course of treatment is necessary. The skin begins to assume its natural hue; the dilated veins, which have been showing themselves through it, disappear from sight; and, first in one spot, then in several, and finally over the whole surface, the swelling subsides, and the peri-synovial tissues are felt to be restored to their normal state, although occasionally still remaining somewhat thickened. This restoration shows itself at different points with varying rapidity. In the knee, for example, the infiltrated tissues over the external alar ligament are the slowest to recover. course: The process of cure very likely takes the following The serous effusion is first absorbed, after the manner that has previously been described. The newly formed areolar tissue becomes cicatricial, thickening the peri-synovial tissues and the synovial membrane, and, by its contraction, diminishing the calibre (lumen) of the newly formed vessels, so that their walls contract and atrophy. The dilated vessels, under the manipulations, become more or less completely emptied, and their walls are thus enabled to contract by their own elasticity. At first, however, they dilate again between the applications of the treatment, but gradually they more and more regain their proper tonicity. Still further, by means of the stronger frictions, the thinner vessels are ruptured, and blood is effused into the cellular tissue, where it is absorbed; and then the ruptured vessels atrophy. In synovitis granulosa such extravasations often occur during a treatment by massage; but when care is exercised to prevent the effusion of blood from becoming excessive, no bad results ever follow. In synovitis pannosa, as is well known, the cartilages of the joint present a vascular development whose vessels chiefly originate from, and stand in connection with, the newly formed vessels in that portion of the articular tissues which is transitional between the synovial membrane and the joint-surfaces. If we can cause the last-named vessels to atrophy, we may reasonably expect the vessels on the joint-surfaces, with which they are directly connected, to atrophy also; and therefore, in employing massage in such cases of joint-disease, it is of importance to direct a special attention to those portions of the tissue which pass across from one joint-surface to the other. Atrophy of the pannous tissue can still further be promoted in another way; namely, by active and passive movements of the joint. In the foetal state a physiological pannus is de.veloped at those points where, during the condition of rest, the joint-surfaces do not come in contact. The same cause partly determines the existence of a pathological pannus, which also is chiefly developed on those parts of the synovial surface which, on account of a forced condition of rest, do not come in contact. By motion, on the other hand, these pannous surfaces will come together, and their newly formed vessels will be forced to atrophy. Furthermore, every synovial membrane which has been the seat of a hyperplastic inflammation has a tendency, during its process of recovery, towards contraction (indskrumpning). The stiffness of the joint, which is a result of this, may be best counteracted by a timely use of movements. These also promote the circulation of the blood and lymph, and are active agents against that form of muscular atrophy which, as a rule, is present in joint-affections of long standing. Dr. Mezger recommends to his patients, both in acute and chronic cases, a moderate use of the affected joint, to an extent which is limited by the production of pain. Passive movements are also used by him at the same time. He has treated several hundred cases, during the past fourteen years, by his peculiar system, and in no instance has he seen bad results follow upon the moderate use of movements. He is of opinion that many cases pass into the suppurative stage on account of the absolute rest which is enforced by the forms of treatment which are in common use; and those instances of suppuration which have developed while under his own treatment, he thinks would have suffered in the same way, even though manipulation and movements had not been employed. According to the views of Candidate Kiær, Dr. Mezger's chief merit consists in the fact that he has separated massage from the system of therapeutic gymnastics, of which it forms a part, and that he has studied its effects upon disease more thoroughly and completely than has ever been, or could have been, done while it remained in the position of an accessory to other treatment. Mezger has elevated massage to the dignity of chief therapeutic means in his treatment of joint-affections, and passive movements assume with him a secondary importance. Mr. Kiær thinks that no one who has practically observed the effects of his treatment will be disposed to deny that his system of manipulations constitutes one of the most powerful remedies for combating synovitis-acute, chronic, serous, and hyperplastic. At a meeting of the Medical Society of Copenhagen on the 25th of September, 1872, Dr. P. Winge made some practical remarks