digestion. The raw white of eggs in cold water, raw beef or oysters, scraped or grated, soused pigs' feet, pickled lambs' tongues, chicken or other meat jellies, and such rich but digestible soups as turtle, mutton broth and consomme, if the cooking be perfectly trusty, are the best. I have relied upon Bovinine too many years to pass it by without a word of commendation. Ten drops to a teaspoonful may often be added to the other food with great benefit. Another most valuable, I may say essential, form of food is to be found in the fruit juices. Some day it will be found that perfect health requires the protoplasm of the body to be constantly refreshed and recruited by the living protoplann of raw, uncooked plants. No one can eat raw meats long without acquiring a preference for them over the same food in its cooked forms. No one can long utilize raw fruits, celery, lettuce, onions, radishes and cresses, without growing to look upon them as necessities. I have often stopped milk and fed my babies affected with summer complaints upon the freshly-pressed juice of grapes, peaches, and other fruits, with excellent effect. I have never known them to do harm, when freshly pressed from sound, ripe fruit. Use abundance of pure water, within and without. I used to keep my own bath tub always filled during the heated term, and my babies clad only in a loose little slip, with the house. well shaded; and whenever they felt too warm they would slip into the tub and splash about till cool enough. A dozen times a day they would be in the tub. Result, health and happiness. The mother must watch the dejections with solicitude, and on the first evidence of fetor or unhealthiness, give a few doses of neutralizing cordial (rhubarb, hydrastis, ipecac and soda), with a grain or two of a sulfocarbolate. If acidity be present, or if the stomach be unduly irritable, give sodium sulfocarbolate, one or two grains for a child under two years of age, repeated every one to three hours. If the child be strenuous, vachitic, tardy in teething, walking or talking, or if it be thin and delicate from any cause, use the sulfocarbolate of calcium, in the same dose as the soda. But if there be pronounced diarrhea, fever or fetor of the stools, rely only on the sulfocarbolate of zinc, one-half to one grain every one-half to two hours, as the need may be, the better results following the small and often repeated doses. With this system in operation I cannot see why one should ever lose a case of summer complaint, or cholera infantum. It has been many years since a death from this cause occurred in my practice, and I cannot claim any more than ordinary skill in the treatment. Many of my former students and personal friends have employed my method with results fully equal to my own. I am early in the field with my discussion of this subject, because it looks as if we were to have an early and hot summer; and because it behooves us to be wise and prepare for the campaign before the enemy is upon us. Most of us have summed up our summer's work at its close, with the conclusion that we have not in reality interfered materially with the course of the disease; and the conclusion that next summer we will try to find some more effective method of treatment. But the winter comes and goes, and when the next summer begins the doctor instinctively commences upon his calomel and chalk mixture, paregoric and astringents, feeling that perhaps more care will give better results. But this is only historical medicine nowadays. The introduction of the intestinal antiseptics has revolutionized the treatment of this group of affections, and the doctor who refuses to avail himself of them cannot be held guiltless if the child's life is sacrificed. The evidence has accumulated beyond the reach of objections, and the only question now is as to the choice of antiseptics. Many other agents are capable of giving good results, but from none have I been able to obtain as good as from those above mentioned. WILLIAM F. WAUGH, M. D. 103 State St., Chicago, Ill. A Surgical Essential. Editor MEDICAL WORLD:-Nearly every physician, whether in the country or in city, is frequently called upon to do emergency surgery where there has been great loss of blood. Too many of these cases in the past have been left to die, or ingested with strychnin, digitalis, or even whisky, under the mistaken idea that the chief danger was from shock rather than exsanguination, when the prompt injection of a quart or two of the normal salt solution might have saved their lives. I wish therefore to report the following cases through the columns of THE WORLD, in the hope that they may be of some service to the general practitioner. I would emphasize the fact that wherever blood is needed, and needed quickly -even as the Texan is alleged to need his revolver at time "with an urgency amounting to profanity "-in all such all such cases there is no resource like the normal salt solution. Timothy age 34, of splendid physique, a switchman in the employ of the Erie Railroad, was brought to the hospital one evening about 8 o'clock, his left leg crushed to a pulp just below the knee. A rude tourniquet consisting of a clothes-line and a short stick had been applied, but the patient had evidently lost considerable blood. When