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composition, besides the ill effects of bad ventilation. I have seen large families live in a house of this kind that only contained two small rooms. I am sure the disease has decreased in frequency seventy.five per cent since the sod house has disappeared.

Whether the disease is malarial or typhoid, or a mixture of both, or whether it is caused by a poison different from either, I can not say. I will say, however, that the most common manifestation of malarial poisoning, ague, is not seen here at all. I have never seen, either, a well marked case of remittent fever. If it is typhoid it must arise in many cases de. novo, for I have seen many cases, isolated, far from public thoroughfares and miles from any other cases, where there is not the slightest suspicion of a contagious origin. Bushton, Kan. S. C. Cook, M. D.

This most excellent, almost classical, description of this disease, including treatment, will be concluded in next issue.-ED.]

or very young. My youngest patient was three and my oldest fifty-five years old.

Sex.--It attacks either sex equally, but is more fatal to girls from sixteen to twenty years of age.

Physical condition ---It seems to specially attack persons of previous good health. All my fatal cases were of this class. Young, strong, robust, the very picture of health, yet they fall soonest. Pregnancy offers no obstacle to the disease, as I have seen often. I treated one case where the woman was confined during the progress of the disease; but the puerperal condition did not seem to affect the course of the disease in any way. The patient made a good recovery in the usual time. The babe did not contract the disease. I have never noticed any tendency to abortion from the disease.

Climatic conditions. --The only particular point that I have noticed is, that the disease is much more prevalent and also severer in very hot, dry years. In 1879, at Ellinwood, Kansas, the disease was extremely fatal, some cases proving fatal in the first week. In 1887 a very extensive epidemic prevailed in western Kan. sas. In both these years the vegetation was killed in July by the hot winds, and the weather was extremely hot and dry until late in the fall. Neither moisture nor drouth seems to have any effect except when accompanied by heat. But the disease is by no means always epidemic. I have frequently seen isolated cases, as well as epidemics confined to certain small neighborhoods or villages.

Season. -The disease almost always occurs in the last six months of the year, and it seems fair to presume that the conditions prevailing during that part of the season have some in. fluence in its production, although we see the disease under widely different climatic conditions.

Sanitary conditions. The disease has de. creased in frequency and severity in exact ratio to the improved sanitary conditions. In the newer parts of the State, where people live in sod houses, small and badly ventilated, the disease is much oftener seen than in the older parts, where the people are better housed. For the benefit of those living in the East that are not acquainted with the sod house, I will describe one. It is built of sod cut into squares of convenient size, and about two inches thick, and laid up into walls from two to three feet thick and five to six feet high, and is covered by the same material supported on posts or poles, or sometimes boards or brush. The whole structure is composed of vegetable matter and dirt, and usually rots down in a few years. The inhabitants thus live in an atmosphere laden with the products of vegetable de

Cold Abscess of Neck. Editor MEDICAL WORLD:--Je sie W. H., a full-Llood Sioux female, aged 17, presented herself at the dispensary July 29, 1891, with a swelling on the right side of her neck immediately over the sterno-cleido-mastoid muscle and about midway of its length. It was about as large as a lemon, and on palpation revealed fluid contents. I diagnosed cold abscess of tuberculous origin, and made a small puncture with a bistoury. On the escape of the pus the tumor had completely disappeared, leaving at its site only a bunch of shriveled integument. I then washed out the sac with a solution of chlorinated soda and carbolic acid, and applied a compress, sustained by a roller bandage about the neck.

This was repeated three times a day for a week, when it was observed that the sac had closed entirely, and the wound of puncture healed. There has been no return of the absress. Now had she not applied for treatment, but allowed the abscess to take its own course, it would have have finally opened itself, and degenerated into a large ulcer, which would have lasted her for years, prob. ably, and by constitutional infection possibly destroyed her. These cold abscesses are very common among the Sioux, and this seems to be the best treatment of them.

2. T. DANIEL, M. D. Cheyenne River, U. S. Indian Agency,

South Dak.

The Physician should be a good business man. Get our ne suggestions during the coming year.

rules and

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A Case of the Keeley Treatment.

