the patient to diagnose his disease, but having convinced himself of the existence of the disease, treated it accordingly.

Dr. Tindal agreed with the most of what Dr. Park had said. Mercury was useful, but would not depend altogether on that drug. He recommended the tonic treatment alluded to by Mr. Maylard. Coryza was never, in his experience, caused by iodide of potassium in a syphilitic patient, and he considered that the iodide was useful for diagnostic purposes, for if coryza was produced by it, he concluded that the patient was not a syphilitic one. He would not give mercury in strumous or renal cases. Prolonged use of one preparation lost its effect, so that he recommended a change from one preparation to another. Sarsaparilla, he thought, possessed no virtues.

Dr. Barras said that he had at times great difficulty with ulcers, but as soon as he put the patient on the use of the "black wash," the ulcers healed wonderfully quickly. These ulcerations he considered were syphilitic, and the rapid improvement was no doubt due to both the local and constitutional effect from absorption of the mercury. Coryza,

he said, was due to the small dose of the iodide of potassium; large doses produced no such effect. He did not agree with some members in their fear of mercury in struma, and thought that Dr. Park had "thrown the wet blanket" over Dr. Cadell's theories.

Dr. Park, in reply, thanked the Society for the reception his paper had met with. He took for granted that in struma every one would combine the mercurial treatment with a tonic one. With regard to Dr. Pollok's criticisms on the physiological action of mercury, he said that no doubt mercury was a "heart poison," but so was syphilis. The line of treatment recommended by Dr. Maylard was much the same as he had adopted for the last four or five years. He assured the denouncers of sarsaparilla that that drug was a most valuable aid in many syphilitic cases. Syphilitic patients, he assured Dr. Tindal, were iodised, and coryza produced by the administration of iodide of potassium. His reasons for not treating the patients until they recognised the fact that they were suffering from syphilis were important-viz., that they might not blame him for administering mercury unnecessarily, and that they might continue it until he considered them cured.

Corrosive Sublimate as an Antiseptic Surgical Dressing. (Cbl. f. Chir., 29, 1882, Beilage).-Dr. Kümmell, of Hamburg, has for some time used corrosive sublimate in surgical dressings with excellent results, basing his practice on Koch's recommendation of that substance as a most powerful antiseptic, even in very dilute solutions. As disinfectant fluids simple solutions (as 1:1000) have been used in large quantities, and so far indications of the action of the mercury on the system (very transient salivation), have been observed h only two debilitated patients. Sublimate solutions, like 1:20 solution of carbolic acid, make the hands rough and harsh, but without producing tingling or anæsthesia.

The carbolic solution is used only for the spray, and to disinfect those instruments which are attacked and blunted by the sublimate. Sponges and compresses lie constantly in a 0.1 per cent sublimate solution, and all the dressing materials are prepared with the same substance. Sublimate silk is prepared by boiling the raw material for two hours in a 1 per cent solution; it is then kept in a 0.1 per cent solution. An excellent sublimate catgut also is prepared by placing the catgut for twelve hours in a 1 per cent watery solution, rolling it tightly up and preserving it in a 0.25 per cent spirituous solution of sublimate to which 10 per cent of glycerine is added.

Sublimate cotton and sublimate gauze are prepared as directed below.

To provide a dressing which might be disinfected by means of heat or the mineral acids, and rendered antiseptic by corrosive sublimate, which should readily absorb wound secretions and have the additional virtue of cheapness, inorganic materials have been used, namely, sand, ashes, and glass wool.

Ordinary white quartz sand is employed; it is thoroughly heated in a crucible and prepared as directed below. This is applied after the fashion of iodoform as an antiseptic powder. Thus, wound cavities may be filled with it, and covered in with a few layers of sublimate gauze and a bandage; or the wound may be stitched, drained with the capillary glass drains, covered with the glass wool and a thick sprinkling of the sand, the gauze and bandage. This dressing is applic

able in cases of operation wounds about the extremities and head, abscesses, fistulæ, &c.

When the glass and sand dressing cannot be conveniently applied the ash cushion is useful. Ordinary coal ash is prepared as directed below, and enclosed in thin cotton bags. The cushions are made in five sizes, from 12 to 40 square ctm. They sit closely on even the most irregular surfaces, and exercise slight compression.

The glass wool is prepared as directed below. It is easily cleaned and disinfected by means of concentrated acids, and its absorbent power, due to its action as a surface drain, confers on it many advantages over the ordinary protective.

The glass wool (or glass silk) plaited in various thicknesses, forms excellent drains. Its fibres are exceedingly slender, and take up so little room in the tissues as never to lead to the formation of a drain canal; union takes place immediately they are removed; their capillary action is continuous, and is not interrupted by any kind of dressing (sand, gauze, &c.), and will bring discharge to the surface even vertically from the bottom of a cavity. In certain situations, where counter-incisions cannot be made, they are invaluable-as after removal of large cervical tumours which reach down behind the sternum, and in the drainage of Douglas's space. Nevertheless, they are suited only for aseptic wounds; for purulent fluids the old drainage tubes are necessary.

