Florida and all along the Gulf sea coast has long been recommended for consumptives. But that is a mistake. I have tried it.

After doing an extensive country practice for 26 years, during which time I never turned off a call on account of bad weather, my health broke down. I had a bad cough. I was generally and greatly debilitated. I had fever at times and night sweats. I went to the Gulf shorestayed principally at Biloxi, Miss. I was in Florida and in every town from the Florida line to Galveston. I found them all alike the finest climate in the world. Right thru January I saw the ladies. carrying their parasols to keep off the sunshine, and fanning themselves while at church. The flowers were blooming, the grass was growing, the birds were chirping and the leaves on the trees were green. So far so good. This was thru the fall and winter and spring of 1890-91.

But the objection to this region is that the atmosphere is heavy and damp. The dews and fogs are excessive. Breathing is oppressive to any weak lunged person.

If such a person can escape a northern winter and give his weakened lungs a chance to heal, he would better do so. But there are other and better places to visit for such purpose.

I returned home in the summer of 1891, not much benefitted. After remaining at home a few weeks I went to Boerne, Texas, where I found an elevation above sea level of 1600 feet. No dews or fogs to amount to anything. The site of the town is high and dry. The atmosphere is pure, there being no swamps or bogs within 100 miles. I soon learned I had struck the right place. I remained at Boerne nearly two years, and came home sound and well. I am now in the fifth winter since my return, and I am still able to attend to my practice altho I am 61 years old.

While there I saw many invalids from the north and east who had gone, some to Colorado, some to California, Arizona, and other places of high altitude-all getting down into this hilly country above San Antonio; and all agreed that Boerne was the best place for consumptives; and they all agreed, too, that those localities of high altitude had an atmo

How to Cure Colds and Coughs. Editor MEDICAL WORLD :-As soon as

you discover that you have taken cold, before the fire for an hour, eat plenty of take an active cathartic, heat the feet salt and drink plenty of cold water. Let hot drinks alone.

To cure a cough: To 4 oz. of alcohol, add one teaspoonful of chloroform; shake well. Dose, from 10 to 20 drops, every time you cough; clean the nostrils inside and out. well and lubricate with oil or vaseline

W. B. RADFORD, M. D.

Suggested in Chronic Rheumatism. Editor MEDICAL WORLD:-A correspondent in the December WORLD asks a question that has interested me as well: What is the composition of the "knockout-drops?" The facts of the case appear to be illustrated in the following history: A physician came from a distant city to consult me concerning his health. Arriving in Chicago in the evening, he put up at a hotel in a bad neighborhood. Strolling into the barroom, he called for a glass of beer, drank it, and knew no more until he regained consciousness two days later, to find himself minus a gold watch and chain and his money. Now what drugs are capable of producing an effect so instantaneous and so powerful? Obviously not an opiate, since even if morphine were injected into a vein we would scarcely have its action so speedily. Hyoscein was thought of, as in certain instances I have obtained similar effects, though not so lasting. Given hypodermically, in

doses of gr. bo to gr. 1, the patient has been found several hours later in the same posture as when the dose was administered. But hyoscein is not uniform in its effects; it sometimes produces atropine symptoms, wakefulness, redness of the face, delirium and dilated pupils, the patient being quite excited and noisy. And even when it produces instant sleep, this does not last more than eight hours at the most; and an increase of the dose does not correspondingly lengthen the period of slumber. Moreover, it seems Moreover, it seems unlikely that the thugs should be acquainted with the properties of hyoscein, a rare drug, but little employed by phy: sicians, excepting in insane asylums and by a few specialists.

I have been told, however, that the "knock-out drops " are really composed of tincture of cocculus indicus. This drug and its active principle, picrotoxin, are still less familiar than hyoscein. Cocculus indicus, under the name of fish-berries, has long been employed as a domestic remedy for pediculi, which it destroys with certainty.

