turpentine in a cup of milk. Great stress is laid upon the treatment during convalescence-fresh air, a nourishing diet, and strict confinement to bed being insisted upon. Of sixty-one cases of contagious diphtheria treated by this method, Dr. Selldén lost but three. Several years ago, Dr. Erichsen, of St. Petersburg, proposed the mercuric cyanide as a valuable remedy in the treatment of diphtheria, giving it in doses of to grain. Of twenty-five cases thus treated he lost three. Others who have used the same drug report favourable results, but from the small number of their cases and the absence of systematic observations, their testimony is of no great value.

THE LEEDS SCHOOL BOARD AND OVER-PRESSURE.

It is humiliating to have to argue with such men as are to be found on some of our school boards. You cannot convince them by reasoning. Elected to this office by popular voice, their feelings are enlisted on the side of their school board. As a rule ardent politicians, they can see only good in these institutions, and detect in every attack some political move on the part of the Opposition. Dr. Clifford Allbutt had to teach a lesson to a member of the Leeds School Board. Now Mr. Teale administers the following trenchant rebuke to the whole board:-"Having undertaken as a public duty," he says, in the Yorkshire Post of the 8th ult., " this critical review of the Leeds School Board report on over-pressure, I have deliberately come to the conclusion that it is not judicial, that it is not a correct deduction from the facts collected and presented, that they have not been carefully weighed by the committee, nor impartially weighed without bias. Let those who will take the trouble to study the report judge whether my verdict be true or not." The Leeds public know Mr. Teale and the members of the school board who drew up this report. There cannot be a question as to who will be believed, or as to the verdict of the public.

VITAL STATISTICS.

THE report of the Registrar General shows that in the course of the past quarter 224,694 births were registered in England and Wales, and, despite increased population, this total is lower by 7,392 than that in the previous March quarter. The birth-rate is taken at 32.2, which is 2.8 below the mean of the ten previous corresponding periods. This is the lowest March rate since 1850. The Meteorological Reports for the quarter show that the mean temperature of the air was 43.4, and the Greenwich records prove that this is nearly five degrees above the average of the corresponding periods in 113 years; it is therefore not surprising to find that the death-rate was as low as 19.5, this being 3.7 below the mean of ten years, and, moreover, according to the Registrar-General, this is lower than it was “in any winter quarter since civil registration commenced. This low rate implies that no fewer than 33,600 persons survived the three months who would have died had the death-rate

corresponded with the average rate in the 46 preceding corresponding quarters." The deaths happened in the proportion of 113 males for every 100 females.

SUCCESS OF VACCINATION IN INDIA.

It might have been supposed that of all the countries in the world India was the one in which the bitterest opposition would have been offered to compulsory vaccination. This, however, does not appear to be the case. According to the latest report of the sanitary condition of the country, the working of the Acts, wherever they have been applied, has not been attended with any great difficulty. The people in most cases yield to simple persuasion, and in a few instances where they prove refractory the issue of a summons is almost always effectual. Opposition fostered by caste prejudices is in some places still offered, but as a rule the masses now accept vaccination with readiness, and in some parts it is even sought after and paid for. In Bengal, Madras, and Bombay, the Punjaub, the northwestern and central provinces, Berar, Assam, and British Burmah, the total number of persons operated upon during the year was over 4,400,000. Generally speaking, the treatment appears to have been successful, the ratio ranging as high as 98.39 per cent.

HOSPITAL FUNDS.

AT a meeting of the Hospitals Association on the 22nd ult. an important paper was read by Mr. Henry C. Burdett on the "Hospital Sunday and Saturday Funds." The enormous extent to which these have grown was shown by some figures quoted by the lecturer. Some thing like a million and a half sterling has been handed to the various charities from this source during the past quarter of a century, and the annual contribution now approaches £250,000. Mr. Burdett, however, thinks that a better organization would secure even more important results, and in this conclusion we cordially agree with him. The Hospital Saturday and Hospital Sunday Funds in each town should be united and placed under the management of a general council, and should act on uniform principles. A good deal of inevitable waste and superflous expense might thus be avoided.

SANTA BARBARA.

