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Dobell's solution is one of the best means of applying the acid, and may be prepared as follows:

Carbolic Acid Crystals,

3 grains.
Biborate of Sodium,
Bicarbonate of Sodium, each 20 grains.

5 ounces.

I ounce.

When applied by means of the spray, this solution lessens the tenacity of the mucus, assists in its expulsion, and has also a marked effect in lessening the paroxysms. Next to carbolic acid is thymol, which is powerfully antiseptic, and is also supposed to act on the disease germ.

The following solution may be used with the atomizer:


Thymol, 10 grains.
Alcohol; 3 drachms.
Glycerine; 12 ounce.

34 ounces.

Other remedies have been used with good results—the hydrochlorate of cocaine being one of the most promising, and as the decreasing cost of this drug is rapidly placing it within the reach of all, it is coming into much more general use. A solution of one grain to an ounce of water, inhaled, has in several cases quickly relieved the paroxysms of coughing and lessened their frequency.

This last remedy has given very satisfactory results in relieving the terrible dysphagia of advanced laryngeal tuberculosis, though it must be confessed the good effects are but temporary; who, however, that has witnessed the terrible sufferings of a patient, unable to partake even the blandest of nourishment, laboring for breath caused by engorgement of tissues, will not feel grateful, that even temporary relief is to be obtained? It is best in making use of this remedy in laryngeal tuberculosis, to thoroughly cleanse the parts, first with an alkaline spray, (Dobell's) then apply thoroughly a four to six per cent. solution with a large laryngeal brush. One application is usually sufficient, and allows the patient to eat and drink with comparative comfort for a short time.

A somewhat longer anæsthetic effect may be produced by the following solution thoroughly applied once or twice a day with the brush:

Carbolic Acid,

1/2 drachm.
Tincture Iodine; 12 ounce.
Glycerine, 2 drachms.

Mix. A burning sensation is felt for a short time, which is followed by anästhesia of the parts, lasting from eight to ten hours.

Of course either remedy is but palliative though by the use of the last solution, the disease may be held in check much longer than by the first.

In the treatment of pulmonary tuberculosis by inhalation, the presence of a large amount of residual air bars the entrance of the medicated vapors, or gas, into the bronchioles and air vesicles, except through the slow process of mechanical diffusion. Notwithstanding this difficulty, however, great benefit is frequently obtained from the use of inhalations of vapors medicated with the various remedies by relieving irritation in the larger bronchial tubes, and assisting in the cleansing and expulsion of the unhealthy exudations from the mucous membrane.

To overcome the resistance of the residual air, a pneumatic cabinet has been devised by Dr. H. F. Williams, which is described by Dr. W. E. Smith in the Journal of the American Medical Association, Nov. 14, 1885. With this apparatus in the hands of competent physicians, and especially in hospital practice, there can be little doubt but that much good can be accomplished; but for obvious reasons it is not likely that the cabinet will come into such common use, as to be found in the office of the general practitioner, who will have to depend upon inhalations from the ordinary steam atomizer. The remedies generally employed are:--carbolic acid, iodine, corrosive sublimate, thymol, eucalyptol, oil of turpentine, ammonium chloride, Monsel's solution, chloride of iron and the various preparations of opium.

Following are the solutions which have been found very useful, but other combinations may, of course, be substituted as occasion may require:

No, I.

Ammonium Chloride, 2 drachms.

12 drachm.
Water to make 12 ounce,


No. 2.

Muriate Morphia, 72 grain.
Muriate Ammonium, 3 drachms.
Water to make

4 ounces.

2 ounces.

This solution is one I am in the habit of using frequently for bronchitis, both acute and chronic, where the expectoration is scanty and cough troublesome, with the effect of promoting the secretion and greatly lessening the cough.

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This solution is chiefly used to restrain severe hæmoptysis, and may be made weaker or stronger as occasion may require. In making use of this solution, the hand ball apparatus is preferable to the steam atomizer on account of the lower temperature of the spray.

The above are, of course, but few of the many combinations which

may be employed in the treatment of the various diseases of the air passages, while they may prove but palliative in the tubercular forms, yet in view of the great strides taken in therapeutics within the last quarter of a century, may we not hope that an actual specific may be discovered for this class of diseases?





I have selected for brief consideration, to-day, a surgical aftection which is not unique nor so rare, but that all of you can cite more or less of personal experience in dealing with this particular disorder, viz: that of necrosis of the integument following erysipelas. I therefore ask your indulgence, if in the remarks and comments upon the case, which shall serve as our subject, I have presented nothing that is new or original.

Notwithstanding the fact that most of us—in private practicehave met with one or more of the class of cases in question,-not to speak of those who have had a very extensive experience in our large hospitals,-our text books on surgery and special pathology scarcely more than mention necrosis of the integument following erysipelatous inflammations. The anatomical changes are barely hinted at by some, and entirely overlooked by most authors, and they seem to content themselves by simply mentioning the fact, that such a condition does sometimes occur.

I have endeavored to collect such facts as the very limited resources at my command permitted, so far as they bore a direct or indirect relation to the subject in question. Permit me to present the following case, that shall serve as the subject of our discussion.


T. S., farmer by occupation, aged 74,, native of Ireland. Says he was bitten on the end of the thumb of his right hand by a hog, receiving a lacerated wound, about one-half inch in length. The wound partially healed, with some suppuration. Patient says that he experienced some pain. He continued his work from day to day,that

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