This makes a thick mixture, which is not unpleasant to take. If syrup be not desired, use tincture of ginger with water or mucilage of acacia The salicylate or the sub-gallate of bismuth is a good substitute for the sub-nitrate.

As we have so often stated in regard to medical knowledge, we did not originate this formula entirely. Like all other valuable information, it has grown, each one improving it according to his experience. Dr. Cline's example should be more generally followed-that of reporting successful or unsuccessful experience with methods of treatment that have been published. Sometime we should like to publish a special number composed entirely of confirmatory experiences with facts that have appeared

in THE WORLD. It would make a most useful and valuable number.-J. J. T.]

An Obstetric Experience.

Editor MEDICAL WORLD:-I have a case of obstetrics to report that may be of interest to the many readers of THE WORLD. January 24th, was called at 4 P. M. to see Mrs. S., age 36, and the mother of four children. I found the patient suffering from la grippe, with a terrific cough and vomiting, with uterine hemorrhage, seven months and a half gone in pregnancy. The os uteri dilated to about the size of a ten cent piece. I gave medicine to check the hemorrhage.

January 25th, was called again-hemorrhage again. I gave as a checking powder:

On the 10th of February, I was called again. Still found uterine hemorrhage. On the 9th of March, I was called again and found patient in labor. Upon examination I found the o8 dilated and a spongey substance within. I notified the husband that we had a case of placenta previa; I gave ergot. The next day at two o'clock she was delivered of a 2 lbs. child. The placenta was split. One-half was lapped over the child's face; the other half was attached to the uterine walls. It looked smooth, as if it had been split with a knife. She made a good recovery, and the child is doing well. Ozark, Ark. J. R. DUNN, M.D.,

Respiratory Inflammations Treated by the Fumes of Acetic Acid or Red Wine Vinegar. Editor MEDICAL WORLD:-I have read in the May number of THE WORLD a letter from Mr. E. J. Marsters, mentioning the use of fumes of acetic acid in consumption, bronchitis and other respiratory inflammations. I have been using this medication since 1889 and I have always obtained very good results. The remedy was suggested to me, first by an "old woman." It consisted in:

"To boil a handful of hops in about one pint of water; when hot and steaming, add to the mush one or two tablespoonfuls of strong vinethe steaming vessel, covering his head with a gar, instruct the patient to place his face over large towel or table-cloth, and let him inhale and breathe the steam freely."

patient, a woman, in the last stage of consump tion, with hectic fever, hemoptysis, colliquative sweats and diarrhea, and my only successful way to relieve her was by atomizations of creasote in glycerine by means of a Codman & Shurtleff's steam atomizer.

About the time mentioned above, I had a

I

She became disgusted with the creasote atomizations and I knew that I would be compelled to let her die without any more relief on this account, when I noticed in the January number of THE MEDICAL WORLD (1889) an article on "acetic acid as a disinfectant." thought then I would try to use it in place of creasote, but as my poor patient was tired of atomizations, I determined to improve (?) the manner of administering the old woman's remedy. My patient grew decidedly better, she experienced remarkable relief and I am satisfied I prolonged her life and made her considerably easier; she died, anyhow, about two months after.

I have used the treatment frequently since, and I have always been very much pleased with it, and to the satisfaction of my patients. This is my way of operating; I put in a glass re

the other neck of the bottle a bended tube passing through the cork about one inch into the bottle; my apparatus is then ready. In placing an alcohol lamp under the bottom of the retort, the fumes of the vinegar are generated; they pass through the hot hop mush and are breathed, as warm as possible, by the patient. Hops. may be probably omitted or replaced by other aromatic or sedative.

This treatment always affords great relief in sore throat, tonsillitis, coughs, asthma, dyspnea, hemoptysis, etc., etc.

I have also employed successfully, in cases of la grippe, the simple method suggested by the old woman.

Red wine vinegar is by far the best to be employed, probably on account of the astringency of the tannin. DR. H. P. MONTBORNE, Spokane, Wash.

Dr. Green's Treatment of Bronchial Affections. Editor MEDICAL WORLD:-In answer to Dr. J. R. Thompson, of Woodburn, Ky., I will say that I was living in Virginia in the year 1856, before graduation in medicine. At that time Dr. Howard Green, of New York City, had acquired quite a reputation in the treatment of chronic bronchitis and incipient tuberculosis by the injection of a solution of nitrate of silver (strength not known) through a rubber tube into the larynx or, as some said, into the bronchial tubes. I remember that a practising physician of our county, Dr. Thomas H. Miller, went on to New York and remained

doctors and very little was said of it, outside the newspapers and laity. Salisbury, Mo.

