not yet visible on post mortem examination, except by the microscope. As to what these changes are, there are several theories. One reasons that the senile change is resident in the nature of the cell which holds within itself the condition of its life; that in mankind there is a constant molecular renovation, the cessation of which in old age cannot be explained. Another writer thinks that at the climax of life, the plastic or formative force begins to grow weaker, and that it changes Its object in the generation of pseudoplasma. Still another thinks that the essential feature of senility is the quality and quantity of the interstitial nutritive material, the cause of which change he finds in an alteration in the conditions of the circulation, induced by the atheromatous process. Whether this condition exists solely in the cells or in the plastic force, or in the interstitial nutritive material, we know that it is general, affecting every part of the body. The flesh is shrunken, the skin wrinkled, the nails and bones become fragile, the hair white, the frame bent, everything denoting decay. The arterial system becomes atheromatous, a fatty and calcareous degeneration, extending from the the capillaries through the entire arterial region, involving the heart, the right side of which, especially, suffers from a disordered nutrition, because of a sclerotic condition of the coronary arteries. This produces a sluggish circulation to overcome and restore a circulatory equilibrium, the action of the heart must be quickened and strengthened, which results in cardiac hypertrophy. The chest walls are wasted from an absorption of fat, and a changing of the cartilaginous substance into bone causes the whole of the chest wall, the sternum, and the two sides, to act as one piece in respiration. The apex beat is much more pronounced, and located lower down, generally between the sixth and seventh ribs. Old age is an indefinite term, since those conditions which go to make up old age are often prematurely produced by hardships, dissipation, and exposure in early life. A man may suffer from the effects of old age at fifty, or, because of a rugged body and discreet life, it may be postponed till eighty. Instances of premature senility are abundant at the present day, and are rapidly increasing with each generation, while instances of death from wearing out, uncomplicated by disease, are few. Extremely unfortunate is the child of healthy parents, born into the world with a sound and vigorous body, reared by intelligent and thinking parents, for here the treatment of disease and old age must begin if successfully practiced. In that perilous time of life, youth and young manhood, the foundation for a long and healthy life must be laid, if at all, but how disproportionately large is the majority who strand at this stage of life. Treatment of disease in the aged should be different from what it would be in adult age. First, caution should be taken in diagnosis of the case, because of complications which are almost sure to be present, having been induced by the wear and tear of years of activity and toil. All applications and drugs should be avoided which tend to weaken the action of any vital organ. It is not a thing by any means unknown for the delicate aged to die at the hands of either an ignorant and careless or over-busy practitioner, through indiscriminate or indiscreet medication. An ordinary dose of an oplate for an adult, given to an old delicate person, would possibly overcome and depress the vital organs and render them unable to resist the ravages of the existing disease, and death come later as a result of the oplate, and the same might be said of antifebrin, antipyrin, aconite, and a vast number of drugs in every day use; hence we urge caution to the extent of refraining from the use of the above named class of drugs, except when the physician is cautious in the size of the dose, and will remain at the bed-side of the patient and notice the effect of the drug. Under certain circumstances they might be of benefit if so guarded. The tendency of disease is to depression, so we urge all to exercise great caution in the use of depressant drugs, lest the already flickering flame of light be entirely put out. On the other hand, measures should be taken to build up. Their place of abode 8 should be in an equable climate, warm and dry. Sudden atmospheric changes should by all means be avoided. Flannel should be worn the year round, a sufficient amount of exercise taken, and the habits of life should be regular, with such food as is most easily digested and assimilated. Cedar Rapids, Iowa. A COLLECTION OF DRIFTWOOD FROM Ν BY WM. HOOKER VAIL, M, D. IN reading an article in an eclectic jour nal, I was impressed with the potent point that was made obvious by the writer, namely, that their treatment of pneumonia did no harm, at least. Well, this is a most excellent point