I soon found out that nearly everything given in the way of food, or medicine, did harm. They could not take one drop of any stimulant of any kind without producing distress in the stomach. A single drop of tincture of aconite would burn, and quinin in any form caused great distress. When malarial complications were present quinin was given only in pill present_quinin form. This was found to be the least irritating.

For food and drink one tablespoonful of skimmed milk was given every hour or every two hours. This was rigidly adhered to all the way thru the disease. Sometimes a little lime water was added if the stomach became sour. But it never could be continued any length of time on account of its irritating effect. It was impossible to give mineral acids for like

I said in reply that "of course they all die, for that treatment is calculated to assist in killing them. But with soothing treatment and good nursing with skim milk diet-they all get well."

Of the two patients I lost, one was 78 years of age and the other killed himself by overeating during convalescence.

Every case of milk sickness has acute gastritis, and no stimulant should be given at any stage of the disease. Neither should the patient know that he has that disease.

This report is written from memory, as I have no clinical record. At one time I

had 22 pages of foolscap description of this epidemic, but it is lost now and that is why I cannot give a full account of the temperature and many other things. I was young at the time and did not fully understand the importance of the subject. I am sorry now for I realize that the full history of those cases would have been an important contribution to medical literature. It is evident from the success of my management and treatment, that the disease has not been understood by the profession. The radical change from a stimulating to a mild soothing plan and the success attained, shows that it merits the attention of the profession, and I hope this paper may be of some use to all who may be called upon to treat such cases. Columbus, O.

S. C. DUMм, M. D.

[Why not supply the crying need of the system for liquid by injections into the bowel? also frequent baths, sponge baths at least, to reduce the temperature and to some extent supply liquid to the system by absorption?-ED.]

The Injection Treatment of Hernia.

Editor MEDICAL WORLD:-I have read with much interest and benefit all the articles on the injection treatment of hernia since Dr. Souder's excellent paper in November, '97, WORLD, and if the facts justify his sanguine expectation of permanent cures, it will certainly be a great boon to those afflicted with hernia. The per cent of those afflicted who are willing to undergo an operation for its radical cure is much smaller than it should be. The natural fear of cutting operations of all sorts cause thousands to bear great inconvenience and danger from hernia that could readily be cured by the skillful use of the knife. "Rupture Institutes" have been doing a profitable business in most of our large cities for the past few years. They no doubt do some good and much harm. There are great opportunities for deception in this line of work, as the first effects are good, and for this reason, taken with the persistent advertising, bring to them many cases. Some of these quacks no doubt have been deceived themselves about the permanency of their cures as others and honest workers have been, as I will show further on.

66

I have recently made use of the injection treatment, and with apparent" cures, but will suspend judgment for a year or two. My experience with the Bassini operation is limited, but entirely

satisfactory, and I believe it is the ideal method of curing hernia. Until this method of transplanting the cord was perfected there was great difficulty in making the pillars of the internal ring sufficiently strong to hold the intestines in, after they had once worked their way out. Just here, to my mind, is the impossible in the injection treatment in a large number of

cases.

Recently Dr. George B. Fowler, of Brooklyn (see Ann. of Surg., Nov. '97), advocates transplanting the cord within the peritoneal cavity" from the site of the internal ring to a point below the level of the pubic bone." This, it would appear, leaves a better chance to more firmly close the internal ring than the Bassini, but it is doubtful if it ever gains such a popularity with operators.

I think the idea given out by Dr. Souder and others, that the injection treatment was little used because it was little known, is not entirely correct. Dr. Heaton gave the method quite a "boom" in his day (see Secret Nostrums and Systems, page 89), and here also Dr. Shimwell, of Philadelphia, is quoted at length from THE MEDICAL WORLD in "the adaptation of the modern aseptic system to the Heaton method," and some years ago, in the Medical Record, Dr. DeGarmo, of New York, gave his seven years' experience with the injection treatment. At that time I was quite enthusiastic, claiming to cure 75 per cent. of selected cases. At his hernia clinic in the Post Graduate School, New York, November, '95, I heard him say he was very sorry he had ever published anything favorable for such a treatment, and that it had been a great disappointment to him; that about 75 per cent. were apparently cured and 75 per cent. of these relapsed within one year." (I quote from notes taken at the above date.)

