upon the supposition of an interruption to the circulation in the part. Doubtless the blood-current in the affected part possessed at this time but little force, so that when lost in a dilated capillary system, from whence it past into tortuous and widened venous channels, a relative slowness of the circulation must have resulted. That an inadequate supply of blood was furnished for a time, is evident from the fact, that the affected leg became dropsical, a result which could not be attributed entirely to inactivity of the muscles, lasting, as it did, for months, for the opposite member shared the same rest without any diminution in its size. So soon as the patient began to use his limb, the already established collateral circulation assumed greater dimensions. At the time I ceased my visit the nutrition of the parts appeared to be carried on normally. It was clear that this perfect nutrition was mainly due to the strongly developed collateral vessels, probably sustained by a small stream of blood through the crural artery which may in the meantime have become partially pervious. Owing to the great rarity of this happy termination, as presented in our case of embolus of the right external iliac artery it may be permitted me to call your attention to the therapeutic means resorted to. The leg and foot were, from the second day on, subjected to the energetic action of the camphor spiritus. Compresses saturated with this liquid and wrapt around the parts were constantly kept on and moistened anew at short intervals. To prevent rapid evaporation, the compresses were covered over with gutta percha paper, and this also rendered it certain that the remedy would remain in permanent contact with the skin. I am compelled to emphasize the method indicated, as no less an authority than Gebert incidentally observes that he attributes no value whatever to fomentations with the spts. camph., or similar irritant, in the treatment of the disease under consideration. It may be possible that Gebert's experience, in regard to this point, is based upon a less energetic mode of procedure. In our case it was evident that the use of fomentations of spts. camph. was accompanied by most desirable changes in parts, where the circulation had entirely ceased. At first the leg, and shortly afterwards the foot, were rendered much warmer by the action of the remedy.

The circumstance that the temperature of the parts, after removing the compresses again sank, proves irrefut

ably that the increase of temperature was the result of impression made by the irritant. Neither can we regard it as a purely accidental phenomenon that, immediately after instituting the treatment decided upon, the intense neuralgic pains, for which large doses of morphine had been prescribed without effect, became greatly moderated. I have good grounds for believing that the alleviation of pain held a close relationship to the local treatment. The neuralgic pains were, undoubtedly, owing to the necessary nutritive material being withheld from the terminal ramicafitions of the crural nerves. If alleviation of the pain took place without narcotic remedies, the supposition may be entertained, that a supply of blood did reach the vital parts, and all circumstances indicate that this result was promoted by the irritant action of the remedy upon the skin of the leg and foot. If, moreover, we take into consideration that the above mentioned increase of temperature of the skin, in contact with the spts. camph., is considered intelligible, only by supposing that a free supply of nutritive material was furnished, we are entitled to the inference, that the topical treatment contributed materially to the development of a collateral circulation in the right lower extremity.

ART. III.-CARBOLIC ACID AS A REMEDIAL AGENT. By W. KEMPSTER, M.D., Utica, N. Y.

It is not my intention to speak particularly of it as a disinfectant, but rather to offer a few suggestions concerning its use a therapeutic agent.

Pure carbolic acid is a white crystalline substance, the particles adhering with considerable tenacity, and, after standing for some time, especially if the bottle be frequently opened, becomes slightly deliquescent and more tightly packed together. The two varieties of crystallized acid more generally found in the American market are prepared by Merck, of Darmstadt, and Calvert, of Manchester, England. Merck's preparation has a slight reddish tinge. Calvert's is quite white, having the appearance of snow which has been soaked in water. Merck's contains about 98 per cent. of pure acid, and is slightly more deliquescent than Calvert's, which is pure. Merck's, however, is sufficiently pure for all practical purposes, and is furnished at a lower price.

The first application of this agent, under my own observation, occurred in a case of catarrh, where the discharge was profuse, offensive and, consequently, very annoying to the patient. Various remedies had been previously tried without success. Hoping to derive advantage from its properties as a disinfectant, it was administered to the patient by inhalation, using one grain to an ounce of water, and conveying the liquid to the affected parts by means of a steam spray-producer. The effect surpassed my most sanguine expectation. It not only relieved the fætor, but in the course of two or three inhalations changed the character of the discharge and the patient recovered rapidly.

This induced a trial in a second case, not so serious as the first, but still severe, and the result was equally satisfactory, the symptoms all disappearing in the course of four weeks. After the first few inhalations, the patients were instructed in the use of the spray-producing apparatus, furnished with a bottle of the solution (one grain to the ounce) and directed to inhale the vapor for ten minutes at a time, both morning and evening, enjoining upon them not to leave a warm atmosphere for half an hour after each inhalation.