to take into consideration in treating a case. Too much medicine and dosing for any length of time in grave diseases is positively dangerous. My method is to get control of the case as soon as possible, and then give as little medicine as possible. I have been favored with remarkable success in treating pneumonia, and I consider it due to the cotton jacket, thus dispensing with the excessive use of medicaments. But when you shoot your medicine at a case of any kind, take good aim, and hit the bull's eye the first time. I will write an article on typhoid fever for the next issue of the SUMMARY, if possible, showing the remarkable success I have had with well directed medicaments. I wish to thank Dr. John R. Smith for his kindness to me in regard to the prescription for vomiting of pregnancy. It was applied to a case that had previously resisted a number of other remedies used, and it gave almost instant relief. Regarding vaccination, I beg to say that in my opinion it has never done any good to the individual or to the human race, but it has produced destruction to both, and the results of its heinous practice will be visited upon the human race for a protracted time. "The sins of the fathers are visited upon the children even unto to third and fourth generation." You can place a dozen children in the same house with a virulent case of variola, and none will contract the disease if the apartments are fumigated with formaldehyde morning, noon, evening and midnight, carbolic sprays over all paraphernalla of the house, night and morning, one-third carbolic acid and two-thirds water, sulphur fumes every other day; also formaldehyde sprays, one-third water and two thirds formaldehyde, all about the apartment. Appendicitis is cured, and the generally high-priced belly-slitting, with one stroke of the knife (expert brag) is avoided, by very hot applications of sweet oil to the right abdomen, but if the following is obtainable, give it in preference: M. ft. pill No. 1j. Sig.-Take at once. If there is a pus sac there, the pus will flow out of the anus instead of the surgeon's hole in the abdominal wall, or by graviation through some rags stuck into the hole. By the former method your case is cured in a few days; by the latter the patient stands an excellent chance of dying in from a few hours to six weeks, although they often recover after such mistreatment. One case in about one hundred require surgical procedure, and if this case did die from the lack of it, the death rate of appendicitis would be astonishingly mitigated without surgical interference. Suppose all the vaunted experts are successful with their fifty or hundred operations without a death, should we put these unfortunates to the expense, trouble and pain, and mar and maim them for life, when other methods have vindicated their efficacy time and again? Many physicians, though they have brilliant minds and great intellectual ability, are by no means fit to practice medicine. Common sense, experience, logic, and a mathematical method of treating disease, (in other words, step by step), is what makes a good and successful physician. I know physicians who have killed children by too large doses of diphtheritic antitoxin, and still they continue to use large doses, and say that the patient died from heart failure. I note in the January issue of the SUMMARY that Dr. C. E. Boynton has learned the value of giving small doses of antitoxin at intervals, and is successful in treating diphtheria, though he gives little larger doses than I would. I will say here that the secret of the successful use of antitoxin in diphtheria, is its early injection in small doses, repeated once or twice, if necessary. Remember that large doses at the stage of great difficulty in respiration and great engorgement of the fauces, etc., are sure to kill. They talk about bold stimulation after an injection of 1,500, or 2,000, or even 3,000 units at this critical period. Well, all the stimulants in christendom won't save the pet of the family, but 500 or 1,000 units, depending on the age of the patient, at intervals, are quite likely to be attended with very happy results. Don't kill your little patients with too large doses of antitoxin; you can save them with a much smaller dose, at intervals of six to twelve hours, or so. Jenner is a long time dead, and so are most of the advocates of venesection. Vaccination is not dead, but it is dying. Its advocates are killing it; give them plenty of rope. Smallpox is smallpox in the meaning of the word, but we have mild and severe cases of the disease, as in other diseases, depending upon the rottenness of the individual, his personal cleanliness and the environments; also the same is true in regards to where he contracted it. Cleanliness and sanitation have modified smallpox, as it has other diseases, such as cholera, yellow fever, etc. Immense good has been derived from sewerage and sanitary measures. In Memphis, less than thirty years ago, they did not know what a proper sewer was, and what was the results then compared to those of to day; and also in this city, St. Louis ? 