that will improve the vital forces. Attention to the digestiv tract, looking after digestion and elimination, is an essential. In the polar regions the inhabitants depend upon the free ingestion of fat, eating whale blubber in great quantities and using animal oils freely. When the general health is best, resistance to cold is highest.-ED.]

Comments on the February WORLD.

Care of Drug Habitués.

EDITOR MEDICAL WORLD:-What is to become of the drug habitués after February? One thing sure, the institutions for their cure will be thronged. Let us hope that the fakes and incompetents may not get the majority of the victims. The man who determins to stop such a habit is going to pass thru an ordeal, and he may as well make up his mind that he will suffer. But it is not at all difficult for one to obtain "promises" of a painless cure. In selecting the physician who is to be entrusted with this grave responsibility, the patient should be assured that his life is safe, that he will be really cured; and he may reasonably ask that his suffering shall be reduced to the lowest possible point and confined within the shortest period. This much can be honestly promised, and the engagements kept; and provided the patient really intends to be cured and gives enuf time for it, the cure may be permanent. But many victims will go to the people who make the biggest promises without reflecting on King David's sage estimate of human veracity. Autoserotherapy, Serotherapy and Vaccines.

The editorial on autoserotherapy, page 45, would make mighty interesting reading to any physician who had been out of activ work for ten years. How the practise is developing! Some striking results are also being secured in treating pruritus ani with vaccines. The autogenous form seems most successful. One writer tells of an obstinate case thus cured, and refers to the old-timers who still look on the malady as due to constitutional faults rather than to local staphylococcal infection. He takes it for He takes it for granted that his cure will prove permanent, altho he speaks of the tendency to recurrence after apparent cure by the older methods. Let us hope that his faith may be justified. Meanwhile, applications of scarlet red seem to afford more relief than others.

Our ideas are apt to be based rather on single impressiv cases than on more extensiv

data; and I know my own views on this malady have been largely influenced by one case: It was a doctor who had been driven to morphin by the atrocious itching. On opening his abdomen we found that his colon was contracted to the diameter of a lead pencil, and along its whole course was a double row of little pockets, each containing a scybalum the size of a marbletoo large to escape into the bowel. conclusion was that the pruritus was caused by a discharge from these retained masses. After this I treated all cases by very careful and complete emptying of the bowel, and in many the pruritus was thereby relieved. But not in all; and I am free to say I believe this is one element in causing the itching, but not the only one.

Drugs in Therapeutics.

The

Despite the popularity of serotherapy we are told that America's drug bill amounts to half a billion dollars annually. How much would it be, if every person who used the drugs should be compelled to give a definit reason for the use of each? Take your most commonly used prescription, and tell us why you use each ingredient, what it will do, how you recognize its action and how you know when enuf has been given, how soon its action reaches its acme and how long this lasts, how long its subsidence takes, and how soon and by what means it gets out of the system. How many doctors know that after an animal has received a full dose of digitalis it is months before the effects have disappeared? Yet they give this powefrul drug right along, "every four hours."

Despite the present popularity of the so-called physiologic therapy, the profession will return to drugs, if only for their convenience. But it must be to a very different drug therapeusis from the old. We must have absolute accuracy, and on this base an absolute knowledge of the powers of drugs and the influence they exert over the bodily functions. Every day I am askt if I still believe in the activ principles. Draw a broad line between their therapeutic use and the commercialism with which they have been connected, and I reply, most assuredly I believe in them. To quinin, morphin, strychnin, atropin, pilocarpin, apomorphin, cocain, has now been added emetin; and the possibilities inhering in ipecac have been demonstrated as they never could be, so long as we were confined to the older galenic preparations. That

similar values are to be found in the other pure alkaloids is hardly a matter for argument. Some day we will have the 27 alkaloids of opium, the 30 principles of cinchona, the 17 of chelidonium, the 6 of jaborandi, and the hundreds found in other plants, each separated and arranged for our use, like the numerous little instruments on the dentist's tray, each for the applications it is better adapted to than any other.

Corrosiv Sublimate Poisoning.

