I notice an article written by Dr. W. E. Alumbaugh, page 298, July WORLD, in which he says, in giving his treatment for ivy poisoning. "I have used it up to the thirtieth dilution." I wish he would tell us just how much water (or alcohol) it requires to dilute one drop of a given tincture to the thirtieth dilution? I confess I am unable to "figger it out." I mean by this, I want the whole drop retained to the thirtieth dilution, and then tell me just how much liquid he has.

Franklin Grove, Ill. W. C. SMITH, M.D.

Hay Fever.

Editor MEDICAL WORLD:-The season for hay fever is at hand, and as but few who are susceptible to the complaint know how to avoid, much less to cure it, a few words relative to the nature and treatment of the ailment would perhaps not be amiss.

Hay fever is a nervous affection analagous to asthma in its manifestations, usually most prevalent during the spring and early summer. The poorer classes, and more especially those living in populous towns, rarely, if ever, suffer with it. It occurs principally among the educated classes, whose nervous systems are highly developed. Tho not in any sense a dangerous ailment, it is at all times very troublesome and irritating.

The inhalation of atoms of hay or blooming grass, the pollen of flowers, the particles producing the odor of fruit, dust or exposure to draught will excite an attack in persons subject to the complaint, but rain or damp weather invariably brings relief.

At one time it was generally supposed that the odor of hay when being mowed or carted could induce an attack, but recent observation shows that it may occur entirely independent of the existence of hay fields and is really a nervous derangement. A visit to the seaside, a trip to the mountains, or residence in a populous town, will, however, remove the asthmatic tendency. To effect a cure the treatment should begin from six to eight weeks before the attack is expected. A good prescription to use is:

peated again the following year at the same season. Each successive year the attack will become lighter and susceptibility may cease in two years, altho four years is the average time required for a cure. This line of treatment was taught us back in the '70s, by Prof. William H. Thomson, of the New York University,

In addition, experience has taught the necessity of regulating the condition of the bowels and kidneys by a rigid attention to diet. If a uric acid diathesis exists, correct it by a vegetable diet, permitting the use of white fish, but avoiding alcoholic drinks. Free use of simple diluents, such as Vichy or Carlsbad waters, give excellent results. In the acute stage start in with:

You may also prescribe hot shower. baths, followed by good rubbing. Among other palliatives is tobacco smoke retained so long as possible in the mouth, and then ejected thru the nostrils.

Keep in mind the fact that this affection is of a nervous origin, and hence that regular out-door exercise, tonics and nourishing diet are more essential than palliatives, which, after all, only afford temporary reJ. J. S. DOHERTY, M,D.

lief.

New Haven, Conn.

Dr. Waugh's book on Treatment and THE WORLD until 1900 for $5.

Asepsis in Country Obstetric Practice. Editor MEDICAL WORLD:-I would like to ask the following questions of your readers with the hope of ascertaining what is the usual habit of the ordinary physician with regard to antisepsis in obstetric practice, and to learn how nearly said practice corresponds with the theories of modern teachers and authors.

(1.) What method of cleansing and disinfecting do you practice for self and patient?

(2.) Do you employ preliminary irrigation of the vagina? if so, what do you use? What is your practice as to vaginal douches after labor?

(3.) How about sterilization of patient's garments and bed-linen? Do you ever allow an unsterilized article of body or bed apparel to come in contact with your patient? If not, how do you sterilize them: steam, dry heat or boiling?

Supposing you should come, at the end of a twenty-five mile ride over one of the roughest roads on this edge of North America, to a wretched little hovel on the side of a mountain, hardly fit for a respectable crow's nest, and find there a poor, miserable, little woman just ready to shell out her fourth child, the product of an old wreck of a husband who might easily have been her grandfather; in the cabin a clean sheet, a clean wash bowl or basin, or a clean anything for that matter, among the unheard of luxuries; tacked upon the wall back of the bed where the woman lay, an old grain sack literally incrusted with the dried expectorations from the old man's diseased bronchial tubes, an ideal breeding ground for all sorts of bacteria; I say, supposing all this, how would you go about inducing that young would-be mountaineer to defer "borning" for such time as would enable you to get material together and make preparations to receive the youngster in harmony with modern antiseptic theories?

