first, but worth the trouble. But I would be sorry that anyone would believe I confine my practice wholly to granules, and I do not hesitate to use whatever preparation will give me the best results. One difficulty is, that many of the granules are too small in dose to be of any use, unless one gives a handful.

I have never seen a genuine case of hydrophobia, nor have I seen any one who had. Those who are in a position to know best of such matters, such as Prof. Zuill, U. P. Vet. College, strongly doubt the existence of such a disease in man. Meningitis, septicemia, tetanus, uremia and other affections, have been treated as hydrophobia. Had I a case, however, where a diagnosis could be fairly made, I would give jaborandi in full doses, or muscarine.

Dr. Gregory (page 289) may attribute his cerebral symptoms to uricemia, disease of the ear, eye or nose. Each of these is capable of producing giddiness, tinnitus and confusion; or these symptoms may be due to indigestion, constipation, malaria, anemia, plethora, or too free use of coffee. From the history, I would expect to locate the trouble in the eyes, and would first have them examined by a competent oculist.

Dr. Farrar (page 289) describes a form of fever that has given trouble to diagnosticians in many parts of the country. There are three elements possible, and I believe most cases come under one of them: 1st. Typhoid fever. 2d. Malarial fever. 3d. A gastro-intestinal catarrhal fever, due, I believe, to a specific as yet unknown germ. I have seen a number of the latter, which I am sure were neither typhoid nor malarial; the whole aspect of the cases was unlike either. There was depression, verging to the typhoid state, with coated tongue, with a dry, brown stripe down the center, but not the "small red-tipped, pointed tongue" of typhoid; nor were there rose spots, "taches bleuatres," or pea soup stools. Gurgling at the right iliac fossa is so generally found in abdominal diseases, that it is not characteristic of typhoid fever. The fever course is not the typical one of the latter disease, varying weekly, though the temperature is higher in the afternoon. The force of the disease is felt in the stomach, and the epigastrium may be hot and bulging while diarrhea is not present unless cathartics are given, when all symptoms are aggravated. Nothing did my cases as much good as sulphocarbolate of zinc, in doses of gr. v., every two hours, with 20 gr. quinine suppositories, and rectal feeding. I believe the diagnosis of these three conditions can only be certainly made by a microscopic examination of the stools and blood, showing the presence or absence of the

typhoid bacillus, Laveran's, or perhaps a new micro-organism. Otherwise we cannot be sure but that we have a variety of one or the other of these diseases.

Mara-mus is a pretty comprehensive term, as we find included under it cases of tuberculosis, rickets, indigestion, malassimilation and catarrh. Of these, rickets is that most likely to be overlooked in the early stages. There is the rickety type-flat head, large cranium small face, teeth delayed and crowded into a small jaw, late closure of fontanelles, and late walking; nervousness, fretting, irritative diarrhea, the food giving distress till it is voided undigested; wasting, fever, and later, inability to hold the head erect. The treatment consists in the use of calcium lactophosphate, gr. v.-xv., daily, malt extract and the diges ive principles combined, at each feeding, and a diet of raw white of egg, beef, and strictly predigested milk. Sometimes milk in any form disagrees, and must be suspended for a time. Cream may be substituted, if good and pure. Rub the body from head to foot daily with hot cod liver oil. Of the malt extracts, the best I have ever used in this form of marasmus was a granulated extract, made by Wiley & Wallace, of Philadelphia. I usually give sour fruit juice also, either lemon, orange, grape or shaddock, as experience shows to be most acceptable to the child. Of the pepsins, I have used papain, lactopeptine, Wyeth's peptonic pills, and Carnrick's peptenzyme, and do not like to express a preference, having found all serviceable in some cases. Pure water, woolen under clothing, and proper hygiene of the house and surroundings, are absolutely essential to success in treating any form of ma

rasmus.

For "ethmoiditis," I would recommend thorough washing out the diseased cavities with peroxide of hydrogen solution, then spraying with fluid petrolatum. It may be necessary to trephine the frontal sinuses to secure proper antisepsis and drainage.

Dr. Desmarais (page 290) will have a morphine case on his hands soon. If there is still albuminuria, give potassium acetate until the symptom has disappeared. For the neuralgic pains in the arm, nitro glycerine to relieve, and strychnine arseniate (full doses) to cure, as this arm-pain points to the heart. All the eliminants must be kept in good working order.