VIE C. A. JENNINGS, M.D.,

Periodic Headaches.

Editor MEDICAL WORLD:-Some time since, I called attention to an article published in THE WORLD, in regard to Haig's uric acid theory of periodic headaches, trusting that the attention of physicians might be called to this subject and more light gleaned to guide us in the future.

In this paper I shall only attempt giving a few of the symptoms attending these headaches and an outline of the treatment which I have pursued, with, at least, a fair degree of success; some of my patients having been relieved permanently, others for many months and some of them for years, to become sufferers again on a return to an unwholesome diet, as a too free use of nitrogenous food, or the use of wines, and malt or other spiritous liquors.

While I do not believe all cases of periodic headaches result from a lithemic condition, yet, in my opinion, this is largely the case.

On inquiry we find that, previous to an attack, the urine is clear, more copious and of lighter specific qravity than normal, but during, and immediately after an attack, it becomes darker, is of lighter specific gravity and deposits, on standing, a brown or reddish sediment, leaving a stain on the bottom of the vessel that is diffi cult of removal. It is also abnormally acid. The patient is irritable, despondent and complains of lassitude and weariness. The tongue

is coated, skin sallow and bowels constipated. There are eructations of gas, with other evidences of faulty digestion. The heart's action is irregular and irritable. Patient complains of rheumatic pains in the pectoral, intercostal and cervical muscles, also in the occipito-frontalis and the joints. In my opinion these attacks often take the place of a headache. I have had two such cases within the last few months, that have suffered, one from a rheumatic attack of the shoulder joint, and the other of the hip, the latter winding up with a headache of several hours duration.

Treatment; during the paroxysm, if light;

To be given at a dose and repeated every hour until relief is obtained, or three or four doses have been taken. If the attack be severe, the extremities will be cold, when a hot foot bath, with plenty of mustard, continued for twenty five or thirty minutes, the bath being kept hot by the frequent additions of hot water, will be found useful. If the hands be immersed in hot water, at the same time, the effect will be heightened. If the coal tar preparations are given, special attention must be paid to the heart's action, as many patients will not tolerate them, and a dangerous cyanosis may be brought on. Phenacetine, in my opinion, is the least depressing. Next to this, I prefer the acetanilid. If the patient is restless, the pupils contracted and the pain pretty general over the head, ten drops of the tincture of gelsemium (green) with twenty or thirty drops specific passiflora, every hour, but with only half the quantity of gelsemium after the first dose, will often give prompt relief. If there be nausea or vomiting, wash out the stomach with water as hot as can well be taken, adding, if necessary, a few drops of fl. ext. ipecac. Should the above treatment prove inefficient, as it sometimes will, especially if not begun early, it only remains for us to give relief by a hypodermic injection of morphine.

The treatment between paroxysms will be largely, but not exclusively, dietetic There is invariably faulty digestion, but no rigid course. of diet can be adhered to in all cases. Temperament, habits and surrounding conditions must be taken into consideration. Foods that are easily digested and assimilated, consisting largely of non-nitrogenous substances, must be chosen. Toast with milk, Graham mush, eaten with cream and a little pure white sugar-though little saccharine matter should be allowed-with such vegetables as are found to agree, and as digestion improves, small quantities of fish and soft boiled or poached egg may be taken. Every thing eaten should be properly cooked,

and no fried food of any kind, should be taken into the stomach. Avoid all sweet meats, pastries, pies, gravies, pork, desserts, malt liquors, sweet wines, usually all alcoholic stimulants.

A warm sponge bath, containing chloride of soda should be taken every day or every second day, followed by a thorough rubbing, with a moderately coarse towel. If convenient, the shower or tub bath may be substituted for the above, with advantage. Systematic massage is most excellent.

Το

Medicines If the tongue is coated and bowels constipated, I begin treatment by giving five grains of triturated calomel (one to five), and one grain of triturated podophyllin (one to five), every three hours until bowels move or three doses of the mixture are taken, following the last powder, in two or three hours, with a small dose of effervescing sulph. of magnesia, provided there is not free action from the bowels. regulate the bowels and excite the liver to healthy action, give one granule (grain) of podophyllin, with two granules (grain) of aloin, at bed time, to be followed on rising, next morning with a heaping teaspoonful of eff. sulph magnesia, into glass of cold water. This may be administered daily until the bowels become regular, then gradually omitted, giving every second or third day or less frequently until no longer required, using in the meantime such dietary as will conduce to a regular condition of the bowels.