Well, in this case, I didn't try it, but simply let him born, and the little fellow showed his appreciation of my consideration before I got the cord tied, by lying on his back, sticking his little penis up, and micturating a stream straight toward the zenith for a distance of at least fifteen inches.

Without opportunities for asepsis, this woman got along and made an ordinary recovery, except that she suffered from a gathered breast, the result of too early exposure.

A late author says that "in the dwellings of the poor the antiseptic precautions may be much simplified and yet be quite effective;" which is equivalent to saying that many of the "antiseptic precautions" are unnecessary.

(4.) Is it the opinion of any of the WORLD's readers that many of these "antiseptic precautions" are elaborated and taught simply to satisfy a popular demand? Do any of you dare to think that possibly the antiseptic pendulum has swung a little past the center of gravity, and is imminently liable to come swinging back one of these fine mornings?

If these crude questions and suggestions shall have the effect to draw out a candid and sincere expression of opinion of some of your large family, I shall be glad indeed. What I want is a truthful expression of opinion and statement of experience, and not theory. READER.

Dixon, California.

Hour-Glass Contraction of Uterus-Dysentery. Editor MEDICAL WORLD:-According to promise, I report two cases interesting to

me.

I

(1). Hour-Glass Contraction of Uterus. I was called December 5, 1896, to see a primipara, aged 26, small, narrow pelvis, weight about 110 pounds, having pains about every 15 minutes. I made an examination and there was complete dilatation. I assured her everything was "all right" and gave her no more special attention, until the pains became of a severe bearing-down nature, when I watched her closely until I delivered a 7 pound girl. kneaded externally gently with the left hand and shook the cord with right hand to start up uterine contraction. I waited about half an hour, but the pains did not seem to increase, so I made a thoro examination, and it seemed that the cord stopped completely and the fundus uteri had been reached, but I could not find any placenta. I now suspected I had a case of hour-glass contraction. I gave chloroform, thrust my hand in past the constriction and delivered the placenta, without any unusual suffering.

I report this case because I have read in different medical journals that different obstetricians say there is no such a thing as "hour-glass" contraction of the uterus, owing to the position of the muscular fibers. I think they have failed to study their anatomy thoroly enough to learn

that there are transverse fibers which cause this complication.

(2.) Dysentery.-I was called July 4, 1898, at 8 p. m., to see a youth aged 17, who had been having bloody stools for three days previous. I thoroly evacuated the bowels (as I thought) with calomel in broken doses, followed by epsom salts, and on my return next day found him stooling as usual every 15 to 20 minutes. There was blood and slime in the discharges, but no fecal matter. I prescribed:

Tr. opii

gtt. xx Sulfo-carb. zinc grs. iij Fresh milk dr. ji Sig.-Inject high up in the rectum every six hours, after flushing the bowels well with tepid water.

I continued treatment as above for five days, when patient was loaded in a farm wagon and driven about ten miles. He is still improving, one week after the ten miles' drive.

The point I want to impress is the use of sulfocarbolate of zinc in the rectum with laudanum to allay the tenesmus, the sulfocarbolate being the healing agent. I have never heard of a similar treatment. I would, however, insist on a thoro trial by other practitioners. Of course, you have got to restrict the diet, so as to relieve bowels from any bulky substance, and I usually prescribe lemonade freely. Short, Ind. B. C. WRIGHT, M. D.

The Proper Management of Confinement. Editor MEDICAL WORLD:-In the August MEDICAL WORLD, J. G. L. Myers, M. D., gives his idea of the proper conduct of labor cases. Such a recommendation for neglect savors strongly of ancient practice. I think it is poor advice to give, especially to young practitioners. "Old Father Time" should and does have a chance; the time for professional interference is when Father Time is over-exhausting the patient, when the process is at a stand-still. In many

cases, if no interference is made, Father Time would allow the patient to bleed to death. He certainly would often give ample time to kill the victim by septic poisoning if after-births were allowed to remain until he removed them.

My idea is to remove the placenta immediately, by Crede's method, if possible. I will work faithfully for about half an hour, and if not successful by this method, I pass my hand into the womb and remove every particle of its contents, then thoroly cleanse the womb and vagina with hot water, with or without antiseptics, as circumstances indicate. Then the womb can rest as long as patient sees fit to give it rest.