1849? Well, all know who are not too young. Did vaccine correct this evil? The public are wise, and the majority know that vaccination is a criminal procedure; why should the profession be so blind? There are none so blind as those that won't see. Money causes a disease of blindness in cases of this nature. It would appear from Dr. John Burnett (page 348, January SUMMARY) that with chloride of sodium we could treat most of our patients successfully. I am glad that he has given its usages, as we are too little acquainted with the value of common medicaments and methods. Dr. C. W. Canan has pointed out a great and mighty evil and source of disease, and he is to be praised. The common house fly is certainly the most dangerous and nasty of all bug kind, and I hope we will wake up to its great menace, and all take a hand in its extermination. Dr. G. B. T. asks several questions regarding vaccination, (page 314, DecemberSUMMARY.) In reference to same, I truly believe that there are few skin diseases, or other diseases, that the contaminating practice of vaccination does not in some way decidedly facilitate. Its practice has no redeeming feature, whatever, and it abounds with destructive elements. No vaccine ever produced is so pure but that it is fit for anything but fly food. No chemist ever lived who knows what the ultimate sequela of the introduction of this venom into every born creature will be. To say the least, it is bad practice. Now imagine the enforcement of this practice upon every living soul. Is there any method that could be devised that is so complete in its venomous effects upon the human blood and flesh as this? 1464 Belt Ave., St. Louis, Mo. The author of an article, entitled "Masturbation in Childhood," says: "The habit of masturbation in very young children is not common, but how a small infant of nine months can acquire the habit is sometimes difficult to explain. It is usually accomplished by the rubbing together of the thighs. It is much more common in boys than in girls. It is seldom practiced in moderation, but when once acquired is carried to great extremes. Examination shows the vulva, and especially the clitoris, red and greatly irritated, and usually malnutrition with indigestion and constipation. A case that came to the writer's observation was that of a two-year-old babe, with very light hair and blue eyes. She was taken up from the floor into the lap of a man who was visiting her father. One day he passed his fingers between the lips of the vulva and titillated it for some minutes, and the child immediately resumed the act upon being put on the floor. She inherited a tubercular diathesis. No measure that was ever adopted was successful in even influencing the habit of the child. There was slow emaciation, mental inactivity and general debility, until ultimately tubercular deposits occurred on the glandular parts of the body, with evidences of general tuberculosis, to which the child succumbed." The glans penis being bound by the prepuce, and the clitoris being bound by its hood, is also the cause of some cases of masturbation, as well as a great variety of other diseases. The noted orificial surgeon, Dr. E. H. Pratt, of Chicago, said to me, in a personal letter: "The first intimation I ever had that girls suffered at times from sexual irritation when quite young, was about twenty years ago when I was attending a little girl of six, who had scarlet fever. The little thing masturbated constantly, in spite of all efforts to stop her, (at that time I did not know enough to loosen the hood of the clitoris), and finally she died, keeping up the practice until the very end. Since then I have saved many little lives from thrush, meningitis, convulsion, diarrhea, and all forms of malnutrition, at ages from one year old upward, by freeing the clitoris from its hood." In the treatment of masturbation in the male sex, if you find the glans penis bound by the prepuce, and in the female the clitoris bound by its hood, a speedy cure can be expected by an operation, but when this is not the cause, and the habit has been acquired by titillation of the genitals, and practiced for several years, and the mind and nervous system is much deranged, it is one of the most difficult diseases to cure that a physician usually comes in contact with, and the treatment must be principally hygienic, dietetic, hypnotic (suggestive) and hydropathic. Sullivan, Ark. HOUR GLASS CONTRACTION WITH ADHERENT PLACENTA. BY S. S. TURNER, M. D. OME months ago, I was called to see Mrs. S., who was in labor with her second child, her first being six years old. I found the patient doing nicely. In about two hours after my arrival, a fine baby girl was delivered. After waiting my usual