made of a U-shaped glass tube fastened to the bottom of the box, as shown in the illustration. Between the arms of the tube is fastened a millimeter rule to show the rise of the mercury in the long arm of the glass U tube when air pressure is applied by the inflation bulb, which is to be attacht to the long rubber tube extending out from the side of the box (lower a). The cuff that goes around the arm is to be connected with the rubber tube projecting from the top of the box (upper a). No space is allowed within the box to place the bulb for inflation or the cuff when not in use. They can be carried in the pocket.

The reading of the instrument is practically the same as the one made by Dr. Attix, except that the millimeter rule is stationary. The trap-door at the top allows for the use of a movable millimeter rule, as in the Attix instrument, if the owner would prefer that. If the column at rest is at 13, or 130 millimeters, and the pulse disappears when the mercury has reacht 250, the former is subtracted from the latter and the difference is multiplied by 2. This equals 240 in this instance, and that number is the blood pressure as recorded by the apparatus. An instrument taking up the same amount of space can be made to register as high as perhaps 260; ordinarily enuf.

The ordinary pressure bag and cuff of such instrument is used, one of the tubes being connected to the pressure tube, the other to the bulb. When in use the instru

ment must be held in the upright position, and the small metal clip removed; otherwise, by reason of the comprest air in the long or registering tube, it will fail to properly record. While not in use or lying in a horizontal position, these small clips must be securely applied, otherwise the mercury will run out of the tube.

Constructed of hard wood and polisht, it can be made very attractiv. Metal would be a much more substantial material for the box.

The small opening in the top is to allow the vent tube to slip thru, thus preventing its kinking and thereby interfering with the pressure of the air and consequent faulty reading.

I hope that I have not claimed more for it than would be warranted by circumstances, and that it may be useful to someone.

Herewith is a drawing of the bloodpressure apparatus made in metal. You will notice that so constructed it takes up

even less room than that made of wood. At the top you will observe a trap-door for the free passage of the rubber tubing. If measurement of higher pressures are desired they can be obtained to almost any degree by the addition of an extra piece of glass tubing attacht to the hose at the top. JOHN GILBERT, M.D.

373 W. Market St., York, Pa.

[We sent the instrument and communication to Dr. J. C. Attix, who is an accomplisht physicist, and the following is his statement.-ED.]

DEAR DR. TAYLOR: The instrument structed by Dr. John Gilbert, of York, Pa., which you sent me for inspection, and conhas been received and I have gone over it with care. All that the Doctor claims for it seems to be justified.

As is the case with practically every instrument where size or space, portability, accuracy and ease of manipulation are taken into consideration, beyond certain limits one or the other must of necessity be sacrificed or one enhanced at the expense of the other, when abbreviation is attempted. As is the case with practically all and every instrument, it is not so much the instrument as the man behind it. One may have all the finest, most complicated and expensiv surgical instruments and be far from a surgeon, while some of the most skilled surgeons I have known use but a few of the very simplest instruments with greatest mobile of the cheapest model made, but who success. One person with the simplest autothoroly understands it, will get service out of it, while another with the most expensiv, complicated and powerful machine, who has little or no understanding of it, will get nowhere. I have no doubt that Dr. Gilbert can use this instrument with the greatest understands it, and the underlying principles ease and accuracy, because he knows it and of physics which govern not only this, but all such instruments.

I have contended for years that the most reliable blood-pressure instrument was a mercury column and that the U-shaped tube type was the most accurate of these; but to make matters as simple, accurate and practical as possible a 12" to 14" column of mercury must be used.

While Dr. Gilbert has curtailed somewhat the size of the Attix instrument which was brought out two years ago by THE WORLD, and is now so generally used, it is very doubtful if his instrument would

be anything like as useful to the general practician.

As the Doctor states, it can be slipt into the overcoat pocket; but while one pocket is filled to overflowing with the case, another is filled with the sleeve, cuff and bulb, so there is not much gained in this respect. As to going into a grip, most mercury instruments will go into a fair-sized grip.

There are one or two mercurial instruments on the market with a reservoir and broken or jointed column which will go into the pocket, but the Doctor needs either extra buttons or suspenders for support of it.

One other fact which must not be lost sight of is that some doctors, as well as laymen, like the display of an instrument, and in some instances they think it gives prestige.

The readings on Dr. Gilbert's instrument are perfectly plain and simple to him, but on account of subtractions or corrections from the fixt scale would be a source of error for many. The effort is a worthy one and deserves the commendation of every WORLD reader.