The professsion is honorable, because it is chosen by the best of men, and its honor is maintained by them. Its honor would soon be smirched if its scientific attainments were applied to dishonorable ends. In my practice, were I to allow "Nature to take her course," I would soon be accused by some of my brother practitioners of criminal neglect in some cases. There is no question in my mind but that mechanical interference is sometimes resorted to when uncalled for, but this does not justify abolishing intelligent aid in labor Yours truly,

cases.

Ridgway, Col.

B. B. SLICK. [We do not understand Dr. Myers to enjoin a policy of non-interference where the converse is indicated. He is speaking merely of normal cases of labor.-ED.]

Cerebro-Spinal Meningitis.

Editor MEDICAL WORLD:-The diagnosis of the following cases was confirmed by competent counsel:

CASE 1, 1887.-Girl, age four years, the youngest of a large family, father a brokendown soldier. She was taken sick suddenly, with vomiting, cephalalgia and a scarlatiform rash, which disappeared in short time. The pupils were dilated at first, but contracted the last two weeks.

She died in four weeks, after being comatose, for several days. I treated her with calomel, the bromid and iodid of potash and blisters.

CASE 2, February, 1889.-Girl, age three years, clinical history and treatment same as above, also the same result.

CASE 3, February, 1895.-Girl, age eight years, a history of tuberculosis on the father's side.. She was taken sick suddenly at school, with nausea, cephalalgia,

and chills. The rash appeared on the second day, lasting a short time. The temperature was 104°, pulse 120. In the second week the head was retracted and there were convulsions, followed by paralysis of the left side. Delirium was present thruout. The joints were swelled and very painful. She was comatose for about two weeks. The vomiting was persistent for ten days.

Treatment-Counterirritation over stomach and neck, tincture opium, bromid potash and gelsemium, alcohol baths, and enemas. Patient fully recovered.

CASE 4, February, 1895. Girl, age nine years, family history good. She was taken sick same time as case three. The course was mild, tho the symptoms were well marked. The treatment was the same as above, and terminated in recovery.

CASE 5, March, 1898.-Girl, age four years. History of tuberculosis on the mother's side. Patient had a delicate, nervous organization. She was taken sick suddenly, and the vomiting was persistent from beginning to end of her illness. The axillary temperature was 102°, pulse 80 to 90, irregular jerky respiration and very rapid; paroxysmal pain in head. There There was a rash resembling measles, which disappeared in six or eight hours. She ground her teeth during pain. There were blue spots on the soft palate. She complained of intense thirst and pruritus.

The head was retracted, and there were convulsions on the fourth day, slight attacks recurring for several weeks. Paralysis of the left arm was noticed and a large blister appeared, covering little right toe. The temperature ran a very irregular course, frequently 95°, 96°, 97°, in the axilla, in the morning, while the pulse was up to 140.

Treatment-Tincture opii and tincture gelsemium given after vomiting. At times I gave morphia hypodermically, but found codeia and gelsemium were better. Alcohol baths were used with inunctions of cod liver oil, and rectal feeding. A hot water jug was kept continuously in bed.

The patient has now apparently fully recovered, after being sick four months; cases three and four were sick 23 months.

My object in reporting these cases is that by comparing the treatment and results some one of the brotherhood may benefit. KARL MANTEY, M. D.

Minerva, O.

WORLD one year and Dr. Waugh's book, $5. You need them both.

Treat the Symptoms.

EDITOR MEDICAL WORLD:-I was recently called to see a robust old gentleman of sixty-eight. He had been sick several days, but not confined to his bed. He complained of severe chills every day and loss of appetite.

I found him with a high temperature, 103° F.; stupidly sleepy; tongue dry, glazed and fissured (the latter being a somewhat natural condition), with scattered sordes here and there; breath fetid and abdomen somewhat tympanitie. When aroused his mind was perfectly clear.

A diagnosis of some specific fever might possibly have been warranted; but knowing the patient well, I surmised auto-infection and made no diagnosis-simply prescribed for the existing symptoms.

As the pulse was tense, full and hard, I selected for defervescence aconitin amor., gr. 1-134; veratrin, gr. 1-134; and digitalin, gr. 1-167, giving them in the form of the "Defervescent Compound No. 1," and gave one every one-half hour for four doses, and then every hour until 10 o'clock p. m. This would use up the ten doses prescribed.

