hollow thruout, and the portion that is buried in the growth is perforated with holes, permitting an excess of mercury to be injected around them as a cushion. These active electrodes are of course connected with the positive pole of the battery, the negative pole being attached to large dispersing pads applied to appropriate distant regions of the body.

I have employed as much as 1,200 milliamperes of current for half an hour, tho in some cases from 300 to 500 are sufficient.

This method is naturally restricted to cancerous growths that are still local and that are accessible, tho cases in which the first set of lymphatic glands are affected may be successfully treated if the glands can be reached by an electrode. In a case of this nature two enlarged glands in the axilla were dissolved by an electrode thrust into them while application was being made to the primary growth in the breast.

G. BETTON MASSEY, M. D. Philadelphia.

A Further Word on Chloroform. Editor MEDICAL WORLD:-Since the publishing of the article "On the Use of Chloroform," the following additions have come to hand:

Chloroform is contraindicated in acute yellow atrophy of the liver. Bandler, of Prague, performed a herniotomy on a hitherto strong, healthy man, who was, however, a hard drinker, using chloroform as an anesthetic. A few days afterwards icterus developed, and the patient died with cholemic symptoms. As leucin and tyrosin were found in the urine during life, the diagnosis of acute yellow atrophy of the liver had been made, and it was confirmed by the necropsy. Bandler has been studying the literature on the subject and experimenting on animals to determine the exact effect of chloroform narcosis on the parenchymatous organs. He states that every case of chloroform narcosis showed degeneration of the liver cells afterwards, while this was absent or very slight after ether narcosis."

I have been informed by Dr. Jefferds, Portland, Oregon, that in rooms lighted by coal-gas, the vapor of the chloroform and the product of the burning gas form

a deadly compound. He writes: "Several years ago I gave chloroform in a small bedroom when the gas was burning and the window closed. There were two of us besides the patient. After but little more than fifteen minutes I developed a most irritating and irresistible laryngeal cough, as if I had inhaled bromine or the like, but there was no sense of inhaling an irritating vapor, no symptom, in fact, but the cough. Fortunately for all of us I remembered a sad experience which H. had in his hospital in New York city, and threw the window open. With the fresh air all trouble ceased." At the time he refers to, a nurse died suddenly from the poisonous combination. It seems that in the other person who was with Dr. J. at the time, no cough was produced by this new gas.

By an oversight it was not mentioned in the published article that chloroform is used in convulsions and tetanus.

Roseburg, Or. F. G. OEHME, M.D.

Appendicitis.

Editor MEDICAL WORLD:-Your remarks at the close of Dr. I. C. Hazlett's

article on "Appendicitis Complicated with Pregnancy," in December WORLD, page 501, cause me to write a few lines, giving you my experience with appendicitis. I had quite a number of attacks of acute appendicitis myself. Several times I was very seriously ill in consequence. I had my first attack in May, 1881, and the last in June and July, 1883. The last was the most severe, confining me to my bed for five weeks. After this last attack, in July, 1883, I continued to take medicines regularly until February, 1884, before my doctor considered me sufficiently recovered to cease the treatment. That long course of medicine under an old doctor effectually broke up my attacks, altho I constantly have a feeling of soreness in that part of my body. Since I had this personal experience with appendicitis I have altered the opinion I had previously held concerning this very painful and dangerous disease; also my treatment.

When called to a case, the diagnosis must be made between appendicitis, an impaction of fecal matter or something else. The correct diagnosis is not always

easily made, yet it is all important. But given a case of acute appendicitis, my experience does not justify treatment with castor oil nor any other active purgative. I always got to vomiting too soon for cathartics, and this is my experience with most of my patients. I have for quite a number of years treated all these cases that fell into my hands with full anodyne doses of pure pulverized gum opium combined with sufficient calomel in each dose of opium to overcome its constipating effect. I am never in a hurry to move the bowels. I promptly succeed in relievingthe pain and fever with the opium, while the calomel that is taken with each dose of the opium gives free discharge from the bowels in from twelve to forty-eight hours. When the acute symptoms are well relieved I give increasing doses of iodide of potassium with small doses of mercury until all soreness is cured. This alterative treatment is sometimes continued for several months. This plan has been so uniformly successful with me that I feel as comfortable and as easy when I have an appendicitis patient under treatment, as when I have a typhoid fever patient on ten grain doses of sulphocarbolate of soda every two or three hours; a cure always results. THE MEDICAL WORLD is a great teacher. G. A. REBMAN.

