Yet how often is this error storing the memory," curing apoplexy and the like. As a perfectly reliable sedative for a laboring heart, however, it has not an equal. I usually prescribe it in half-drachm doses, with thirty drops of dilute hydrobromic acid; which last, by the way, is an excellent method of giving the bromide in a debilitated constitution, where, as we know, the bromides are contra-indicated. Its acidity also relieves the very unpleasant taste of the convallaria. As patients of this class are, as a rule, very anemic, to the unthinking practitioner it might immediately occur to prescribe iron; but this is bad practice, for in beginning treatment the stomach is not in a condition to receive iron. The patients must be closely questioned, as they will not complain much of their digestion (the more important symptom being foremost in their mind), and you will discover that the heart's action is more annoying after the meal, that the desire for food has much diminished, and that frequent eructations and a rising of sour mouthfuls of fluid indicate plainly the gastric derangement, and the scarcity of healthy gastric secretion. Surely then, this is not a stomach for the administration of iron. made in all cases of chronic indigestion, and how often that oldfashioned fact is forgotten, that it is not what we put into our stomach that does good, but that which the stomach uses when it gets there. So our principal efforts should be firstly to promote healthy gastric secretion, and stimulate good digestion. In this manner we relieve the irritation of the pneumogastric nerve which is keeping up to a great extent the heart trouble. A good many drugs are named as being useful for these purposes, and among them pepsin. That this medicine is very applicable in weak digestion there can be no doubt; but it is an artificial digesting, for it only supplies to the stomach what it lacks. I question its power of increasing a particle of the peptic juice of the stomach itself, consequently its action is not permanent. That we do possess a medicine, and an old one at that, which is particularly useful in promoting healthy gastric secretion is quite certain, and from which a sure and permanent tonic effect can be gained. I refer to calumba root. I prefer the powdered root, as it ought not to be given in tincture form, for a delicate stomach or one in a state of chronic inflammation will not bear the alcohol well. When given in capsules of five or ten grains with the same amount of bismuth, it will act like a charm; and, my word for it, it will fulfil your best anticipations of a digestion restorer. The diet for these patients should be only of a very unstimulating nature; milk and cocoa, with light broths and meat, at most only once a day. It is time enough to give iron when good digestion is well established; and in this, too, a choice is desirable. Vallet's mass, from being more soluble in the stomach and easier assimilated, is preferable. JOHN P. NOLAN, M.D. CATARRH AND ITS SEQUENCES. PERHAPS very few complaints have been more neglected and more subjected to empirical treatment than catarrhal affections. What makes this more remarkable is, that they are so general-a very numerous portion of the community being sufferers. The medical text-books are meagre in their treatment of this subject, and one would almost imagine that their authors had never heard of it. Very many physicians, if asked by a sufferer what to do, will give some brief, half-intelligible directions, and then hurry to change the subject. They abandon the field to the experimenter, the quack, and the empiric, virtually confessing that they are themselves unable to cope with it. Indeed, the number of medical men who have catarrh, and do not know what to do about it, is in equal proportions to the rest of the commuity, who have tried many things and received no benefit. They seem to regard it about as hopeless as cancer, with the one redeeming feature-that it does not kill so quickly. It is passed over cursorily, skipped as soon as may be, and may as well be classed with the opprobic medicoricum. The professors of theory and practice of medicine seem not to know much about it, judging by their lectures. "It a cold, or the result of a cold," is the usual explanation. This would seem to be very plain, but it is far from that. What is a cold? One will discourse about damp weather, chilly rooms, and the like; another will be very explicit about sudden transition from a heated to a cold atmosphere. So we have a round of explanations. But then a person is seldom unpleasantly affected by passing quickly from a hot to a cold atmosphere. In Norway, Russia, and other cold climates, it is the practice to keep the houses at a very high temperature, as a protection against the severe weather outside. Damp weather is almost constantly encountered in island countries, with very general impunity. Indeed, it is almost safe to say that climate has little to do with the matter. The complaint is about as common in summer as in winter, and in dry as in moist countries. The causes must be sought from other sources. Annoying as the complaint is, there is much connected with it that is really laughable. The New-England people have contracted a peculiar nasal tone of voice, which is regarded as specially Yankee, but is more truly a result of catarrh of the posterior nares. Probably nobody hears his own voice correctly; and hence, few are aware of any improper intonations. Yet it gives a queer impression to hear the peculiar a, u, and ow, which are sharp enough to cut. Perhaps the absurd pronunciation is a modern distortion of utterance; but it evidently originated in the obstruction of the breath, and has become classic. In Eastern estimation it seems to distinguish the culture of Boston and New England from the broad enunciation of the Knickerbockers, and other outside barbarians of the United States. The causes of catarrh, and the various seats of the disorder, are numerous. We are safe in assigning the origin to debility. It is usual to attribute it to taking cold, yet no person who is not already debilitated is liable to contract the complaint. Indigestion and fatigue are the principal causes. Dr. Franklin used to say that he would take cold any time by over-eating. Samuel Thomson observed that the great body of disorders which he was asked to treat were attributed to cold, bad air, insufficient