Extract cinchona comp. fluid...ounce jij

Extract coca fluid..............ouncej Editor MEDICAL WORLD:-I have a case

Glycerine......................ounce ) which I think will interest the many readers of Water...............:;... THE MEDICAL WORI D, both on account of its M. Sig. - Take a teaspoonful every two hours when rarity and as relating to the latest craze-the

awake. And the following hypodermic injection every

four hours; I 10 grain of the chloride of gold and soKeeley morphine treatment.

dium and 1.40 grain of the nitrate of strychnine, Miss G., aged 30, a morphine habitue, began

. This will produce the same symptoms and the home treatment by Leslie E. Keeley, with

same results as the Keeley cure. the "bichloride of gold," about two months

H. E. Whitsey, M.D. ago. She was using about to grains of morph

Spring Creek, Pa. ine a day at the time. From the first of the treatment she began to complain of her failing

The Effects of Coffee. health and came to me for remedies, which I

EDITOR MEDICAL WORLD :- The effects of refused to give while she was taking the treat

coffee or the influence of coffee on the growth ment. She took two bottles, about 20 ounces,

of organism in the human system is very great. of the remedy in the time, losing about 20

Prof. Carl Luderitz made a careful series of pounds in weight. During the last two weeks

experiments in which he determined the influshe was taking the remedy I was away from

ence of coffee infusions of different strength, home. On the evening of my return, Nov.

(varying from 10 to 20 per cent ) upon the 20th, I was again called to see her. I found

growth of various forms of pathogenic and her very weak- much emaciated and her skin

non-pathogenic micro-organisms. The coffee was a perfect yellow. The conjunctivæ were very

y freshly roasted and ground, this was covered yellow-so much so that I could plainly notice with boiling water, the infusion thus preparec it 20 feet away. She was much constipated

was placed in a closed flask in a water bath for and was passing immense quantities of urine, abo

about ten minutes, it was then filtered. This perfectly black and very bad smelling, but infusion was used in part for making gelatine, which caused no pain on passing. She had no and in vart directly. He found that the deappetite and was generally in a very weak and

structive power of coffee upon various microbes bad condition. I at once credited the condi

was very great. He found that the organisms tion to the “bichloride of gold” and at once

all died in a longer or shorter period. In one vetoed that remedy. The patient was put on series of experiment anthrax bacilli were de the following prescription :

stroyed in three hours, cholera bacilli in four B Calomel....... ........grains v

hours, erysipelas streptococci in one day, &C., Pulv. podophyllin.............grains x &c. The antiseptic effects of coffee do not M. Sig.-One powder at bedtime, repeated every depend on the caffeine, as some suppose, but on second night.

the empyreumatic oils developed by roasting. I also gave tablespoonful doses of syr tri

Prof. Luderitz's observations have been confolium comp., three times a day and wine glass firmed by Profs. Wees, Oppler, Rabateau and doses of infusion of buchu twice a day. others. Hence these observations may be

At this date (Dec. 3rd) the patient is doing considered reliable. If infusions of coffee finely, the jaundice has almost entirely disap- have such marked deleterious action upon peared, the urine is clear and natural and the pathogenic organisms, and especially upon some patient is on the high road to recovery, but is forms which are the cause of epidemic types still using the morphine in slightly reduced of diseases, it is certainly a valuable agent for doses. I am satisfied that two weeks treatment the restriction of these, and may be used as a more of the Keeley business would have called drink instead of water, when there is any sus. for an undertaker. The World is the best picion as to the contamination of water; especmedical journal in the universe.

ially is this true in cases of epidemics of ty. WM. JOHNSTON, M.D. phoid fever, cholera, erysipelas, scarlet fever, Williams, Arizona.

and the various types of malarial revers, which

are transmitted almost entirely through the Keeley Cure.

medium of food · nd drink. Numerous exper. EDITOR MEDICAL WORLD:-Seeing several iments have also been made with infusions of requests in The World for the Keeley cure for coffee upon living animals, such as dogs, &c., drunkenness, I will give you what I believe to in order to ascertain the effects of coffee on the come very close to it:

organs of digestion, circulation, respiration, B Sodio-auric chloride...........grain xij

