and then a brother were stricken with it; then I began to look for some unheard of weapon to slay the enemy. I flattered myself with more sense than to try tuberculin, having never been schooled in serum therapy. Medicine I already knew had never vanquished him. I was totally unarmed, but I did summon all my reserve force and met him on his own ground. I began to study tuberculosis, the patients as well as the disease. I find we can do a great deal. It is true not many get well, but we can keep them going. They can attend to their business. We do not cure syphilis in two or three months, and when we relieve a rheumatic we are called on again a half dozen times the same year, and the uric acid diathesis we have always with us. Will you please write a series of articles on tuberculosis for the general practitioner? I suggest as the title, "Home Treatment of the Consumptive." If you knew how little is done for them I believe you would.

I have used nuclein hypodermatically, but do not believe it does any good. I have them take bovinine, one and onehalf teaspoonfuls every three or four hours, in ice cold water in summer and in sweet milk in winter. This causes a gain in strength every time. Phillips' emulsion of cod liver oil, taken at regular meal time, improves the most of them. Beechwood creosote can be given to the majority of patients in sixty grain daily doses if the dose is increased a drop a day, provided all the functions are looked after, but the time comes when the stomach or kidneys, or both, will not bear it; then the more costly carbonates can be given. They cost so much I have to make them know they are improving before they will buy it. Baths to cleanse the skin, sprays to cleanse the throat, the sulphocarbolates or beta-naphthol, to cleanse the bowels, good diet, bovinine in all cases, emulsion of cod liver oil, to those whose expectoration is difficult, and plenty of horse back exercise when they are physically able-with these, patients gain in weight and strength. There are suggestions in your article in the December WORLD that I thank you for. Hot vinegar steam, if it will take the place of morphine for the harassing cough, will be a blessing.

I am using iodoform now in my treatment since ment since you have encouraged me, but I have not reached 20 grs. a day in any of them. I am sure now that I have never given large enough doses of arsenite of strychnia. In the last month I have doubled my tablets and find a marked benefit. I have a patient that I have been treating three weeks in the third stage. She has been the victim of tonics, cough syrup, changing climate, is bed ridden and a skeleton; tuberculosis of lung, bowel and larynx. There is extensive ulceration of bowel, and she could hardly swallow three weeks ago. Diarrhea and pain in the bowel were so great at night she could not sleep. She swallows well now, and the diarrhea is improved by antiseptics. How would it do to wash her bowels out with a weak solution of nitrate of silver? It is said not to be precipitated by saline and albuminous solutions. Enemas of boiled water have done her good. The ulceration is in lower bowel.

For fever I have found frequent baths and a modified Loomis treatment to succeed, along with antiseptics: Atifibrine, gr. 24, quinine, gr. 16, morphia, gr. 1⁄2; mix, ft. 6 capsules; one every 4 hours, or every 3 hours commencing with rise of temperature. Reduce in a few days and continue to decrease until I gr. of quinine, 2 of antifibrine and 4th to 4th of morphia to the dose is sufficient until finally none is required. Nelta, Hopkins Co., Tex. J. M. SIMONS.

If the sulfocarbolate and iodoform are given there will be no diarrhea or ulceration, and these are the best remedies therefor, tho I have used silver, bismuth, the volatile oils and cotoin, as well as cannabis, as a sedative and anodyne. Iodide of calcium will not replace the preceding, as they do not form a chemical combination.

Very good sulfocarbolates come from Merck, Schering, Rosengarten and Mallinckrodt. Between these I have no preference, but I know of no other house making these salts fit for internal administration. If the intestinal ulcers are within reach, I would wash out the bowel and throw in a silver nitrate solution, not more than a grain to the ounce. Chicago, Ill. W. F. WAUGH, M.D.

Specific Medication.

Editor MEDICAL WORLD:-Dr. A. C. Cowperthwaite's article (beginning on page 48 February WORLD) pleased me greatly; but if you will compare his introductory remarks with what I said about specific medication, you will find he is a specific medicationist, hence an eclectic. Hahnemann founded the homeopathic school, basing it on the so-called law of similia similibus curantur, and laid great stress on the virtue of high potencies. These characteristic features of homeopathy are rejected by Dr. Cowperthwaite, while the distinguishing feature of eclecticism, viz., specific medication, is adopted instead.

This is very important, as it shows a disposition on the part of the leaders of the various schools to get together in the important and essential matter of treatment, even if they are designated by different names.