length of time, I tled the cord, then giving the uterus time to contract. Kneading the uterus through the abdominal wall to secure contraction, I made traction on the cord. I saw at once that there was something wrong. I lubricated my hard and arm well with green soap (P. D. & Co.) and introduced my hand, and found that I had a case of hour glass contraction to deal with. With considerable difficulty I passed my hand through the contraction, on to the fundus, only to find the placenta sticking fast to the uterine wall. After separating all I could, I withdrew my hand with a portion of placenta. I again introduced my hand with same procedure, for several times, until I had removed the whole placenta, curetting the uterus with my finger. You may think that I could have detached the whole thing at one time, and removed it all at once, but the resistance was too great, and contraction would force my hand out. I expected the patient to have fever afterwards, and left instructions to give five grains of quinine three times a day, (which is my custom). I also give small ོན་ ས་ ་ མ ོ ་ 1 doses of flald extract of ergot, with full doses of fluid extract of viburnum prunifolium. I left no instructions for vaginal irrigations, as I believe more harm is done than good, in a great many cases, when it is left to an uninformed attendant. This woman made a rapid recovery, without the slightest trouble, whatever. I mention this case simply because they are of such rare occurrence. I had a case of hour glass contraction in 1890, which was my first, this being my second case in thirteen years practice. Ellisville, Miss. COMPOUND FRACTURES OF THE BONES FR BY THOMAS H. MANLEY, M. D. ¡RACTURES of the tarsal bones or their total dislodgment in luxation, most frequently ensue from the application of direct force. When the parts are not completely crushed through, by the violence in action, or this is indirect, luxation commonly, simultaneously occurs with the shattering; or the bone, in some cases, may be shot out through the integuments without coincident fracture. These bones lle superficially, but have a ponderous ligamentous and tendinous support. Fracture, or compound luxation of the tarsus, occurs only after great violence. They may occur after violent sprainentorse, or twisting of the foot. Let us always bear in mind the vast vascular supply, and hence the marvellous reparative power of the parts in this situation, and exhaust every possible expediency in this class before we even think of a sacrifice by amputation, as any sort of a stump which will comfortable support the body is a great triumph over severance of the member, which, however skillfully performed, is a confession of the impotence of the healing art. ture, there is seldom displacement, and why, too, that after repair, or even loss of one or more of them, yet a useful member may remain. A few cases to the point may suggest a lesson here: COMPOUND DISLOCATION OF THE TARSAL BONE. Case 1. Patient 36. Foot crushed by falling elevator. Fracture of all the metatarsus, the internal cuneiform projected out through the integuments over the dorsum of the foot. Patient in great shock; but little blood lost. Tarsus chipped away. Rigorous antisepsis; limb placed in comfortable position. Recovery rapid. Sued later for $10,000 damages; jury gave him but $1,200 as he had returned to his usual occupation of teamster with apparently as good a limb as ever. COMPOUND Case 2. LUXATION OF FIRST META TARSUS. Patient was young man; was injured by being thrown from a horse. Sustained a compound dislocation of the phalangeal head of metatarsal bone of big toe of right foot, phalangeal head being driven out through stocking and leather of shoe. By enlarging the opening through the integument, it was possible to effect reduction, meanwhile making powerful traction on the toe. The break in the skin was left open, dressings and plaster applied. There was but little reaction, no suppuration, primary union, with very good fractional result followed. COMPOUND Case 3. FRACTURE OF SECOND META TARSUS. Patient 35. Sustained a compound fracture of second and third metatarsal bones, by the crush of a horse's hoof, the sharp cog opening through the integuments and dorsum of foot. At first treated at home by tentative remedies; later, the aspect of the parts became somewhat menacing, and he was sent to hospital. After examination here, the case was pronounced a "dead foot," and immediate amputation was urged. This he would not consent to, and he was again brought home. Now he was seen by me. At this time the foot certainly presented a hideous appearance, and his general easily understand why, as a rule, in frac condition was very bad. For weeks the Any sort of a nondescript may slash through a limb and destroy it, but the acme of science comes in on its preservation. With a proper knowledge of the anatomy of the tarsus and their functions, we can |