For tan and freckles, use an ointment of camphor, chloroform, glycerine and lanoline, applied every night. It will remove tan, and perhaps the freckles.

Dr. Culler (page 291) should try the lactate of strontium for his case of diabetes. It has

given me better results than any other remedy, excepting possibly the jambul.

If I can get the time before THE WORLD goes to press, I will send some cases of morphinomania, to complete the series of papers I have been writing. If not, they will be ready for the next number.

I have just been notified of my election as Professor of Physiology in the College of Phy. sicians and Surgeons of this city. The course opens on September 4th, so that I will have to commence at once on my lectures. 1 have always had a wish to deliver a course on physiology, feeling that there is more in the physio logical treatment of disease than is generally thought. This will not conflict with my course at the Post Graduate College, where I now give clinical lectures three times a week. There is some talk of a summer medical college here, which may materialize in the coming spring. WILLIAM F. WAUGH, M.D.,

103 State St., Chicago..

[Dr. Waugh writes us that his numerous engagements are keeping him so busy that he is finally compelled to make some discrimination in the perfect avalanche of letters that he receives, asking advice in difficult cases. Some send fees, and others do not. In justice to himself and to those who pay, he is now compelled to charge a fee for all consultations by letter, which will, however, be made so small as to work no hardship on any one. The fee to WORLD subscribers will be $1.00; to all others $2.00. For cases requiring microscopic or chemical examination of urine, sputa, tumors, etc., there will be an additional fee of $5.00. The doctor is, of course, free to charge his patient what he pleases. This will enable Prof. Waugh to continue these letter consultations, which he would otherwise be compelled to give up, on account of the increasing pressure on his time.-ED.]

A Prompt and Cheap Remedy for Anemia. Editor MEDICAL WORLD:-As every physician knows, there is a large number of poorlynourished children, who are so pale that, like one of Victor Hugo's street gamins, the skin is "white with a lymphatic whiteness." A mere glance at one of them causes the doctor's mind to revert to the blessings of the iron age, and it is to call more especial attention to one of the most common, and at the same time one of the most neglected, preparations of this metal that prompts me to indite these lines.

The preparation to which I refer is the massa ferri carbonatis, or Valet's mass. It is cheap, and easily made into pills by adding to it a cer

tain amount of cinchonidia sulphate or powdered gentian root. I use these to give the mass the proper consistence, and for the additional reason that either will add to the tonic properties of the prescription.

When one of these short winded, puffy looking cases is presented, I put him on pills containing about 3 grains of the mass, three times a day, to be taken immediately after meals. It is surprising to see how rapid is their improve

ment.

But there are numbers of cases of anemia that will not improve until they get a cardiac tonic. The heart is weak and irritable, and nutrition cannot improve, for obvious reasons. A case I remember some years ago: A girl, 14 years old, had been treated by several physicians, and they all prescribed iron, but with no improvement. At the time I was called to see her she had been given up to die. I found that she was a subject of mitral insufficiency, and as soon as I added digitalis and nux vomica to the iron she improved at once, and was completely recovered in a few months, married the next year, and is now the mother of several children.

Other cases improve rapidly under the iron There preparations, but they cannot be cured. seems to be a constitutional tendency to degeneration of the red blood corpuscles, and they relapse as soon as the iron is withdrawn. The iron preparations should be alternated with each other, and at times arsenic or mercury added to the treatment. Keep them growing, and keep up the health to the highest standard possible, until they "outgrow" the disease.

Homer, Ga. V. D. LOCKHART, M.D.,

The Cold Bath in Malignant Scarlet Fever. Editor MEDICAL WORLD:-On July 31st I was called eight miles distant to see a strong girl of ten years with scarlet fever. Temperature 104°; other symptoms of moderate severity. Hed been sick two days. I prescribed tr. aconite rad., pot. chlo. and listerine, internally, and listerine as mouth wash, and externally mild carbolized vaseline, to lessen the irritation of the skin.

August 1st.-Temperature 105°. Excessive delirium and restlessness, and dusky-red skin, with sluggish capillary circulation, diarrheic stools, and profound impression of the nervous system. The appearances were that she would not live more than thirty-six or forty-eight hours.