NUMEROUS letters have been received from our readers in reference to the article on Santa Barbara as a Health Resort which appeared in our issue for April. They were forwarded to the writer of the article, who is at present at Naples, with a request for a further article. In reply he writes that there is little if any additional information to give. Santa Barbara has a very fair permanent population and comparatively speaking an exceedingly large floating one. The cost of living is extremely moderate. There are several medical men (English, French, German, American, etc.) already settled in it, and the locality affords but little opening for a medical man who is not possessed of at

least a small private income-say £150 a year. At the same time there are many methods of earning a competency which might be followed in conjunction with the practice of medicine. Game is abundant, and a sportsman would have no difficulty in procuring large quantities of it in the woods and hills which surround the town. The climate is beautiful-the scenery superb, and for a man not entirely dependent on his labour for his bread no more suitable place could be found to retire to than Santa Barbara, but to sever old connexions in England and to go to a strange country to start afresh when the bloom is off the plum of life, and when the activity of early manhood is fast being lost, is a course which cannot be recommended. Our contributor concludes with the advice, "Take a holiday and go and see the place.

STRETCHERS IN THE SURGERY.

THE armeniaria of the surgery would be more complete if each medical man added to it a stretcher of the pattern issued by the St. John Ambulance Association. The advantages to the public and to the profession by the adoption of this plan would be very great. The cost would be two guineas. This might be recouped very soon by charging a small sum for the use of it, the tariff to be fixed according to the means of persons using it. If it were known that all medical men had stretchers at their residence in cases of accident, the public would know where to apply. As accidents are at all times happening, this suggestion is well worthy of consideration. The surgeon has, as a rule, a number of instruments he will never require the one we recommend is sure to be used.

SOME of the American citizens have been arguing that matters are carried to an extreme in athletic training, and many worthy divines have been asked for their opinion on this weighty subject. Dr. Cleveland Coxe, the Bishop of Western New York, says that thirty years ago he was urging the students at Hartford to introduce cricket and boating. Now he feels that the effort everywhere must be to restrain. "Will Americans," he exclaims in despair, "never learn the virtue of moderation? In everything one sees the vice of overdoing. If it must be muscle versus brain, I plead for the defendant as against the brutal pugilist who murders intellect and common sense." Bishop Huntington declares that games are taking the chief place, and are destroying the proper objects of a college. He objects to them also on the score of their costliness. Chiefly on account of athletics, a college course costs three or four times as much as it did fifty years ago. Nor is this all. "Nothing," says Dr. Huntington, can prevent these games and matches from being an enormous school of bad morals in betting and gambling." Dr. Howard Crosby, the Chancellor of New York University, declares that athletics are perverting college life and debasing the morals of the collegians by bringing them into contact with "professional roughs," and teaching them to bet, and drink, and swagger.

Abstract.

LECTURES ON REST AND PAIN.

BY HILTON..

LECTURE I.—The author unfolds his theme. REST is the greatest of all therapeutic agents, and the surgeon [and we might add, the physician too] is successful just as he is able to secure rest for a diseased or injured part. PAIN does a twofold work. It befriends the patient because it compels him to keep the diseased part at rest; it befriends the surgeon by guiding him to the diseased part-that is, if he can read the indications of pain aright.

LECTURE II. The principle of rest is illustrated by the mode in which the base of the brain is protected from injury. The cerebrospinal fluid, passing into the ventricles and bathing the base of the brain, forms a hydrostatic bed on which the brain floats. The pressure of the cerebro-spinal fluid is balanced by the pressure of the blood in the venous system, and any shock to the brain is communicated to the cerebro-spinal fluid, and from that to the surrounding veins, where the elastic coats absorb it all. Hence in concussion of the brain the parts most likely to be injured are the anterior inferior lobes, which are in direct contact with the bone. In illustration of the effects of pressure at the base of the brain, a case is given of hæmorrhage taking place between the optic thalmi and passing into the fourth ventricle and producing sudden death, the author says by pressing on the roots of the vagus, paralysing these nerves, and so arresting respiration, an explanation which cannot be accepted now. Either irritation of the vagi fatally inhibited the heart, or pressure on the respiratory centre arrested respiration.

