summer complaint and true cholera infantum. I have called attention to this point and to the treatment of the latter malady in an article published in the New York Medical Journal, 1894.

It is also to be remembered that heat stroke or thermic fever may give rise to vomiting and diarrhea as in summer complaint, and to high temperature as in cholera infantum, as has been set forth by me in a paper in the Cincinnati Medical News, September, 1891, also, Philadelphia Medical News, August, 1891. The cure by means of the wet pack is very rapid and very satisfactory.

I shall be very thankful to any and all of your readers who may give this method an extended trial, if they will let me know the results either thru your publication or privately.

DR. H. ILLOWAY, Formerly Prof. Dis. of Children, Cincinnati Coll. of M. & S. No. 1138 Madison av., New York, N. Y.

Physicians' Offices-Intermittent Fever. Editor MEDICAL WORLD: -Your editorial in the April WORLD, "Better than Popularity," regarding the condition of physicians' offices, etc., is right to the point. I live in a village of 2,500 or 3,000, having an office on the main street. I know that in these small towns, if the doctors do not have their office in their house they are too prone to think that anything will do for the office. An old sofa and a few old chairs, not good enough for the house, "will be good enough for the office." This is a great mistake. The money spent to fit an office up nicely, even richly, is the best possible investment that one can make. Avoid a cheap, vulgar display, however, and if conscious of one's own lack of taste, get a few friendly suggestions. A neat rug for the floor, a nicely finished flat-top writing desk, one or two pieces of statuary, as a bust of some medical celebrity, and a Roger group of an appropriate design ("Weighing the Baby," or "Going for the Doctor"). A tall pier glass from a low shelf to the wall overhead will do more to give a room an appearance of quiet elegance than any article I can. mention; indeed, an office is not complete without it. Have a few nice pictures on the wall, books nicely arranged in bookcase and so placed that they are visible; it is a mistake to remove one's books, as I find many do. A square stand covered with the latest magazines and fashion book or two I have found is very popular.

Many times, of course, patients have to wait for the doctor, and perhaps after becoming tired of reading, for want of something better they will begin to study their surroundings. As they become interested, perhaps unconsciously, the different articles are associated with the doctor, and when she (it is a woman) has finished, ten to one she has formed an idea of this doctor that will never be eradicated. If, in her exploration, she finds herself rather undecided, the instant her eye lights on the pier glass a little squeal of delight indicates that the doctor has won. A poor doctor with a handsome office will be visited by the better class (financially), and the poorer people as well enjoy the thought that they are as free to sit in the handsome office as is Mrs. Rastor.

Last year the intermittent fever was prevalent during the summer. Out of 150 cases all but three were of the tertian form. So far this year, out of 16 cases, 11 have been quotidian the first 8 cases were such. Is this not unusual? or is it apt to take this form certain years? If this be so, is it apt to be universal? Can you tell me why it is that in a disease for which we have a specific so few doctors, at least in this vicinity, treat the same with reasonable success? Last year about 50 Canadians working on Fisher's Island, brickmaking, were taken with the chills; they took medicine prescribed by a number of physicians in a nearby city, but not one derived benefit. At the end of a month so many were shaking that they were upon the point of closing the works and returning to Canada. At this time they were advised to see me, with the result that but one man out of the 37 that came to me had a chill after coming to me, and he had but one very mild one. 4-oz. bottle of medicine was the most that any took. Because of the difficulty of making them understand, a few of them had a mild chill the seventh or fourteenth day, but a few doses of medicine ended it.

A

Two weeks ago I was called to see two ladies with the quotidian form. One was much reduced in strength and much emaciated and jaundiced. From the reputation of the homeopathic physician who visited her seven consecutive days without giving the slightest assistance, I expected some trouble, but after having fourteen consecutive daily chills she had no more, and four days after she called "just to tell you how nicely I feel." I regret that the above sounds a little conceited, but I trust

you will acquit me of any such intention, as I do not consider it any particular ability on my part. Indeed, it is not original, having got my points from Dr. Hartshorn's practice, and also Bartholow's. Is it because many physicians do not consider how rapidly quinin is absorbed and passed off and give doses too far apart? Mystic, Conn. A. M. PURDY.

[We infer from the above that the Doctor gives quinin in few but decided doses, and in this way gets his favorable results.-ED.]

How to Disguise Quinin.

Editor MEDICAL WORLD:-If W. B. Watt, who asks for a disguise of quinin, is looking for a rival of chocolate creams for ladies and children, I fear he will be obliged to wait for some time; but if he wishes to give quinin to people who do not take pills and tablets readily, I will give him my way, followed for many years. Formerly I had much trouble in giving quinin to children. For a long time I have had very little trouble. I give it with syr, rhei aromatic in the proportion of one grain to the dram, eight grains to the ounce.