Have we exhausted the possibilities of drug medication? Hardly. My friend and former pupil, Dr. Thomas A. Carter, has recently attracted attention thru his treatment of sublimate poisoning. He has now treated 44 cases, losing 3. He employs sodium phosfite as an antidote, keeping enuf of it at all times in the stomach to neutralize the sublimate as it is dissolved. Of the three fatal cases, one was moribund when admitted and the remedies had not time to act. One died of anuria and convulsions. She was doing well and the kidneys had commenced to secrete a few ounces of urin a day, when an interne applied to a sore arm a hot solution of sublimate as a dressing the renal secretion ceast and death followed quickly. The third case was especially interesting. The patient was doing well, when friends insisted on feeding her; hematemesis followed and she died. This points to an essential feature of treatment-absolute prohibition of food. The local action of the sublimate is corrosion; some tissue is killed and some retains a little vitality, being just on the verge of death. Give food, and the acid gastric juice pours out, attacks the enfeebled tissues, and erosion follows, with hemorrhage from the patulous vessels. If this is correct, all food must be forbidden, and alkalies should be given almost constantly to neutralize any possible acid forming. This is included in Carter's method.

Teacher and Pupil.

Dr. Beard (page 54) might have termed his cases nerve exhaustion instead of nerve wear. And why does he limit the malady to neurotics? Any man may develop such conditions by overworking his brain, even if he have no strain of abnormality in his ancestry-if that be possible. The paper illustrates the importance of a suggestion I have just made in a school journal, that the teachers beginning with the first grade of the primary schools should stay with their class thru five years of teaching-and

then graduate as teachers. If a teacher gets to know the child, it would be well for her to have charge of him for five years instead of changing every year.

Irritable Cough.

Apply a strip of mustard leaf an inch wide over the right pneumogastric in the neck, until the burning is decided. Restrain the cough by the will. Remove sources of reflex irritability. Let 1/12 grain of zinc cyanid dissolve on the tongue, without swallowing, repeated every half hour for three doses. If this does not suffice, the diagnosis is wrong.

Tuberculosis.

Is there any germicide with which we can safely saturate the body so as to kill the germs and yet not injure the patient? If we do kill them, how long before they will reinfect? For the body once submitting to such invasion is very liable to succumb to others. The phenol group, iodin and sulfur, have been urged as systemic germicides. Some success has accrued to the use of each. I recollect one girl who took creosote till she smelt like a ham; and she was cured. Iodin has been reintroduced many times. Sulfur has been utilized mainly as calx sulfurata; and it looks reasonable, since it has proved of value in other infections. Phosforus and phosfates are not therapeutically interchangeable. Many applications of the salts have been made, but the nearest anybody has come to using phosforus was when Luton advised the phosfide of copper. In not one of these has a real scientific test ever been made. The danger of reinfection has not been recognized, and true cures may have been overlookt.

For dyspnea of pulmonary tuberculosis give a whiff of amyl nitrite or a very small dose of nitroglycerin.

Respiratory Affections.

Williams cured nasal catarrh by keeping the bowels clear and clean. Do this and apply the crusht tablets of the Bulgarian bacillus locally.

For dry cough: Emetin, lobelia, cocillana, antimony, narcein.

For loose cough, bronchorrhea: Copaiba, cubeb, tar, petroleum, narcotin, myrrh, terpin, iron, tolu.

To soothe cough: Codein, heroin, cannabis, cyanides, glycyrrhiza, sugar, steam. To stimulate cough: Squill, senega, sanguinaria, ammonia, thebain.

Infection of the Uterus.

EDITOR MEDICAL WORLD:-I have seen so often where the curet has been used and prescribed for all kinds of uterin diseases that I often wonder if we realize the great danger to infection that we often risk our patients, and the complications that often. follow a curetment.

To make it more impressiv, and worth more than anything that I could say on the subject, I will quote from the October "Clinics" of J: B. Murphy, page 959:

The average curetment is done almost always with a sharp instrument; and a sharp curet abrades the surface of the uterin mucosa, opening up the lymphatic spaces of the submucosa and muscularis, and simultaneously inoculating them with infectious material. Frequently brisk infection sets in, and with that infection comes, first, the chill and then the rapid rise of temperature.