I arrived at the hospital an hour later he was nearly pulseless, and even the conjunctivæ were pale. Little or no bleeding followed the removal of the tourniquet. One hypo dermic of strychnin had been given him, but he had rapidly become unconscious. Accordingly the leg was simply amputated with a scalpel, the rough stump irrigated and the larger vessels tied. a proper tourniquet was applied, low down, followed by a loose cotton dressing, bandaged tightly. Meanwhile the injection of normal salt solution had been begun. I use a fountain syringe with a needle about the size of that on the antitoxin syringe. During the first three-quarters of an hour the patient was given two quarts, and the circulation began to rally, as shown by the character of the pulse and the general appearance of the patient. One pint of the solution was given every two hours thereafter for 30 hours, pains being taken to regulate the pressure by avoiding hanging syringe too high. The needle was placed alternately in the lateral femoral region and under the mammæ. The following afternoon the circulation had become restored, ether was given, and amputation was made above the knee. The patient is now on the high road to recovery. Charlie M-, age 8, was brought in by the police patrol with a leg and an arm crushed by a locomotive. He was unconscious, exsanguinated, and pulseless. Normal salt solution was given as in the foregoing case, and operation took place within three hours; the thigh being amputated at middle of the lower third of the femur, and the arm close to the insertion of the coraco-brachialis. The injection of the salt solution was continued during the operation. He rallied after the operation, but would frequently become pulseless and unconscious. At such times he was given the salt solution and immediately the pulse would become strong, the mind clear, and respiration regular. The solution was used every three to five hours; fifteen quarts being given altogether within the five days following the operation. He made a prompt recovery. Mary, age 30, a typhoid patient, suffered a hemorrhage from the lungs on the 18th day of her illness. This was consequent, I believe on a bronchial typhoid ulcer. The quantity of blood lost was considerable. Symptoms were similar to the preceding, and results on giving the normal salt solution were fully as satisfac tory and complete. I might go on with the testimony, but enough has probably already been said to call its consideration to the attention of the general practitioners, many of whom will doubtless confirm what I have said. The manufacture of the normal saline solution is very simple. One teaspoonful of common salt is used to a pint of water, and this is boiled ten minutes and strained, and is injected at a temperature of about 98° or 100° I would add that I have lately returned from a visit to the Johns Hopkins Hospital, and that while there, in all my stay of several weeks I saw no strychnia injections used; nothing, in fact, save the normal salt solution, before, during, and after an operation when a stimulant was required. J. P. WEBSTER, M. D. Chief Surgeon Chicago and Western Indiana R. R. and Belt R. W. of Chicago. Professor of Surgery at Harvey Medical College. Brain Fever and Its Treatment. Editor MEDICAL WORLD:-In these days of haste and hurry, when a struggle for an existence or a future competency is going on among the masses, in our present state of civilization we must expect to have many cases of nerve and brain disorders. Too many families live beyond their means and assume obligations that they can never meet; hence some kind of a crash some day-broken down brains, as well as broken down constitutions, health and for tunes. Excessive nervous activity, over-work, worry, neglected headaches, constipation, blood disorders, neglected earaches and abscesses of the internal ear all have a tendency to terminate in cerebral menin gitis. In the line of treatment the first requisites are quiet, rest, restricted diet and careful medication. It has fallen to my lot to treat in private practice a few scores of cases of cerebral meningitis, the major part of whom have been in females. Of course it is well known to those of experience that it is a very difficult matter to make a differential diagnosis as to the kind of meningitis, and in some cases impossible, according to the best authorities. Simply meningitis is a good enough diagnosis for the laity, and so far as the treatment is concerned it makes but little difference. When we are called to a beginning case of meningitis we generally find as an accompaniment a train of other symptoms, such as biliousness, constipation, dizziness, indigestion nervousness, vertigo, insomnia, etc., besides the proverbial cry of "Oh! my head!" The patient should be put to bed at once and kept upon the back. Begin with a lively purgative-something that will stir up the liver and bowels to brisk activity. I find the following very effective: B Pulv. mass. hydrarg.. Magnesia grs. x grs. iij dr. ij M. F. chart no. 1. Signa.