Inorganic dressings are easily used. The glass drain is inserted, a thin layer of glass wool is placed over the wound, then one or two small slightly damped ash cushions, and over all a large ash cushion, kept in place by a tolerably firm gauze bandage. The first dressing is retained till the wound is presumably healed; in about seven to ten days, in small wounds earlier, the dressing is changed and the glass drain at once removed, and a further dressing of sand or a cushion at once applied; this last dressing remains till the wound is definitively closed.

Pyrexia is usually unknown in such cases, and "aseptic wound fever" is more rarely observed than with any other antiseptic dressing; union by first intention occurs with a certainty and regularity unheard of under even the strictest Listerian treatment; drain-fistulæ have not yet been met with, nor has eczema of the skin, from this dressing and treatment. Kümmell has obtained union by first intention in very short periods in this way: in thirteen days in an amputation in the thigh, five to eight days in herniotomies, in fourteen days in smaller necrotomies.

The materials named above are obtainable everywhere, and are very cheap. The sublimate for 100 litres of the strong solution costs about sevenpence; the ætherial solution of sublimate used to prepare 10 kilogrammes of sand, costs about the same sum; the preparation of 25 kilogrammes of sublimate ash costs rather more than a halfpenny; the materials needed for two dressings of a typical thigh amputation, including bandages and sublimate solution, cost less than a shilling, for herniotomies, about fivepence.

Since the introduction of this method of dressing in that part of the Hamburg Hospital where it is employed, no disease due to wound infection has attacked a patient so treated; formerly such diseases were there "frightfully" frequent.

The two points the author insists on in carrying out this treatment are strict primary antisepsis, down even to the minutest details, and the retention of the first dressing as long as possible, till the wound is presumably healed.

Directions for the preparation of the inorganic dressings :—

The Ash Cushions.

1. The sewed bags are washed with green soap and soda, rinsed first in clean water, and then in solution of corrosive sublimate (1:1000), dried, and packed away in suitable boxes.

2. About one day before they are filled, these bags are soaked in solution No. I, wrung out, and hung up to dry on a rope, which also previously had been washed in sublimate

solution.

3. 10 kilogrammes of the ashes, carefully passed through a sieve, are weighed out and gradually added, with constant stirring, to one litre of sublimate solution No. I.

4. The bags, filled with ashes to the prescribed thickness, are stitched up with thread soaked in sublimate solution (1:1000). The large sized cushions, Nos. i, ii, and iii, are not stitched across; No. iv has one cross row of stitches; No. v two such rows crossing each other, while No. IV has several such rows. The prepared cushions are then stored away in a close-fitting tin box.

Sublimate Sand.

5. 10 kilogrammes of sand, thoroughly roasted and passed through a fine sieve, are slowly stirred up in 100 grammes of an ætherial solution of corrosive sublimate, No. IV (10.0 sublimate: 1000 ether).

Sublimate Gauze and Cotton.

6. Cotton wool (as prepared for dressings) is soaked in the sublimate solution, No. II, in an enamelled iron vessel, passed through a wringing machine, wrapped up in rolls, and dried for several hours in the air, or in a hot air chamber.

7. The gauze is prepared in a similar way, but directly after the wringing out is cut up in pieces of six metres length, and placed in layers in a tin box.

Glass Wool and Glass Drains.

8. The glass drains are made of four sizes, and are plaited in three strands; these, as well as the glass wool, are kept in a 1 per cent sublimate solution.

9. Before beginning the preparations of these dressings, the glass table, and every other vessel to be used, must be washed out with sublimate solution No. III.

The Advantages of a Dry Local Treatment in Otorrhoeal Diseases.-One of the greatest hindrances to cure in an ear disease accompanied by otorrhoea, whether the disease be due to inflammation in the auditory canal or middle ear, is the presence of granulations and polypoid growths. Yet one of the oldest forms of treatment of otorrhoeal disease has been by copious syringing and instillation of various fluid medicines. Hence, in such treatment of this class of aural diseases, moisture has been repeatedly applied to, and kept in the ear, a naturally heated locality. Now, as heat and moisture tend to promote granulations and keep up a discharge, it is very apparent that a moist treatment of otorrhoea in many instances has a tendency to keep up rather than to check the morbid discharge from the ear.

On these grounds, therefore, Dr. Chas. H. Burnett, in a paper with the above title, in the American Journal of the Medical Sciences for January, 1883, holds that the syringe and all forms of drops should be omitted from the home treat