I will say that Dr. De Garmo is a careful and conservative man and cures many cases in children by the careful and diligent use of the truss.

By "tendinous irritation," I presume, is meant the production of new tissue partially or completely filling up and closing up the internal ring and canal around the cord from the "local inflamation" following the irritating injections. I wish some one would explain just how this differs from "cicatricial tissue."

The failure of McBurney's open operation for the care of hernia (see second edition Wyeth's Surg. page 559) confirms

what was already known of the lack of durability of this sort of tissue; but let me quote you Samuel Lloyd in Post Graduate, Med. Journal, vol. XII, page 572. He says: "Formerly the idea prevailed that inflammatory adhesions must be set up along the canal, but we all know now, since the complete failure of the Heaton and other injection methods, how little dependence can be placed upon simple cicatricial tissue. This soon gives way under continued strain, and the original conditions are produced." He also refers to the McBurney operation which depended on this same "filling in" process and consequently failed, and led to the frequent occurrence of ventral hernia in cases where abdominal wounds had healed by granulation. A. E. SCOFIELD.

Tilden, Nebr.

The Quack.

Editor MEDICAL WORLD:-The quack is a scorpion in butterfly clothing, who looks upon every person with whom he comes in contact as a possible victim, and he flourishes thru the credulity of congenital dupes whose impulses outweigh any problematic good sense when they meet a plug hat full of plausible brag.

I once knew of a dressy young dude whose brains underwent metastatic degeneration and turned to whiskers, he having at 23, a glossy black Pefferian beard' which he kept tied up in a rag and buttoned in his vest. In his senior year at college, the professor in anatomy asked him what he knew about the diaphragm. He answered that it formed the lower boundary of the stomach and was analogous to the gizzard of the fowl; in dissection he had found one with three lobes." He was

going still further out to sea when the boys punctured his voluble gas bag with a laugh that caused its immediate collapse. In the final examination he described lumbago as "a state of depression in the lumber regions," and made the ovaries 66 accessary organs of defecation." Of course he was "plucked," but not subdued.

His undaunted gall prompted him to open an office in a neighboring town regardless the possible inquisitiveness of the ever alert examining board. His shingle read "osteopath," and his double-head half-column card in the local papers announced an ability to heal nearly everything unless it was the bone of contention. One of the ministers of the town

was somewhat of a ladies' man, and he became the first patient of this "specialist." The preacher, as by miracle, was cured of "nervous prostration" of several years' standing. No other mundane intervention could have cured him so quickly, not even the audacious donation party. He became a confirmed optimist, while his gratitude and exuberant spirits slopped over in the oily loquacity of his sermons, so much indeed that many eyes were unconsciously directed toward the immaculate scion of science in the front pew-he of the whiskers.

Well, business business boomed, osteopathy struck a bull market especially with the other sex. Some had their legs pulled literally, while all had it done figuratively and the osteopath solemnly sang:

"Come, ye sinners poor and needy,
Weak and wounded, sick and sore."

with variations.

The "regulars" across the street were nursing their grief, and it added no balm to their wounded feelings to take a peep at the stairway leading to the osteopathic dispensary. In about six months the local sheep had all been shorn, and "osteopathy" in the dim shades of night "folded its tent like the arab and as silently stole away," presumably carrying a wallet well filled with fleeces, at least so many creditors seemed to think. Since then the real chronics have relapsed, and the imaginary invalids have begun to grunt again, while the various bumps of gullibility are about restored to normal.

That American people love to be humbugged, long since passed into a proverb, Like liberty, humbuggery appears to be in the very air we breathe, and we take to it as naturally as we go into politics. It is the mainspring of many acts we loudly praise. I am sometimes inclined to the view that humbuggery is a disease, and that some doctor will yet discover a "gold cure" for it, or at least will demonstrate that it is due to microbes that get into the mind and make trouble trying to turn around, or to bacilli that bore holes in the moral character and let honesty leak out. Why not?