When the infection passes out along the lymphatics into the cellular tissue of the broad ligament, it usually forms an abscess there, which extends along the tube. This abscess, if not opened, may open spontaneously in the peritoneum, bowel or bladder.

I heard this great surgeon say to a class of physicians that if we had seen how often he had taken guts out of a uterus after a curetment we would never put another sharp curet inside a uterus, and that a sharp curet had no place inside a uterus.

He also said that infection of a uterus was always carried in from without, and warned against making examination in abortion cases until we were ready to clean out the uterus; and do it with all the antiseptic precaution that we would use in any other kind of an operation on the

uterus.

This coming from such a great surgeon and teacher as Murphy put me thinking over my long list of treatments for abortion, and I could not remember a single case of infection following abortion where there had been no examination made before I was ready to remove the contents of the uterus or it had been expelled beforehand. On the other hand, I have seen

and had cases by the dozens where there was no infection following examinations made before the expulsion of the uterin contents. I have removed several dead fetuses that I know some of them had been dead for several days without any infection. I can cite some interesting cases, and will cite one:

A few years ago I was consulted by a man in regard to his wife's condition. He said that they thought she was pregnant, but as she was smaller than she was three months before, and having some flow lately, made them think it was a retarded menstruation. A few days later I was called to see this lady, and I removed a dead fetus. This lady had not menstruated for six months, and had noticed her abdomen had increast the first three months, and decreast the last three months. From made me think possibly that it had been dead for this history and the shrunken condition of the fetus

three months.

Why cannot a dead fetus stay in a uterus for three months without any infection when a gallon of pus can stay for six months without any infection? I had a patient two years ago that came fifty miles to see me in regard to a dropsy that her doctor was treating. I drained over a gallon of pus from this woman's abdomen that had been there for five months, and gave no more trouble than had it been water. We cannot have any infection as long as the pus and contents of the uterus are steril. From a long obstetric practise of thirty years I believe that infection always enters or is carried into the uterus from outside. Careful asepsis is always required in uterin treatment of any kind. W. C. STIRLING.

Sulphur Springs, Texas.

Puerperal Eclampsia. EDITOR MEDICAL WORLD:-I report the following case of puerperal eclampsia that was controlled without any attempt to bring on labor.

Mrs. M., age 38, mother of five children, 834 months pregnant. Feet and legs badly swollen. Complained early in the morning of feeling badly. By 12 m. had violent headache. At 5 p. m. was seized with a violent convulsion, and it recurred every twenty minutes. When I arrived she was having the sixth one (according to the count of the husband and friends). Found her unconscious; pulse, 128 and bounding. No signs of labor whatever. I injected 1⁄2 grain morphin, 1/75 grain atropin, and 10 minims Norwood's veratrum viride carbonated soda (in powder) to be given 4 hours in arm and left 10 grains of calomel and 5 grains of after the injection of morphin, etc., to be followed in two hours with 2 ounces of castor oil (hot). Saw her the next morning at 8 a. m. Pulse, 90 and soft. No more convulsions. Was able to answer questions fairly intelligently. Had her first labor pain at 8.15 a. m., and by 12 m. was delivered

naturally of twins weighing 71⁄2 pounds each (living and doing well). Ordered the nurse to give 10 minims of turpentine at 10 p. m. and 6 a. m., to be followed with 1 ounce of castor oil at 11 a. m., with light diet for three days. The mother is doing well and is ready to resume her regular housework.

Allow me to say I have been in the work for thirty-five years and I never try to hasten labor in these cases and have never lost a mother or child.

H. B. STEWART, M.D.

Fountain Inn, S. C.

Puerperal Eclampsia Treated by Veratrin
and Lobelin.

EDITOR MEDICAL WORLD:-The following report may interest your readers:

On October 8, 1914, I was called to attend Miss N., a girl 18 years old, primipara. I found labor advancing normally and I very soon delivered her of a ten-pound boy baby.