&c. These experiments demonstrated that Ammonium chloride...........grain vj

coffee was a very valuable agent in assisting Strychnine nitrate, .... ....grain ;

the digestion of food; it quickened the digesAtropine.............. .......grain 4

tion and in a way increased the demand for food. This should be well born in mind by antiseptic properties will preserve the teeth those who live in a hot and malarial climate.. from decay, if used daily. The experiments also demonstrated that coffee Igo, Shasta Co., Cal. H. SCHAFER, M.D. aided the blood to take up more nourishment than it would without it. It also quickened

Fatal Pulmonary Emboli. the circulation of the blood and of respiration,

EDITOR MEDICAL WORLD:--Mrs. R. expected and a rise in the temperature of the body was perceptible.

to be confined about November ist. She was Apart from the above experiments, it is well

the mother of two children. Both confineto mention that coffee is also stimulating and

ments had been normal and easy. Youngest refreshing, and that this quality is due to the

child one year old, girl; oldest three years, caffeine it contains. Coffee contains also be

boy. October 2nd I was called to attend the sides caffeine, sugar, fat, acids, casein, &c. It

boy in what proved to be a severe case of ty

phoid fever. His life lay as in a balance for is also a neutral stimulant of the highest order. But if carried to excess it will produce wakeful.

nearly two weeks. His mother was his constant

watcher and the mental strain told severely on ness, debility, irregular pulse, injury to the heart and spinal functions, &c. But coffee is

her. October 29 I made my last visit to the a sovereign remedy in tiding over nervousness

boy, he being convalescent, in emergencies. In order to derive the good

November 6th I was called to see the mother

and found her with a temperature of 103°. I effects from infusions oi coffee, it is of the utmost importance to know how to prepare a good

diagnosed the case as one of typhoid fever. infusion. The first step towards it, is the

The temperature stood 102° morning ; 103 roasting of the coffee bean. This should be

evening from that time on. November 10th, done at home within twenty four hours of being

about 6 a. m., labor began. I found her temused. The roasting is a too delicate an opera

perature 102°; pain, slight; vertex presentation to be left to the grocer or merchant, who

tion ; os soft and dilating. About noon the invariably subjects it to a too severe fire. They

membranes ruptured. Expulsive pains came buro it either dark brown or black, charring

on at once and continued. The head deit to the core, and thereby deprive it of its

scended, entered the pelvis and the occiput aroma, and render it intensely bitter. The

presented at the vulva, slightly distending the coffee bean, in its natural state is sweet and

perineum, when suddenly she turned purple in contains, as above stated, sugar, &c. To re

the face and was in a state of collapse. I intain this quality it should only be roasted to

stantly applied the forceps, which were in an amber brown. Coffee infusion made from

readiness, and quickly and easily delivered her beans thus roasted possesses an exquisite flavor

of a still born child. I gave the lady several and should be drank without sugar and cream.

hypodermic injections of whiskey and by shak

ing and dashing cold water in her face, general The following is a good way to prepare a friction and other appropriate measures we good fresh cup of coffee :

established respiration again. I then gave a Take two or three ounces of fine ground cof hypodermic of strychnine sulph. 1.25 gr., fee, pour upon this one pint of boiling water. morphine / gr., atropine sulph. 1:75 gr. She This makes a first class beverage or drink. To

improved shortly and swallowed at intervals avoid bitterness, don't boil the coffee. The whiskey and strong coffee, taking in all about following is also a good way. Pui two or three four ounces of whiskey and one cup of coffee. ounces of fine ground coffee in a granitized The radial pulse could not be felt for a time, kettle and pour a pint of cold water on it and

but gradually returned ; it was small, threadlet rest over night. Heat it next morning to like, very rapid and difficult to count. Respira. just the boiling point, set it back to prevent tion was also rapid and difficult and her lips further ebulition. The strength is extracted, still remained purple. The placenta was exits aroma is preserved.