I have recently administered picrotoxin in two cases of chronic lateral myelitis with benefit. But in the rather contradictory, and scanty reports in scanty reports in the books, there is nothing to account for its "knock-out" effects. It seems that this drug is worthy of more extended study than has been given it. It is not mentioned by Wood, Hare or Ringer, and has only three lines in Nothnagel. I have recently been putting to practical test a suggestion made to me by a correspondent, that intestinal antiseptics would prove useful in the chronic forms of rheumatism. There is something There is something peculiar about this affection. It does not follow an acute attack, there is neither fever, sweating nor acid urine; the joints become stiff and sore, and the patient is distinctly better or worse according to the weather. Yet, the salicylates have very little if any good effect, and the urine can be rendered alkaline by lithium benzoate in doses of g%, repeated hourly. If this be rheumatism it is clearly very unlike the acute form. It is my belief that the pathologists will eventually show us that the disease depends upon some other cause, chemical or microbic, than that of true rheuma

tism. At any rate, I have found decided benefit from the administration of the sulphocarbolates of soda, zinc and lime, in doses of twenty to forty grains daily. In young people with feeble cell structure, I use the lime salts; in older subjects who have already too much lime I prefer the soda; while in neurotics and cases where the bowels are loose or the stools unusually offensive the sulphocarbolate of zinc is my preference. In all cases these rules are to be observed: the bowels must be absolutely emptied (an aggravation of the pan being sure to follow when old deposits are stirred up) and kept free the diet must not contain an excess of nitroge; the patient must dress completely in wool, and must bathe daily. Stiff joints should be daily rubbed with some hot animal oil, such as goose grease or lard. The feet must be properly protected, and sufficient outdoor exercise taken to insure good digestion.

WILLIAM F. WAUGH, M. D.

108 State street, Chicago, Ill.

Diphtheritic Croup and Antitoxine. Editor MEDICAL WORLD: I wish to express my confidence in antitoxine for the treatment of diphtheritic croup. I am confident that with intubation and antitoxine, used early, we can save 80 per cent of these cases, where without these valuable agents we lose 9934 per cent. I am satisfied, in my mind, that 98 per cent. of these cases are true diphtheria. Possibly about 2 per cent. belong to the streptococcus infection, as we know that the streptococcus has the power of producing a membrane. Of course, this would not be contagious, and intubation alone would save these cases, if the infection is not too malignant. nant. I have never used the streptococcus antitoxine serum, but should I have a case that would not yield to the diphtheria antitoxine, i. e., did not show an improvement in the disease after a full heavy dose of antitoxine, I shall use the streptococcus serum. I lost my first three cases that I used antitoxine on. I wish to state here that I am speaking of laryngeal cases. I have never used antitoxine in the faucal cases simply because of the expense; and my treatment outside of the laryngeal cases has

been entirely satisfactory. I feel confident that I could save those three cases and cure them now. I gave 1,000 units every twenty-four hours, which was a snare and a delusion; that was not antitoxine treatment at all, for severe cases as they were. The point is to fill the system full of antitoxine. Give it according to the severity of the case. If a case is very severe, give 2,000 units at one injection, and repeat in eight hours with another 1,000 units, and keep this up every eight, ten, twelve or twenty-four hours, according to the impression you have made on the disease. But I will assure you that you will make an impression. There is no fact established in therapeutics in which

I have more confidence.

Aside from this specific treatment, you want to keep the various excretory organs at work. For the kidneys nothing is better than cream of tartar, two drams to a glass of water, and a teaspoonful to be given ad libitum. Give the little patient a daily hot bath; allow him to sit down in the bath tub and keep him in the water from five to ten minutes. Mop his tongne off and rinse his mouth with a 50 per cent. solution of peroxide of hydrogen; this antisepticizes the mouth and prevents reinfection. Burn all rags used for handkerchiefs; change sheets and pillow cases every day. Give strychnia every six hours in the proper dose to sustain heart and vasomotor system.

I believe every case should be intubated early. Whenever the breathing becomes difficult and the patient restless, intubate. It saves nerve force, allows the patient to have the proper amount of sleep and composure, which is so essential to any severe disease. There is no harm in passing these tubes, if done by a skilled and gentle operator. I wish to give you the history of a very severe case that I have just discharged a cured boy. Luther H., age 5 years; father died of tuberculosis at the age of 28 years. Mother 25 years old, with a tubercular taint on her mother's side. The child has always been delicate, has enlarged tonsils, and subject to acute attacks of tonsilitis.

