treatment very different from that required in the other.

Mechanical obstruction is often the cause of constipation, and generally a dangerous one. It should be detected early, so that if operative measures are required, they may be instituted before the patient is so far gone as to make the outcome of surgical interference doubtful or even hopeless. These states are usually sudden in onset, and accompanied by early disturbance of the upper enteric tract, the symptoms being nausea, retching and vomiting, besides a facial expression of anxiety, and later, fever. Abdominal pain is a common as well as an early symptom, but not uniformly present. It is safe to say, however, in my judgment, that constipation of sudden onset, and unrelievable by medication, associated with an anxious countenance, indicates an obstruction that is likely to demand the use of the knife for relief.

Bad habit is one of the most prolific causes of constipation, especially in women. this regard, they are notoriously careless. They usually neglect a call of nature so long as it can be resisted without too much discomfort. Many of them go four or five days without a stool. As a rule, they drink less liquids than do men, and are, therefore, that much more prone to dry stools. One cause of their neglect is their sensitiveness to being seen going to a closet, especially in public places. Anyone, with even very moderate ability to observe, must be able to recall numerous instances of the truth of these remarks, and many other illustrations of their correctness could be adduced. It is, therefore, needless for me to catalog them here. It is sufficient to call attention to them. Women thus situated should have the danger of the costive habit fully explained to them. Its effect upon the intrapelvic organs of women should never be overlookt. Women have been sent to private gynecologic hospitals to have their uterine adnexa removed, and have even been prepared for operation by experts, only to be sent home with the statement that they had no serious trouble as they had supposed, but this only after a large preliminary enema had removed masses of fecal accumulations that had weighted down the sigmoid flexure so that it simulated an enlarged ovary with a surrounding pus tube.

The rule may be laid down as a very reliable one, that it is always safe, and almost always beneficial, to move the bowels

amply once in twenty-four hours. The exceptions are almost self-evident, but I will mention several, such as in operations upon the rectum or anus, upon the perineum or base of the bladder, or when the patient is upon a liquid diet with no residue. A. H. P. LEUF, M. D.

Philadelphia.

[This series of articles will be continued in subsequent issues of THE WORLD. Comments are invited by the author.-ED ]

Amyl Nitrite and Nitroglycerin.

Editor MEDICAL WORLD:-Both nitrite of amyl and nitroglycerin decidedly reduce the reflex activity of the spinal cord, and relax the tone of unstriped muscle. Both diminish oxidation, blood in both sides of the heart becoming the same color. The energy of nerve centers is diminisht. Physiologically, both lower blood pressure by relaxing the muscular coat of the arterioles, blood passing thru the capillaries into the veins with great facility, the right heart being crowded.

In doses not immoderate the left side is well supplied and the circulation becomes freer. The immediate effects are flushing of face, carotids are full and throb, head feels full of blood, oppression of mind. If the dose is a trifle too large the heart beats fast and the systoles are weak. Arterial pressure is lowered and blood circulates feebly. The functions of the nervous system are lowered by doses beyond a certain limit; in small doses of glonoin the functions may be raised, owing to more blood circulating thru the nerve centers.

Nitroglycerin and nitrite of amyl, in proper doses, relieve congestions and engorgements of parenchymatous tissues, by allowing the blood to freely enter and leave tissues in which the arterioles are constricted and the tissues anemic. The loss of nervous tone in the system favors this unphysiologic condition of the circulation.

These are excellent remedies in the first stage of Bright's disease of the kidneys, when the pulse is hard, the arterioles of the kidneys are constricted, blood pressure is high, urine greatly diminisht and albuminous, with pain in region of kidneys, small of back; fever. In great depression of the nervous system, give glonoin in doses of solution, 1-100 of a grain, either put on the tongue or dissolved in cold water, repeated every four to six hours. In urgent cases, repetitions may be more frequent. The effect of the remedy is to relax arterial

walls in constricted renal areas and promote normal circulation.

The remedy is indicated in angina pectoris; the symptoms being removed by doses of 1-100 grain by the mouth. It is also given hypodermically in doses of 1-100 to 1-60 grain, repeated at such intervals as urgency of symptons may demand.

It has been given in 1-100 grain doses in cases of epilepsy accompanied by pale face, hard pulse, and rigid muscles, with gratifying results. Two cases of opium poisoning have been successfully treated by nitroglycerin in 1-100 grain doses, repeated every hour three times. In another case, where 10 grains of morphia were taken at one dose, hypodermic injections of 1-100 grain of glonoin repeated every hour, several times, met with success; treatment was begun more than an hour after the morphia was taken.