2

Remedies which improve digestion and give tone to the digestive organs will be foun useful, as gentian, wahoo, wafer ash, or nux vomica, before meals, followed by an after meal dose of some reliable preparation of pepsin. If the pepsin be given in maltine, plain, better results may be secured. A favorite remedy with me is the pepsin and wafer ash, in which glycerine is used as the vehicle. Three granules (grain) of quasseine with one or two granules (grain) of arseniate of strychnine, is also a favorite prescription.

These remedies should be given before meals. If acids are indicated I prescribe the hydrochloric. I have not tried the nitro-muriatic acid in these cases. I have sometimes found Howe's acid solution of iron to act remarkably well, improving digestion and toning up the system generally. Alternated with Fowler's solution of arsenic, each to be given in four drop doses, the latter before meals and the former between meals and at bedtime, will often give the best results.

But we must clear out the abnormal quantity of uric acid. Acetate of potash, salicylate of soda, and the preparations of lithia are among our best remedies. The acetate of potash is apt to

disagree with the stomach. A three grain tablet of citrate of lithia (prepared by W. R. Warner & Co.) is not unpleasant and with me has proven quite efficient. I order one tablet four or five times a day dissolved in a glass of water, to be taken while effervescing.

The length of my paper admonishes me that I am calling for more than my share of space in one of the best medical journals published.

In conclusion let me urge the necessity of securing normal digestion and proper assimilation of food. W. B. SQUIRE, M.D., Worthington, Ind.

The Morphine Habit.

(Concluded from July WORLD.)

Editor MEDICAL WORLD:-At the beginning of treatment every patient is placed on the use of an alkaline water, containing potassium bromide, carbonate and acetate, the proportions varying with the case. The urine is kept slightly alkaline, the kidneys active, and the nerves sedated, by the three salts named. The bowels are cleared out by cathartics, and the result of this is sometimes surprising to the patient, as well as to his attendants.

These preliminaries being attended to, the physician's duty is to watch the reduction, and note whether the symptoms are due only to it or to underlying disease uncovered by the removal of the morphine. All emergencies arising must be treated without opium, this drug being blotted out of the patient's materia medica for all time to come. Weakness of the heart demands the liberal use of sparteine; neuralgia requires heat and the anti-nervine powders (acetanilide, ammonium bromide and sodium salicylate). Nausea or diarrhea are best treated by the oxides of zinc and silver, bismuth and oxalate of cerium. Aching of the bones and muscles, particularly of the knees, is greatly relieved by the salicylates, and by hot or cold water. Faradism and the galvanic current are also of value in some cases, to relieve the pains until the proba tionary period is past. To reduce the severity of withdrawal symptoms the hot bath is of the utmost value. The hotter the water, the greater is the relief. The patient may spend hours in the tub if he so desires, and return to it whenever he pleases. Hypodermics of water, hot or cold, or of chloroform water, as near the seats of pain as possible, often give relief, but should only be used with the patient's knowledge, as deceit, once detected, ruins the physician's influence. Excessive doses of bromides cause a very offensive breath and injure the digestion. Hydrobromic acid sometimes answers a good purpose, in doses up to half an ounce. For insom

nia, some do well on trional, while others sleep better on sulfonal. The large doses sometimes fail when moderate ones succeed.

The secret of success is sedation. The nerves, released from the paralyzing effects of morphine, react sometimes with violence. Hyperesthesia is the rule, and little bumps give rise to complaints of pain, that are not altogether imaginary or assumed for a purpose. The special senses are acutely sensitive. I have given antimony, aconite, veratrum and apomorphine with advantage. The latter is a specific for removing the desire for tobacco. But the drug that best replaces morphine is eserine, or physostigmine salicylate. This contracts the pupil, acts as a sedative, but is a tonic to the muscular fibers of the intestinal canal, and to the heart. It was for these reasons that I first administered it to a morphine case, and unexpectedly found that it produces the sense of comfort, euphoria, fully equal, or even superior, to that of morphine.

This alkaloid is derived from the physostigma venenosum, the ordeal bean of Calabar. Physostigmine depresses the motor functions of the spinal cord, in large doses depressing the motor nerve ends also, and even the sensory. It stimulates involuntary muscular fiber, increasing the peristaltic action of the bowels, and raising the arterial tension, while slowing the pulse. It contracts the pupil and decreases intra-ocular tension. When the morphine had been reduced in one of my cases togr. per day, the symptoms presented were: Abnormal irritability of the brain and cord, hyperesthesia, motor restlessness, weakness of the pulse, giving the sensation of half-filled arteries, mobile pupils, tending to dilate; lack of tone to the stomach and bowels, and the bladder as well. This condition seemed to indicate the use of physostigmine, and I gave grain hypodermically. Not only did it relieve the condition present, but it produced euphoria; the patient insisting that I had given him morphine in a larger dose than at the preceding injection. This result has followed every dose of the drug I have since given. The relief is complete for the time being. It does not last as long as that of morphine. I am not able as yet to say how often it should be given, or to what extent the dose may be increased, because in every case thus far treated by me the patient has been able in a few days to throw off the habit, and do without either morphine or the substitute. And I am firmly convinced that nothing will enable a man to adhere to his resolution, and make the cure permanent, like the ennobling consciousness that he has fought his battle and won it. "Resist the devil and he will flee from you." Set your