upon Mezger's method of treating various forms of disease by massage, which he had personally examined during a visit of three weeks' duration at Bonn. (Norsk Mag. for Læg., 3d Ser., 2d Vol., No. 11.) He describes it briefly as consisting essentially in kneading, rolling, percussing, and rubbing the parts which are the subjects for treatment. Whenever these are hairy, Dr. Mezger has them shaved before commencing his treatment, for when this is omitted the manipulations are apt to excite an inflammation about the roots of the hairs, and must be suspended until it subsides. The operator sits in front of his patient on a low stool, and begins by oiling the part with perfumed lard. He rubs strongly whenever indurations, infiltrations, or effusions are to be dealt with, and follows from below upwards the course of the lymphatic vessels in the extremities. When the knee-joint is the subject of treatment, he works across the joint with the fingers of one hand, on both sides, below the patella, pressing inwards with more or less force; while the fingers of the other hand work in the same manner, upwards along both sides of the patella, over the capsular ligament, or any ligament which is felt to be swollen. This process is continued from three to five minutes. He then grasps the joint with his right hand, and, pressing firmly, rubs upwards over the patella, as high as the superior insertion of the investing ligaments. This is repeated a number of times, varying according to the circumstances of the case. The applications are repeated once or twice every day. As the method of procedure is the same in principle. for the other joints (the hip-joint, as we have already seen, being seldom treated by massage), this single example will suffice. Passing over Dr. Winge's explanation of the theory of the mode of action of massage in synovitis, which is essentially the same as that which has been much better expressed by Candidate Kiær, I will give a few of the cases which he reports as having been treated by Dr. Mezger under his own observation. It is to be regretted that his visit continued only three weeks, for he was unable to follow up the ultimate results in any case. CASE I.—A merchant, aged sixty-two, twenty years ago had a synovitis of the left knee, which subsided under rest and other treatment, and left him well. Ten years ago he injured the same joint by being thrown from a wagon. A large effusion resulted, which was absorbed after a time, but was followed by several relapses, and the patient walked with difficulty and uncertainty, being very liable to falls. Mezger diagnosticated a chronic synovitis levis, pannosa, and treated him three times a day by massage. Dr. Winge saw fifty applications made, and reports that the improvement, up to the time of his departure from Bonn, was very decided. CASE II. A gentleman, aged forty-five, had had disease of the left hip-joint when he was five years of age. Twenty years ago was attacked with an inflammation of the left knee, and received treatment for a year, recovering with a stiff joint, and a subluxation backwards of the leg on the thigh. Five and a half years ago he had another attack of inflammation in the knee, attended with pain and loss of power of locomotion. He came to Mezger on crutches. A diagnosis was made of synovitis chronica, hyperplastica, levis, cum ankylose. After eight days of treatment by massage, the patient could walk with the aid of a cane. The ankylosis and the posterior subluxation were of course unaltered, but the inflammation was removed. In treating synovitis of the ankle-joint, which is complicated with flat-foot (talipes valgus), Dr. Mezger either treats both conditions at once, or waits until he has improved the position of the foot before he proceeds to treat the joint-inflammation. To accomplish the latter he arranges the shoe so that the inside of the foot is well supported, and brings the heel forward under the plantar arch. In chronic rheumatic inflammations of the joints, accompanied by stiffness and contractures, Mezger gives a tolerably good prognosis when the soft parts alone are involved; but when the bony and cartilaginous tissues are invaded, his prognosis is decidedly unfavorable. He never uses chloroform in treating such cases, because he does not employ very forcible manipulations and movements. He often ruptures pseudo-membranous formations; but he carefully avoids exciting an inflammatory reaction, which might result in the production of stronger adhesions than before existed, and thus render his treatment more harmful than beneficial. Rheumatic distortions of the fingers, when treated by his method, are sometimes very painful: the wrist-joint is less so. The anklejoint is apt to be more painful under treatment than the knee, but much less than the fingers and wrist. CASE III-A gentleman, aged fifty-eight, had suffered from rheumatism for a long time, and for the past year had had a persistent swelling and infiltration in the fingers and wrists; the thumbs not being involved. When he came to Dr. Mezger he was so helpless that he could neither open a door nor dress himself. He was treated at first by massage, and then by flexion and extension of the stiffened joints, for the purpose of rupturing the pseudo-membranes. In the three weeks that he remained under Dr. Winge's observation he improved so much that he could flex his wrists very well, and could write his name; but the fingers still remained quite stiff. CASE IV.