-Take at once in lemonade. Give lemonade fre quently to drink during the night. Then apply the ice bag to the head, shifting its place from time to time, and in about one hour after the powder has been taken I order the following: B Morphiæ sulph Tinct. digitalis Chloral hydrat Elixir simplicis gr.j gtts. xl · grs. lxxx q. s. ad. oz. j Misce. Sig. Give two teaspoonfuls when necessary as directed. I have consulted the writings of a score of leading authors, the majority of whom speak against the use of opium and morphia on theoretic grounds. Some authors advocate the use of the same drugs with equal ardor. I have cautiously tried all the drugs recommended and think that the above prescription fills the bill as well as any, and at a much less cost than many others. The price of trional is about $1.50 per ounce, wholesale, and if you use much it soon amounts up. You must be careful and use a thoroly reliable preparation of digitalis, as in these cases chloral is liable to produce heart failure; but not any more so than some of the coal tar derivatives, so you must watch the heart. I have tried hyoscin in two cases, hypodermically 18 grain, but did not expect any better results from it than other hypnotics; it should be used with caution on account of its depression of respiration. In some cases after commencing with the foregoing line of procedure, I have changed off and followed up the treatment with small doses of the red iodid of mercury, from the use of which I felt that my results were good. I have also used hydrarg. bichlorid in doses of and so gr, with fair results. I have used iodid of potassium in ten grain doses four times a day with ordinary results, but never gave over that amount daily on ac account of it being hard on the stomach. If the patient becomes dull, stupid or in a comatose condition, apply three or four big leeches to each temple and let them stay until they are filled up and drop off. I have seen great good done by them. Some patients do not rest well after being blistered back of the neck if they are sensitive and of a nervous temperament. I have never seen any good issue from shaving the head and from inunctions. Some years ago I attended a man, who would wake up during the night and scream out with the terrible pains in his head, and hold his head in his hands in agony; and while other remedies seemed to relieve him only in slight degree, I gave him every two hours a Gross' neuralgia pill, and that seemed to control him better than anything else. I kept on with the neuralgia pills, dropping the dose to every three or four hours, alternating with small doses of the red iodid of mercury given in The bladder should be examined and emptied with the catheter, if necessary. The medicines mentioned generally keep the bowels in order; if not, I give broken doses of sol. magnesia citrate. Pure cold water should be offered often during the day, and if the stomach be irritable, a few pellets of cracked ice will be found grateful. The diet should be liquid, consisting of cold milk, beef juice, animal broths, thin much by talking with patients when on the road to recovery, by cheering them up, holding out a hope, and reasoning them out of the idea of future attacks, sequela. paralysis, insanity, etc., and building up a confidence as it were. All that I have treated have shown disposition to worry, and some anxions friends are not so discreet as they might be in their talk within hearing of the patient, who is alert and will pick a meaning out of a single word. Much progress can be made during convalescence by conversations with a cheerful physician who gives words of encouragement. For some time after a recovery they need a good fonic. Phosphorus s indicated to repair brain waste. Lastly I would advise my fellow practitioners to do their own prescribing; write out your own prescriptions in full, instead of writing for somebody's ready made stuff, which is liable to deteriorate on standing after being made up a length of time, which they claim is made up by a process peculiarly their own, but our patients have to pay about four times the usual price for the same medicines. Write out your own prescriptions, see that they are properly dispensed from pure and fresh drugs, and then you will know where you stand, and know what you are giving and what results to expect. After recovery, if practicable let the patient take a trip to the sea shore; or better still, let him spend a few weeks on a quiet, well regulated farm, with good soups, a cup of tea, if desired, with a more hygienic surroundings, the season of the liberal bill of fare as the case improves. year permitting. Latterly a little quinin sometimes needed and does good. For a state of collapse, a teaspoonful of old Hennessy brandy is the best bracer, with hot water. and sugar repeated as the case may require; and in bad cases, hypodermics of strychnia gr.. I have tried alcohol in the form of brandy in advanced lingering cases with good results. About ten years ago I attended a lady who had all the general symptoms, and she was blind and in a semi-comatose state for over thirty days. I gave her all the usual remedies, book remedies, and routine treatment until I was tired of them. Then fearing that such condition would result in softening of the brain, and knowing that alcohol had the reputation of hardening and preserving albuminous substances, and also for its stimulating properties, I ordered two teaspoonfuls of brandy four times a day for a few weeks, and discontinued at the same time all the other medicines. She recovered under the treatment, is living and well to-day, in full possession of all her faculties. As the influence of the mind over the body is very great, the physician can do I would be pleased to hear from some of THE WORLD's readers in relation to the treatment, as many cases are exceedingly difficult to manage. Camden, N. J. G. W. HENRY, M. D. Dr. Wm. H. Burgess, of Chattanooga, Tenn., writes: "I like your monthly talks. I believe in free speech any way. I have heard men say they believe in a free press, but the press is so free, as a general rule, to sell itself, that it makes us appreciate one that does not boast of that much freedom. God bless you. 