LECTURE III.-The importance of long continued rest in cases of concussion of the brain and spinal cord is insisted on and illustrated, and the frequency of chronic disease resulting from neglected cases of injury is pointed out. The lecture closes with the remark that many of the major operations of surgery are for the purpose of securing rest to a diseased part.

LECTURE IV.—In this lecture the author enters on the subject of the diagnostic value of pain. The foundation principle is that diseased conditions affecting internal organs are expressed by pain referred to the peripheral distribution of those nerves which are connected-either directly, or by anastomoses with other nerves with these organs. A persistent and localized pain must therefore be traced centripetally till a cause for it is found, and if the cause is inflammatory it can be localised by the discovery of increased temperature in the affected part, a means of diagnosis often overlooked. The following illustrations are given. Pain in the lobe of the ear or occiput is due to irritation of the second cervical nerve. Pain in the auditory canal or upper part of the ear is due to irritation of the fifth cerebral, so that search for the cause

must lie in opposite directions in the two cases. The distribution of the spinal nerves must be specially attended to in searching for disease of the vertebræ, noting particularly that the pain is usually symmetrical in these cases. Unsymmetrical pain is generally due to a cause existing in one side, such as an aneurism. Here, as throughout the work, the author protests in the strongest manner against the current belief that caries of the spine, diseases of the hip joint, knee, or indeed any other joint, are "scrofulous" in their origin, insisting that they arise in the majority of cases from injury or strain of some kind, and if recognised early enough are always curable by rest.

LECTURE V. is devoted to the illustration of the diagnostic meaning of symmetrical and unsymmetrical pains. Cases are given of disease between the cervical vertebræ, where sandbags were invaluable for fixing the head. The patient having been laid on a hard mattrass, and a small cushion placed behind the nape of the neck to support the second vertebra, and prevent it nipping the medulla oblongata. In these cases small doses of bichloride of mercury (th to th grain) with quinine or co. tincture of bark may generally be given with great advantage.

LECTURE VI.-In this lecture the application of rest to the treatment of abscesses is illustrated. The abscess is to be opened early at the lowest point (of course antiseptically). It may also be washed out by being distended with an antiseptic solution, and rest is then to be secured by attention to position and the application of pads, adhesive plaster, and bandaging. From the many illustrative cases we select the following-Postpharyngeal abscess from diseased vertebræ causing suffocation was opened through the sterno-mastoid, giving immediate relief. A sub-occipital abscess laying bare several square inches of the cranium resisted all treatment till the occipito-frontalis muscle was fixed by strapping, and the sides of the abscess approximated by a pad. Two other cases of the same kind are recorded. The platysma myoides must be kept at rest for the cure of cervical abscesses and sinuses. Popliteal abscesses and sinuses may require the application of a splint. Those who follow the author's example in opening deep-seated abscesses must follow the mode he adopted of doing it. He first cut down to the fascia covering the important parts, then pushed in a blunt-pointed director till pus was reached, and finally slipped a pair of closed dressing forceps along the groove of the director, and when the abscess was entered, by opening the forceps, free vent was given to the matter, while all important parts were pushed aside. Painful and irritable ulcers are due to a loop of nerve being exposed on the denuded surface. Discover the exact point by touching the surface of the ulcer all over with the point of a blunt probe, and then divide the branch by an incision through the subcutaneous tissue about an eighth of an inch from the edge of the ulcer. The division of the nerve is followed by the healing of the ulcer [a very suggestive illustration of the connection between perverted nerve force and cutaneous diseases.]