Nitro-glycerin has been given to arrest the chills and congestion of pernicious fevers, with good results. It acts as a diffusible stimulant in profound congestions of the lungs in some cases of pernicious pneumonia in which the lungs are engorged and the powers of the circulation nearly overwhelmed by the pneumonic poison. In some cases of the disease, when periodic pulmonary exhaustion from passive congestions occur, 1-100 grain nitroglycerin given in time hypodermically will distribute the blood out of the overwhelmed lungs and save life.

Nitro-glycerin is a valuable remedy in pulmonary hemorrhage of severe type. I have saved two cases of this kind by drop doses, every two hours till hemorrhage ceases. It relaxes other vascular areas that are unduly constricted and sluices the blood out of the lungs. Similar results are obtained in hemorrhages from other internal organs.

Amyl nitrite is useful in severe attacks of angina pectoris. A few drops are let fall on a cloth which is held near the nose that the vapor may be breathed into the lungs. Immediately the spasm gives way, and life is saved, which may have gone out under less physiologic treatment. The immediate effect of the remedy is to arrest the spasm of the walls of the blood-vessels and let the blood have a free distribution, thus relieving the angina symptoms.

I believe many deaths from pernicious chills may be prevented by careful administration of glonoin in drop doses of the alcoholic solution, each equaling 1-100

grain

Several years ago in the American

bottoms where pernicious fever prevailed, death occurred in some cases during the chill, from congestion of the thoracic organs. In all these cases, glonoin distributed the blood and stopt the chills, after which large doses of quinin cured the

cases.

I have given the remedy in cases of intensely severe cardiac asthma which were threatening life by engorgement of the thoracic organs. These are in the same category, i. e., spasm of unstriped smooth muscle. The walls of the arterioles are the subject of spasm; blood is kept out. To this must be added certain neuralgic conditions that favor, highly depresst nutrition and exhaustion of the defensive powers of life.

Nitro-glycerin and amyl nitrite are not remedies that cure only indirectly, by influencing blood distribution and relieving oppression owing to spasm of the arterioles. Considered in the light of protection of conservations of the life forces thru the proper distribution of the blood and removing engorgements of vascular areas, glonoin and its congeners are valuable remedies. I cannot help believing that, in small doses, the remedy is a stimulant to nerve centers, and, while it relieves spasm of the arteries, it strengthens the circulation energies of the organism.

In minute doses 1-200 to 1-250 grain glonoin, often repeated, is, in my opinion, a stimulant to the heart and respiration, and tho not a sedative in any way to the cord, protects it by its influence on the supply of blood. Thru this, the nutrition of the nerve centers is enhanced and the substance of the heart better fed and its fibers made stronger. In this way, likewise, the oxygenating powers of the organism may be augmented, life better sustained, and the vital activities promoted. The intrinsic value of the remedy in small doses is great. DR. Jos. ADOLPHUS.

South Atlanta, Ga.

That Case of Synovitis.

Editor MEDICAL WORLD:-I thank you for your favor conferred in directing the treatment in that case of synovitis. The ankle has healed and the puffiness has in a great measure gone. The bones of ankle are enlarged on the inner side. There possibly might be some displacement of the bones, but I do not think anything can be done, only what time effects, the case being of seven years' standing. The limb

is growing nicely massare being used

several times daily. The general health is good. I have placed the patient on iron and cod-liver oil, and have insisted on complete rest. The Esmarch bandage can be borne now--there is no pain or soreness. Slight puffiness continues in different places over top of ankle; continue to use the lead lotion and guaiacol yet. E. C. SECORD. Farmerston, Carleton Co., N. B., Can.

More Anent Malaria.

Editor MEDICAL WORLD:-I had malarial fever about eighteen years ago, and I studied that disease on myself and made observations on others. In 1889 I visited malarial districts of Italy, where I had occasion to watch the progress of malarial fever from its mildest type to its most pernicious varieties.

The symptoms of malaria are too well known to need any description, except the maskt cases of malarial poisoning where the diagnosis is uncertain. The viscera infected are usually the stomach, liver, spleen, small and large intestines, altho the bronchi and lungs may also be infected. I have seen cases which presented no symptoms whatever of malaria, except a slight dry cough during the day, a severe cough in the evening. These patients presented an appearance of close suffering from consumption, and resisted any other treatment until quinin was administered in large doses, which broke it up at once. In many cases the poison infects both the alimentary tract and the nervous system at the same time, in some cases only the liver and spleen; in others only the lower bowel is invaded, as evidenced by dysentery; in some cases the stomach only, while in others only the nervous system carries the brunt of the disease.

That the liver and spleen are not in every case involved, as claimed by many, is proven by the fact that a great number complain only of a periodic headache, etc.; also by the fact that a good many have a normal tongue, which in others, where these organs are affected, is always coated, and mostly with a yellow fur.