On the last of November the boy came down with what the mother thought to

In

be one of his tonsilitis attacks; on the second day of his sickness he became hoarse, and on the third day I was called. I found him with temperature 100, pulse 120, tongue heavily coated, eyes dull, giving the expression of a severe toxemia. Cough shrill and croupy; respiration slightly obstructed; tonsils had a patch of membrane size of little finger nail on them. This was late in the day, and I had to send 15 miles for antitoxine. 12 hours the case had grown desperate; it looked like two more hours would have relieved him from the cares of this mundane sphere. I intubated at once, and waited a few moments for the oxygen to dispel the carbonic acid gas, then I gave him antitoxine, dose 2,000 units. I followed by a dose of 1,000 units every ten hours. Altogether he took 6,000 units. I kept the tube in six days; never had it out. He possibly could have gotten along without it sooner, but as he was doing so well I left it in six days. I also carried out the other treatment that I have already related, and he made a splendid recovery.

Cornelia, Mo. J. T. ANDERSON.

Report of Seven Cases of Diphtheria Treated

with Antitoxin.

Editor MEDICAL WORLD:-Case No. 1: A little child three years old had had laryngeal diphtheria for three days. A sister had died the previous week from diphtheria, and three others, two brothers and a sister, were then convalescing from the same disease. When called to see the little sufferer he was attended by a quack botanical doctor who was giving him tincture of lobelia every half hour. He was gasping for breath with what little strength yet remained. I at once injected 1000 units of antitoxin and had them stop the use of lobelia, and instead gave whisky and strychnine to keep up the action of the heart. I called next day to find my patient breathing much better. Then having no more antitoxin, ordered calomel sublimations and peroxide of hydrogen spray and continued use of whisky and strychnia. On the eve of second day I again called to find my little patient breathing without making a particle of noise and to all appearances perfectly well.

Case No. 2.-My own child, aged

twenty months, had had a diphtheritic patch on one tonsil with fever for only eight hours. Injected 500 units of antitoxin and gave nothing else, with the result that in thirty-six hours the membrane had disappeared, but the swelling of the glands and the fever had subsided in about twelve hours after the injection.

Case No. 3-A school girl of twelve summers had had a sore throat for three days. On inspection I found that the tonsils were covered with a dirty yellow false membrane; temperature was 102°. I at once injected 1000 units of antitoxine and had her gargle the throat with a solution made of Seiler's tablets. In twenty-four hours I saw her again. She was sitting up feeling much better, having a temperature of 100°. The membrane seemed to be breaking down. On the next day I saw her again; her temperature was normal and the false membrane had entirely disappeared.

Case No. 4.-A boy, aged 10, had been sick about seventy-two hours. Had a Had a large membrane covering one tonsil, uvula and soft palate. This case was seen in connection with Dr. John R. Morehead. We injected 1000 units of antitoxin; would have injected 1500 or 2000 units if we had had it. The boy could not talk or swallow. Temperature 102. In twenty-four hours he could talk and swallow, and the swelling, which was considerable at angle of jaw, was reduced. In sixty hours after the injection the membrane had disappeared entirely.

Case No. 5.-Little girl, aged 4, had diphtheria four days; no treatment. She had large membrane over both tonsils, brownish yellow in color; temperature 103°; pulse 130. Under strict aseptic precautions I injected 1000 units of antitoxin. I saw her no more, but her father told me that the membrane came off within forty-eight hours, and all other symptoms as rapidly vanished.

Case No. 6.-A miss of 16, had diphtheria three days and a half. Her temperature was 103°. Membrane covered both tonsils. Injected 1000 units of antitoxin, and in and in thirty-two hours exactly the membrane came away and the other symptoms as rapidly vanished.

Case No. 7.-A child, aged 16 months,

had membranous croup. I was called on the fourth day, and at once injected 1000 units of antitoxin; as a double precaution had them spray throat with a solution of hydrogen dioxide and lime water equal parts; also to use calomel sublimations under an improvised croup tent. The result was that in thirty-six hours the child was well.

In not a single instance was there any reformation of the false membrane in any of the above cases. And in every case there was marked improvement within twenty-four hours, some in less time than that. I am satisfied that some of them would have recovered in still less time. had they had 1,500 or 2,000 units instead of 1,000. There was no untoward effect in any case more than the slight soreness at site of injection. Every case was injected under the strictest aseptic precautions. All but one, my own child, were injected in the abdomen. I noticed that my child could not rest on his back on account of the soreness at the site of injection. By injecting in the abdominal region such interference with the rest of the child is obviated. Dixon, Ky.

