orrhage return and had them prepared and in 1 to 2,000 Hg Cl, solution. This was not necessary, for the fetus was expelled before any hemorrhage of any consequence and without rupturing the enveloping membranes. The placenta formed a perfect hood and hid all of the head and neck. The features had made a perfect impression in the placenta. There was much edema about the eyes and one side of head movements ceased two days before delivery. I had suspected a dead fetus when I advised forced delivery, and the delivery showed I was correct. I was never able to catch heart-beat because of the strong placental bruit. The reason that hemorrhages ceased was because of the child's head, which made a pressure first at the internal os, where the detachment first began. Then, as the os dilated, the head made pressure on the margins, thus forming a natural tourniquet. As dilatation progrest the head passed on and formed a stopper or natural tampon so that the detaching of the margins of placenta did not cause any hemorrhage till the fetus with all the "belongings" were expelled. Then there was a rush of blood that had collected behind the fetus and all was over. I kept the fetus as it came and preserved it in alcohol. I had the family provide themselves with fountain syringe and had ready a 1 per cent. solution of lysol, which was to be injected hot; this was used but once, and the action of the lysol, together with the heat, checkt hemorrhage completely. The mother had given birth to three children before and was twenty-seven years old. She had what she called "a show" at times since September, and one serious hemorrhage about December 26, but no physician was called. I report this case because of its interest to me and I hope it may interest the WORLD readers. This is the third case of placenta previa I have had and I have saved one child and the three women. One case I forced delivery by artificial dilatation. Before closing my say I wish to call attention to the fact that our town and surrounding country has had an epidemic of jaundice. Hardly a family in town. escaped one or more cases. The parties did not go to bed. Was it a contagion or was it caused by malaria? I think malaria. Imboden, Ark. G. A. WARREN, M.D. Injection Treatment for the Cure of Hernia. Editor MEDICAL WORLD:-Since my first article on this subject appeared in the November, 1897, issue, page 467, of THE MEDICAL WORLD, I have received about 150 letters from physicians requesting further information concerning the treatment. The receipt of so many communications of this character indicates the great interest manifested in the subject; also that the readers of THE MEDICAL WORLD are progressive and anxious to become fully acquainted with the various methods that offer the greatest advantages in relieving suffering humanity. In answer to those inquiries, other articles were written and appeared in the following 1898 issues of THE MEDICAL WORLD: February, page 64; March, page 105; and April, page 155. However, letters continue to pour in, showing that there still remain directions as to administration that have not yet been made clear to those unacquainted with the treatment. This article will be devoted principally to explaining the reasons why early writers and others have frequently failed to secure satisfactory results with the injection method, also to show the need and advantages of said treatment. The four principal reasons why physicians have failed to secure satisfactory results or permanent effects are due: First, to the fluid used. I have given the fluids advocated by Doctors Heaton and Warren, which consists principally of white-oak bark, but the results were so unsatisfactory that I would have discarded the treatment entirely, were it not that less objectionable and more efficient fluids could be procured. The following are the principal fluids used by me, giving a few injections of each in most cases, but depending on the last one for children: Ꭱ Guaiacol M. Sig. Inject 2 to 5 minims once a week till cure is effected. Second, failure to apply at the outset a support or truss that will retain the hernia 'under all conditions during treatment, Third, failure to deposit fluid at the proper place. Before it is possible to give the treatment properly it is necessary to diagnose correctly whether the hernia, if inguinal, be direct or indirect. If indirect, then to determine the length of the canal. A fair distinction can be made by pressing with the thumb, midway, anatomically, between the internal and external ring, then have the patient cough. If the hernia appears, no doubt it is "direct;" but if the hernia descends thru the canal until obstructed by the pressing thumb, it is "indirect." If it be indirect, the length of canal can be determined by advancing the thumb toward the internal ring, having the patient continue coughing till a point is reached where the hernia comes out below the thumb. Fourth, failure to apply a light support of some kind on those who have a predisposition to hernia, or in whom the abdominal walls are not sufficiently