In some cases only the nervous system is affected, and these patients, if their mind is busily occupied at the time of the expected attack, miss the attack. I have seen cases eating ravenously before, during and after the attack of malarial fever, and when the chills came on them they came with such force that it was hard for the trembling hand to bring the food to

the mouth, or if in the mouth, the patient could not steady it for mastication. These patients usually go to bed at the beginning of the hot stage, which is severe and prolonged, while the sweating stage is short. after which they get up and go around. eating all the time, apparently as healthy as ever, until the fourth day (rarely the third), when the attack recurs. The people in that district used to call it "hog fever," because the patient eats like a hog during the attack, but it usually is a profound poisoning of the nervous system by the malarial poison, as manifested by the nervous symptoms.

I think all cases of malaria, if not chronic where there are structural changes, are curable, and even the chronic cases, if not very old, by judicious treatment could be cured. I never gave quinin before I opened the bowels thoroly. When a patient comes to me four or five hours before the expected attack, I can assure him that he will have no more attacks. In ordinary cases I give him in my office to save time one or two tablespoonfuls of Epsom salt in a glass of hot water, and tell him to move about for an hour, and if by that time the bowels did not move to make an injection.

Before two hours pass, the patient has a passage. I also tell him that so soon as this is done, and not before, to take the following:

M. Sig: 3ss t. d. (adult dose.) This is a very unpleasant mixture to take, but we have to remember that the disease is more unpleasant, and the prospect that if not vigorous measures be taken the disease becomes chronic, is still more unpleasant. I believe in giving quinin for antiperiodic purposes by the mouth, in powders or solution in its unmodified form as nature gave it to us. The shock of its bitterness helps to cure.

I also tell the patient to come back when the medicine is out, when I give him a few more 5-grain quinin pills to take,' three a day. I don't think I have one patient to my credit who merged into chronic malaria thru my carelessness,

I was surprised to see in THE MEDICAL WORLD a statement made by a physician that he cures malarial fevers with quinin in two-grain doses. If there is time enough

before the expected paroxysm, I administer small repeated doses of calomel, followed by magnesia sulfate. This latter I always give, time or no time, because Epsom salt is an antiperiodic by itself.

The diet is of great importance in malarial fever. In Europe, in certain sections, nothing but bean soup is allowed for the patients, as long as the fever is active; later on a few more articles could be added to the diet, as soft-boiled eggs, barley, milk, etc., but only easily digestible food, for about a week or so. There is a great prejudice against milk of any kind among the laity; also among some physicians of Europe in this trouble.

In chronic malarial fever I start with calomel, followed by phosphate of soda or some other salt; give iodid of soda to awaken the lymphatics to action; Turkish baths, hot bottles applied to skin, or pilocarpin for the skin; flush the kidneys with a lot of water or potassium citrate. All this must not be done all at once, but gradually open all the emunctories. Some stimulation may be necessary at this part of the treatment, because there will be great relaxation of the system.

After this, start with your quinin or Warburg's tincture, which is the best in chronic cases; but get a good reliable preparation, at first fair-sized doses, decreasing the dose of quinin till you get down to a tonic dose, when you give it conjointly with iron and arsenic. Restriction of diet when taking quinin in antiperiodic doses, and change of residence from low to high land will help to cure. If the spleen is not very large, ergot internally and a mercurial ointment, preferably the red iodid, externally, will restore that organ to its normal size.

M. FRIEDLANDER, M. D. [This article is not so timely as we could wish, but as it is the only one of its kind, we give it insertion with the notice that this closes the discussion of malaria for the year. Let us have what you know of cold weather diseases of any nature whatever. -ED.]

Dr. I. E. Stephens, of Bruning, Neb., a Lincoln republican, writes: "I have read quite extensively along the lines of reform, but, to me, your 'Monthly Talks' bring out the best thoughts."

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

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

Malarial Hematuria.

Editor MEDICAL WORLD:-The pernicious type of malarial hematuria reported in the November WORLD, by Dr. Dorris, is not infrequently met with by the writer. Georgia on Flint River, the source of maAs a practicing physician in South-west larial hematuria (as it was from here, I believe, the first case of malarial fever with hemorrhage was reported), I have had some experience.

Malarial hematuria is a neglected and aggravated type of malaria poisoning in which the disintegration of the blood corpuscles by the hematozoon malaria is more or less complete. It is a theme upon which there is great latitude for discussion. The blood constituents, the vasoplay the leading rôle. The symptomatolmotor nervous system and blood-vessels ogy is too well known, at least by those who have seen it, to require discussion.