J. C. ATTIX, M.S., D.D.S., M.D., P.D.

Professor of Chemistry and Toxicology in Temple University, Philadelphia. 2355 N. 13th St., Philadelphia, Pa.

Full Development of Seven-Months' Child.Treatment of Colds.

In

EDITOR MEDICAL WORLD:-It may interest some of your readers to know that on October 10, 1891, I was called to attend Mrs. N., at Pipestone, Minn., in childbirth. When I arrived I was somewhat disappointed, as it lookt like a miscarriage, as the abdominal tumor was so small. a short time she gave birth to a 11⁄2-lb. female child. The skin and hair, as well as the nails, did not indicate full development; in fact, were not fully formed. The mother positivly declared that she was only seven months pregnant. The child still lives and now is a young lady. At the age of 14 her mother sent me her photograf, and she was well proportioned, good looking and weighed 128 lbs., and was well up in school.

Treatment of Colds.

In the November WORLD you ask for articles on common colds. I have made this quite a study for the past fifteen years. or more. I take it for granted the most of us understand the pathology of it, so I will give my treatment.

To an adult give from 5 to 8 grains of

EDITOR MEDICAL WORLD:-The "cold" patient has, thru exposure, been chilled and the natural elimination of waste products thru the skin has been prevented, and to compensate for this the mucous membranes are overtaxt and become more or less congested and even inflamed. Particularly so is this the condition in the air passages, and this brings us to speak of the remedy.

First of all, the patient should be put to bed and kept comfortably warm. Now for the drugs, and the first to think of is ferrum phos., 3x trituration, 20 grains to the ounce of distilled water, to be used as a spray in the nostrils, mouth and throat every half hour until relieved, then every one to two hours until all symptoms disappear. Also use internally 3 tablets, every 1 to 2 hours, of a combination, in tablet form, of bryonia 3x, phosforus 3x, and tartar emetic 3x. These remedies may be obtained from any good homeopathic pharmacy. The patient's bowels, of course, should be well cleared and kidneys kept in good action. A. M. ZEBOLD.

Sherby, Ohio.

In rheumatism, remember that the salicylate of strontium is less apt to disorder the stomach than the salicylate of sodium; the dose is the

same.

DEAR DR. TAYLOR-For twenty-four years I have sent you $1 every year. I am thankful to receive more than the dollar's worth. Please keep up your "Monthly Talks," for they are just the change of thought that the doctors need. A merry and prosperous Christmas to you. R. D. RAMEY. Garden City, Mo.

[Doctor, think what you would have saved if you had sent $3 at a time, each $3 paying for four years in advance.-ED.]

Healthy Triplets.

EDITOR MEDICAL WORLD:-In reporting this case I am aware of the fact that triple births are rather common, being 1 to 6,500 in multiparous women between 30 and 40 years of age. But for triplets to live and thrive as here shown is an unusual occurrence. On May 5, 1914, I was called to see Mrs. Joseph Powell at 7 o'clock a. m., and at 8 o'clock a. m. I delivered her of a girl baby, buttocks presenting: weight 8 pounds. I then thought I had a case of twins, and so informed my patient. At 9 o'clock a. m. I delivered her of another girl; normal presentation: weight 71⁄2 pounds. I then

The

1334 pounds; Sarah, 14 pounds; Joseph, 15 pounds. The boy, who was born last, showed signs of low vitality. I thought he would live only a short while; but this proved to be from mechanical causes only, and, he soon came around all right. triplets are not the care that one would suppose, but, to the contrary, they have not been sick a single day, and are the source of unalloyed pleasure to the devoted mother who bore them, the pride of the fond father who endowed them, and the magnet that draws into the home many strange as well as familiar faces anxious to look upon the unusual sight as they occupy

made up my mind that we had something else to contend with; I did not know what, but in a short while, on examination, I discovered an amniotic sac; then at 11 o'clock a. m. I delivered her of a boy, feet presentation: weight 7 pounds. They were three chorions, three amnions, and one placenta.

Mrs. Powell is a blond, tall, weight 160 pounds, 40 years of age. Up to this confinement she had given birth to three children all living, of the following ages: Two boys, 14 and 11; one girl, 5 years. The triplets nurse the mother in addition to being fed on other food. They are 51⁄2 months old, and weigh respectivly: Evelyn,

their little bed side by side very much the same as in the picture.

Lenoir, N. C. C. L. WILSON, M.D.