strong to bear the pressure required of them. Heredity is a great factor in the causation of hernia. I am now treating three brothers and six of their children for hernia. All of them are strong, healthy and without any other constitutional defects that would cause weakness in those parts. It is a common occurrence to hear of from three to five persons in one family thus affected. A large percentage of hernia is due to relaxation of the walls of the abdomen, which is not overcome by apparently curing the rupture. It is necessary, in such persons, to apply sufficient support to balance the natural weakness, in order to prevent recurrence after any treatment. When one considers that there are as many ruptured people in Pennsylvania as there were soldiers in the recent war, that most of them are constantly enduring great annoyance and misery either from hernia or a severe and uncomfortable truss, and that they now live in torture because they are under the impression that hernia is incurable, we cannot overestimate the necessity of bringing into general knowledge and favor the treatments which offer the greatest advantages for its alleviation and cure. Unfortunately the afflicted have until quite recently been compelled to depend upon a truss as the principal source of relief, the result of the continued wearing of which, with the necessary pressure required to retain most hernia, not only causes absorption and weakness to the structures underneath the pads, but frequenty produces serious disorders. The percentage of cures from the cutting operation varies; some writers claim they have never had any failures, while others -whose ability and reliability are above reproach-do not claim over 50 to 60 per cent. of cures. Unfortunately for patients, if the cutting operation is not a complete success, thereafter they are generally in a worse condition than before. The number of persons undergoing the cutting operation for hernia in this city in 1896 averaged less than 1 to every 500 thus afflicted. The operation has been a great blessing to many, but until the aversion the laity now have to the knife is overcome, it will play but a small part in affording relief to the innumerable sufferers needing treatment. The percentage of cures from the injection method also varies, some writers claim they can cure all cases. Everything depends on what the term "cure" implies. If it means to entirely eliminate the trouble and remove all disposition to its recurrence, the patient being able to dispense with support of any kind for an indefinite period, the percentage of cures will be lessened; but, if it means "to entirely eliminate the hernia" the patient being directed to wear a light support, perhaps only a bandage, more as a protection and not for retention, then the average will be 80 to 90 per cent. From my experience, which includes over 400 patients, I know that the openings and canal in practically all cases of reducible hernia can be entirely and permanently closed, with proper care. It will be necessary to give an occasional treatment afterwards in persons whose recuperative powers are weakened; while others, who may not be able to entirely dispense with some kind of a light support. may never require further treatment so long as they wear even a bandage. The following is a brief summary of the principal advantages and meritorious qualities of the injection treatment. 1. It is free from all danger and complications when properly administered, which is proven from the fact that I have given over 3,000 injections without unfavorable results. 2. If a complete cure cannot be effected. the patient can be wonderfully relieved. 3. The only detention from business is the few minutes required for giving the treatment. 4. If the hernia were to return thru accident or negligence, the patient would not be in a worse condition than before, and a few treatments will remedy the difficulty. 5. Finally and most important of all, is the fact that it overcomes the principal objection entertained by the laity to the cutting operation, and therefore is acceptable to the masses as a curative agent. C. FLETCHER SOUDER, M. D. 1607 Arch Street, Philadelphia. Various Uses of Apomorphia. Editor MEDICAL WORLD :—A correspondent in a recent medical magazine in an interesting experience with apomorphin relates that he produced instantaneous emesis by the hypodermic injection of gr. . This is a little contrary to the usual action of the drug. It ordinarily requires 8 or 10 minutes to produce its effect. Perhaps it is like its great congener, morphin, which we have noticed get in its effects almost instantaneously, but these occurrences are not common and are perhaps owing to individual peculiarity or to the occasional puncturing of a small blood-vessel. The dose referred to above is large. Potter makes it the limit, but I have had no untoward experience in using it. In an emergency I would risk it and I only use it hypodermically in emergencies. The more usual dose is from gr. r to gr. f. remedy. In fact it should be the very first it to be convinced of