-An officer, aged thirty, with an inherited tendency to gout and rheumatism, was attacked with a rheumatic inflammation in both ankle-joints during the Austrian war in 1866. He recovered under the treatment which he received at that time. In 1870 he took part in the French war, and again was attacked with rheumatism of the ankle-joints. When he came to Dr. Mezger he could scarcely walk, and there was a good deal of infiltration present, especially about the malleoli. His ankles were at first submitted to massage, and then flexed, extended and rotated, to rupture the pseudo-membranes. His improvement was very rapid: after two weeks of treatment he went home well. CASE V. is that of a young Hollander who sprained his ankle severely a few days before coming to Dr. Mezger. He complained of great pain on pressure, or on attempting to use the joint, and there were large ecchymoses beneath the skin about the ankle. Massage was commenced at once, notwithstanding the pain which it excited in the beginning, and after six applications (three days) the patient was entirely well, and able to jump down from a sofa to the floor without causing himself the slightest pain. After describing these and similar examples of the good effects of Dr. Mezger's method in joint-affections, Dr. Winge went on to give an account of his treatment, by the same means, of various other conditions, such as muscular atrophy, neuralgia, mastitis, chronic ulcers, etc. These do not now concern us, and we will follow him no further, but turn to a paper by Professor Nicolaysen in opposition to Mezger's system of treating joint-diseases (Norsk Mag. for Læg., 3d Ser., 3d Vol., No. 1). The professor denies that Mezger has the right to claim the credit of having developed a new method of treatment, since massage, as he understands it, is merely a form of manipulation which has been and is used in many other parts of the world; and he gives a historical survey in support of his statement. He admits that massage is of great value in the treatment of sprains; but in inflammations of the joints he would restrict its employment entirely to the after-effects of disease; laying down the rule that all inflammation must have subsided before manipulations or movements can be at all permissible. This extreme conservatism, on the other hand, has been attacked by the Danish supporters of Mezger's system, on the grounds that it is partly based upon theoretical objections, and partly on Nicolaysen's omission to carry out, in the treatment of joint-diseases by massage, the rules of procedure which Dr. Mezger has laid down as essential to success. when agitated, has an agreeable sparkling appearance. Its odor is that of hydro-sulphuric acid mixed with earth or clay, the latter being retained after the hydrosulphuric acid is dissipated or destroyed. In taste it is hepatic, cooling, and invigorating. By ebullition it does not immediately become turbid, gases escape, and when reduced in volume by evaporation, deposition takes place. The specific gravity of this water, compared with pure water at the same temperature and pressure, equals 1.00029. Its temperature is 54° F. Chemical Analysis.-Fifty thousand grains (about seven pints) of the water, from which the hydro-sulphuric acid had been removed, afforded by the usual processes 2698 grains measure of gases, or one volume of gases from 184 volumes of the water. re-dissolve it. It has no acid action on test fluids, but bears that character with bases, and forms compounds analogous to salts. In its decomposition, ammonia is formed, and hydro-sulphuric acid is liberated; or if heat be employed in the experiment, sulphur is separated. It combines with the oxide of silver, and forms a salt of a reddish-purple color, in the form of flocculent precipitate, which dissolves in pure water; with the oxide of lead, a yellowish-white powder; and with the oxide of copper, a pale-blue salt in fine powder. In these compounds it remains unaltered, and may be separated from them and transferred to other bases. Mixed with a small quantity of water, and exposed to the temperature of 80° F., it decomposes, and emits a most offensive odor of putrefying matter with hydrosulphuric acid gas. It is to this property that the hydro-sulphuric acid gas in the water is due, and to the oxidation of a part of this compound most of the sulphuric acid found in the compound may be referred. There are traces of chlorine in some specimens, but at most only 0.13 grs. of chloride of silver could be separated from 10,000 grs. of water; this substance being rarely absent from natural waters that have penetrated the earth. This substance (sulphur compound) was thought to be analogous with barégine and glairine of the Eaux-Bonnes and Cauterets in the Pyrenees, but Dr. Hays