Mammary Extract in Uterin Hemorrhage.

EDITOR MEDICAL WORLD:-In your November issue, pages 454 and 455, appear two letters, side by side, the one asking for suggestions regarding the medical treatment of uterin fibroids and the other detailing a case of severe menorrhagia which did not seem to respond to medical treatment, and on examination did not evidence any indication for surgical interference, for which help is also requested.

Interaction of Internal Secretions. The editorial suggestions were interesting and profitable, but it occurs to me that some additional suggestions might also be useful. With our increasing knowledge of the intimate relationship of certain of the organs of the body by means of the chemical messengers, called by Starling hormones, we now know that the mamma and ovaries are intimately related to one another. one another. There is plenty of evidence to warrant the statement that the mammary glands are not merely excretory organs, or milk producers, but that they produce an internal secretion that controls certain other of the internal secretory organs and are in turn controlled by them. It is well known by the majority of medical practicians that certain substances-probably hormonesfrom the pituitary, ovaries and thyroid exert a markt influence on the activities of the breast. I cannot forget one of the meetings of the Seventeenth International Congress of Medicin last year when Sir Edward Schäfer, the physiologist, demonstrated before the Section on Physiology the influence of pituitary extract on the lactating mammary glands of the cat. In spite of the fact that the spectators were the élite of the world's research men in

physiology, including professors of the highest eminence from practically every corner of the earth, there was a schoolboy murmur of enthusiasm and surprise when almost immediately following an intravenous injection of the pituitary principle the milk in the glands squirted out even beyond the dish set to catch it. Even these scholarly men had to admit it was wonderful. This is, however, a little beside the point.

Mammary Glands and Ovaries.

In addition to being controlled by other organs thru hormone influences, the mammary gland, by its internal secretion, exercises a considerable degree of control over the reproductiv organs and particularly the ovary. As a matter of fact, it seems to have been proved that the luteal internal secretion-"corpus luteum" is now considered the essential internal secretory part of the ovaries-and the mammary internal secretion balance one another-they are virtually antagonists, just like the pancreas and the adrenals, or the thymus and the gonads. This antagonism has been put to extremely good use in therapeutics by the inauguration in Russia of what has been

called mammary opotherapy. This consists in the administration of suitably prepared extract of the parenchyma of glands secured from certain animals, especially goats, ewes and the cow. The extract of the parenchyma contains a principle which tends to neutralize the excess of luteal principle and hence is given in conditions where there is excessiv activity of the ovaries or hyper-ovarism. Now this very condition may be a cause of menorrhagia, and, watching very carefully to ascertain that an organic condition such as a portion of retained placenta, a foreign body, or cancer is not the cause, mammary extract may be used to control the bleeding with remarkable results. It is obvious that, just as your correspondent, Dr. Schultz, suggests, surgical conditions must be ruled out, and, this being done, especially if there are other evidences of unusual ovarian activity, mammary medication may be instituted with considerable possibility of notable improvement.

Physiologic Action of Mammary Extract.

It should be remembered that the action of this remedy is very different from that of ergot. It does not contract the uterin muscles, but neutralizes or counteracts the hormone stimuli which may be the cause of part or all of the excessiv bleeding, constituting a physiologic or chemical antagonist. To be of practical value in matters of this nature the information should be amplified by clinical excerpts, and I can do no more than quote a few paragraphs from my book* as being worthy of consideration in this connection.

In

According to Battuaud, in menorrhagia of young girls this form of medication has proved very valuable, just as it has in the metrorrhagia of the climacteric. Ovarian congestion, due to salpingooöphoritis and other causes, is reduced, altho, of course, the influence is purely decongestiv, and not directly antagonistic to the infectiv process. hemorrhage due to uterin sclerosis and fibroids, as well as in those indefinit uterin oozings of the menopause which are not associated with malignant growths this method offers a valuable and physiologic means of control. Battuaud has found it useless in the hemorrhage resulting from retention of placental fragments and from mucous or fibrous polypi. A number of writers have called attention to the possibility of diminishing an excessiv menstrual flow and curtailing its undue length by the use of mammary extract. It is also useful in lengthening the abnormally short interval between the catamenia, bringing back the normal rhythm of menstruation as to frequency, amount and duration. Luncz especially credits this method of treatment with remarkable efficacy, and emphasizes its absolute harmlessness.

*Practical Hormone Therapy," reviewed in the August, 1914, issue of THE WORLD.

