGRESS 
 
 
 I ■ 
 
 ■ 
 
 si