thinks it is a substance new and peculiar, and seems to be an azotized base, and so combined as to neutralize the distinctive characters of sulphur. The hydro-sulphuric acid gas found in the water is produced through the agency of this body ; either by its action on the sulphates present, or more probably the substance disengages hydro-sulphuric acid before reaching the surface of the earth, abstracting oxygen from air already dissolved in the water. It is in favor of this view that less oxygen is in this than in common water. I believe no trace of uncombined sulphur can be found in it in its fresh state; and when I fermented it, “hydro-sulphuric acid" was the form it appeared in. All the sulphur in this compound is therefore fitted to be absorbed in the animal system-an important medical fact; and it is therefore more than probable that the sulphur compound in this water is the principal medicinal agent contained in it, although its action in combination with other constituents may be necessary to produce the effects for which this water is so justly celebrated.* Its action. The action of this water when taken into the system is cathartic, narcotic, diuretic, diaphoretic, sedative, alterative, and tonic. The most marked effect of this water is a reduction of the pulse. It has been known to diminish it from 10 to 20 pulsations in 24 hours. In my own case, on the evening of my arrival, it was 89; the next morning it was 69. Its action in this respect resembles digitalis. It increases the volume, and diminishes the pulsations. Its sedative action is most marked in moderately small doses, say four to six glasses per diem. In larger doses it acts like the infusion of digitalis as a diuretic. In small doses of two to three glasses per diem it acts as a cathartic, producing very often full and even copious evacuations. This is most always observable at first on commencing the use of the water, but the cathartic effect soon subsides; and if not, can be easily controlled by exercise, warm baths, or small doses of opium. In larger doses, from twelve to thirteen glasses per diem, it produces free diuresis and constipation. The latter symptom may easily be obviated by using a teaspoonful of table-salt in a glass of water before breakfast. It acts ginia. * See Dr. Burk's book, On the Action of the Mineral Waters of Vir freely as a diaphoretic if exercise be freely taken directly after drinking, which modifies very materially the excessive cathartic or diuretic action. Its action as a soporific is decidedly marked; patients that have been unable to sleep for months soon enjoy a calm, refreshing sleep. Its tonic action I believe is by improving the appetite, which is always improved after drinking the waters for a short time, and I may remark is characteristic of all sulphur waters. As an alterative its effects are shown very markedly, especially in phthisical persons, by a more free respiration. Very often the first thing that convinces the consumptive that he is improving, is that he "breathes easier." The expectoration is increased at first, but the patient expectorates more easily, and soon the expectoration becomes thicker, less in quantity, and finally disappears. I can recall one case where the cough entirely disappeared in four weeks from the use of the water. One patient in particular, who was troubled with night sweats for the past six months, was entirely cured in ten days by the faithful use of the water. The introduction of this water into the system exerts a great influence on the circulation, and consequently on the mucous surfaces that are in a morbid condition; and when we consider that the greater portion of the fluids taken into the stomach are directly conveyed into the circulation by the absorbents, we can at once perceive that the great hygienic power of this water is dependent on the characteristics enumerated, all of which, combined, act as a singular alterative in equalizing an excited circulation, in correcting the highly acrid and vitiated secretions of an irritated mucous membrane, by modifying the fluid that supplies the matter for that secretion; and that by sending to the heart and lungs also a modified supply of blood, it calms these organs by producing in the latter a condition favorable to the proper performance of the functions of oxygenation, and by soothing the irritation of the former, causing it to send forth its stream with a milder impetus; and moreover, by diffusing more equally the capillary circulation, and in return obtaining not only a more moderate, but a more healthy supply. Having thus briefly considered the action of the water, I will now enumerate the diseases in which I have seen the waters beneficial, and the vast experience of others who have long watched its action. These diseases are: chronic phthisis, chronic laryngitis, chronic bronchitis, subacute pleurisy, pericarditis with effusion, hydrothorax, functional disease of the heart, nervous irritability, hypertrophy of the heart, Bright's disease, cirrhosis associated with ascites.' The sec night sweats, at the same time to increase the flesh, Having enumerated those