With each dose of the above, I ordered one granule, gr. 1-6, of calomel; with instructions to give a heaping teaspoonful of saline laxative in two-thirds of a glassful of cold water early in the morning, and repeat every hour until bowels should move freely. Food was interdicted, but permission was given to drink water freely and to take nothing else, excepting what was prescribed, until directed to do so.

This visit was made at 3:10 p. m. I instructed the attendant to report in the evening, and was told that the temperature was falling and that the patient felt better.

On my visit the next morning, at 10:30, I found the patient absolutely free from fever; pulse long and elastic at sixty-four; tongue clean and moist; patient anxious for his breakfast and ready to get up. I allowed a light breakfast of toast and hot milk, ordered the patient to remain in bed and prescribed quinin arseniate, gr. 1-6, and strychnin arseniate, gr. 1-134, together every two hours during the day, saline laxative to be taken early every morning, with instructions to report if improvement was not continuous. Everything progressed favorably, and the man was soon up and out at work as usual. My purpose in mentioning this case is to emphasize the

importance of applying active measures to active conditions. In this particular case my assumption was verified, and by heroic treatment, properly applied, a knock-out blow was given before organic lesion could take place.

What that organic lesion would have been, is mere conjecture; and, I do not care; the patient is well.

Brother, have your medical fist in your pocket and always with you; keep it doubled up hard, and when the occasion presents itself, plant it good and hard and squarely between the eyes of the prevailing symptoms and you will see many a condition change in a manner that will surprise you and all concerned. Give the right thing in the right place, and push it till you win. DR. W. C. ABBOTT.

Chicago, Ill.

Prickly Heat-Corns-Ovaritis-Sprained

Ankles.

Editor MEDICAL WORLD:-August number of THE WORLD has arrived and, as usual, I have digested the monthly talk. Both of the Wisconsin Senators and our Representative have received letters from me, and I enclose their replies, which you will return if convenient. Shall write them again soon. Keep up the good work. Recently I had a very interesting case of what is commonly called prickly heat. The attack began by chilliness and intense itching of the body and extremities, and was followed by swelling and redness. After the swelling, the skin thickened and a slight oozing of serum was noticed, but scratching may have altered some of the symptoms.

Slight cough, smarting of the eyes and diminished quantity of urine were the only accompanying conditions. Appetite and bowels were normal.

Patient could not work or sleep on account of itching, which was worse during the night, after eating and from heat. Gave diuretic of buchu, juniper and potassium acetate; also, some apis 2x.

These seemed to have no effect upon the kidneys or skin, and at the end of 36 hours I changed to five-grain capsules of chloral hydrate, every 24 hours, and a wash of carbolic acid and bran. He returned in two days with no improvement. I then gave some homeopathic remedies-one drop of tinct. aconitum radix and followed with dulcamara first dilution, three drops every three hours. I continued chloral to quiet

Ácid. salicylic

grs. xlv

Tinc. rhus tox (fresh plant) gtt. iv
Collodion flexile.

q. s. 3j I suppose many physicians have tried this formula without success, but it is because they did not start rightly. First soften the corn with soap and hot water and frequently scrape with a dull knife until the callus is removed. This will take a couple of hours sometimes, but be careful not to start the blood or make the foot too sore. Then apply the collodion with a camel's hair brush twice a day. In a week or ten days a thick plate of epidermis can be removed easily, by repeating the soaking and scraping process.

The treatment causes some soreness, and a very soft, loose shoe must be worn, but continue with this process, several times, if it takes two months, and you will be rewarded by success.

Many physicians advise operation for chronic ovarian troubles. If they would spend some of their time studying materia medica, the patients could often be cured by medicine. I use thuja and oil of tansy principally. Case in point:

A girl, aged 14, nurse and servant, was brought to me with both ovaries extremely inflamed. She was very anemic and pale, with constipation, weakness, palpitation and anorexia for three months.

Gave cascara sagrada, aromatic (P. D. & Co.), 10 drops morning and evening. She returned in a week with bowels regular, but pains as bad as ever. Gave oleum tanacetum, drop doses, one hour before each meal. She returned in a week and said she was compelled to stop medicine after three days, because it made her worse. Gave her oil of tansy, or drop doses, same as before. This was followed by immediate improvement, and at the end of a month the constipation, ovaritis, anemia and palpitation had all disappeared,