LECTURES VII. AND VIII.-Further illustrations are given of the cure of abscesses and sinuses by rest, especially two of very chronic sinuses parallel to Poupart's ligament, cured by a truss having a pad regulated by a ratchet. The author next expounds a very remarkable theory, that a joint, the muscles which move it, and the skin which covers them, are invariably supplied by the same nerve, or generally, parts associated in function have a common nerve and blood supply. The proofs he advances are very striking, but must be studied in the lectures. The author's explanation of the arrangement is a teleological one. One would like to see an evolutionist one placed beside it. At all events, the connection has a most important bearing on treatment, for the irritation of the joint stimulates the muscles to action. Pressure is thus kept up on the inflamed articular surfaces and the mischief increased, and ultimately the joint becomes more or less dislocated. Rest can therefore only be obtained by splints so placed as to oppose the action of the muscles. Further, the connection between the nervous supply of the skin and the muscles gives a clue to treatment, as by the application of powerful sedatives to the skin the tension of the muscles under them is subdued. The important point is to use them strong enough. [For hints as to this, see M.M.M. for April, p. 120. Atropia ointment, chloroform of belladonna, aconitia ointment, &c., may be applied under a covering of spongio piline.] Some curious illustrative cases are given :-" Bent arm," arising after venesection, is due to some loops of nerve being entangled in the cicatrix. The irritation arising causes spasm of the flexors of the elbow. The remedy is excision of the cicatrix. A case is given where the callus of a fracture of the radius pressed on the median nerve and caused ulceration on the thumb, fore and middle fingers. When the pressure was taken off by flexion, the ulceration got well. And another case in which an exostosis on the first rib had obliterated the subclavian artery and pressed upon the ulnar nerves, gangrene occurred in the ring and little finger, but did not extend to the fingers, the nervous supply of which was intact.

LECTURES IX. To XII.-The lecturer holds that furring of the tongue on one side is due in many cases to irritation of the fifth nerve. The proofs advanced are strong enough to make one hesitate to accept Mr. Hutchinson's dictum that the sole cause of unilateral fur is that

mastication is on one side only. [We have for years been in the habit of masticating only on one side, yet when fur is present, it is always uniformly distributed over the tongue.] Many illustrations are given of the importance of tracing upwards the nerve at the periphery of

which pain is experienced-among the rest, one where constant pain was experienced on one side of the penis. The cause was discovered in the thickened tissue which involved the perineal branch of the inferior gluteal nerve, where it passes the tuberosity of the ischium. The thickening was due to sitting on a hard seat, and the ailment was removed by discontinuing the cause. Again, instances are given of ulcers in the rectum being cured by rest being afforded them, by the regular use of opiate enemata, and a diet of such a kind as to keep the motions pultaceous. A crack, fissure, or ulcer at the margin of the anus is painful and does not heal because filaments of nerves are exposed in it. Divide the nerves by an incision through the mucous membrane, or protect them by coagulating the albumen, by the application of nitrate of silver or solution of perchloride of mercury, and the ulcer will heal. In this connection, the author puts forward the theory already alluded to, that the arteries are distributed on a similar principle to that of nerves-namely, that parts functionally connected are supplied from a common source. The stomach, liver, pancreas, spleen, and part of the duodenum - all organs concerned in digestion—are supplied by the coeliac artery. The subclavian supplies all the parts in and about the chest concerned in respiration, and sends off a branch, the vertebral, to supply the centres whence the principal respiratory nerves spring. Several other illustrations are given. The lower part of the rectum is brought into close structural connection, both by nerve and artery, with the urethra and bladder. Hence ulcers, etc., in the rectum produce retention of urine and various bladder troubles, while on the other hand sedatives introduced into the rectum relieve urethral affections. A case is given of anal ulcer producing retention of urine and abdominal enlargement, and thus causing suspicion of pregnancy. All the symptoms were removed by dividing the sphincters through the ulcer. In this connection the author points out that the landmark for dividing the external sphincters is the white line which runs round the anus at the junction of the skin and mucous membrane. This line marks the separation between the external and internal sphincter. Very numerous filaments of nerves pass out between the sphincters, and therefore just under the white line.

LECTURES XIII. TO XVIII.-The remaining lectures in the book are devoted to the illustration and enforcement of the position that diseases of the hip-joint and knee, which are usually considered scrofulous in origin, are in the majority of cases due to injury or overwork of a growing part, and are to be cured by properly adapted splints, and continuous rest of the part. The importance of the early recognition of disease of the hip-joint is especially insisted on, as it is only in this stage that treatment will result in perfect restoration of the joint. There are also several curious and interesting cases recorded of disease in one or others of the pelvic articulations, almost invariably cured by rest. We are conscious that this abstract gives a very imperfect idea of the work. We might have tabulated the cases in this style: :No. 1, A. B., female, æt. 7, disease of hip-joint, duration, 9 months, etc., etc. But we confess to finding a hundred or so of such cases very dry reading, and therefore do not inflict them on others. Mr. Hilton's book is a living one, and had better be studied as such, and not dissected.