foot on his neck and his power over you is broken. Henceforth the demon may come as a siren to seduce you, but never as a relentless tyrant to master you by force.

From the time the victory is won I employ every effort to confirm in my patients the moral force. The pride of manhood in its strength is aroused by gymnastic exercises, feats of strength and field sports, whenever possible. The moral force is strengthened by urging the man to face unpleasant things. Morphinomaniacs are luxury-loving_weaklings, physical cowards, moral shirks. I will make them plunge into a tub of ice-cold water, and when they learn to do this, and to enjoy the shock, as they do in a few days, I feel sure of the cure. A man cannot help respecting himself better when he marches into the cold tub resolutely, when he has never before in his life done such a thing. The first letter received when my patients return to their homes is pretty sure to tell of the tank being put up.

When the morphine has been wholly withheld for twenty four to thirty hours, in those deeply sunk under its influence, the suffering may be severe. I then give one dose of morphine,to grain; the patient has a good sleep, and awakes free. In milder cases this sleep comes without morphine; but in all, when the marked abstinence symptoms have endured for forty-eight hours, the crisis is past and the battle won. A return of the symptoms is then only likely after exposure to cold or wet, or to work; the likelihood to such return decreasing rapidly.

The after treatment consists in such measures as are required by each case. Every underly ing disease is studied and treated on the best systems. Nerve degeneration and the neurotic condition require massage, electricity, systematic feeding, inunctions of oils, carefully graduated exercises, and the use of the drugs we have learned to classify as nerve foods-phosphorus, arsenic, quinine, iron and strychnine. Fellows' syrup and hydroleine are preparations I am never without, and give to every case during convalescence. Neuralgics always take the following:

R. Phosphori....

Acid arseniosi...
Strychninæ sulph.
Quinin sulph....

vel

Ferri carb. sacch.

M. et in pil. no. xx div.

S. 1 three times daily.

gr. 4

....dram ...dram j

There is not much need of appetizers; during the four weeks' reconstruction they have a ravenous appetite, and get fat. Pepsin and malt extract are employed at first, with hydrochloric acid, until the digestive power catches up with the demand.

I have said that unless a man wants to be cured there is little use in making the attempt. Sometimes a patient comes at the solicitation of relatives-a broken-hearted mother, perhaps. He goes through the course, is completely relieved of his habit, put in excellent physical condition, and immediately goes back to the morphine; not because he has any reason, or even excuse, but because his moral nature is completely depraved by the habit. He is no longer compos mentis, and the only hope is in a prolonged confinement in an insane asylum. By years of abstinence, with suitable reconstructive treatment, the degeneration of nerve tissue may be stayed, and a fair recovery made, enabling him to resume his place in society. Without this he is doomed. He is as surely insane as any maniac.

There are numerous devises by which the suffering can be reduced, so that I have repeatedly been told by my patients that they had not experienced anything meriting the name of pain. The greatest suffering is due to the apprehension of death, and this requires the quiet assurance of the trusted physician. As treated at a sanatorium, the severer withdrawal symptoms are over in twenty-four hours; and when a patient has been that long without the drug he is past the crisis, and commences to pluck up courage. It is the rule then for him to urge that he be given no more morphine-that he will take no more, let the consequences be what they may; and this is perfectly sincere. From this time on the feeling of rejuvenation, as the currents of life begin to flow once more in their old channels, imparts a delightful sense of returning vigor, of freedom, youthful buoyancy, resembling the sensations of one released from long imprisonment. In the whole range of medical practice I have found nothing so fascinating as this releasing of the body from bondage, rescuing the soul from perdition.

In placing before the profession my new remedy I do so with profound misgivings. I dread lest it may be seized upon as the agent of a new drug habit. I know it will be used to accomplish that impossible task-curing a doctor of

the phosphorus.

For the paroxysms they take:

tice. It will be employed also improperly, while the patient is still taking morphine, or without the use of the system to which it is only an accessory. And from these causes its use But to those will be disappointing to many.