WINTER ECZEMA. There appears to be something in the winter climate, at least of the sea-board States, to cause in many persons a troublesome itching of the surface, generally of the extremities. This itching abates or disappears during mild and moist weather, but recurs with every cold, dry clearing up of the weather. From being slight at first it is apt to increase and become very troublesome, especially upon undressing, and through the night. At this stage vigorous scratching becomes irresistible, and then the surfaces soon become abraided, red and papular with an exudation which sooner or later becomes copious, drying in crusts on some parts, but presenting open ulcerative patches on others. In this stage the itching is replaced by soreness and irritation, and the tendency seems to be to become worse instead of better. By a consideration of the climatic conditions which seem to start and keep up this affection in persons who are otherwise in good health, there seemed to be an indication for some agency to keep the surface from becoming too dry, -to keep it in dry cold weather in a similar condition to that of mild moist weather. This would be accomplished by a proper use of glycerin. Then there is a very evident indication for an effective astringent to prevent or correct the tendency to the exudation, and such would be found in tannic acid. Add to this a moderate stimulation of the surface to take the place of the scratching in the relief which this gives, and then the indications for the following solution are fulfilled: Take of Tannic acid 2.6 grammes, or 40 grains. Glycerin and alcohol, of each, 15 cubic centimetres, or half a fluid ounce. Water sufficient to make 120 cubic centimetres, or 4 fluidounces. This solution applied to the itching surfaces by means of a small sponge or rag, morning and evening, will in a large proportion of cases avert the affection. The itching will be reduced, or will cease altogether, so that scratching can be avoided, and as the other stages arise from the scratching they will fail to occur. If the affection shall have gone on to the stage of irritation and exudation before the solution is resorted to, the solution may then be found to be too strong. Then if diluted with an equal volume of water for a time, until the surface is re-established, it will better serve the purpose, but after this it should be resumed in full strength. When once the affection is found to be curable in this way, it should never be again allowed to go beyond the beginning of the itching stage before the remedy is applied. After being thus cured once or oftener during a winter, it is apt to recur at the beginning of the next winter and must be watched for. The solution does not keep indefinitely and should be freshly made for each attack. OPIUM ASSAYS. Since the publication of the last note on Opium, assays of four cases have been made which presented important peculiarities. These cases were all direct importations into this market and were sent here as being of very fine quality. On careful inspection the representations of quality were well sustained, for the Opium appeared to be very good. The cases differed very much in some respects, but not in the internal appearance of quality or richness. One case was of uniformly small lumps, so that there were between 300 and 400 lumps in the case, as against the usual number of from 150 to 250. Another case was so soft that the lumps had all coalesced into one mass, while the other two cases presented the more usual appearances of Opium of higher grade. All were of very uniform consistence throughout each case, and all of good consistence, except the one which was so soft as to coalesce. The cases were separately sampled and assayed, giving the following results: Morphia 10.8 per cent. Insoluble Residue 28.4 per cent. Water 24.6 per cent. When reduced by calculation to dried and powdered Opium, the powder would assay 14.4, 14.1, 12.9 and 12 per cent. of morphia. Thus this Opium, which was unusually good in appearance, proves to be about of the average market quality for "prime Smyrna Opium," often called Karahissar. The peculiarities developed by the assay process were--First, the very unusually small proportion of insoluble residue. In two of the cases this residue was of the usual character, only very small in amount. In the last two cases it was very different in character as well as small in amount, smaller even than the first two cases, and the smallest insoluble residue ever met with by this writer. Then the proportion of water is unusually great, except in the last case, and there it is unusually small. This was the case which contained so many small distinct uniform lumps. Judging by the appearance of this Opium, in comparison with the higher grades of this market, such as the Boghaditch, Yerli, Salonica, etc., it would be said to contain not less than 12 to 14 per cent. of morphia. That is to say, the appearance would be likely to mislead an ordinary observer by about 3 per cent. of morphia, which is equivalent to more than a dollar a pound in actual value. The insoluble residue in the higher grades of Opium, which this resembles, rarely falls below 36 per cent., and ranges from that to 40 per cent., perhaps, for Opium in the moist condition (42 to 48 per cent. when dried and powdered), and from this it must be reasonably inferred that some soluble matter had been added to this Opium probably to improve its appearance. From time to time, within the past year or two, private reports have been made to the effect that a new diluent for Opium was being used in Asia Minor, by which the appearance was improved, and once or twice this new diluent was reported to be strained fig paste. Some such diluent as this, holding a large proportion of