its usefulness. More About the Thirtieth Dilution. Editor MEDICAL WORLD:-The quantity of liquid it would require to dilute one drop of a given tincture to the thirtieth dilution depends on whether the decimal, or centesimal method is used. The latter process is the one adopted and described by Hahnemann in his Organum. He says: "If two drops of a mixture of equal parts of alcohol and the recent juice of any medicinal plant be diluted with ninetyeight drops of alcohol, and the whole twice shaken, the medicine becomes exalted in energy to the first development of power or first potency; the process is to be continued through twenty-nine additional vials, each containing ninety-nine drops of alcohol, so that every successive vial after the first will be furnished with one drop from the vial or dilution immediately preceding. In this diately preceding. These manipulations are to be conducted thus up to the thirtieth or decillionth development of power which is the one in most general use." (Organum, Second American Edition, page 200.) It is in lung and throat troubles where I have had my richest and most pleasant experience with this drug. In all harsh, dry, hacking coughs, or where the sputum is tough, this is the remedy par excellence. Acute laryngitis and capillary bronchitis are foes to be dreaded, armed with the usual remedies, but with apomorphin in our armamentarium, we fearlessly march to victory. The dose is small and oft repeated. The following case will serve to illustrate: Cough incessant and hacking, expectoration very scanty, pulse feeble, beating from 120 to 130 per minute, temperature 103°, countenance flushed and anxious, respiration accelerated. In this case four granules, gr., were given every half-hour until signs of improvement, when it was given less often. The good editor of the aforementioned magazine advises against the use of this drug in croup; but I know of no better Dr. Hooker, of New Haven, Conn., and Prof. Post, of University College, New York, made computations of the quantity of alcohol or liquid required for the dilution in this ratio if instead of throwing away ninety-nine parts in every hundred the whole is retained. For the first dilution, 100 drops; for the second, 100 times. as many, or about a pint; for the third, 100 pints; the fourth, 10,000 pints; the ninth dilution would require ten billions of gallons; for the twelfth, 500 lakes as large as Lake Superior; the fifteenth, a quantity of liquid in bulk greater than the earth; but this, they say, would be concentrated compared with the thirtieth. Probably this is as near an answer to his question as Dr. Smith will be able to get, in the present state of mathematical knowledge. The Volume of the Thirtieth Dilution. Editor MEDICAL WORLD:-Dr. W. E. Alumbaugh's assertion that the thirtieth dilution of a homeopathic tincture represents one part to one billion parts of water is a great mistake. Dr. W. C. Smith in September WORLD, page 391, makes fun of this thirtieth dilution, and wants to know how much water he needs to bring one drop of a given tincture to the thirtieth dilution. To show him the waste amount of medicinal power in a teaspoonful of this high potency, I venture to explain that each potency represents one with a cipher attached; one drop to nine drops menstruum =1, 1 to 99=2x, 1 to 999-3x and so on, Syphilis, Appendicitis, Gonorrhea. Editor MEDICAL WORLD:-Dr. F., in October WORLD, asks for the treatment of syphilis, appendicitis and gonorrhea. In the first place, he should sign his full name. In the case of syphilis he should give calomel, to grain; soda bicarb., one grain. every two or three hours for five or six weeks, every day. Then follow with succus alterans in the full dose. He needs no other treatment. In every case of appendicitis commence at once with the following prescription: B Epsom salts Flu. ext. cascara . 3j 3ss žj 5jv M. Sig. Give one tablespoonful every two hours until it acts thoroly on the bowels. Repeat every other day until the patient is cured. For pain use hypodermics of morphin as needed, or small doses of tincture of opii, deod. Apply hot fomentations. Now for the gonorrhea. Let all injec tions alone. Give him aconite for the fever, epsom or rochelle salts to keep the bowels in a soluble condition. Give him sweet spirits of niter in teaspoonful doses three times a day for one week; also mucilagenous drinks. Bathe the organ in hot water frequently. After the first week give him: Ꭱ Spts. lavender co., q. s. ad. . živ until the 30x is equal to one with thirty spoonful three times a day. Now calculated, that one ounce represents 500 drops, one gallon is equal to 64,000 drops, consequently a number, consisting of one with thirty ciphers following, representing drops, would be equal to 14,625,625,625,625,625,625,625,625 gallons. I doubt if the Atlantic Ocean contains water enough to furnish that amount. Zell, Mo. DR. THEO. HERMANN. This is old style, but it cures rapidly and is not followed with complications. Columbus, Ohio. S. C. DUMM, M.D. Malaria. Editor MEDICAL WORLD:-Living as I have all my