glass factory, constantly handling the amalgam and exposed to its noxious influence. About six weeks ago he began to have severe headache, and his muscles to become very tremulous. Soon after appeared a profuse papular eruption over the whole surface of his body. His gums then became tender and mastication difficult. On admission; is well nourished, appetite and sleep good, tongue clean and moist, bowels regular, urine normal, skin natural. He complains of pain in the head; and the muscles of the extremities are in a peculiarly tremulous condition whenever he exerts them, and they have lost some of their tone as shown by the use of the dynamometer. The breath is not fetid, there is no salivary flow, and the gums only slightly altered in appearance.

He was given a sulphur bath every day, potassic iodide as an eliminant, and laxatives and anodynes as needed.

He made a rapid improvement as far as the muscular tremors were concerned, but as these symptoms wore away he began to show symptoms of hysteria, and slight, and finally acute, mania. Now (on the 7th of August,) he appears as stout and vigorous as could be desired; his muscles are firm, there are no tremors, the gums are no longer sore, the appetite is good, and he is the picture of health. It is only seldom now that he gives way to the crying fits and delusions which so troubled him two weeks

ago.

RUSH MEDICAL COLLEGE CLINIC.

Service of Prof. MOSES GUNN.

(Reported by EDMUND M. LANDIS, M. D.)

Lateral Curvature.

C. F., German, aged 15, is a poorly nourished lad, whose appetite is good, but who eats sparingly of fats. He states that he was well up to four months ago, when he first noticed pain in his right side, which began to be crooked, and that his breathing was embarrassed.

On examination, find a lateral curvature to the right side, and a prominence in the dorsal vertebral region. On stooping, at request, to pick up an article from the floor, he bends over with ease and freedom. This little experiment at once dismisses the suspicion of disease of the vertebræ, and we have lateral curvature resulting in a corresponding angle at the back, causing the suspicious prominence noticed at first. The respiratory movement of the chest seems good, yet the patient complains that he cannot breathe well. On making pressure on the chest, find that we can materially restore its natural shape.

The question, in this case, is whether we shall advise the usual apparatus, or suspension by the arms and hands from a swing. [See a paper on suspension as a means of treatment in Spinal Distortions, by Benjamin Lee, M. D., of Philadelphia, read before the last meeting of the American Medical Association, by Dr. Frank Woodward, of Philadelphia.] We have a case under treatment for whom a modification of both apparatus and swing is being used. The patient had double lateral curvature, and the bowing in on the left side was so great that the chest could almost be spanned with the fingers. The respiration of the left side was much embarrassed. The only means of treatment had been a stiff corset, which tightly compressed the chest. An apparatus was made for this patient, the essential features of which were a pelvic band or girth, a part which corresponded to the natural curve of the spine, and armlets or crutches to support the arms, and to keep the shoulders back. This made no pressure on the chest. With this, the child was put in the swing and made to frequently inspire and expire as fully as she could. Full diet was ordered.

That child has steadily improved, the curvature is being reduced, and the embarrassed breathing relieved.

In this case we would hardly recommend an apparatus, as a swing would be all sufficient.

Epithelioma.

J. B. W., aged 58, German, farmer. The patient, whose previous health had been good, states that he first noticed, some two or three years ago, in the right side of the mouth, close to the gums, a small whitish looking, painless ulcer, which he thought to be a simple sore. This not disappearing he consulted a physician, who treated it for sometime without success, and finally cauterized it. After this the sore began to spread, ulcerate and pain, the pain being of a sharp, shooting character. He had several teeth extracted, hoping by their removal to gain some benefit. The sore continued to enlarge and spread. Three months ago he consulted a physician, who pronounced the disease carcinoma.

On examination, find an infiltration in the right cheek, extending within and without, covering an area of about two inches, and approaching the angle of the lips. It is fixed, immovable and ulcerated internally and externally. The gums about the disease, and also on the opposite side of the jaw, present a number of whitish looking deposits, or patches. There is some pus, but no ichorous discharge. The alveolar process is involved, and we find it softened, broken down, and filled with sinuses, the disease also spreading to the soft parts on the inside of the mouth. On probing with several probes in different directions, find that one of them passes clear through the cheek, and alveolar process to the side of the tongue.