'Cry aloud and cease not.""" A Case of Puerperal Septicemia with Complications. Editor MEDICAL WORLD : In obstetrics, as in all other matters pertaining to medicine, it is usual to report only emergency cases, or complications, when they have been successfully met by superior knowledge and skill. On the contrary, very few cases of septicemia are reported, as it more or less implies carelessness on the part of the accoucheur. it suffice to state that the case herewith reported was treated from beginning to end aseptically and antiseptically. Let Mrs. L., aged 23, second confinement ;occurring March 19. The labor was easy and without any complications, with a vertex presentation. The duration of labor was about six hours, and there were no severe after-pains. The flow of milk was established on the third day. Lochia were normal and without odor. The temperature during the first six days was not over 99.4° and the pulse not over 90. March 26 temperature ran up to 102°; the pulse was 120, and intermittent (lower during mornings) until April 3, when fever became constant. When the temperature went up on the sixth day, a careful examination was made, with an almost negative result, i. e., uterus normal, no odor to lochia, no laceration to perineum or vagina or cervix; a slight parametritis, such as is often found, but almost every time disappearing in a short time. On the twelfth day the patient complained of severe pain in the right lung and consultation was asked for. The consultant (a gynecologist of large experience in a local public hospital) after a careful examination only could affirm that there was no pelvic trouble, as the exudate had almost disappeared. The pleuritic pains and high temperature were the only bad symptoms. On the seventeenth day after confinement another consultation was held and aspiration was advised. I was almost sure there was no effusion, and on several trials no fluid was found in the pleura. Cough and bloody expectoration became now very troublesome. The temperature ranged from 105° to 106°, the pulse from 140 to 160, and the respiration from 40 to 60. We expected that the patient would succumb almost any minute. At this stage a new consultant ordered a quart of normal salt solution in the cellular tissue and also into the rectum, with decided benefit. From that time the patient im proved and is at present-six weeks after confinement-fairly convalescent. CAUSATION OF THE SEPTICEMIA AND THE SECONDARY CIRCUMSCRIBED PYEMIA OF THE LUNGS AND GENERAL INFECTION. 1. Auto-Infection.-This would be a very convenient reason for the accoucheur to assign, especially as the patient attended a dairy and milk depot during her preg nancy. 2. Septicemia Lymphatica. Altho this might have been the cause, I doubt it very much, as the bowels would have been distended, the course would have been shorter and very likely there would have been affections of the joints. Lymphatic infection may therefore be excluded by the absence of bowel-distention and diarrhea. 3. Septicemia Venosa (Pyemia Metastatica). I am inclined to consider the case an instance of the latter infection. It is probable that at the site of the placenta a thrombus (embolus) was carried into the general circulation, and that subsequently we had to deal with a general pyemia, manifesting itself in metastatic conditions of the lungs, pleura, glands, etc. Treatment.-After I was sure I had an empty uterus, I did not attempt to irrigate or curet it. I had done it, however, many times after abortion and metritis, without any bad results, and still consider it a semi-surgical procedure. I excluded from my treatment all coal-tar antipyretics, and have also to record that large doses of quinin did not make any perceptible impression on pulse or temperature. At the beginning of the pyretic stage I gave the sulfids and sulfates a fair trial, but later on, when the on, when the patient was sinking, I changed to a capsule, as follows: Codein, gr. ; strych. sulf., gr. 1-30; glonoin, gr. 1-100; and protonuclein, gr. iij; every four hours. I also gave ammo. carb., gr. x, and tinct. digitalis, gr. xxv, in whisky and simple elixir every four hours. After the cardiac weakness was overcome, the ammonium carbonate, digitalis and glonoin were omitted. I am fully convinced that if the case had not been treated on a general supporting plan, antipyretics and opiates being used instead, the patient would have succumbed. Doses of gr. of codein do not interfere with the peristaltic action. Strychnin, glonoin and digitalis were given to overcome the cardiac weakness. Am |