C. M. SMITH, M. D.

Impotence.-Sexual Neurasthenia.
(Concluded from December WORLD, pages 507-508.)

Editor MEDICAL WORLD: In the first

paper the causes of impotence were considered. We now come to the important subject of

Treatment.

This will vary with the age, sex and condition, as well as the habits of the patient. patient. The underlying cause should also receive careful attention. With many the prime factor is excessive indulgence; with others, business or domestic worriments; with still others, advancing age, coupled with one or more of the other causes mentioned in the first paper.

The most difficult class with which we have to deal is the men of fifty years and over, who wish to retain the vigor of youth. They cannot understand why they cannot at once be rehabilitated and kept so. A typical case will illustrate : Mr. R., fifty-two years of age; strong, healthy, vigorous, good appetite, sleeps

well and has nothing the matter with him, except that erections are imperfect and at times quite impossible. Has several "friends" with whom it is pleasant to spend a half hour or so frequently. Upon electrical examination we will find the reactions nearly all normal excepting in the brain and spinal cord. There will be abnormal tenderness over the lumbar and gluteal regions. There may There may or may not be any tender spots in the cord itself; this will depend upon the cause of the impotence.

The examination is conducted in the following manner: Have the patient remove the upper clothing; drop the lower garments and seat him upon a stool on which is a well-wetted pad connected with the positive pole of a faradic battery. Apply the negative to the nape of the neck, turn on just enough current to be very distinctly felt, and slowly pass the electrode down upon one side of the spinal column, noting the variation of sensation, if any. In some neurasthenics you will and tender spots between the shoulder blades or just below, the tenderness following the line of the nerves partly around the sides and occasionally forming an almost complete girdle. Passing still further down, we note more or less tenderness over the lumbar and gluteal regions, as before stated. In some cases this is so great that not only is the mildest current unendurable, but the slighest touch of the fingers causes intense discomfort. In such condition the patient is more or less hysterical; unable to control his emotions; laughs or even cries, much to his annoyance.

Both sides of the spinal cord react in like manner.

Passing around to the abdomen, an abnormal sensitiveness may be found in the inguinal region and down the inside of the thighs. These symptoms will be more or less exaggerated according to the severity of the case.

Any kind or size of faradic battery may be used for diagnosis, but only the best make should be used for the treatment.

We select the fine secondary coil, remove the cylinder covering the coil and regulate the current with a suitable controller. The current direction is now

reversed and a large broad pad applied to the back. Turn on sufficient current to be pleasant and go over the whole of the affected region with the anode to subdue the irritability. The sitting may last for twenty minutes and should be repeated every other day at least. In some cases I use it every day. After a half dozen or so treatments, if the sensitiveness has been sufficiently reduced, we may apply one pole to the genitals, using an electrode, say two inches wide and six in ches long, covered with a wet towel, and keep the broad one on the back. The one upon which the patient sits may or not be removed. With my apparatus this is done by a switch cutting it out of the circuit. While the whole lumbar and sacral region should receive attention, especial care should be given to the genito-spinal centre, situated at about the fourth lumbar vertebra. Use a current of moderate intensity, with a sitting of twenty to thirty minutes every day or every other day.

Where the sensitiveness is of a minor degree, frequent reversals of the current will be most beneficial. This should be done without shock.

In cases where the urethra is not sensitive a metallic sound may be introduced and used as an electrode with the faradic current only. A current plainly perceptible to the patient should be used with sittings of five minutes. In some cases the current may be reversed, but a moderate swelling current is better. This is given by more or less rapidly increas ing and decreasing the current by mean of the controller. At no time should it be painful.

Where there is hyperesthesia o the urethra, and especially if it be in an inflammatory condition, inject a 4 per cent. solution of cocaine, pass in a Neuman bougie, such as is used to reduce strictures, attach the galvanic anode, turn on three ma. of current and slowly with. draw the instrument, the time occupied being one minute. When at the meatus remove the bougie quickly without waiting to turn off the current. Repeat every day or every other day as may be convenient.

As a rule the anode is not used with a metal instrument, but as the electrode is not allowed to rest for an appreciable