We have here an example of epithelioma a little out of the general type. Its advent, progress and present appearance, are singular. It began in the duplicature of the mucous membrane just where it begins to be reflected upon the gums, commencing, as is now observed, with a thickened condition of the mucous membrane, as a number of patches of a snowy white appearance. Epithelioma does not usually begin in the mucous membrane as a white degeneration. Seen at the first glance, one would call it a diphtheritic deposit, but on examination find it a part of the mucous membrane. The patient complains of a soreness which is characteristic of pus, and pus is found, but the ichorous discharge which we would expect is

absent.

The characteristic pain is present, and the disease is

apparently spreading to the opposite side.

If an operation were made it would be necessary to remove the whole of that part of the jaw involved in the disease, and we have examined the case with reference to this, and find that a section made through the symphisis menti, and another as far back as the first molar teeth, would accomplish the object.

The large amount of the soft parts of the cheek which would be involved in the operation would make a gape, that would be difficult to close. But even if we were successful in this, on account of the liability of a disease to return, which has progressed so far and attained to such a degree as this, we cannot conscientiously recommend the operation.

We inferred that in the first stage of this disease the whitened condition of the mucous membrane was singular. This is not the case in the later stages. Remember having removed an epulis, where the patient came back after a few weeks with return of the disease, when this same whitened thickened condition of the mucous membrane was present.

NOTES FROM PRIVATE PRACTICE.

The poisonous effects of arnica.

Mr. L, a healthy gentleman, of excellent habits, and with no specific cachexia, slightly injured his knee by falling on the sidewalk, while attempting to reach the street cars. Partly to quiet the pain, and partly to follow a very fashionable and orthodox custom prevalent among a majority of the people, he purchased at one of our best drug stores, a two-ounce bottle of tincture of arnica, the contents of which he applied to the knee. In this application no particular attention was given to the quantity used, and some of the tincture trickled down the leg, and a small amount of it came in contact with the fingers, especially between them. During the night the affected limb, swathed in a cloth saturated with the arnica,

came in contact with the inner part of the other leg, and at some time, probably while applying the lotion in the evening, the patient's fingers came in contact with his eyelids. In the morning every part of the integument which had been touched with the arnica, was slightly red and swollenerythematous. I was immediately summoned, October 17th, and ordered salines, a cooling lotion and rest. 18th, swelling and redness increased-some fever. 19th, vesicles between fingers and upon left knee. 20th, vesicles upon portions of all the integuments (except eyelids) with which the arnica had come in contact-eczema. 22d, eye nearly well; integuments less swollen; considerable itching and burning; pustules around the margins of affected parts. 23d, intense itching and burning of the surface of the thorax and abdomen. An examination showed a profuse redness or vascular congestion of the entire surface, and the presence of what Wilson would probably call eczema erythematosum. 24th to 28th, eruption on body disappearing; crusts forming on leg; fingers nearly well. 29th to 31st, crusts clearing; pruritus disappearing; new skin looking healthy; patient discharged.

This gentleman, without doubt, from the external use of the arnica, had an acute eczema running through the different stages of hyperæmia, increased sensibility, infiltration, vesiculation, incrustation and degeneration, terminating at about the usual time. The constitutional disturbances were greater than is usual, as was shown by the eczema erythematosum, which took place the sixth day, and by the excoriated and ulcerated patches which continued for two or three weeks after his discharge. I should mention, perhaps, that some two or three years ago, I treated the same gentleman for a slight eczema on the hand, and it is perhaps in these people who have, as it were, an eczematous diathesis that this unusual susceptibility of the skin is present. Until this case occurred, in my own practice, I was ignorant of the fact that arnica applied externally ever produced poisoned effects. I considered it a domestic remedy used very generally without the advice of a physician, and supposed it perfectly harmless. I find, however, that Fox, in speaking of medicinal rashes, says, "Arnica may produce erythema and swelling of the part to