of hydrocephalus. As I desire to confine the signification to mean that quantity of fluid which, in addition to the free flow of blood to the brain, may produce troublesome symptoms, and the above is a strong case in point, as bearing on this position of my subject.

4

A lengthy description of the various forms and symptoms and conditions of this so-called disease, only leads me to the point where I shall advise for these cases little or no medical treatment. They are better off where the "let-alone" plan is adopted. It is better to know what not to do than to use remedies indiscriminately, as is too often done.

Tapping has been resorted to, but never with success. Where tapping may be considered necessary the case is a hopeless one, and had better be left to nature.

Bandaging has never been of any service, and has been the means of some injury. It has caused convulsions and death. But where the little patients are not bothered by the doctor's physics, they live and enjoy life for a number of years, and finally die, at ages from one to six years, and occasionally at the middle period of life, with no great amount of suffering. They are sometimes monstrous to look upon; are cumbersome and seldom ornamental; yet their parents do not desire to part with them, and they deal tenderly with them as their unfortunate offspring.

The only benefit claimed in this paper from any manner of treatment is by arresting the progress of the disease in the acute or prodromal period, and thereby prolonging life, and this only in occasional cases. Such a result has been obtained by the use of bromide potassium and ammonium, in discriminate administration. The cases benefited are always of the inflammatory type. Indeed, we always rely on bromide potassium to allay all reflex phenomena and peripheral disturbances to control excitability, and ammonium when the stimulating influence is desired. Purgatives are not simply useless but harmful in all cases. If it were possible to overcome the tendency to accumulation, the gradual withdrawing of the fluid might found a hope of success.

On page 373, third paragraph, third line, should read "iter e tertio ad quartum ventriculum.”

[LII.J

DISEASES OF THE NASAL CAVITY-GALVANO

CAUTERY.

BY PROF. EDGAR READING.

Having availed ourselves of all the means at our command to thoroughly explore the nasal cavity, which will enable us to locate the seat of disease, we can apply the remedies directly to the parts affected, instead of groping our way in the dark after something-the exact nature and location of which we do not know. It is only by this means that we can make use of the most potent remedy for the treatment of chronic catarrh, and a number of other obstinate diseases of these parts. I refer to the galvano-cautery. This is by far the most effectual remedy for these complaints which we possess, and can be used with great facility under the foregoing advantageous circum

stances.

With the galvano-cautery we can accomplish more in one month than we can in several months from all other local remedies combined. It is also much less unpleasant than many other remedies. During the operation in some excitable persons, they become quite agitated, more from fear than from actual distress, and re-action may be accompanied with considerable fever for a few hours, but this is the exception.

For favorable results, however, I am taking it for granted that the operator is master of the situation and understands his business, otherwise he may cause much distress, and serious consequences may ensue, manipulating with his red-hot or white-hot wires, rings or plates, in these parts.

A suitable apparatus is indispensable, and this can be furnished by Mr. John Byrne, of Brooklyn, N. Y., as full and complete as from any other source. A suitable battery is required as well as a suitable apparatus. A competent assistant is also necessary to manipulate the battery, and to increase or diminish the intensity of the heat at the command of the operator.

All things being in readiness, it is better to be conservative. Go slow and repeat the operation more frequently until a familiarity with the business is acquired which will enable us to push

the operation just far enough. When we are able to accomplish this, the most satisfactory results follow from performing the operation just right, and this must, in a measure, be acquired from experience.

Hemorrhage is frequently one of the most troublesome complications, and can only be avoided by pushing the operation slowly and cautiously, and, when it does occur, to arrest it by the application of ice-cold water, or more active styptics if necessary.

The cavity sometimes fills up badly with steam, but, by arresting the current for a moment, a few forced expirations will remedy that difficulty, when we can proceed with the opera

tion.

be

Some of the advantages from this operation may summed up as follows: We obtain all of the benefits to be derived from any kind of a cautery, and this can be manipulated so much more accurately than can any other kind. The heat can be controlled in an instant to any required degree. It can be, also, much more readily confined to the exact parts affected.