Wrightsville, Pa.

A Desperate Obstetrical Case. Editor MEDICAL WORLD:-The December number of that eminently practical medical journal, THE WORLD, came to hand this morning, and, true to the natural instinct of an "unwashed, semieducated, and unregenerate" Hoosier, I inclose my dollar for another year, hoping that you, Waugh, Love, John B. Hamilton et al., will finally train us up to the point that will enable us to pass inspection under drill master A. W. (Always Whining) Brayton.

In your December editorial you ask "What are you doing? and how are you doing it?" These interrogatories were probably addressed to your patrons outside of Hoosierdom, as you could hardly expect us, "unregenerate" Indianians, to know just what we are doing. However, some people are good guide boards,

always pointing the road in which sensible people should travel, tho they are always wrong themselves. If Brayton will read the following from Bobby Burns, and treasure up the suggestion contained therein, it will possibly prevent him passing completely into "innocuous desuetude :"

"Oh wad some Pow'r the giftie gie us To see oursels as ithers see us; It wad frae mony a blunder free us And foolish notion." But, to attempt an answer to your questions. On November 8, 1897, I was called to Mrs. Rev. S., a primipara, aged 20 years, whom I found in puerperal convulsions, the most violent that I ever saw. She is tall, slender and pale, her general physique suggesting lack of vital resistance. She supposed herself to be at the end of the seventh month of gestation. A catheter introduced into the bladder showed no urine present and an inspection of the clothing and bed showed that none had been passed while in the paroxysms. Face, feet and legs much swollen. Examination per vaginam showed no uterine contractions nor dilatation, and also that the head presented and that the end of pregnancy had been reached. Seeing that I had a desperate case to deal with, I sent for Dr. George W. Harding, of this city, to assist. Patient was treated by hypodermatic injections of 14 gr. doses of morph., sulph., and tr. veratrum viride was administered until its characteristic effect on the pulse, a reductiou in frequency to 40 beats per minute, was reached. The convulsions ceased for a time, but the patient showed profound and continually deepening coma. The pulse was becoming weak and irregular; the respirations were very stertorous and irregular, and the blood was already showing the lack of proper oxygenation, as the hands and feet were very blue and cold, and large quantities of mucus were in the upper respiratory passages. Having already bled her about 32 oz., and having employed all the usual remedies, it was apparent to us that our patient must soon succumb. To attempt delivery under such desperate circumstances was to invite failure and seemingly just criticism. As we watched her life slowly but surely ebbing away we said to ourselves: "This

is a case of uremic poisoning; the brain centers are so saturated with poison as to render them powerless to act." Having read of the employment of normal saline solution in the treatment of coma due to Bright's disease, and reasoning that the conditions are the same as in the "albuminuria of pregnancy," we concluded to risk the censure which would attach to a failure in the attempt, and proceeded to inject 5 pints of the solution into the bowel, which was retained by a compress held by a nurse. Four pints more were hastily injected under the skin in the axilla and groins. At the same time to gr. of strych. sulph. and gr. atropia sulph. were given hypodermatically. The pharynx was wiped with pledgets of cotton. I ruptured the membranes, and pushing the head up, allowed a large quantity of liquor amnii to escape, and then proceeded to dilate the os with my fingers. It was but a short time until the uterus began to respond to the mechanical irritation and the strychnia and atropia. The patient was hedged about with hot bricks and bottles and heavily covered with blankets. From this time the patient began to show improvement. The skin became warmer, more moist and had more elasticity, and the pulse began to return. The kidneys began to secrete, and ere long we obtained 24 oz. of albuminous urine containing casts. No No more convulsions occurred, due partly, no doubt, to the continual use of veratrum. In less than two hours we delivered our patient of a 12 lb. boy, from whose surface the skin readily peeled off.