Hoping to prolong her life until the poison should be eliminated in part, a cold bath, Brand method, every half hour, was ordered. Alco

holic stimulants were freely used, and brisk rubbing of the entire surface on removal from the water.

Improvement was noticed from the first bath. August 2d.-Temperature 103°. All symp toms improved.

tate the parts. In such cases a milder solution must be used.

My results from this treatment have been excellent. Out of about twenty cases treated, no deaths have resulted, and I can say that no cases have been included in this list that were

August 4th.-Temperature 99°. Symptoms all of mildest character. Functions all good. Eruption incomplete, but of good character. Discharged the patient, conditionally.

It seems proper in this case to attribute the extremely rapid improvement, and the change in the character of the disease from one of malignancy to one of mildness, to the efficacy of the cold bath. If this be true, need we lose so many of those malignant cases?

Please let us hear from those who have had experience with this method of treatment. J. C. MCALLISTER, M.D.,

Driftwood, Pa.

The Use of Creolin in the Treatment of Diphtheria.

Editor MEDICAL WORLD:-Having had considerable experience in treating diphtheria, and not being satisfied with the results obtained, about one year ago I decided to try a new antiseptic locally to the affected parts, an antiseptic which I am very partial to, especially in obstet. rical work, viz.: creolin.

Believing, as I do, that diphtheria is primarily a local disease, and that the systemic symptoms are not due to the absorption of the germs of the disease into the general circulation, but that the ptomaine of the germ produces its deadly effects, local antisepsis comes into great prominence in my method of treatment.

Of course, few, if any, would deny that the disease would entirely disappear if perfect sanitation and hygienic conditions could prevail.

I believe that internal medication is only of use in so far as it stimulates the patient and counteracts the damage produced by the absorbed ptomaine.

Some of the reasons which lead me to believe that creolin has superior virtues in the treatment of this disease are as follows:

Formerly, when using bichloride, H2O2, iron, etc, locally, and strychnine, iron, stimulants, etc., internally, as indicated, my average death-rate was over twenty per cent., notwithstanding every care was taken by having good nursing and surroundings for the patient. In the general run of cases where creolin has been employed by me, it has been used in a one per cent. solution with water. In some instances this will be found to be too strong, and will irri

cases of diphtheria, and of the usual type of severity; and at the same time, during the past year, I find upon investigation that the deathrate in our city from this disease has been about the same as in former years. Certainly I could not have escaped the severe cases altogether, and it naturally follows that there was some virtue in the treatment employed in my cases.

Now, since all the other treatment was used as in former years excepting the antiseptic, applied locally, I am led to believe that the success I have obtained has been due to the use of creolin.

It has been applied in different ways, to meet the various indications of the cases. Where the patient could gargle, I have used it in this form. Then, again, it may be used by means of a spray, or applied on a swab. In every case great care should be exercised. In all cases where creolin has been used it will be noticed that the affected parts are kept in a very cleanly condition; that is, if care has been used. But if force is used when applying the solution, the membrane may be entirely detached, and this does no good, because it will soon return, but it may do great harm, because it leaves a raw surface, through which fatal absorption can take place.

Again, if the solution is applied with care, and often-say every hour-one will observe that the spreading of the membrane is limited, and that it soon begins to lessen in size, like a piece of ice in the sun, and finally disappears without leaving any raw surface.

In fact, when the membrane has entirely disappeared, the parts will usually be found healed. In all cases, whether or not the nares show signs of infection, they should be carefully cleaned by means of the spray several times each day.

Of course, I do not believe that creolin is an infallible remedy in this disease, but since it is a non-toxic antiseptic, it is safe to use freely; and since it has given me such good results, I am led to believe that there is more virtue in it than has been previously supposed, and that it is worthy of an extensive trial in the treatment of diphtheria.

O. W. BRAYMER, A.M, M.D., Ph.D.,
Camden, N. J.

Physician to the Camden Home for Friendless Children, Surgeon to the Camden City Dispensary, etc.

Theory and Treatment of Diphtheria. Editor MEDICAL WORLD:-The question, is diphtheria a constitutional disease from the beginning, or not, seems to trouble the profession as much as ever. Having had considerable experience in diphtheria, allow me to contribute my mite.