"A rose by any other name would smell as sweet," and if the different schools can once agree on therapeutics, school names would soon be dropped.

The leaders in our own school are headed in the same direction (and many of the rank and file are already there). Thruout Dr. Waugh's "Treatment of the Sick" can be found much advice which is based, whether consciously or unconsciously, on the theory of specific medication.

Dr. Cowperthwaite has said nothing regarding the important matter of dosage. This is as important as the selection of the right remedy, and must be based somewhat on the theory of the desired action of the drug.

The regular physician is inclined to give medicines for their physiological effect; the eclectics for the purely remedial effect; that is, they are directed at certain symptoms, and the proof of their efficacy is determined solely by noting the improvement in the condition of the patient (as denoted by signs and symptoms). The physiological effects of the drugs are not looked for nor expected on account of the smallness of the dose (as a general rule; which, how ever, is not invariable and absolute). Hence, an eclectic will generally choose a different remedy for the removal of a pathological condition than would a

regular. Thus you will notice (page 59, February WORLD) that Dr. M. G. Price says that tartar emetic is of the "greatest service in the first stage" of inflammatory diseases of the respiratory tract; and (p. 60) says: "The dose must be small, gr. -." A moment later he contradicts himself by recommending it in ro gr. dozes for "rattling breathing and difficult expectoration of much mucus,' and saying it will "pleasingly surprise you." This is approaching very near specific medication. You will notice that Dr. Cowperthwaite's indication for tartar emetic is very similar, while in the earlier stages he uses really small dozes of other remedies equally as potent in overcoming the pathological condition for which they are symptomatically prescribed.

I can better illustrate what I mean by the difference between the physiological and the medicinal action of remedies by a short study of a single drug, and will choose aconite.

The regulars give aconite for its physiological effect, consider it a depressant, and look upon it as a dangerous remedy in asthenic conditions. Eclectics hold directly opposite views, and a comparison of results in practice tells which are right. Osler gives hospital statistics showing a mortality of 20 to 40 per cent. in pneumonia, while it would be a mighty poor eclectic that would lose 3 per cent. of the same cases. Scudder says (Practice, page 23): "The frequent pulse, not full, evidences debility of the heart-a want of power to circulate the blood; hence frequency of beat in proportion to the want of contractile power. Capillary obstruction will give frequency, as it imposes on the heart an extra labor, and requires increased frequency of action to compensate for the want of power in single contractions.

"This condition of the circulation requires small or stimulant doses of the sedative. I think there can be no doubt but that they do improve innervation of the heart, giving increased power of contraction. Necessarily if frequency is dependent upon want of power, any means that will increase the power, will diminish the frequency."

Thus we see the philosophy for the

eclectic indication for aconite-"the small, frequent pulse, with increased temperature." Use 5 to 10 drops of the specific medicine to 4 ounces of water, and give a teaspoonful every hour or two-every 15 minutes for first three or four doses.

If Dr. Hankins (page 64, February WORLD) employs his spare time during 1898 in studying remedies from this standpoint, he will have more faith in their efficacy.

I like the suggestion of the Editor about turning over the sick nation to the doctors, and not leave it entirely in the hands of politicians. The latter are in politics as a business, chiefly if not solely for what there is in it to themselves, regardless of the welfare of the whole people. Doctors, if they abstained from holding office, could only help themselves politically by helping those around them.

But don't you think we ought first to agree on the diagnosis and a remedy? It is hard to agree on these while distinct parties exist. Prejudice is apt to creep in in spite of a desire to be fair. For example (page 71, February WORLD) Dr. Covert says: "Under the prosperous conditions coincident with the McKinley tariff, etc.," when everyone should known that the panic of '93 was raging in all its glory one and one-half years before the adoption of the Wilson bill. He fails to take into consideration the fact that silver was being coined in large amount and going into circulation under the Sherman Coinage Act (which the bankers could not manipulate to their advantage), increasing the volume of money and maintaining prices, and that the panic was precipitated by the bankers to facilitate the repeal of the Sherman law.

In my estimation, the most urgent reform needed is the initiative and refer endum-direct legislation. This would largely do away with prejudice, bribery and the power of politicians. Next in importance, and a natural sequel, would come the government ownership of monopolies. I believe the doctors could have both these questions settled right in less than ten years by circulating the right kind of literature as they have the opportunity.