The object in reporting this case is to elicit some discussion on certain points. (1) Before using the saline solution and while the patient was so near death's door, would it have been good practice to attempt delivery? Remember the patient was practically dead. (2) What effect had the atropia and strychnia? I may further explain that the subsequent history is also quite interesting, and that everything was done as nearly aseptically as hurry would permit; that we got a small abscess in the right groin; that the patient had a chill on the next day with a temperature of 105° F.; that the temperature afterwards showed a regular septenary curve; that there was enlargement of the spleen and liver, dry cough

and nose bleed, together with a disproportion between pulse and temperature range, the pulse rarely reaching 96 per minute; that the fever lasted three weeks and subsided; that there was no metritis, cellulitis nor other pelvic inflammation to account for the continued fever; that the history showed headache, backache, malaise, chilliness, nosebleed and diarrhea for ten days prior to the eclamptic seizures.

Now the above explanatory remarks lead me to ask these questions: Was the Eberth bacillus present in this case? and did she have enteric fever before the onset of the convulsions? Did the typhoid poison kill the child in utero ? Did she suffer from albuminuria complicated by sapremia due to a decomposing fetus? If so, what caused the fever which followed delivery? No culture tests were made, as we "semi-educated" Hoosiers are too busy acquiring ignorance for any tomfoolery of that kind. Inviting a candid, earnest discussion of the above queries by the "WORLD Family," I am yours most respectfully,

T. A. LANCASTER.

North Manchester, Ind.

Cure of a Case of "Cramp Colic." Mrs. A. has been subject to "cramp colic" for about three years. She has been examined and treated by prominent physicians with only temporary relief. The attacks come on almost invariably at night, and in about the following manner: All the way from two hours after supper to a late hour in the night she would begin to belch, usually a dozen or more times in rapid succession. In a few minutes the process would be repeated. Pretty soon darting pains were felt in the stomach, then severe cramping, which was only relieved by morphia, hypodermically, or by the administration of forty to sixty drops of chloroform. Usually a fourth grain of morphia gave relief, but I have given her as much as three-fourths of a grain before relieving her. After trying numerous plans of treatment, the following was adopted about three months ago by the advice of our Editor. Immediately on rising each morning a heaping teaspoonful of seidlitz salt in half a glass of water was given. Half an hour be

fore each meal and at bedtime, six grains of sulfocarbolate of zinc and a teaspoonful of elix. lactopeptin were given. Every other night an enema of half a gallon of warm water was used. As the attacks seemed always at night, no supper was eaten. Food was eaten dry and thoro mastication and careful dieting insisted on.

For two months she has been in excellent health, hardly complaining of a single pain.

This case has been exceedingly interesting to me and I thought that it might be of interest to others.

W. H. BUTLER, M.D.

Farmers Branch, Tex.

The Use of Clay in Surgery. Editor MEDICAL WORLD:-Having used clay in a fair number of cases and finding it very useful, I feel it my duty to report it to THE MEDICAL WORLD, hoping it will be of some use to its readers.

My method of using the clay dressing in wounds is as follows: I have collected a lot of clay, either the dark or light, which is free from grit and sand; have this thoroly worked up into a dough with warm water. I then pour well over it a solution of carbolic acid or creolin, dr. ij-iij to a pint of water. I have the wound or sore completely encased in the clay. Every morning I have the nurse to pour warm water over the clay to soften it, and allow it to fall off; without trying to remove all of it I have a new dressing applied as above. Several times during the day I have the clay dressing moistened with the carbolic acid or creolin solution. I claim the following virtues for the clay: It is an excellent antiseptic and disinfectant; it is very healing; it is one of the cleanest things we have; it absorbs all of the discharges and is in reach of both the rich and poor.

I will cite a few cases that have been treated as above:

1. C. G., male, aet. 45, became engaged in a difficulty with brother-inlaw about 8 years ago, and received a gunshot wound thru his knee joint, shattering the lower end of femur and upper extremities of tibia and fibula. Three physicians decided that amputation was

necessary to save life. Patient refused. Clay dressing applied. Patient recovered with useful but stiff joint; died 3 weeks ago with tubercular phthisis.

Case 2. A large carbuncle on back twice the size of a silver dollar; opened, curetted, applied pure carbolic acid and then clay and carbolic acid dressing. Early recovery.

Case 3. Case of senile gangrene of foot; bones exposed and flesh rapidly decaying. Applied clay and saved foot.

Case 4. Small boy was playing ball and was struck on left arm and received a green-stick fracture of forearm and a large bruise at elbow. Fracture reduced. Erysipelas set in, sloughing began. Placed arm in clay with excellent results. Who has tried vinegar or alcohol for carbolic acid burns? Clinton, N. C.