The medical fraternity has gravely informed us that kleptomania (sneak thievery by eminently respectable people) and dipsomania (sottishness by the social salt of the earth) are simply diseases that should be treated with pills and powders instead of penitentiaries and whipping posts. If a man will steal a saw-mill and

go back after the site simply because his pericardium is out of plumb or his liver gone into politics, or if he will nurse a juicy old jag until it develops into a combined museum and menagerie, because his circulation has slipped an eccentric or his stomach got out of its natural orbit, I submit, in all seriousness that he might be physically incapacitated for telling the truth by an insidious attack on his veracity by the fungus mendax; and that the best way to restore his moral equilibrium-to remove him from the category of chronic humbugs -would be to fumigate him.

The quack is properly defined as "one who has a single remedy for all the diseases 'human flesh is heir to'". When the remedy of one quack fails the people who patronize this variety of talent, simply resort to some other charlatan.

Sturgeon, Pa. R. L. PATTERSON, M. D.

Dr. Ransom's Case of Persistent Headache.

Editor MEDICAL WORLD:-In reference to Dr. R. P. Ransom's case of headache, lasting from the time the patient was 11 years of age until 22, let me suggest a possibility of some ocular defect, such as astigmatism, or even a more serious trouble. An examination of the patient's eyes by an oculist may reveal some organic trouble. The pain in the back of the head coming on some time after the headache would indicate that the trouble, whatever it was, was progressive.

There is a possibility of urethral trouble producing the pain in the back. Sipe Springs, Tex.

P. E. GOLD, M. D.

Composition of "Grove's Chill Tonic." Editor MEDICAL WORLD:-I see you ask for the formula of "Grove's Chill Tonic." I suppose what is meant is the preparation known as "Grove's Tasteless Chill Tonic." There is no doubt but that this is composed of the pure alkaloid of either cinchona or quininidia (not quinia nor cinchonidia) with iron by hydrogen suspended in syrup. It is flavored with lemon or orange and contains bicarbonate of soda to render it alkaline. This is because any acid will dissolve the alkaloid and develop the bitter taste. "Tasteless Syrup of Amorphous Quinine (Lyons)," prepared by the same company, is the same thing without the iron.

These are prepared by the Paris Medicine. Company, now of St. Louis, Mo., formerly of Paris, Tenn. I see in May WORLD, page 213, this firm thinks they have a secret

Auvray has conducted on animals a study of the possibilities of resection of the liver in the human being, that leads him to conclude that the procedure is applicable, in the living, to the ablation of tumors and cysts situated in the parenchyma of the liver; so long as they are not placed too deeply in the abdomen; that is, if they, for example, are situated in the left lobe or on the costal margins. The method consists in passing through and through the parenchyma of the liver, outside of the line of resection, two interlooped sutures, which are so arranged that the various loops formed by each include and ligate the vessels of definite portions of the parenchyma in a continuous series.-Pacific Medical Journal.

THE Cincinnati Lancet-Clinic says that coffee is an excellent vehicle for the administration of the iodides of potassium and sodium.

Dr. M. V. Hors, of Alvin, Tex., writes: "I like THE WORLD best of all the journals that I read, and especially those talks on governmental affairs. You certainly hit the mark."

Don't forget that we still supply Dr. Waugh's book, "The Treatment of the Sick," and WORLD for one year, for the price of book alone, $5. This book is the most helpful book published. You want help in your daily practice. WORLD and Dr. Waugh's book are the best helpers obtainable.

Quiz Department.

Questions are solicited for this column. Communications not accompanied by the proper name and address of the writer (not necessarily for publication) will not be noticed.

The great number of requests for private answers, for the information and benefit of the writer, makes it necessary for us to charge a fee for the time required. This fee will be from one to five dollars, according to the amount of research and writing required.

A Case for Diagnosis and Treatment. Editor MEDICAL WORLD:-If you or your subscribers will help me with the following case it will be greatly appreciated.

Mr. W., well to do, Jew, 55 years old, has never had any serious illness, is in good flesh, a hearty eater and drinks to excess once every three or four weeks. His bowels are regular and he sleeps well. He is very amorous and indulges to excess every few weeks, and has had gonorrhea several times, but not within three years.

Two years ago he began to have a tickling sensation at the head of the penis and just within the meatus. He will be troubled for a week or two then perhaps be free for a few days.

I have examined his urine carefully several times and find it normal. Have forced large sounds and bougies and can find no obstruction.

I have corrected his diet and his habits, and rendered the urine alkaline. I can find no signs of herpes. There is no discharge. Have used anaphrodisiacs and aphrodisiacs.