Everything went well until the night of October 12th. At 1 a. m. I was called again, and found her restless, with slight headache and pulse accelerated. I was told that she had had some kind of a spell before I came. I gave a cathartic and she went immediately into convulsions. Then I gave a hypodermic of H. M. C. (Abbott), with orders to give salts at 6 a. m., and left.

I returned at 8 a. m. next morning and found her unconscious. Had had no action of the bowels. Had had three or four convulsions during the night. I pause here to state that this unmarried girl lived with her uncle and he refused to have filled the necessary prescriptions for her, the nearest drug store being five miles away. Therefore I was left with a limited amount of drugs to work with. So I set to work with enemies, together with one granule of Abbott's veratrin hydrochlorid by mouth every hour until 3 p. m. Up to this time no improvement, no movement of bowels; but the water thrown into bowels would pass back. Convulsions continuing, at 3.30 p. m. I gave a hypodermic of Abbott's lobelia sulfate. Convulsions now farther apart. So I repeated the dose at 5.30 p. m. and ordered oil given at 7.30 p. m.

I then went home, and returned at 7 p. m., October 14th. I found patient perfectly quiet, yet unconscious, bowels moving freely, and had been all thru the night, and had not had any convulsions since 8 p. m. that night. I gave a dose of oil and left again, and returned on the morning of October 15th. I found her conscious and feeling fine, and called for her breakfast. In a few days she was out of bed; no more trouble. No medicin was given at all after beginning the lobelin sulfate except oil.

Now, my object in writing this is to call the profession's attention to the lobelia treatment for eclampsia. I do hope the brothers will try this and report results. Rentiesville, Okla. J. J. Lowe, M.D.

Cause of Decapitation of Fetal Head. EDITOR MEDICAL WORLD:-For the benefit of Dr. Daisey and "the family," referring to the above heading in the February WORLD, page 68, I would say that during the late winter or early spring of 1898 I met with the same condition of affairs in a newly married young woman, who upon close interrogation admitted having called upon a noted abortionist (then living) in the community-and excused herself upon the ground that the normal time of birth would be too soon after wedlock.

The head was completely severed from the body, and was delivered with placental forceps, as did Dr. Daisey in his case.

That same season I also ran into another case cf a young unmarried woman who aborted about the fifth month. This infant was completely dis

emboweled.

No admissions could be obtained from her-but the conditions were powerfully suggestiv.

From the foregoing Dr. Daisey can guess how much reliance I would place on that woman's story about the fall two weeks previous to her delivery-so far as decapitation was concerned. Elliott, Ill. HERBERT B. PERRY.

EDITOR MEDICAL WORLD:-On reading Dr. Oville Daisey's report of his unique case, in which the body was born leaving the head behind, reminds me of a case I had some years ago, the difference being, however, I pulled the head off, leaving the body to follow.

It was a colored woman, and four months previous to the incident she was thrown from a mule, at or about which time, I suppose, the child died.

On the day of confinement the woman had a fight with another woman at a wash place, and in the combat she was knockt down with the washboard, which brought on her labor. As it so happened, I was passing the place, and being called in had barely time to sterilize my hands and get back on the job before the head was born. Taking it in my hands and making gentle traction, as is my custom, lo and behold the head pulled off!

Recognizing that I had a decayed body to deal with, I waited patiently for another pain, which came soon, expelling body, placenta and all. After this I thoroly washt out the uterus with a 1 to 3,000 bichlorid solution, when all went well as tho nothing out of the ordinary had happened. So we learn that all dangers are not death. Cascilla, Miss. B. FRANKLIN, M.D.

The Prince of Weeds.

EDITOR MEDICAL WORLD:-I suppose I am one of those "hysteric" writers of whom you speak as assailing intemperately the tobacco habit, albeit I am not aware that I am intemperate, since I try to have my arguments fair and free from pernicious

excess.

I must say I do not quite like your half-hearted way of dealing with this matter, vital at least from the social side and in my judgment of no practical use from the physical side, ranking as an evil because on the down rather than on the up side of life. "The man who does not begin its use until maturity" gets no very deleterious effects, but how rare a bird is he-hardly worth mentioning, and yet when this rare maturity man, who should know better, so sets the smoking example that nine-tenths of the "little men" around him take