I believe, from experience, that diphtheria is first local, and changes into constitutional very quickly. To relate cases :

August 10th, 1892.-F. W., a boy 14 years old, fell from a wagon, was kicked in the head by the horse, and sustained four severe contusions, three of them open. I dressed them. For forty-eight hours all went smoothly; then the stitches of one wound were cutting their way out. I removed them, and found the wound covered with a dirty.gray exudate and an acneous eruption around the margin. Treated with H2O2 strong solution for forty-eight hours. Wound looking clean; all other wounds healing by first intention. In forty-eight hours after the wound had acted badly, patient complained about sore throat, and I found a full fledged diphtheria of the throat. Treatment by peroxide spray, and tr. iron, twenty drops every two hours, cleaned up matters in four days. I traced the cause of the disease to diphtheria germs, retained for two years in the soil. There had been five cases in the house in front of which the accident happened.

2. While tearing out old rotten cellar boards in a house where diphtheria had been rampant five years ago, C. B., male, 30 years old, complained about malaise, slight stiffness in the angles of the mouth, and a slight sore throat. In twenty-four hours diphtheria developed, but was mild, and resulted in recovery in three days under local treatment by peroxide of hydrogen and iron.

Another, who helped to do the work, was taken sick forty-eight hours afterwards, neglected to call a physician for three days, and had one of the severest cases of diphtheria.

My treatment is not original. I use peroxide of hydrogen (13 vol.) spray, full strength, every two hours for forty-eight hours; then reduce strength of the solution one half and use for twenty four hours. After that I stop it, as I find a new membrane developing when used too long. Then I substitute permang. of potash, gr. 4 to the ounce, in spray. I clear out the bowels with calomel and soda, and depend entirely on tincture of iron (I always use a tincture at least a year old, as larger doses can be given and retained). I also employ poultices to the neck, steam inhalations with cinnamon and carbolic acid; fluid diet. Use stimulants if heart sounds are weak, and watch carefully.

Spray out nostrils every four hours with 1 to 4 peroxide or permanganate. Sulphate of copper sol. added to the poultice seems to reduce the swelling. Do not give chlorate of potash. P. H. VON Zierolshofen, M.D., Croghan, N. Y.

Traumatic Tetanus.

Editor MEDICAL WORLD:-On May 25th, 1894, I was called to see Isaac Johnson's boy, age 13. At that time I found him suffering and in great agony. His jaws were so tightly locked that I could not introduce the tip of my little finger between his teeth. I was unable to question him, for as I did it would throw him into a tetanic spasm and cause him to assume an opisthotonus position.

From ocular symptoms I at once suspected tetanus and immediately sought to determine the cause. An examination of the foot revealed a small punctured wound, situated in the sole of the left foot, about an inch below the junction of the great and first toes.

On questioning other members of the family, I elicited the fact that a few days previous, the boy had called his mother's attention to the wound, which he said was caused by having stepped on a nail, and which at the time appeared trivial, so that no further thought was given it until alarming symptoms suddenly developed. My suspicion being confirmed as to the diagnosis, I first injected hypodermically grain of morph. sulph, and then made a crucial incision through the puncture, evacuating a thimbleful of pus with about twice that quanity of a mixture of blood and pus. I then prescribed a preparation containing morphia sulphate, bromide of potash and chloral hydrate, to be given every two hours, with instructions not to waken the patient, and directed the nurse to paint the entire foot twice a day, and the sole of the foot to the edge of the incision every 3 hours, with iodine. Poultices of flaxseed and blatta orientalis being applied continously.

The spasms continued during the four days following my first visit, although not so violently. The entire muscular system remained very rigid and there was complete inaction of the bowels. For the muscular rigidity the patient was frictioned with a liniment composed chiefly of chloroform, spts. camphor and aqua ammonia and an ointment of sulphate of quinine, with lanolin as the base. For the bowels a saturated solution of sulphate of magnesia was given per orem, aided by enemata. Liquid nourishment and very little of that is what sustained the patient.