Have injected solutions of morphin, cocain, belladonna, lead, clay, and silver nitrate. Have used galvanic electricity but have not improved the patient. I also have a patient with an amputated stump who has similar sensations.

Would also like help on the operative treatment of urethral carunoles. Have not been able to find anything in standard authorities. I am now depending mostly on THE WORLD. J. E. HOLDEN, M. D.

Осса

Cattaraugus, N. Y. [Very little can be suggested for treatment of such hyperesthetic areas. sionally bathing the affected mucous membrane with a solution of carbolic acid and peppermint or of corrosive sublimate and peppermint will give relief when all other remedies fail. If it is at all likely that the uric acid diathesis is a factor in etiology, it will be necessary to treat the trouble accordingly, paying particular attention to the use of the salicylates and the salines, especially our old friend mag. sulf.-Ed.]

Editor MEDICAL WORLD: - It is well known that disciples of the healing art are often incapable of correctly diagnosing their own ills; hence I have no hesitancy in asking assistance from the profession in my case, particularly as the nearest physician is 100 miles distant. Briefly, the case is as follows:

Last November I was taken very suddenly with acute pain in the bladder, in the bladder, accompanied with desire to urinate about every 10 minutes. Urine passed in small Urine passed in small quantities, with severe pain following contraction, was loaded with mucus, and was sometimes bloody.

I took some simple remedies but without avail; severe pain in the back over the right kidney and sharp headache following. A physician was sent for, and came 100 miles. He prescribed morphin, made an examination, and diagnosed inflammation of bladder consequent upon uterine congestion. Later treatment has consisted in the use of potassium bromid and bromidia, yet there has been another attack.

Will some one suggest the best measures to adopt with a view to permanent cure?

A good physician would find an exceptional opening here. The vicinity has been somewhat overrun with quacks, and such are no longer in demand. There is not much sickness, and the rides are somewhat long, but the fees are proportion ately high, while bills are easily collectible.

Upper Renasco, N. M.

M. L. COE.

[Evidently Mrs. Coe is doing the best she can in that far away field, and we hope that "a good physician" will respond to above invitation. Regarding her cystitis, we fear that it will be difficult for her to take the rest which is absolutely necessary to a cure. Next in importance comes the copious drinking of pure water. Drink a brimming glassful every hour while

awake, and more if possible, making a special effort to drink several glasses before retiring at night. Next in importance comes vesical irrigation (comparatively easy in a female) with boiled water, which should be quite warm, with suitable antiseptics added.—ED.]

Bust Developers and Hair Restorers.

Editor MEDICAL WORLD:- -Whatever promotes happiness and beauty should be legitimate knowledge for the physician. The writer has often wondered how much valuable information certain advertising quacks possess and has wished that he might acquire the power claimed. As an example a local advertiser guarantees to grow hair upon a bald head inside of ninety days. An eastern advertiser claims to have discovered a specific treatment"an internal, vegetable remedy "--which will restore or develop the female breasts. What physician does not know scores of flat-chested women lacking in beauty and positively unhappy on account of their lack of bust development? With the hope of restoring the breasts of one dissatisfied woman, whose mammæ nearly disappeared after nursing, I ask for aid. Circulars enclosed.

S. M. METCALF,

243 N. Hope St., Los Angeles, Cal.

[The hair restorers recently so much advertised are preparations of resorcin, cantharidis, and either jaborandi or its alkaloid, pilocarpin. The combination varies, some preparations containing all the above mentioned drugs, others one or two. If a liquid, alcohol, glycerin and distilled water are the menstrua. If an ointment, as is sometimes more advisable, some form of petrolatum is invariably the base.

The breast developer owes its efficacy to the 66 cream," a soft emulsion of sweet almond oil, and to the massage necessitated in its application. The "tabloids" are a side issue, calculated to increase the haul of shekels. A mild galactagog will assist the external application.-ED.]

The price of cotton is keeping very low, really the South exported about 232,000,000 more below the cost of production. The planters of pounds in 1897 than they did in 1896, and received $21,000,000 less.-Farm Journal.

Those who are not yet subscribers are invited to join us without further delay. How can you better invest $1 than for WORLD for one year? If you are not ready to do this, we will send it to you for the remainder of 1898 for 50 cents. Please let us hear from you.