A. W. WALLACE, M.D. Edin.

MEASLES have been somewhat prevalent in Dundee during the last two months, but since the commencement of May there has been a marked increase in the number of cases, especially in the western part of the town. The outbreak is engaging the attention of the sanitary authorities.

It is

THE Revenue returns for the first quarter of this year would seem to show that the public are beginning to give heed to the many warnings that have been uttered against the too indiscriminate use of tea. no new thing to find that the quantity of spirits has decreased 160,000 gallons, but the decrease of 80,000 lbs. in the quantity of tea is a striking fact; and it is further most interesting to note that the quantity of cocoa has been increased by 650,000 lbs. There has been a large decrease in the quantity of coffee imported, which may probably be in great part explained by the increased facilities for adulteration.

D

Cardol is an oily fluid obtained from the pericarp of the fruit of the cashew nut Anacardium occidentale, a small and elegant tree indigenous to the West Indies. Cardol has been recommended as a vesicant possessing some advantages over cantharides, and also as an application for the removal of warts, corns, and other callosities. It has also been used as a specific in leprosy, and as an application in ringworm and obstinate ulcers.

CHEMISTRY.-The pericarp or shell of the cashew nut contains a dark oily fluid, consisting of about 90 per cent. of a fatty acid called anacardic acid, C44 H64 O7, and about 10 per cent. of an oily body called cardol, and a little of an ammonium compound. The cardol is extracted by means of ether, in which the acid is also soluble; the ether is distilled off, and the residue washed well with water to remove tannin, and dissolved in 15 to 20 parts of alcohol. This solution is then treated with freshly precipitated oxide of lead, which removes the anacardic acid as an insoluble salt. The remaining liquid is deprived of the greater part of the spirit by distillation, and water is then added until the liquid becomes turbid, when acetate of lead is added until it is decolourised, the lead being subsequently removed by the addition of sulphuric acid. Cardol is a yellow, oily liquid, insoluble in water, but very soluble in alcohol and ether; it is not volatile, is decomposable by heat, and the solution is neutral to litmus paper. It precipitates basic but not neutral acetate of lead. Strong sulphuric acid dissolves it with a red colour. Solution of caustic potash colours it yellow and ultimately dissolves it, the liquid becoming of a deep red colour when exposed to the air.

PHYSIOLOGICAL ACTION.-Staedler, who examined the chemical constituents and therapeutic action of the oily juice of the pericarp, proved that neither the ammonium compound nor the anacardic acid were irritant, and that cardol must be the vesicating principle. He found that when a square inch of the breast was covered with the juice, and a piece of blotting paper moistened with it laid over the same spot, in about fifteen minutes a slight burning was perceptible, which rapidly increased and reached its greatest intensity in about half-an-hour. The skin beneath the paper had then become whitish, surrounded by a red circle. When the paper was allowed to remain for about three hours, the skin became covered with small vesicles that increased in size during the night, without attaining the size of those usually produced by cantharides. The spot when dressed with tallow healed very slowly, and the after effects lasted for a long time. Some persons seem peculiarly susceptible to the irritant action of the juice. A case mentioned in the United States Dispensatory of a lady who was exposed to the fumes of the nuts while roasting, and whose face became so swollen that not a feature was discernible; and another of a boy who cut open a nut and ate the kernel, touching different parts of his body with the juice of the pericarp. In this case the tongue, face, neck, forearms, &c., became enormously swollen, red, and very painful. Dr. Wesener (Practitioner, 1884, p. 301) describes a case of acute eczema, beginning at the head and face and spreading over the whole body, caused by wearing round the neck the fruit of Anacardium occidentale as a remedy for headache. The eczema in the face was accompanied by so much swelling as to resemble erysipelas, but differed from it in the absence of fever. It remained in one part or another of the body for between two and three weeks, and the redness of the skin was succeeded by papules, vesicles, and pustules, which dried up into scales. The contents of the vesicles contained cardol, and if conveyed to other parts of the body by scratching or friction of the clothes, produced dermatitis. The place where cardol is applied must therefore be carefully guarded by covering, bandaging, &c.