R. E. LEE, M. D.

Lavage.

Editor MEDICAL WORLD:-The idea has recently occurred to me that irrigation of the stomach is not practiced as much as it should be. When we stop to consider the process by which digestion is carried on, and the continuous amount of work that the stomach has to do, with its anatomical features before our minds, we certainly can see why lavage should be done more frequently. We would hardly think of eating a meal without rinsing out our mouth or cleaning our teeth; yet we, as a rule, never think of the foul accumulations in the delicate folds and rugae of the mucous membrane of the stomach. A condition like the above is the source of a great many unpleasant things, viz.: "sour stomach," "bad breath," "fermentative dyspepsia," etc., all of which could be cured by the simple method of washing out the stomach, either with plain or medicated water. The siphon action is all that is needed, since it can be used at a time when there is no danger of having the openings of the tube plugged, or if small pieces of the contents of the stomach should be aspirated, they can be easily dislodged by raising the funnel a little higher. By alternately raising and lowering the funnel it agitates the fluid in the stomach, so that mucus and other substances caught in the folds of the mucosa may be removed. I remember

in one instance to have washed out a patient's stomach who had been having sour eructations for several weeks. He had taken the various drugs recommended for that purpose, but to no avail. I irrigated his stomach thoroly with an antiseptic wash, ordered light diet for a few days, and a speedy cure resulted. It has been observed that seeds and other hard substances have been obtained from the stomach many days after their ingestion with the food.

Cleanliness is next to godliness in every particular; so let us look after the stomach in a way that will aid us in keeping up the general good health.

PERRY WOOLERY, M. D.

Heltonville, Ind.

The "Fluke."

Editor MEDICAL WORLD:-Your article in September WORLD headed "Worm Coughed from the Lungs," reminds me of a case very similar I had experience with in Honolulu, H. I., about six years "fluke" is common. ago, where the

The patient in question had been ailing for some time and appeared to be going into a sort of mysterious decline. One day while in conversation I suspected her trouble. I returned to my office and prepared some powders, the chief constituent being ordinary table salt. I directed my patient to take a teaspoonful of the mixture every morning in a glass of cold water. On the second day I was suddenly called in, and to my astonishment I saw the "worm" which the lady had coughed up a few moments before. It was still alive. She made a speedy recovery and never coughed after that. Another case was that of a young man who appeared to be suffering from chronic pleurisy. All available proved useless in his case. After death he was opened and found to be a victim of fluke." The parasite had actually riddled the liver and lungs full of holes. I have had several cases here of a similar nature. The germ finds its way into the system by the eating of green vegetables, such as water cress, spinach,

etc.

Pardon my brief note. I send it in order to inform those who have had no experience with this parasite. Many

valuable sheep and cattle die annually of this trouble. D. MCLENNAN,

Chief Medical Officer Tongan Government, Tongalabu, Friendly Islands, South Seas. [Doctor, tell us more about this strange subject. Can you send a sample in alcohol? Have you made post mortem examinations of patients or animals dying of this malady? Please give us definite information. Is there any literature on the subject?-Ed.]

Whooping Cough-Gonorrhea-Enlarged

Prostate-Goiter.

Editor MEDICAL WORLD:-I do not see why physicians continue to give medicine internally in pertussis, except in exceptional cases, when they know of its inefficiency. Almost all know, or ought to know, that the germ infests and develops in the pharynx; hence the remedy is an antiseptic spray The treatment is not original. I vary the I have used formula to suit the case. it 5 years, and have seen bad cases cured in three to seven days, and some never it with babies two weeks old, and have used the spray but twice. have used never seen the straining from the treatment that I have from a bad case of coughing. The head must be held so that they cannot get way, and when they gag keep on spraying a little to get I use a formula it below the epiglottis about like this:

I know I have done a great deal of harm and prolonged gonorrheas by strong injections. Now I seldom give an injection until acute symptoms subside, and then a very mild one.

I have reduced the size of several enlarged prostates by first injecting cocaine into rectum, then in 20 minutes a weak solution of iodide potass., then apply negative pole galvanic battery in rectum and large pad anode over bladder and abdomen. I treat goiter successfully the same way, only omit cocaine and apply solution KI to the negative pole.

I like your plan for systematic study.