In the few years that I have been in the medical profession I have treated about thirty-five cases of this fever. I have seen it in all of its phases, from the mildest form to the most pernicious and malignant type. In my own personal experience I have lost one patient-and one in consultation. Until I had my twenty-eighth patient my record of success was complete. Many a young physician with a like record might have been elated over the success, but not so with the writer. For, truly, it

is a most formidable disease.

In the early stage of the disease I usually administer hypodermically 1-6 grain morphin to procure rest. This also relieves the nervous excitement which is always attendant, and controls to some extent the distressing nausea. I give mild chlorid of

mercury or blue mass in small doses at frequent intervals until I get a half-dozen free evacuations. I give strychnin in 1-60 to 1-40 grains four to six hours apart for its effect on the nervous system, and ergot per mouth when it can be retained in 15 to 30-drop doses, or ergotin or ergotole, hypodermically repeated two hours apart, until the hemorrhage is controlled. Ten drops of dilute nitro-muriatic acid is given every four hours. I give medium doses of spirits of nitrous ether to keep the kidneys filtering, phenacetin to control temperature, or grape brandy as stimulant when indicated. I also give ten grains of quinin bisulfate by the rectum every four hours, or the following by inunction:

I do not like the hypodermic method of using quinin, altho I sometimes employ the preparation for hypodermic use. When there is distressing nausea and vomiting I sometimes use embrocations of chloroform over the epigastrium. During convalescence I prescribe fifteen drops of dilute nitro-muriatic acid (C. P.) before meals and elixir calisaya bark (ferrated) after eating.

Beyond a shadow of doubt, strychnin thru its influence on the vaso-motor nerves and ergot on the blood-vessels, will control the hemorrhage. Never let the kidneys become blockt. At the first indication of such a condition I use diuretics and hot fomentations over the kidneys. When the tubules of the kidneys become plugged there is little if any hope. I have the inclination to discuss this disease more elaborately, but knowing the value of space in THE WORLD, I refrain from doing so.

Drayton, Ga.

W. B. WATTS.

[Communications like the present, practical and to the point, are so valuable that we cannot refrain from stating that the "further elaboration" in this case would have been appreciated. Do not be afraid of expressing your views as extensively as you desire. We will condense and arrange if the article should prove too lengthy. ED.]

Opium Poisoning and Potassium Permanganate.

Editor MEDICAL WORLD :— -I have used potassium permanganate, administered by the mouth, in opium poisoning with satisfactory results. Its action is very much quicker than that of any other drug I have ever used.

During the past month I have had two cases of opium poisoning, the one in an infant nearly four months old, the other about four weeks. In the first case the mother had given a teaspoonful of "Grove's Anodyne for Infants," and repeated the same dose in an hour; in the second case the mother had given the infant two or three drops of laudanum.

Both patients were completely narcotized, showing the pupils to be minutely contracted, breathing slowly and could not be aroused. Each were given between 1-8 and 1-10 grain of potassium permanganate.

True vs. False Homeopathy. Editor MEDICAL WORLD:-In regard to the homeopathic treatment of typhoid fever, page 480, November WORLD, I would like to say a word. I should be sorry indeed if the readers of THE WORLD accepted the treatment there given as a sample of homeopathic treatment of typhoid.

For a hundred years homeopathy has been antagonizing shot-gun prescriptions and the like, and advocating the single remedy in minute dose. Thus, for a man to use four or five different drugs in one definite disease, and call that homeopathic treatment, is ridiculous. Rhus tox has one set of symptoms, clear cut and distinct; baptisia has another set of symptoms. toms. The set of symptoms calling for either drug may be present, and often are present, in typhoid fever. The two drugs may be indicated at different times in the same case. But for them both to be indi

cated in the same case, and at the same time, is utterly impossible.

Dr. G. Fell (page 432) says: "I use for all kinds of fever my febrifuge, which consists in the main of aconite, leptandra, cinchona and calcium sulfid." I wonder if that is the kind of homeopathy they teach in the Cleveland University? Such statements place homeopathy in a wrong light. No homeopathic authority ever advocated such treatment. It is not homeopathy, but a confession of ignorance of materia medica and the science of prescribing.

The homeopathic physician prescribes the single remedy, in small dose, for symptoms similar to those produced by the same remedy in large or continued doses in the healthy body. For example, if croton oil produces a diarrhea, yellow, watery, gushing forth like water from a hydrant, aggravated by taking anything into the stomach, etc., croton oil, in minute dose, not larger than 1-100 drop and as much smaller as you care to goeven to the thirtieth dilution-will cure a similar condition.

Arsenic in full doses will cause edema of the ankles and about the eyes, and in minute dose is the best remedy in these conditions. Arsenic will produce diarrhea and dysentery, various skin eruptions,