On direct legislation the "Appeal to

Reason," Girard, Kan., has a powerful pamphlet at 5 cents, 6 for 25 cents. "The New Time" (Chas. H. Kerr & Co., 56 Fifth avenue, Chicago), has another at 2 cents each. On the Government ownership of monopolies the "Appeal to Reason," a weekly paper at 25 cents a year is the best, I think. The book, "Socialism from Genesis to Revelation," by Rev. F. M. Sprague, of Springfield, Mass., is a masterly work on the same subject. Published by Lee & Sheppard, Boston, price $1.75. The Appeal to Reason is making a special price on it of $1. Don't be afraid of the naine. It don't mean anarchy, but the reverse of the industrial anarchy from which we are now suffering. I would like to suggest that every member of the WORLD family procure and read a copy of this book, then take a vote to decide whether a large enough majority of us are agreed that the correct diagnosis and treatment of the social disease is there laid down.

Ewing, Neb. O. C. MASTIN, M. D.

Dressing Infants-Onion Poultices, Etc. Editor MEDICAL WORLD:-Among the many crying evils of the fashionable world there is none that demands attention more than does the common way of dressing infants. From birth to youth their clothing is neither comfortable nor sanitary. Stiff starched bands, pinned from axilla to pubes, long waisted pinning blankets and long waisted petticoats, all pinned desperately tight, are common tortures that remind any thinking person of the custom of savage tribes. Bunchy ruffles around the neck and a big blanket of a diaper conspire to torture the poor innocents at both ends, and to make them wry necked and bow legged. And when they tell you they are not pinning their clothing tight, do not believe them, for they frequently willfully and deliberately lie. If you will watch the fingers and countenance of nurse or mother you will see that she is concentrating all the strength in her body to the effort of "doing the little one up snug." Do away with the belly band; a simple roll of soft cotton bandage will do far better. with coarse heavy diapers; any little piece of soft absorbent will be better.

Abolish the long skirts. See that there is nothing tight around the neck. A simple soft gown cut without the socalled waist will be better. Baby has a sensitive skin and your clothing tortures him. Why do not the dress reformers look after these things? Why persist in such heathenish notions?

Why do doctors tell people that onions in any form are healthy? Why must the sick room always smell of the abominable bulb? Why not disabuse people of the notion that six or eight pounds of foul smelling mush upon the chest of a child struggling for breath will under any circumstances do any good? Why not explode such old superstitions? Now for one, I say right here that during twenty years of quite active practice I have never seen a single case in which the use of an onion poultice was followed by any good, but I have seen many cases in which I could prove their use to be detrimental. Nor do I know of a single case where the internal use of onions has prolonged the life of a patient, and I do not even except their use upon shipboard in cases of scurvy. Now if we could get some of these vulgar conceits out of the popular mind it would be far easier to convince them of the good we can do and the rapid progress medical science is making. Now, no matter how good our treatment, Mother Dopem's mush gets the credit.

Why is it right for a merchant to send the doctor a statement every 30 days, if the doctor owes the merchant, and wrong for the doctor to send the merchant a statement at all, let the merchant owe the doctor ever so long? I think city doctors should send out statements every 30 days and country practitioners should send them every 90 days. Why not all try it? We wait and wait, and, when we at last tackle our collections, we find that the preacher, the merchant and the banker have tapped them dry, and we who have worked when all the others slept are put off until next crop.

I think that the German way of having all nouns, common or proper, begin with capitals is a good one. In business and in accounts we all know it is quite the rule. A bill of goods made out in small letters would be laughed at by busy business men. It prevents error to use

the German system of capitalizing. The noun is very important in any sentence, and interpretation is greatly facilitated by the use of capitals.

Your political talks are all right. When common people get too poor to procure necessary medical attendance the country will be a poor one to live in.

RICHARD H. WOOD, M. D.

Montrose, Mich.

Difficult Delivery With Perforation of the Cranium.

Editor MEDICAL WORLD:-I wish to report a case that to me was interesting. September 15, 1897, 3 p. m., I was called seven miles in the country, to see Mrs. M., age 37, mother of nine children, supposed to be in labor, and stating she had been taken sick about 10 p. m. the night previous with pains, vomited, and bowels moved freely. moved freely. Bag of waters broke in the night, but the pains had almost stopped, and thinking something was wrong, I was sent for. Digital examination showed the womb high up, no dilatation; gave diagnosis of cholera morbus. She claimed that it must be labor, as her time was up the 1st of September, and she was two weeks overdue now. Gave a dose of opii pulv. and bismuth subnit., waited two hours; pain all gone and resting comfortably. Messenger reported next day that she was all right. I might say at this time, it was a family of those shiftless, poor, lazy, and indolent people. Dirt and squalor had no terror for them, and furniture consisted of old broken up rubbish of charitable neighbors, and in all her previous labors had never had a physician in attendance.