A study of other references to the subject cannot but impress one with the antihemorrhagic sedativ effects of mammary opotherapy in cases of functional overaction of the pelvic organs; but it should be emphasized that preparations of this character are not styptics, as a study of their physiologic action will quickly show.

Bell reports good results from the use of mammary substance in the treatment of uterin fibroids, and mentions a number of cases in which the tumor disappeared or was decidedly diminisht in size. He showed that irregular hemorrhage, as well as the pain, was much diminisht, and in some cases disappeared altogether. Shober reports similar results, and recommends mammary extract in fibroids, menorrhagia, and metrorrhagia, and states that the addition of a small amount of thyroid extract to the dose of mammary extract assures even better results. Feodoroff also found that uterin myomata associated with metritis were favorably influenced by this form of treatment, and that the usual hemorrhages were considerably reduced. He also noticed that associated mastodynia was relieved.

These experiences were confirmed by Pryor and Krause. More recently Feodoroff has publisht another statistical report of the results secured from the use of mammary extract in the treatment of uterin fibromyomata. He noted a reduction in the size of the tumor in 53% of all cases treated in this manner. Hemorrhage and profuse menses were absolutely controlled in 83%. The pain usually noted in the development of the tumor was abolisht in 40%, and in only 14% was there total failure. This author noticed that there seemed to be a secondary influence upon the intestinal function as the bowels were frequently regulated, and there seemed to be a special advantage where meteorism was present.

Mekerttschiantz records fifty personally-treated cases, and is most enthusiastic in his praise of this method, which he considers "the touchstone for all cases of uterin fibroids" before deciding upon operativ measures. He also supplies the same treatment in all forms of uterin congestion.

The above experiences may not be duplicated in their entirety, but my personal observation convinces me that this is an effectiv method of treatment and that it

deserves, like every other phase of practical organotherapy, to be raised from the obscurity in which it is at present involved. HENRY R. HARROWER, M.D.

880 W. 180th St., New York City.

Treatment of Boils, Carbuncles and Abscesses. EDITOR MEDICAL WORLD:-The treatment of boils, carbuncles and abscesses in general goes a long way to make up the every-day business of the general practician. The more dexterous he is and less pain he gives his patient, the more it adds to his reputation. We commonly speak of a boil or abscess as being ripe when the accepted treatment is a free incision. Fluctuation is usually the indication for an incision. In some locations fluctuation is difficult, if not impossible to detect; for example, in the

hand and feet underneath the tense fascia, especially in the fingers in what is commonly known as felon. Here one must be guided by judgment of the symptoms. The application of hot, moist poultices (the best being a towel wrung out of hot water) will hasten the formation and bring to the surface pus. A timely incision will relieve much suffering and facilitate the cure by preventing burrowing of the pus.

The incision should be made by a sharp scalpel plunged in with a sudden thrust, and not with a sawing motion, after the surface has been made numb or deadened with ethyl chlorid, which I regard as the best local anodyne for this kind of work.

The first impulse the physician has after seeing the pus flow is to squeeze or press the walls of the abscess together in order to empty the contents. This I regard as an error, for various reasons; first, the exciting of unnecessary pain, which in a sensitiv and hyperesthetic patient is of utmost importance. Second, nature, in her effort to wall off the pus from the surrounding structures, sets up a fortification of new granulations, and if pressure is brought to bear upon the surface these will be broken down and open up new avenues of infection; thereby frustrating the very object.

we

are trying to overcome. There i sufficient resiliency in the tissues themselves, and this combines with the new growth of granulations in the walls of the sack to expel the pus. This cannot be improved upon by artificial methods. One may occasionally facilitate the healing of slow or chronic abscess by gentle manipulation of the deeper structures.

Before leaving this subject I want to call the attention of the reader to the springing up of too profuse granulations, which are apt to occur where considerable sluffing of the skin has resulted. Here nothing gives such satisfactory results as clipping off the granulations with the scissors and then applying the caustic stick, which is practically a painless procedure.

Once more permit me to enjoin upon. the reader to avoid probing newly incised abscesses, as I have several times in the past done. The application of hot, moist bichlorid dressings are beneficial in the post-operativ treatment of abscesses. DR. M. J. BUCK.

401 Diamond Bank Bldg., Pittsburgh, Pa.

DEAR DR. TAYLOR: I have read several journals, but THE WORLD is the best of all. Inclosed find check for renewal. "The Business Talk to Doctors" or "The Monthy Talk" is worth the price to me if it had nothing else. W. L. SIMS. Whitmire, S. C.