diseases which experience has proven are best benefited by the waters, I will close this article with a brief consideration of the place, its location, etc. The Red Sulphur Springs are situated in Monroe Co., West Virginia. They are best reached by taking the Chesapeake and Ohio Railroad to Talcott station, thence by stage thirteen miles to the Springs, or the Virginia & Tennessee Railroad to Dublin station, thence by stage forty miles. They are situated in a valley, surrounded on two sides by lofty mountains. The springs are situated at the south-west portion of the valley, and the water is collected into two marble basins, sheltered by a noble pavilion in the form of a Grecian temple; this structure alone was erected at a cost of $6,000. The buildings are situated at the bases of these mountains,-a most wonderful mistake, as there is ground within three hundred yards adjacent, which is a most delightful site for hotel buildings. The These buildings were erected in 1840, and since the war the place as well as the buildings has been suffered to run down; still, the buildings are comfortable (though somewhat damp), and in a dry season are comfortable enough for all patients. The great drawback to the Springs is the location of the buildings, built at the bases of the mountains, which is quite damp. They are subject to dense fogs every morning, and the sun disappears behind the mountains about 4 o'clock in the afternoon. But in spite of the serious drawbacks, invalids, and consumptives at that, do improve often in the dampest seasons. What is needed is an enterprising stock company to buy the Springs. lands, including the springs and grounds, are estimated at 1,400 acres, and can be purchased for $25,000. If the buildings were in a suitable place, so that invalids could have the sun continually, where dryness and pure air could be freely enjoyed, which may easily be done, I am satisfied that the Red Sulphur Springs would rank first among curative waters, and would justly bear the name "EXCELSIOR." For when a mineral water is found that will cure or even alleviate pulmonary phthisis, we may all rest assured that it will be a great resort for thousands from far and near. It is not, however, necessary to go to the Springs to get the virtues of the water, as it can be bottled. The writer of this bears testimony to having used it for the past month at home. The water keeps better in cool weather, as heat seems to cause a precipeffect of this water in reducing the pulse is one of the numerous, sin-itate. It is very volatile, and does not keep well after gular, and powerful properties belonging to it. It lessens arterial ac- being uncorked. When well kept it seems to act just tion to such a degree, that it seldom fails to remove fever, difficulty in breathing, and pain in the chest. proper regimen, this water may be taken with greater advantage in pulmonary cases than any other remedy I have seen employed for that purpose. It is also an important remedy in enlarged spleen and liver, and in discases of the mucous membranes generally." This water is contra-indicated in all acute diseases, in plethora or apoplectic tendencies, in chronic diarrhoea and dysentery,† in acute and far advanced phthisis, especially phthisis associated with diarrhoea, and in any acute disease of the heart or lungs. There are two stages of phthisis in which the Red Sulphur water gives prompt and decided relief. One is where the deposit is small and the development slow, associated with occasional hemorrhages. In such cases the water seems to arrest the deposition, to control the In these two latter diseases the waters deserve a trial; no cases, to my knowledge, bave tried the waters. I have thought best to exclude diarrhoea and dysentery from the Hist, as the Rockbridge alum-water is much more efficacious. Dr. R. Bradford, who practised medicine at the Red Sulphur, says: "The as well as at the Springs. When the patient is restricted to the I have been careful not to overestimate anything in regard to this water. I do not consider it by any means a panacea for consumption, and cases that are selected for its use require judgment. It does now and then fail in best-selected cases, but it is easy to know this; when the water increases the pulse, produces fever and constriction of the chest, it is not adapted,---those cases seem to be in the proportion of one in fifty. The water seems to act more efficaciously when active exercise is combined. It is incompatible with stimulants as a rule, though some patients are benefited by the combination. Vegetables are, as a rule, incompatible. The most agreeable and nutritious way of drinking the water is with cream and milk, and I do not find it incompatible with cod-liver oil, which is my daily medicine-Red-Sulphur water, cream, milk, and cod-liver oil. In conclusion, I will truthfully state, that having been an invalid for the past four years, having sought many climes, including boasting Colorado, I have never, since my illness, enjoyed better health since the five weeks spent at the Red Sulphur Springs, and four months on a farm in the glorious Piedmont valley