exercise, and improper food. Exhaustion by fatigue, or other causes, will be very likely to occasion catarrh. Whatever enfeebles the patient and lowers the normal standard is likely to result in disorder, and climatic influences give form to the disturbance thus indicated. When merely a cold has been contracted, this matter is simple enough. The pores of the skin are obstructed, and the effete and noxious material which should pass off by the insensible perspirations, are retained in the body. The lining membranes are called into requisition to perform the duty of the skin; coryza appears among other symptoms, and the patient is annoyed by a feeling of obstruction in the nostrils, dull, heavy pain in the head, and a stupid feeling. After a day or two there is a copious excretion from the nose, accompanied by arrested secretions, a drying of the skin, and constipation. It is generally supposed that this form of the complaint wears off after a few days or weeks. It may be that the patient omits to notice it, but the wearing off commonly lasts one a good while, the disorder of the nostrils becoming a permanent disease, characterized by ulcers in the pos terior nares, inflamed fauces, and other continuations of the affection. Sometimes the uvula is lengthened and becomes a serious annoyance ; the eustachian tube is liable to obstruction, which results in deafness, and presently the affection of the diseased parts becomes more or less malignant, and extends itself toward the more vital structures with more serious results. The various disorders of the membranes of the trachea, larynx, and bronchi supervene, and the parenchyma of the lung itself is often involved, resulting in consumption. It is, perhaps, to be doubted whether coryza alone (simple cold) would of itself make progress to such a final culmination. The numerous army of blood poisons, however, can generally be found at hand to be set going with this provocation. There is scrofula at every turn, manifest or obscure. Various ill-cured disorders, eczemas, exanthemata, and others, are lurking about in most constitutions; and even the vaccine poison, though often apparently harmless, is an active element in accelerating the progress of the various other maladies. The blood having been once set in ferment by it, nobody knows where it stops, or is ever likely to stop. Where there is the most vaccination, there is the most catarrh, and these complications are among the most serious that physicians encounter. This The ozæna is the common form of catarrh among us. The lining membrane of the nose has become permanently disordered, and is reluctant to take on healthy action. The affection often extends to the frontal sinus, and even to the ethmoid and sphenoid cells. is characterized by tenderness over the eyes, and heat over the forehead, sight often impaired, as well as the hearing, while the taste and smell are chiefly abolished. Sometimes the bone itself is affected, and becoms carious. The patient is usually characterized by a quick, whistling breath; but now a most offensive odor is superadded, disgusting to every one, and most sad and distressing to the sufferer. This state of things continues a longer or shorter period, till all the functions of the physical economy are exhausted and death takes place. Certainly catarrh cannot be justly regarded as a trifle. It is indeed a very serious affair. It more or less disordered the function of hearing, it perverts taste and digestion, and all the organs of the voice are more or less impaired. In the hands of most physicians, catarrh has proved intractable. This arises partly from their failure to understand the pathology of the complaint, and partly from the imperfections of the means to combat it. The text-books have been remiss in their instructions; eminent practitioners considering it as any aggravated cold, or disease, or debility, have contented themselves with a placebo, or some mitigating treatment; and the patient, himself, if he imagines himself getting better, is very apt to attempt the "letting well enough alone," neglecting the further care of himself, and charging the fault to his medical adviser, for which he is himself to blame. The treatment should doubtless be largely alterative and corrective. The habitual constipation ought to be removed, the clothing should be cool rather than warm; over-heating and over-dressing being often alone sufficient to produce or aggravate the symptoms. While the lower part of the body should always be normally warm, the chest, shoulders and head may be with advantage left somewhat cool. The food should be plain, and the amount moderate, and over-eating is to be shunned as a prolific source of mischief. One fourth of the food usually taken, and frequently more than that, can be omitted with advantage. The medicines administered should be given with reference to neutralizing morbid matters, and their expulsion from the body; also to attune the nervous system. Tincture of perchloride of iron, tincture of hydrangea, baptisia, or cypripedium, can all be used to advantage. The nostrils themselves ought to be regularly and carefully cleansed from their morbid secretions. These again taken into the system, whether by swallowing or reabsorption, are both disgusting and mischievous. Many of our worst neuralgic aud eczematous disorders are occasioned in this way, and indigestion and loathing of food are inevitable. Nor does the evil stop here; these are only pickets and signals to give notice of more dangerous and overwhelming foes. The insufflating of water has been recommended for years, but it has never been satisfactory. If warm, the results are more or less troublesome; if cold, the work is not thorough. The sensation is more or less disagreeable, and we have known painful ticdouloureaux and erysipelatous inflammation to follow. The insufflation of glycerine is more . beneficial, but is mechanically difficult and often troublesome, so that few could persist in it till results were beneficial. We have been led, therefore, to use a simple spray apparatus, with a medicated water which would be forcible enough to wash all the affected parts, and cleanse all about the cells and turbinated bones, but yet so gently as to occasion no unpleasant violence to the tender surfaces. The poisonous matter will thus be neutralized on the spot, and removed, and the membranes induced to begin healthy func |