water, and being soluble in water, would easily and rationally account for the peculiarities of this Opium, and it is, therefore, probable that this has been made up in some such way to imitate the higher grades, and sent into the market for deception. THE USE OF SALICYLATES IN ACUTE RHEUMATISM. The discussion of this important subject by the Medical Society of London has been so prolonged and complete as to warrant a more extended review of it than that contemplated in the brief notice of the last EPHEMERIS. Hence the following summary, imperfect as it is, may still be useful to those who may not be induced to read the very important articles here quoted. In The Lancet of December 24, 1881, p. 1080, is an "Analysis of Statistics illustrating the action of Salicin Compounds in the "In Treatment of Acute and Subacute Rheumatism," by Dr. Francis Warner, assistant physician to the London Hospital and East London Hospital for Children. Tables are given embracing an experience of four years, and these are summarized as follows: 190 cases in which salicylic acid was employed the average duration of pyrexia was 5.5 days. In 79 cases without salicin, the average was 13.8 days. "In 277 cases in which salicin was used the average duration of pain was 5.3 days. "In 67 cases without salicin the average was 9.3 days." In 342 cases with salicin, the average confinement to bed was 19.5 days. In 211 cases without, the average was 23.5 days. In 352 cases, with salicin treatment, the average time in hospital was 34.9 days. In 387 cases without, the average was 36.2 days. From these data, it appears that the salicin treatment has a very great advantage in every respect, and that in the duration of fever and pain the advantage is more than double. In cases under salicin treatment, "heart disease developed in 13.6 per cent.; in cases treated otherwise, in 14.9 per cent. Relapses occurred in 33.6 per cent. of the salicin cases," at the average time of 15.2 days, lasting on the average 3.5 days. On page 1081 of the same journal, an abstract of a paper read by Dr. Isambard Owen is given. This embraces 210 cases of acute and subacute rheumatism occurring in St. George's Hospital in 1877 and 1878. These cases are carefully tabulated in six sections, and from the analysis thus shown, the following conclusions may be justly drawn: The treatment by salicylates, whether in large, medium or small doses (3, 2 or 11⁄2 drachms per diem), gave an average duration of fever and pain of 33, 4 and 44 days; while for cases treated by full doses of alkalies, with or without quinia, the average duration of fever was 6 days, and of pain 8 days,-an advantage for the salicylates of nearly 50 per cent. The duration in hospital was practically the same under all the varieties of treatment. Relapses occurred in about 30 per cent. of the cases treated by salicylates, and in 27.6 per cent. of those treated by alkalies, with or without quinia, with an average duration of about 5 days for salicylates, and of 2 days for alkalies, thus showing a very consid erable advantage for the alkaline treatment in this respect. The average days of illness from the commencement of treatment was for salicylates, 6.3 days, and for the alkalies, 10.3 days. Heart complications were few and the results not significant. Toxic symp toms were seen in a number of cases, all abating when the salicylates were suspended. "No cases of hyperpyrexia occurred, and none ended fatally." In the same journal, same page, Dr. De Havilland Hall gives statistics based on 54 cases of acute rheumatism treated both with and without salicylate of soda. His conclusions are: "In contrasting the cases-38 in number-treated by the salicylate of soda, it will be noted that their average stay in hospital was less than a day in excess of the average stay of the 16 cases treated without the salicylate, and that in comparing the days of fever and pain the advantage is still more distinctly in favor of the salicylate plan. In comparing the heart complications which occurred 19 times under observation, the proportion between the two sets of cases is practically the same. This speaks highly in favor of the salicylate plan of treatment, when the much more acute nature of cases subjected to this plan of treatment is borne in mind; but it is only what we should expect from the power the salicylate has of reducing the duration of the fever and of the pain." "I In The Lancet of Dec. 31, 1881, p. 1119, Dr. D. W. C. Hood, of the West London Hospital, gives the analysis of 1,200 cases treated for acute rheumatism. In the course of the article he says: must ask you to refer to Dr. Fagge's table"-The Lancet, Dec. 17, 1881, p. 1030—" as a basis for comparison, my own salicylate table being simply complementary to his, and I think, as you will see, fully bearing out his statements." * * * In the same journal, p. 1120, Dr. J. K. Fowler, in compar. ing his experience at King's College Hospital in 1876, with that at Addenbrooke's Hospital in 1878-79, says: "I have been struck by the comparative absence of severe toxic symptoms at the latter, where the pure acid made from the oil of winter-green is exclusively used." "The advantages claimed for the pure acid are that it rarely produces vomiting and never delirium; so that the treatment can be continued without the necessity of temporarily suspending the administration of the drug." He has submitted specimens of Kolbe's acid for examination, and says: "The analysis is not yet complete, but shows the presence of a considerable quantity of a substance not precipitated by nitrate of silver, and therefore not salicylic acid. This is not an isomeride of salicylic acid; nor is it arbolic acid. The investigation is of importance, as it may lead to improvements in the process of manu * * |