of Virginia. AN ABORTIVE METHOD OF TREATMENT IN CERTAIN CASES OF CORYZA AND ACUTE INFLAMMATION OF THE FRONTAL SINUSES. By J. S. PROUT, M.D., OF BROOKLYN, N. Y. I WILL say nothing of the symptoms of coryza, as probably all of my readers have had one or more attacks; but will remark that, in my own experience, the characteristic symptoms of frontal catarrh, as I call the inflammation of the frontal sinuses, are a dull, heavy frontal ache, not to be accounted for by the coexistence of gastric disturbance or biliousness, and a very painful feeling of distention in the frontal region in stooping forward. The treatment is unsatisfactory to a high degree. Niemeyer, in his Text-Book of Practical Medicine (Translation, Vol. I., p. 291), says: "Various abortive methods of treatment for acute nasal catarrh have been proposed; but none of them" (he mentions six) "have obtained general approval." Among other things he recommends the Russian bath. Cohen, in his excellent work on the Discases of the Throat, mentions various remedies that may be tried. He speaks of three, any one of which will generally cause a coryza to abort: 1st, a grain or so of opium; 2d, a dose of alcohol at bed-time; or 3d, the inhalation of chloroform. We may try these means on ourselves, if we choosebut for obvious reasons we cannot trust our patients with them. We need a remedy that is safe, easy to use, that we can put in the hands of our patients without fear of unfortunate results, and that does not waste our time; a remedy that physicians in their own persons, as well as the laity, will not consider worse than the disease itself. Let me, then, without further introduction, state that I have, in my own person, and with patients, often been able to arrest the disease in the course of an hour or less, by taking or giving large doses of the officinal tincture of the chloride of iron, 20 or 30 minims, as soon as possible after the cold is "caught." I generally find that in about half an hour there is a decided amelioration of the symptoms, which may be permanent, in which case I take or give no more of the tincture, or the improvement may pass off in two or three hours; in which case, the dose must be repeated. This may be required three or four times. I have had numerous attacks of frontal catarrh, which I have thus caused to abort. I have had the same good fortune with coryzas accompanied by sorethroat. In other cases, perhaps on account of greater severity or from delay in commencing the treatment, I have not obtained permanent benefit from the use of the tincture. In my hands, therefore, it is not a specific. On the 21st October of this year, I called the attention of the members of our County Medical Society to this method of treating coryzas. I have recently received a note from a member of the Society, Dr. Edson, who was present at the meeting referred to, giving his experience in regard to it, which is so entirely satisfactory and in accord with my own, that I prefer to copy it, as the record of an unprejudiced observer, rather than detail any of my own observations, which might appear unduly partial. He writes (Nov. 28th) : "Mr. B., a lawyer, has for years been particularly subject to colds, with frontal headache, difficulty in respiration, and the other usual attending symptoms. He usually spoke of himself as being a sufferer from catarrh. During the months of August and September his affection generally assumed a severer form, not very unlike hay-asthma. "Upon returning home on the evening on which you spoke before the Medical Society of the successful use of the muriated tincture of iron in similar cases, I found Mr. B. in the early stage of one of his attacks, sneezing and wheezing,' with creeping chills, eyes suffused, etc., etc., presenting that peculiarly disconsolate appearance so general in this complaint. I suggested to him to try the tincture in half-drachm doses, repeated if necessary. In less than half an hour after taking the first dose he expressed himself as feeling decided relief. Another dose in due time, and his attack was cut short, decidedly aborted. Since that time, whenever he feels the hand of his old enemy upon him, he takes a timely dose of the tincture, and thus far with the happiest results. ́“This is one of several cases in which I have prescribed this remedy for similar affections, and with such marked advantage that I have great confidence in its efficiency in this class of cases. "Yours very truly, S. One teaspoonful in a wine-glassful of cold water, through a glass tube, to be repeated according to circumstances. The glycerine in part conceals the iron taste. There is a slight diuretic action. I have found no unpleasant effect on the bowels, and only a slight feeling of discomfort, which soon passed off, when it was taken on an entirely empty stomach. How are we to explain this action of the iron tincture? Dr. T. Clifford Albutt, an excellent observer, says: "In iron we have two kinds of value; its value in ordinary small doses and in mild forms" (he is speaking of neuralgia), "when it removes simple anamia; and its value in large doses-doses such as half |