THERAPEUTIC ACTION.-Its chief value appears to be as an outward application in leprosy, but in India the milder preparation obtained from the somewhat similar fruits of Semecarpus anacardium

is preferred. In certain form of skin disease, it may probably be found useful, especially in those in which there appears to be a temporary paralysis of the nerves of the skin; but great caution is required in its use, especially with those whose skin is normally hyperesthetic. Internally the oily juice of the fruit appear to be less irritating, a few drops having been swallowed without producing a marked effect ("Extra-Pharmacopoeia," 2nd edition, p. 46). It has also been given as a vermifuge.

PREPARATIONS AND DOSES.-A tincture of the nut, prepared from one part of the nut macerated in ten of rectified spirit, has been used, the dose of which is two to ten minims. Eucalyptus globulus.

The leaves of the tree are officinal in the French, German, and American Pharmacopoeias, although not yet introduced into the British Pharmacopoeia. In the young state the leaves are oblongovate, sessile, and somewhat obtuse, but fully developed leaves are lanceolate scythe-shaped, stalked, and six to twelve inches long, of a glaucous or bluish-green tint (whence the name of blue gum tree), and when held up to the light are seen to be full of minute pellucid oil receptacles. Eucalyptus globulus first attracted attention from its having been recommended as a remedy for intermittent fever, in which, however, its value has not been proved. This reputation probably arose from the fact that miasmatic districts were unquestionably rendered healthy where the eucalyptus was planted. This appears to be due to the fact that it absorbs so large a quantity of water as to drain the swampy ground in which it is planted, and partly also to the diffusion of a large amount of volatile oil in the atmosphere, giving rise to the presence of ozone in the air.

CHEMISTRY.-The virtue of the drug appears to be due chiefly to the essential oil and tannin that it contains. M. Cloez found the fresh leaves to contain 2.75 p. c. of oil, and the recently dried leaves 6 p. c., but dried leaves after being kept some time yielded much less oil. The sp. gr. of the oil is stated by Muller to be 0.917, that of E. amygdalina being 0.881, and that of E. oleosa 0.911. This oil consists chiefly of eucalyptol, C12 H20 O, which distils at 338°-352.4° Fahr. It is purified by redistillation from caustic potash, and subsequently from chloride of calcium. When pure it is a nearly colourless liquid of a penetrating camphoraceous odour, resembling that of the leaves. It is very soluble in alcohol, slightly so in water, and polarises to the right. The oil also contains two other bodies, supposed by Cloez to be camphors, the one distilling over at 370.4°-374° Fahr., and the other, which occurs only in minute quantity, at 392° Fahr. The oil of eucalyptus met with in commerce often consists of that of E. amygdalina, which is said not to contain eucalyptol, this oil probably obtaining the preference because the leaves of the tree yield six times as much oil as those of E. globulus. During the last two or three years the oil of E. amygdalina has been replaced by that of E. dumosa. The pure oil of E. globulus has, however, been prepared at and exported from Nice. The oil of E. globulus may be easily recognised by comparing it with the odour of a bruised leaf of the plant. The oil has sometimes been found to be adulterated with alcohol, which may be detected, according to M. Duquesnel, by immersing a crystal of fuschine in it, this being insoluble in the pure oil, but being soluble if even traces of alcohol are present, will indicate the presence of the latter by colouring the oil. Oils of turpentine and copaiba, which have been used to adulterate it, may be detected by the difference in the boiling point: that of turpentine being 311° F., and that of copaiba 500° F.

PHYSIOLOGICAL ACTION.-When applied locally the oil is a powerful irritant, taken internally, in doses of 20 to 30 drops, it increases the rapidity of the pulse, causes restlessness, followed by a feeling of calmness and repose, ending in sleep, but in some cases it produces symptoms of cerebral congestion and feverishness. In animals, small doses cause depression, lowering of temperature, muscular weakness, ending in paralysis, loss of sensibility, and death from failure of respiration. In man, doses of 75 to 80 drops produces loss of power and of feeling in the limbs, the palsy produced being