I usually write prescription about like the following:

Treatment of Nasal Catarrh. Editor MEDICAL WORLD:-Having noticed in your paper an inquiry from Dr. R. A. Pritchard of Kentucky, regarding treatment of nasal catarrh, it struck me as an opportune moment to draw the attention of your readers to a solution that I have used with great success as a nasal wash for the past five years.

Having found Seiler's and Dobell's solutions irritating, owing to the number of socalled antiseptic oils and so forth, which are out of place in the majority of nasal diseases, being sufficiently strong to irritate and not strong enough to be of service where antiseptic treatment is really needed, I looked for something that would be alkaline in reaction and as nearly non-irritating

as any spray solution could be. It struck me that the human blood was the typical example of a non-irritating alkaline medium, and after having obtained an analysis of the plasma, I ordered from Parke, Davis & Co. a tablet containing the soluble salts of the blood to which was added of a grain of menthol, one tablet added to 1000 drops of water (roughly four tablespoonfuls) and lukewarm, making a solution of the same specific gravity and composition as the blood plasma.

They are to be had from the above firm, being known as "Plasma Nasal Tablet" (Murray McFarlane). I only claim that they are a non-irritating wash for nasal troubles and are to be used in connection with the nasal method of treatment of diseases of that organ. They are being used quite extensively in this country and England, the London Lancet having spoken very favorably of the formula. In cases of deafness due to middle ear implication from nose and throat disease, they may be used over a long period of time, causing no irritation and in many cases acting in the most satisfactory manner as to results.

Dr. Pritchard does not tell us for what form of nasal disease he wishes a cure. Nasal catarrh is not a scientific term, for the nose and throat are subject to many different diseases, each of which requires is own special treatment. We have the simple acute and chronic rhinitis, the various forms of septal deviations, hypertrophies, polypoid degeneration, antral troubles, atrophic rhinitis, adenoid vegetations, and the long list so familiar to every rhinologist, each of which requires to be properly diagnosed, the causative factor ferreted out if possible and the disease treated according to its requirements. And above all things the general health must be looked after, for I consider that a disordered condition of the digestive organs is responsible for many of the diseases affecting the respiratory tract.

MURRAY MCFARLANE, M.D.,
Rhinologist for St. Michael's Hospital.

Toronto, Can.

Treatment of Sunstroke in India. Editor MEDICAL WORLD:-The clever articles in the July issue of your very valuable journal anent sunstroke were both instructive and opportune, and will no doubt be appreciated by your numerous readers.

Permit me to briefly refer to the treat

He described his symptoms very clearly and they much resembled those in cases of chronic hepatic diseases. The headache was not altogether constant, but was continuous enough. He was never more than a few hours at a time free from intense headache; a grumbling pain was always present, and at times, especially about an hour or two after a meal, it was very severe, often preventing his giving attention to business. He was troubled much with dyspepsia, which was at times very acute, so that he was really at those times a badly used up man.

I made examination of his abdomen by sight and palpitation, and also chemic and microscopic analysis of his urine. I found his liver much enlarged; it extended beyond its natural limits in every direction, tender to pressure, had a doughy feel when pressed upon. The veins on the abdomen and over the side of the body, extending down the thighs, were enlarged-some of them very prominent and full. The rectum was full of venous tumors like piles. He was very costive, often being obliged to take aperients and cathartics, but with only temporary betterment, since the cathartics left his bowels in a weakened state.

There were no discolorations of the conjunctivæ or skin on account of bile circulating in the fluids of the body, nor were his feces entirely divested of coloring. There were no white stools, but diarrheas would break out as a result of continued constipation. The stools were then at first lumpy and pasty, of bad odor, of a dirty yellowish color, and unaccompanied by pain. The color and appearance of the tongue was not particularly altered, but he had an odiously offensive breath and his appetite was quite irregular. At times it was sharp, and even voracious, but more frequently was very indifferent, even to entire absence of desire for food on some days.

When I took the case I put him on cream of tartar and magnesium sulphate, in broken doses, just sufficient to keep his bowels soluble and clear them out of fermenting food stuffs, thick mucus and collections of depraved secretions, and the like. My first prescription was

hours till the bowels were gently moved, then continue three or four times per diem to avoid constipation.

Every night and morning, the first thing before retiring and before dressing, a pill was taken composed of ox bile, solid extracts of wahoo and menispernum can., each 1 grains. This treatment was maintained for three weeks, attention being paid continually to the state of the bowels to prevent constipation, avoiding too much looseness; only sufficient to keep them fairly soluble.

After this, beginning in three weeks, I gave saturated tincture of chionanthus vir. 20 drops three to four times a day, still paying close attention to keeping the bowels soluble.

