p. m., skin moist, slight soreness in the vicinity of the injection; throat and pharynx looked about the same. Next morning, on the 8th, false membrane shrivelled up, patient feels better every way, odor very slight, no extension to the larynx or nasal cavities. January 10th, no false membrane anywhere, and the patient practically well.

Resume: Owing to the irritability of the patient no correct record of temperature could be obtained. The patient, under the tinct. of iron and calomel treatment, made no progress; the result of the injection of antitoxin (1,000 units) was decided, quick and surprising; that local applications cannot be made thoroly to the throat; that tinct. of iron and calomel will act better as local antiseptics than ordinary applications, by adhering to the mucous membrane; be sides, have a tonic and antiseptic action thru the circulation.

No solid food was allowed; only milk, whiskey and seltzer water.

In regard to the urine, owing to the carelessness of the attendants, the clinical value of the examinations was nil.

FREDERICK P. MUFFE, M.D. 425 Kearney street, San Francisco, Cal.

Fracture of Lower Maxillary.-Hernia In

Children.

Editor MEDICAL WORLD:-A few words from our section may not come amiss, so I will relate my experience with a multiple, simple fracture of lower maxillary due to a horse kick, which was landed on left jaw, producing fractures at angle, at place of eruption of first molar on either side and at symphysis.

There was considerable deformity. Proper reduction relieved this and most of the pain. Patient was 56 years old and teeth gone, so wiring was out of the question along that line. I applied the stereotyped four tailed bandage, but on my return found it loose and some displacement. Tied it tighter after correcting displacements and gave much pain by so doing, but had no alternative. My return visit found him as before. On the third day I approximated my bandage ends, instead of tying with elastic webbing doubled. This put an end to my trouble and re

lieved the patient very much. weeks perfect union had resulted.

In two

Brothers, don't neglect to advise the parents of little patients that an abdominal support may prevent a hernia of some kind, and will give great relief to those afflicted with whooping cough. I had two little patients with umbilical hernia from this cause, which might have been prevented had I known it in time.

The application of a truss on as mercurial a piece of anatomy as a child from two years up to ten is an impossibility, or nearly so. or nearly so. Take a piece of board thin as cigar box, cut out piece large enough to cover the opening well; cover it with two layers of canton flannel and sew to the middle of an inch wide strip of adhesive plaster which is sufficiently long to extend at least three inches on either side of opening. Apply one end far enough away so that some traction can be made thereby, helping to approximate edges of opening, then fasten the other end. Use other strips at various angles and you will have a support that will be there when the little fellow comes in from play with pad in proper place.

Little Hocking, O. BYRON R. EVANS,M.D.

The Income of Physicians.

Editor MEDICAL WORLD:-In Feb. WORLD, page 72, Dr. Wm. B. Ely thinks the medical profession does not deserve any higher pay than mechanics. I would suggest that he ought to be satisfied, for the average compensation of physicians is not more than that of skilled mechanics. Skilled mechanics average $500 to $600 per year, and the average income of physicians is not more than this after deducting professional expenses, like medicines, keeping horses and buggy, and so forth, as well as certain expenses such as higher rents, etc., made necessary by the nature of their business.

The clergy in this country are now much better paid than physicians, and consequently the ranks of the ministry are now full of mercenaries.

DAVID P. JACKSON, M.D.
New Bedford, Pa.

DR. C. M. SPAULDING, of Rochester, N. Y., writes: "Keep on with your Monthly Talks and give us facts which we can use among the people."

Use of Diphtheria Antitoxin. Dr. F. J. Craddock, of Lytle, Texas, writes: "Please give us country doctors a short, practical editorial on antitoxin in diphtheria. Not a long discourse as to its value, but how to use it for best results."

A gentleman who has given this subject much attention was asked to reply to the above, and his reply is as follows: To employ or not to employ diphtheria antitoxine is an answered question. The relevant questions of the day deal with the selection of the product and the employment of the remedy with a view to the best possible results. On these matters the findings of the great collective investigatious of the past year are to the point. The recommendations in their reports are of great value.

The gist of all the best teaching relative to the employment of antitoxine in diphtheria I would sum up as follows:

1. Use the remedy as early as possible and strive to have all cases of "sore throat" reported early.

2. Give not less than 1,000 units in a dose, and if repetition is found necessary, do not wait beyond ten or twelve hours.

