gorged with blood, and the contractions of the heart will be in abeyance; prick the heart with a needle, allow some blood to escape, and the contractions of the heart are re-established. This experiment seems to show that if by striking the chest and by artificial respiration the action of the heart is not quickly re-established, then bleeding from the external jugular vein should at once be resorted to. I have never yet required to have recourse to this remedy, artificial respiration having been sufficient. It must be remembered that it should never occur unless by a fault on the part of the administrator in not using at once the proper remedies-either removal of the tongue if its acting is a mechanical obstacle to the admission of air, or forcible traction of the organ if the obstruction is in the larynx itself, in consequence of paralysis of the intrinsic muscles of the organ.

3. Treatment of fainting.

1. Preventive. Never give chloroform in the sitting posture. Never commence any operation, however trivial, until the patient is fully under the influence of the drug; it is far better not to give chloroform at all than to use it imperfectly.

2. Curative.—If it occurs as a result of a weak heart, or in consequence of an excessive loss of blood during the operation, or as a coincidence during the administration of the drug, then the head must be at once placed at a lower level than the body, the arms and legs must be raised to the vertical, or the patient may be held up by the heels, as recommended by M. Nelaton. The effect in all these ways is attained of restoring a sufficient supply of blood to the brain.

The good effects of Nelaton's practice are in my opinion of a twofold nature. 1st, By restoring the proper supply of blood to the brain in the most efficient and quickest manner. 2nd, In many of the cases the danger may have been at the opening of the glottis, due to obstruction by the tongue; inverting the patient will at once remedy this by causing the tongue to fall forwards. It will also be useful in cases in which blood, in operations about the mouth and nasal cavities, has passed into the bronchi, or in cases in which vomited matter has passed into the larynx, the foreign body being removed by inversion, as Brunel removed the half-sovereign from his

bronchial tubes. The frequency with which Nelaton's practice has been attended by good results in cases of apparent death from chloroform seems to show that inversion may act in this twofold manner, because obstruction of the glottis is a much more frequent danger in the administration of chloroform than faintness, which, as far as my experience shows, is comparatively rare. 4. Treatment of Vomiting.

Do not give any solid food for four hours before the operation. In railway accidents and other sudden injuries in which it is necessary to give chloroform, the greatest care must be taken; if vomiting occurs during the administration, turn the patient on his side in order to allow the vomited matter to escape from the mouth, and prevent any regurgitation into the bronchial tubes. In such cases the administration of the chloroform should be abstained from until the stomach is empty.

When the act of vomiting takes place, the stomach being empty, then the administration of more chloroform is required, in order to stop the abnormal contractions of the muscular walls of the stomach. There is in such a case no danger from vomited matter passing into the larynx.

(D.) The dangers which accompany its abuse and their treatment. -If an overdose of chloroform is administered—and it must be remembered that some patients are very susceptible to the action of the drug-the nervous centres which rule the muscles of respiration are poisoned-the patient has died of an overdose of chloroform; then the treatment required is to pull the tongue forwards in order to allow air to enter or leave the chest by artificial respiration. It is a volatile poison, and perseverance in artificial respiration must be continued until the volatile poison passes away. A case recorded by Dr. J. J. Brown in the Edinburgh Medical Journal (Nov. 1874) well illustrates this important fact. By artificial respiration kept up continuously for 2 hours, he saved a patient in whom complete paralysis of the respiratory ganglia had occurred, but the cardiac ganglia were unaffected. The case also shows that the respiratory ganglia are poisoned before the cardiac ganglia. When the overdose is excessive, then the heart's action is interfered with; by artificial respiration, striking the chest-wall with a wet towel, and the use of the galvanic battery, it must, if possible, be restored.

NOTE ON THE QUANTITATIVE ESTIMATION OF

UREA.

BY DR. W. J. RUSSELL AND DR. WEST.

IN the course of some experiments we made during last summer with the process for estimating urea, of which we gave an account in the Practitioner for February, 1875, we found that the hypobromous solution decomposes in hot weather more quickly than we expected, and that it is very important that it be quite freshly prepared.

We wish to draw especial attention to this, and to suggest that the solution be prepared in the following manner :

A solution of caustic soda is made in water in the proportion of 100 grammes of solid caustic soda to 250 cc. of water. This solution may be made in large quantities, for it will keep good for a very long time. To part of this solution bromine is added in the proportion of 25 cc. to every 250 cc. of caustie soda solution at the time it is required for use.

NO. CIII.

D

SOME REMARKS ON THE ECZEMA MARGINATUM

OF HEBRA.

BY GEORGE THIN, M.D.

In a previous number of this journal (July, 1875) I described a case of eczema marginatum in which the disease had been acquired in the East. It was an interesting one from a diagnostic and etiological point of view, inasmuch as the eruption was not on the inner surface of the upper part of the thigh, which is its usual seat. It was present on three different parts, there being patches on the anterior surface of the upper third of the thigh, the shoulder, and the chin. The disease was on that occasion apparently removed by a vigorous application of the modified Wilkinson's Ointment, the patient much regretting that his inability to procure Goa Powder, or Poh di Bahia, rendered it necessary that he should have to undergo a somewhat severe method of cure. To anticipate his future wants, he procured a supply of Poh di Bahia from Singapore, and it was not long before I had an opportunity of witnessing the effects of treatment by this remedy.

In the autumn of the same year my patient returned, the eruption having again developed in the three places on which I had observed it before. The patches were the same, the rings on the shoulder and thigh being formed by small nodules, and the curved line on the chin forming a continuous reddened elevation. I was invited to observe the effect of treatment by Poh di Bahia, and I can testify that the remedy was for the time effective, and its application attended with little inconvenience. In five days the hard nodules on the shoulder had disappeared, and after a few more days those on the thigh and the ring on the

chin could hardly be detected. Another temporary cure had been effected, speedily, and attended with less pain than had been produced on the previous occasion by the ointment.

In November, 1876, the patient came to me again. The three patches were in full development, exactly the same in appearance and extent as they were when I first saw them in March, 1875, and the description I gave of them then applies exactly to them now. The annoyance from the curve on the chin is considerable, as it readily attracts attention. The eruption had reappeared gradually some months after it had last yielded to treatment, and this time had defied repeated applications of the Poh di Bahia.

Practically, my patient is suffering from a disease that may almost be said to be incurable. The patch on the thigh has now lasted twelve years, and those on the shoulder and chin upwards of two years. During that time the eruption has not only resisted vigorous treatment, but has been uninfluenced by a constant and liberal use of soap and water. So much for the case which I previously described.

The learned editor of the Archiv für Dermatologie und Syphilis, in his reference to my previously published paper, remarks that Professor Pick has established beyond all doubt that eczema marginatum is a combination of eczema and herpes tonsurans, or tinea circinata, and he also affixes to my statement that the disease is rare in Europe a mark of interrogation. It seems to me that the subject will bear consideration a little further.

To take the case of the patient who forms the text of this discourse. It is typical of what is common in the East, and it corresponds accurately with the description given by Kaposi in the volume of Hebra's Lehrbuch just published. At page 648, under Dermatoses parasitariæ, it is stated that “ eczema marginatum forms rings and curved lines which are not so smooth on the surface and do not run so equally as those of herpes tonsurans, but are broken by frequent interruptions, and are thickly set with nodules, vesicles, and scabs. Its course is extremely chronic, and persists on the same part for from ten to twenty years. It is by no means so easily conveyed to other persons as herpes tonsurans." These features, with the exception of the vesicles, which I have not observed in the present instance