I am certain the chionanthus is a very trustworthy, cholagog. It was first placed before the medical profession by the late Prof. J. J. M. Goss. It is a tonic to the digestive apparatus and to the hepatic protoplasm; besides, in virtue of its peculiar tonic properties, it has power to strengthen the functionation of metabolic tissues and processes.

No doubt cream of tartar had a great deal to do in bettering this case. It acts midway between a mineral and organic substance, being burnt in the tissues, the potash coming out in the urine as a carbonate, the organic acid having been oxidized into H, O and C O, after acting with its base in some way on the protoplasm of the anatomic elements. The cream of tartar made the urine more copious and neutralized the intense acidity, no doubt helping to convert the excess of uric acid into more soluble urinary salts, and to clean out the liver, removing effete matters rapidly so that the organization might be kept clean.

I paid attention to food and sought to have it easy of digestion and assimilation. Enough attention is not paid to food and feeding by the medical profession. It is only, in too many instances, of secondary consideration.

I found butter-milk of very great value to the patient. Some of the time I restricted his diet to it, allowing him to have it in unlimited quantities. Sometimes, when the buttermilk was quite acid, he obtained the most benefit from it, but in such cases acid food must not be too long continued, because it is liable to upset intestinal digestion by provoking catarrh and acting reflexly on the liver and other organs of assimilation. Fresh butter

milk, a little cream, plenty of skim-milk, not much proteid food. I believe vegetable proteids more desirable to a certain extent than animal proteids. One part of animal proteid is far more stimulating to the liver and to other metabolic organs than 1.75 parts of vegetable proteid-but proteids of beans and some other legumins are difficult of digestion; avoid them.

Animal diet, in these cases, must be closely watched. Animal food contains much of the extractives, which are highly stimulant to the sympathetic system of nerves and to the circulatory system as well as to the liver and kidneys. A limited quanity is desirable in the food. Too much is too easily given; and as they are of easy digestion, an excess is liable to quickly affect the organism and thus exhaust its energies.

Milk, buttermilk, carbohydrates, some easily digested fats, not too much salts, are all good to feed, but great care is needed to avoid overfeeding and so injuring the digestive organs, to keep which in good active condition must take up much of a practical man's time in treating chronic diseases.

In two weeks after beginning treatment, medical and dietary, the headaches were moderated; not entirely gone, but sufficiently ameliorated to convince the patient that I was about to cure him. One of my greatest difficulties was in the management of patient and his food. Too much food of any kind was sure to do damage by oppressing the digestive and assimilating organs. I found that the proteids caused me most trouble, because they interfered with stability of nervous system and excretion. I find medicines are good in their place; only of secondary importance, yet valuable. Proper food, diet, feeding and hygiene do the cure. We must preach the gospel of food. Jos. ADOLPHUS. South Atlanta, Ga.

Efficacy of Blaud's Pills. Editor MEDICAL WORLD:-I desire to give the following answer to question of Dr. W. H. Howell in regard to the decided beneficial action of "Blaud's" pills of iron over other preparations of iron in anemia: My experience in the treatment of chlorosis and anemia has been the same, and I have come to the same conclusions you have expressed in regard to the efficacy of this preparation of iron. It is averred that the quantity of iron lacking in the blood of the chlorotic and anemic is

but small and that even of the minutest doses a large share is passed with the stools.

I admit this and some cases undoubtedly are benefited and cured by means of but the smallest doses of iron; nevertheless I assert, and it has almost taken the form of a maxim with me, that the preparation of iron which allows the largest doses to be administered and tolerated, carries with it the means of affording the speediest and most certain relief and cure of the chlorotic and anemic. Of all the iron preparations I have tried within a period of 35 years, the one known as Blaud's ferruginous pills, consisting of equal weights of sulfate of iron and carbonate of potassa, and resulting in a double decompositionthat of carbonate of the protoxide of iron and sulfate of potassa-comes nearer doing this than any of the many preparations of iron I have been experimenting with during this time.

It seems as tho it were the quantity more than the quality of iron the system has to select from, which proves of the most importance in these cases.

Success to THE WORLD. I vote for you to keep up your monthly talks. They divert our studies into channels to which we doctors are liable to pay but little attention.

La Grange, Texas. F. A. SCHMITT, M. D.

For Painful Nipples.

I

Editor MEDICAL WORLD:-Dr. Saling, of Ellsworth, Ill., advises the use of local applications in excoriated nipples (page 242, June WORLD). Since the invention of glass nipple shields with the rubber nipple I have had no trouble with sore nipples. direct the use of the shield for nursing, and tell the mother to then wash the nipple with a little warm water and afterward dry it. Generally in forty-eight hours the nipple will be entirely well, when the shield can be discarded. The inventor of nipple shields should have a pension for life. San Francisco, Cal.

C. B. HUTCHINS.