3. In all cases not treated early and in laryngeal cases use 2,000 units.

4. Locally use a simple antiseptic lotion for deodorizing and cleansing pur

ease, as every physician is supposed to know that.

A few years ago I met a man on a public highway and noticed that he was terribly_jaundiced. Upon inquiry, he stated that he had been afflicted for three months. He stated that he had been treated by physicians, but that they did not seem to do him any good. Satisfying myself that it was of the catarrhal form, I gave him three five-grain doses of calomel and told him to take one every three hours, followed by a saline cathartic. cathartic. I asked him to call at my office in a day or two, and then I would give him whatever else he needed.

I did not see him for several days, when he stated that those three powders cured him, and that he had a good appetite and felt well. The jaundice left him.

Soon after this I was called to see a young lady who had catarrhal jaundice, superinduced by too heavy a Thanksgiving dinner.

Her parents were very much opposed to the use of mercury and requested me not to give it. I treated her until the first of the following February with almost every known vegetable and saline cathartic without success. Finally becoming disgusted with all I had done I asked and obtained her permission to let me administer one dose of calomel. For fear that I would not get to give her another I gave her three doses in one, thirty grains. When I called next day she smiled and said: "I am all right now and want to eat for the first time.' The jaundice passed away without any further treatment.

In February, 1893, I was called to see Mrs. G., aged 54 years. She had acute catarrhal jaundice. I was taken sick the following night, and did not see her for one year and a half after. She was treated by several physicians. She had no appetite, and everything she took into her stomach distressed her. She was very much emaciated and debilitated. Every week or two during that time had called a physician to give her a hypodermic of morphia to relieve what they called neuralgia of the stomach.

My first impression was that she had organic disease of the liver, and that 1 had an incurable case on hand. But her

history indicated catarrha jaundice, and I gave her five twenty-grain doses of calomel and directed her to take one dose each week, to be followed with a saline. In addition, I gave her a mixture composed of

R Subnit. bismuth, Cretae prep., Camph. tinct. opii., Aquae menth. pip., Syrupi,.

āā 3 ij.

aa q. s. ad. 3 iv.

She was to shake this well and take one teaspoonful ten minutes before eating, to sooth the stomach and to prevent distress from food.

The result was that she was well at the end of six weeks, and remains so to this day.

My next case was a man aged 50, who had had jaundice for three weeks when I saw him first. He proved to be the most stubborn case of all. I had to give him at least twelve doses of calomel of twentyfive grains each before I could get the ducts open, but finally succeeded, and the patient is all right yet after two years.

In all these cases, in the acute stage, laxatives, counter irritants and opiates are indicated until the tenderness is all gone; then, if the ducts don't open (as they will in many cases), the calomel is indicated and should be given in large doses and repeated every few days until

success crowns our effort.

If this paper is well received, I will continue them. If it is not worth space,

throw it in the waste basket.

Columbus, O. S. C. DUMм, M. D. [The Editor wishes to say that such practical papers as the above are always well received.]

Two Surgical Cases in India. Editor MEDICAL WORLD: Times being somewhat dull in Calcutta, and grand inducements offering elsewhere, I signed a contract as railway surgeon and got appointed to a district-the Brahmini-of 12 miles total area. Of course I was told there would be heaps of private practice and ample room for surgical work. Grand. Too grand! Mighty little of the former came to my share as my district swelled to 102 miles and there was rather too much of the latter to permit it. Most of the cases were those of minor surgery due to accidents in the hurry scurry of "day and night"

construction work. Some of these accidents were most peculiar, and it is marvellous how their recipients escaped as lightly as they did. For instance, while well-sinking, the man who was guiding the dredger-gauntline was stooping forward to give some directions when the crown of the overhead pulley broke, and down came 28 pounds of solid iron from a height of 30 feet on to the poor fellow's head, knocking him senseless into the well, a clear drop of 40 feet. We fished him up, Sylvester-revived him, and to our surprise found that the only damage done his skull was that a clean slice of bone of about the size and thickness of a dime was, with the skin and hair covering it, shaved off close to the median line of the frontal bone near the parieto-frontal suture. The man was at work a week later. The block struck him obliquely or else it would have caved his skull in.