In many applications, the injury to the surrounding parts (which are comparatively healthy), is sometimes more serious than the original disease. The practice too frequently employed of injecting strong solutions of nit. argent, is perfectly barbarous. The sound membrane, which is a great many times larger in surface than that part which is diseased, is affected alike; and, while the application may have a tendency to restore the diseased portion. to a healthy condition, it will cause a thickening and a diseased condition of the sound membrane, besides the serious distress caused by medicating so large a surface. We should not lose sight of the fact that in chronic catarrh, the disease is mostly confined to a very small proportion of the Schneiderian membrane. These applications must necessarily be too weak to produce anything like the full benefit to be derived from a concentrated application to the parts affected.

A further consideration is, that with the galvano-cautery we get the full benefit of the peculiar electrical effects in addition

to the caustic. This, by some, may be ignored. It may be claimed that the effects of the heat are the same whether derived from the galvanic current or from any other source. Others feel very confident that the galvanic current exerts a very powerful influence in connection with its caustic effects. Under some circumstances, and for some diseases, there is probably no doubt about it, and, in many instances, its effects are certainly beneficial.

In adopting our mode of treatment for catarrh, it is highly important that a correct diagnosis should be made. The pathological condition, in the more chronic forms of acute catarrh, is very different from that which we find in a genuine case of chronic catarrh (see articles in July and August numbers). The treatment for acute catarrh, or the more lingering form of acute catarrh, is not at all applicable to the chronic form. In acute catarrh the Schneiderian membrane is more or less affected. In the first stage, we have all the symptoms of coryza with tumefaction and dryness of the whole membrane. In two or three days the dryness and swelling diminish, and a watery discharge takes place. This soon emerges into a thick, creamy discharge, which is very indefinite in its duration, and is frequently mistaken for chronic catarrh, and treated as such without any very decided benefit. The first and second stages of acute catarrh need but very little, if any, treatment except hygienic. In the third stage, we can use our insufflations which are too frequently resorted to in chronic catarrh. In this stage of acute catarrh, they can be made use of with most decided benefit; whereas, in the chronic form, their effects may be decidedly deleterious.

Constitutional treatment should never be neglected in any stage or form of catarrh, or, in fact, for any pathological condition of the nasal cavity.

The galvano-cautery is almost indispensable in the treatment of polypi, and all forms of tumors of the nasal cavity. After having ascertained the exact nature, form, size and location of the morbid growth, select that part of the apparatus which is best adapted to attack the excrescence at the base, and then proceed to burn it out. Be sure and commence at the base,

and, when severed, the outskirts will drop off.

When we cannot reach the base on account of the size and shape of the outskirts, if they cannot be compressed, it is better to excise or twist off the more superficial parts, and then apply the galvanocautery which cannot be used to any great advantage without such preparation.

In recommending the galvano-cautery, I feel very confident that, in the hands of the faithful, judiciously used, it will meet with their most sanguine expectations.

[LIII.]

WHO KNOWS?

BY MILTON JAY, M. D., CHICAGO.

is meant an If specific in But with spe

The question has been asked, "Do you believe and advocate specific medication?” By specific medicine infallible remedy; one that never fails to cure. medicine means anything, it must mean that. cific-medicine men, the term has various and widely different meanings; no two of them define the term alike. One says, specific symptoms, and another, with just as much assurance, says, specific conditions; and another, with still more emphasis, says specific basic lesions; and in each and every case where the specific medicine fails (as it very often does), the advocate of the theory is always ready to cry aloud, the mistake was in the diagnosis, because if the diagnosis had been correct, the remedy would never have "missed fire." All admit that specific diagnosis is necessary, in order that specific medication shall be successful, and stand the test of crucial examination. But writers on this subject are not agreed as to what this diagnosis shall consist in; one says specific and positive symptoms, and another (or the same one at different times), says, no, not symptoms, but conditions. Now, I confess that I cannot see how we can diagnose conditions, except by and through the aid of symptoms, and by the aid of diagnostic symptoms, we arrive at the basic lesion; the only advantage being that when the remedial agent fails, the advocate ascribes the failure to mistaken diagnosis. It is said that he is a good general who can marshal his forces in good order during an attack, but more