At my second visit, May 25th, on re-examining the foot I noticed the appearance of a bluish spot, about two inches below the point of my

first incision. Drawing my lancet through this spot there was a slight discharge of matter and, on probing, I soon found that the two openings communicated. I thereupon introduced a grooved director and made a free and deep incision connecting the two openings. The result was, to my surprise, the discharge of a splinter an inch and a half in length. A continuation of the treatment outlined above was advised and followed.

The patient at this writing is up and about, having called to see me at my office. His appearance does not show signs of the siege passed through. DR. LOUIS E. MEYER,

Thibodaux, La.

Cases in Practice.-Phantom Tumor.-Chancre in an Infant.- Viburnum in Obstetrics.-Gelseminum for Neuralgia.-Treatment for Diarrhea.-Chloride of Calcium for Pneumonia.

Editor MEDICAL WORLD:-On June 3d, I was hurriedly called to attend Mrs. H., aged 40, in her eighth confinement. The messenger, her husband, stated that "the midwife in charge was unable to manage the case." The distance being over eight miles from my office, I made all haste and reached the lady in less than an hour. I made the usual examination but could find no presentation, nor was the os dilated. I then began a careful examination of the abdomen, but could find no child. I diagnosed "phantom tumor," and informed the anxious friends that it was a case of deception. Now, this lady had given birth to numerous children and the husband for the past three weeks had discontinued the erection of a new home awaiting the happy event, and, I may add, is still waiting.

On July 16th, Harry N., aged two years, was brought to my office by his mother, for the purpose of ascertaining the cause of a sore on his penis. After examination I found a true chancre on the "corona glandis." Syphilitic treatment was given and the usual cure resulted.

On рад e 129 of the April WORLD is an article on "Viburnum Prunifolium," by Dr. Hilton. On the merits of the Doctor's article I prepared a quantity of the medicine as directed. My first opportunity came on a lady of refinement, who had been running a lawn mower. She was seven months pregnant. I gave teaspoonful doses every four hours, accompanel by codine, of a grain every three hours. The treatment was satisfactory.

I was called on the 29th of June to attend Mrs. K., in her seventh confinement. Now, here was a chance for the viburnum. This lady is known to always have a very tedious labor, requiring from twenty-four to forty eight hours

and often forceps to terminate the labor. As I confined her on the two previous occasions forceps were necessary and were used. I entered her home, at 3 P. M., gave her one teaspoonful of viburnum repeated every two hours, accompanied with hypodermics of morphine and atropine. (There was slight dilatation upon my first examination.) At seven o'clock I packed my case, the lady having given birth to a 9 pound boy, and the confinement was so easy that all were surprised, as well as the doctor. Try it, my brethren, you will be pleased.

On June 26th I prescribed for Mr. P., who was troubled with facial neuralgia, giving him thirty drops of fl. ext. gelseminum in an ounce of water, teaspoonful every four hours. It worked nicely. He, thinking to prescribe for himself at a later day and thus save a small office fee, went to the nearest drug store and there purchased sixty drops of fl ext., taking the same at one dose. It is needless to say that the Doctor's fee was incurred and Mr. P., is much wiser to day.

In the August WORLD, page 281, you will find Dr. Taylor's "Treatment of Diarrhea in Children." I have for the past two years relied on this remedy, and I can say I have been called to cases that have been given up by other physicians, and with this treatment have caused a cure and often saved life.

IN THE WORLD for July, page 241, will be found an article by Dr. Ben H. Brodnax. relating to chloride of calcium. Well, on July 13th, I had an opportunity to try this drug on a child thirteen months old.

The child was "fretful, a little grunt at expiration, some cough, bowels not loose, but a little tympanitic, slept some." I tried several drugs without relief, child was growing worse. I gave the calcium a trial. After two doses the father of the child came to my office and reported the child as doing so well I need not call again. I fear I have already taken too much space in the good old WORLD. Roger's City, Mich. E. ERSKINE, M.D., [A very practical letter. Doctor, could you find out how that child caught syphilis?- ED.]

Electro Vapor Baths.

Editor MEDICAL WORLD:-To the average mortal the idea of a bath is at once associated with soap and water, and with a large number the soap is omitted and only the water thought of. Some people never take a bath except in hot weather when they go into the water swimming, and then only take a bath incidentally with amusement, and if they did not stay in the water long enough to thoroughly macerate the skin, would not then be clean.