He

Another case, Lobo Ram, at Byturni, near Gamaria, was sent up to clear the dredger-dawgs that were jambed. planted his knee against the lip-shears to get a better purchase to work, and forced the jaws open. Just then one dawg righted itself and his knee slipped into the dredger, but before he could draw his knee out the gauntline was tautened unintentionally by the steamhoist driver. The jaws tightened themselves on Lobo's knee, gripping closer and closer, and as he yelled with pain and fear the driver bolted from his post, leaving the man swinging in air by his knee for nigh an hour and a half, when the assistant engineer coming to the scene (from a very long distance away where he was engaged on other work) had him lowered down. Examination showed 1.5 inch of the femur and a corresponding portion of tibia and fibula literally ground up; but tho the skin was broken, the muscles and arteries were not cut thru. Amputation was advised. I objected and the man begged to be poisoned rather than have his leg taken off. I etherized him (the chloroform in the dispensary was bad), incised the leg over site of fracture, and removing the shreds of bone under a 1 per mille iodine spray, I pared the edges of bone even and put the limb with considerable extension on a long hip splint,

bandage not including the incisions which were covered over with lint constantly wetted with 1 in 4000 mercury bicyanide lotion. Narcotics were not given nor stimulants, and there was very little suppuration. Patient mended Patient mended rapidly, and in seven weeks' time was allowed to sit up. He overdid this and complained of a gnawing pain under knee cap. Pain disappeared under iodine liniment (U. S. P.), but knee joint steadily swelled to near four times as large as the uninjured one. On evidence of fluctuation a puncture brought away nigh a pint of sanious offensive smelling fluid. Fever supervened and the stench getting worse while pneumonia began to develop and trocar exploration was unsatisfactory. I dare not chloroform or etherize, but put him on drop doses two hours about of gelsemium and Fowler's solution till his temperature fell to subnormal. It was a risky It was a risky thing to do, but there was no choice left me, and surgical interference offered the only hope of life. Strapping the leg down to prevent kicking, I made a free incision into the side of the knee, groped thru the wound into the popliteal space where I found a hard movable mass, fixed at one end. Cutting between the tendons I removed this mass, which turned out to be an encysted, partly metamorphosed, blood clot with a sessamoid bone as nucleus. How this cyst formed or why I cannot say, but it had begun to decompose and it was this that must have caused the fever, as the man rallied after its removal, and four weeks afterwards was discharged from hospital. His right leg (the injured one) is half inch longer than the other, and he does not wear a splint, tho he uses a crutch; but as the bones have united by osseous transfusion, I have no doubt that the callous enlargement caused by the new grown pieces will be absorbed.

In my next I shall tell you about some other interesting cases.

Calcutta, India. ROGER S. CHEW, M.D.

two years and at odd times since. Two years ago had syphilitic discoloration of skin. Treatment: mercury and iod. pot.; apparently perfectly cured. A sinus in side that has existed for years continues to discharge pus. He is up to full weight, appetite and strength. Can he now marry with safety to wife and children?

Dr. Waugh says that a man with penis too small for a certain female is impotent, but is "potent if female parts are in proportion." Now what is minimum, medium, and maximum circumference and length of penis? Or does ability to cause orgasm in female depend upon continuance of erection, more than size, or does size take precedence? It is important for us to be able to answer these questions to patients.

Please mention an aromatic flavoring mixture that will disguise fluid extracts containing salicylic acid: for instance, something like that contained in Hayden's viburnum compound.

What is the formula for "Ingram's Complexion Tablets," Complexion Tablets," and Ingram's other preparations.

A woman gave birth twice to healthy children. Third confinement, labor came at seventh month; everything normal. She died in two days. Supposed cause shock from a letter received weeks before; the letter was very profane and obscene, accusing husband of infidelity, etc. infidelity, etc. Her health and labors were normal before; am I correct in considering this letter a probable cause of the premature labor? Husband stated that she never had natural sleep or rest since receipt of letter, and that he was certain that this letter caused a shock that caused premature labor and prostration of nervous system and death, and that is my opinion.

Allow me to mention a point worth, I think, to each subscriber a year's subscription. In January WORLD, page 12, Dr. I. H. Hershey tells how he steamed "for cold in head." My way is this: suspend a small tea kettle on tripod,

of Premature Delivery.-Steaming
for Neuralgia, etc.

Editor MEDICAL WORLD:-A man 34 years old had syphilis 14 years ago. Treatment: mercury and iod. pot. for

place one end of a rubber tube 4 inch diameter and three to four feet long. In distal end insert a small funnel. Place funnel to mouth, face, ear, or any part to be steamed. Good for neu