October 1, 3 a. m., was again called to see her; had been sick twelve hours, pains coming on every twenty or thirty minutes, weak and ineffectual. Womb high up and no dilatation. Was of opinion that it was another false alarm, but she said no; she was sure she was one month overdue. Waited for pains till 5 a. m., then gave 10 gr. quinina sulph., left another dose of 10 gr. to be given two hours later. I went home, promising to be back in three hours. Returned at 9 a. m. and found pains getting better. Examination showed os dilating, left shoulder presenting, and no bag of waters. She was correct in

saying it broke two weeks before, for she had passed water daily for the last two weeks. After making diagnosis, I informed the husband of the state of affairs, and that it would be necessary to give an anesthetic and turn the child, and that another doctor would be required. Sent for physician three miles away to assist. After his arrival and confirmation of the diagnosis, we proceeded to get down to biz. I had gotten plenty of hot water and all the clean cloths, etc., the place afforded. After the patient was well under the anesthetic, I began to dilate the os until I could insert the whole hand; tried to push the child up and turn into vertex, but was unable to do I then had my colleague try it, but with no better success. We then decided to try and deliver by the feet, and after much difficulty finally succeeded in bringing down the feet, delivering the breach and shoulders, and waited for pains, which were now strong and regular, to deliver the head. But they were not effective, and we resorted to the forceps, but could not apply them; after several attempts gave it up. My colleague tried it also, but without success. About this time the cord ceased to pulsate, and we became aware that the child was asphyxiated; and as the patient was not standing the anesthetic any too well, we decided not to delay matters, but to perforate the head and deliver as soon as possible, deciding the head was too large to pass thru the canal. But perforators I had none, and when I asked my colleague for his, said he had never owned a pair. Here was a dilemma; but while we were discussing the matter, I saw a large pair of shears, probably 10 inches long, which had been laid out by some of the old grannies to cut the cord with, but who had now deserted us entirely. Picking them up, showing them to the doctor, told him here were perforators, and putting them into a carbolized solution to sterilize them, I then made an opening into the skull by pushing the sharp points thru the skull and then opening the blades; we opened the skull on the left side below the mastoid process, and on the right side in the occipitoparietal suture. After removal of brain After removal of brain substance, the head was delivered, and placenta removed, vagina washed out

with creolin solution, and patient made as comfortable as possible. No shock. Patient under anesthetic one hour and twenty minutes. Recovery uneventful; no temperature above 1011⁄2°. Daily douches of sol. creolin were given.

There are, to me, many interesting features in this case. The antiseptic. precautions were of very doubtful efficiency, and not having any septic symptoms causes me to wonder. I would not advise anyone to use shears for perforators. The great danger is the possibility of their slipping off the round head and puncturing the soft parts. I suppose I could have made out the position of the child by external palpation when I was first called, but I must admit I did not try. And I was very much surprised at the position when I was called the second time. I think the reason we were unable to turn was that the water had all drained off, and the womb contracting down upon the child, prevented our turning it. I know there is lots of room for criticism in this case, and we are open for it, from the Editor or the profession. Suffice to say, I have perforators now. G. A. STALFORD, M. D. Latimer, Iowa.

[The Editor thinks that the Doctor did very well under the unfavorable circumstances, and extends his congratulatiors on the excellent result.]

Syphilitic Neuralgia.

Editor MEDICAL WORLD:-N. P., aged 30. This case is rather a peculiar one to me, and it may be the means of helping some one out of trouble. I was called to see above suffering with neuralgia of supraorbital nerve of right eye, and spent two weeks running over the neuralgia remedies, e. g., quinine, iron, arsenic, strychnia, aconite, also purgatives, intestinal antiseptics, diuretics, salicylates, bromides, rhus tox, etc., but of no avail. Hypodermics of morphia controlled the pain to a certain extent. Blisters, heat, cold and anodyne liniments-all of no avail. I questioned him as to syphilis, but got a negative reply; but finally, thinking there might be a specific taint, I commenced on 15 gr. doses of potass. iodid, every 4 hours, increasing the doses 5 grains each time until I got him up to 75 grains