professional life in a malarious locality, and having fifty years of opportunity to study its peculiarities, leads me to feel that this amount of experience is sufficient to fix upon a definite plan of treatment. The first half of my practice was when we had numerous mill dams and no sewerage cesspools in every yard. At that time everything shook, almost even to broomsticks. Quinin then was on an average about $3.50 per oz. From an economic standpoint and to obviate the objec tion to the use of quinin, which the ignorant thought was, like calomel, "hurting their bones," and in many causing deafness, I used various remedies and found good results in using solid extract of yarrow, and in many cases the common saw bug which is found under decaying wood. But the more reliable speedy cures were effected by a combination of quinin and arsenic; using arsenic as a prophylactic on those days when the trouble was likely to re turn. My plan was and is and will be always to unload the portal circulation first and foremost. If a diarrhea ushered in the attack I gave blue mass-otherwise calomel, both followed with a saline cathartic. The bisulfate of quinin was always used owing to its readiness of dissolving and speedy absorption. It only took 10 parts of water to dissolve, while the sul fate required 400 parts. Of course the use of acid obviated this use of so large quantity; but if sulfuric acid was used, the quinin was converted into the bisulfatereturning thus to the starting point. I found many cases accompanied with hives and found that curing the chills the hives were also cured. These hives in some cases occurred where no chill or distinct fever was shown but were of every other day occurrence. All such yielded to the bisulfate. I look upon quinin as a specific in malarial poisoning. I believe that the return of the paroxysms on the seventh, fourteenth and twenty-first days is due to the reloading up of this poison. Markt cases of chills and fever were noticed in families who left our city for a summer sojourn where this disease was unknown, and when no symptoms were shown long prior to their departure. The unloading of a home tolerant dose of malaria developed chills and fever. Fortunately with the removal of our dams and the establishing of good sewerage and uniformly good rivulet water, our city now has lost its old unenviable reputation. Nursing children were cured by frequent inunction of quinin mixed in either lanolin, or benzoated lard, or both. In bad cases the mother was given quinin internally. In closing I want to say always attend to the liver first, but never by such drastic purgation as to enfeeble the patient. Rahway, N. J. DR. SILVERS. Those subscribing now for 1899 will receive THE WORLD free for the balance of 1898. Dengue. Editor MEDICAL WORLD:-As we have just passed thru a very severe epidemic of dengue, I thought I would give you a few of the symptoms as I found them in my cases, and also an outline of my treat ment. In some cases the patient complained of "hurting all over," as tho every bone would break. Others complained mostly of severe pain in the head, the back of the neck and in the lumbar region. Still others complained of severe pain in the stomach and the abdomen, and very severe nausea and vomiting. In some cases the fever ran high-to 105°; in others the fever was more mild, 101°-2°. In a few cases there was no fever at all. In more than half my cases, after the fever subsided, the temperature fell to 95° and 97°F., and remained down from two to four days, in spite of stimulants. The pain was just as severe when the temperature was subnormal as when it was 105°. In nearly all the cases the tongue was heavily coated and the bowels constipated -almost paralyzed; it requiring two to four times as much medicine as usual to move them. In many cases an enema of warm water had to be used. In most cases there was an eruption of the skin like measles; that is, the eruption could be felt thru the skin. In most cases there was an intense itching, whether the eruption showed thru the skin or not. In most all my cases the patients had an unusual distaste or repugnance for drinking water -almost famishing before they would drink. These peculiarities-subnormal temperature, seeming paralysis of the bowels and great distaste for water-are they peculiar to dengue or not? My treatment, with a few modifications, according to the patient's peculiarities was about as follows: For fever, the defervescent compound granules No. 1, one every 15 minutes till fever was reduced to 101°, then every one or two hours as necessary, in the sthenic cases. In the most severe cases I used the ice cap, sponge baths, cold drinks, etc., to aid the granules. In the milder cases I gave the dosimetric trinity No. 1, one every half to one, two or three hours, as necessary, to keep fever down to 101°F. In the subnormal cases I gave caffein, glonoin and strychnin as medicated. For pain I gave three codein granules, gr. ; two gelsemin granules, gr. r; two macratin granules, gr., every half-hour till pain was relieved, sometimes |