It is used at the present time in the treatment of ozana, nasal polypi and diseases of the nasal passages in which there is an offensive discharge. Even if it exerted no curative action, its power to correct fotor would be a great recommendation; but this is not all, it stimulates the ulcerated surface to a healthy action,promotes normal granulation and thus assists in the curative process. This remedy is also employed by some of the physicians who are engaged in the special treatment of throat and lung diseases, particularly French practitioners, who direct that it should be inhaled in combination with other appropriate remedies. They speak highly of its efficacy in case of ulcerated sore throat, chronic bronchitis, and that morbid condition of the mucous surfaces of the air passages which gives rise to a constant expectoration of a muco-purulent - material. If a solution of one grain of the acid to an ounce of water does not seem to meet the indication, the quantity may be increased to five grains, or even more, but it is better to begin with a mild solution, gradually increasing the strength until the desired effect is ob

tained.

My next use of the acid was in a case of scarlatina, where

the breath was particularly obnoxious, owing to an ulcerated condition of the throat. A gargle of two grains of the acid to an an ounce of water relieved the foetor at once and apparently proved beneficial. No other gargle or application to the throat was used.

It would seem to be appropriate in cases of diphtheria, a strong solution of the acid being used for a local medicament; its power to correct the foul breath would be an indication for its use, and its astringent and stimulating properties might prove beneficial. In cases of common sore throat (simple tonsillitis) it is found to answer admirably, with the advantage over the ordinary potassa gargles of relieving the "bad taste" and foul breath.

In the State Lunatic Asylum at Utica, it is successfully used to relieve cases of sluggishness of the bowels, accomcompanied hy offensive breath. The dose is a drachm of a solution of one grain to the ounce (which is the house standard). A striking exemplification of the efficacy of this remedy occurred in the case of a melancholic patient admitted to this asylum. He had for a number of years suffered from attacks of dyspepsia, accompanied with acid eructations and the formation of gas. Latterly these symptoms became continuous. He complained of intense heat and a pain in the stomach; stated that the eructation of foetid gas had become unbearable; and the same smell emanated from the cutaneous surface, so that it was offensive to every one in the room. He was at once put into a warm bath, then thoroughly washed with a solution of the acid (gr. v to the ounce). Internally two drachms of the standard solution were given three times daily for two days. At the end of this time, the breath was 'sweet, and no unpleasant exhalation from the skin was perceptible. He was also relieved from the painful distension produced by the formation of gas in the stomach and bowels. Whenever he feels the approach of this difficulty, two or three doses of the house preparation relieve him, at once, from this unpleasant and painful complication.

Yeasty stomach, sometimes consequent upon a meal of rich food, which produces flatulence and expulsion of gas, with a tendency to regurgitation, is usually relieved by a drachm or two of the solution above mentioned; this checks the fermentative process. The power it possesses to arrest fermentation would be an indication for its employment in sarcina, but the opportunity has not offered

for me to test this. Diarrhoea, produced by eating unripe fruit or other articles which promote fermentation, is speedily relieved by combining a drachm or two of the solution with the usual remedies. As a dentifrice, commingled with myrrh or some aromatic, it removes the odor arising from carious teeth.

As a remedial agent in certain forms of skin disease it seems to possess decided advantages. A patient applied for something to relieve a disordered condition of the scalp, which had existed for some time. It proved to be a well-marked case of tinea capitis in an advanced stage. The crusts had cracked open, with a straight smooth fracture, presenting a shining floor, looking as though the scalp had opened and exposed the cranial bones. There were several of these cracks, measuring from a half inch to two inches in length, the principal ones occupying a position over the region of the anterior fontanelle and extending several inches in each direction. Other crusts had formed over the temporal and occipital regions. In order that the acid might be effectually tried, the hair was cut short and the entire scalp washed with a solution of the acid (two grains to the ounce) four times daily. The subsidence of the disease was marked; those crusts in process of formation were checked and the dry grayish crusts already formed, with those cracked open, were speedily removed. After the wash had been continued. for one week, a glycerolate of carbolic acid (strength five grains to the ounce) was applied, which possesses the advantage of being a more permanent preparation. The treatment was commenced January 7th, and at the date of writing (January 28th) the disease has disappeared. No other treatment, either internal or local, was employed. One other case has been mentioned to me, which was even more severe than this, and in which various modes of treatment had been employed without arresting its progress. The treatment mentioned above was resorted to, with an immediate abatement of symptoms and rapid recovery. We have used the glycerolate mentioned in cases of herpes circinatus, with entire satisfaction.

During the month of December, 1867, I was called to see a girl aged four years, who had been taken suddenly ill. The symptoms indicated scarlatina, and, as there were a number of cases in the neighborhood, that diagnosis was made. She was immediately put upon milk punch and carbolic acid solution, the one-sixteenth of a