pelled, the patient losing scarcely any blood,and Whoever drinks this coffee during the day, the uterus could be felt firmly contracted. In will render his system proof in a great measure about thirty minutes from the first attack she against typhoid fever, cholera, erysipelas, had another exactly like the first, which remalarial and other fevers.

fused to yield to the same methods and in a A cup of hot coffee should be drunk before few minutes she had a tonic spasm with slight venturing into the morning air. Fine ground opisthotonos and died. coffee burnt on hot coals will disinfect the sick She had no symptoms at any time of kidney room. Coffee infusion is also a healthíul sub- trouble. There was no rupture of the uterus; stitute for tooth powders, and a most excellent neither did she take any ergot. mouth and tooth wash. The mouth and teeth I would invite comment on this case from should be rinsed with it after each meal. Its the brethren of THE WORLD,

W. B.

Child Crying in Utero.

day to day. Along with the flexion, abduction,

adduction and careful rotation are performed. EDITOR MEDICAL WORLD:-I had an experi.

Then placing the patient upon his belly, masence analogous to that of Dr. McLean, page

sage is applied to the affected parts and along 396, MEDICAL WORLD for November.

the thigh as far down as the knee joint, con. On June 30th, 1891, I was called in consul

sisting of strong frictions, tapotement, petristation by Dr. Russell, of this city, and found

sage and effleurage. (The French terms for Mrs. H., aged 19, in labor at term with her

these different kinds of massage being still in first child. The brow was presenting, and in

common use and none more appropriate in the trying to correct the position through the im

English language having been proposed, I may perfectly dilated os, we were astounded by the

be pardoned for using the.n. stifled cry of the baby. After waiting a few

To apply friction, insert the tips of the finmoments, the crying ceased, only to be

gers of one hand deeply down into the tissues renewed each time we made an examination,

or upon the nerves and perform energetic cirand when the doctor applied the forceps.

cular motion, while the finger tips of the other The grandmother of the child and two

hand apply gentle strokes in an upward direcneighbor women were present and heard the

tion. The aim of these frictions is to break up repeated crying of the child.

and remove pathological products from the F. W. WINGER, M. D.

tissues and to stimulate the nerves. 30 Main St., Bradford, Penna.

Tapotement in sciatica i made either with

the radial borders of the extended hands, The Massage Treatment of Sciatica.

which are brought down upon the muscles in a EDITOR MEDICAL WORLD:--The numerolis kind of forcible percussion, or wito the fists, drugs placed in the field against this linger- where a stronger application is desired (gluteal ing disease are a true indication that no spe- muscles). The arm is not used in tapotement, cific as yet has been found, to effect a posi. all movement being made from the wrist alone. tive cure. Electricity, both faradization and Petrissage is a manipulation by which the galvanism, have proved to be efficacious where muscle is seized between the fingers, and firm internal medication failed. (Compare article pressure, rolling and squeezing exerted. This of Dr. Curries, page 305, and Dr. Bennet, squeezing is begun below and slowly advanced page 425 of THE WORLD, 1891.) Another towards the centre of the body. mode of treatment, unfortunately but very Petrissage and tapotement have a powerful little practiced among physicians in this coun- effect upon the circulation and cause a strong try, is the application of massage, which, as general reaction in the parts to which they are extensive hospital experience in Germany has applied. taught me, will prove a reliable agent in most Effleurage is done by moving the palm of cases with or without the aid of electricity. the hand under more or less pressure along the Most certainly diagnosis must be beyond a surface in a centripetal direction. One or both doubt as to the cause of the neuralgia, to ex. hands may be applied, and while the second clude ovarian cysts, caries and tumors of the hand has nearly finished the movement, the vertebræ, inflammation of the spinal corů and first is brought back near the starting point, its membranes, tumors and abscesses of the thus changing constantly and advancing slowly pelvis, para-and perimetritic exudations, psoas from the extremity of a limb towards the trunk. abscess, pregnancy, etc. Sciatica, however, as Effleurage enforces venous and lymphatic circaused by an inflammatory process of the nerve culation. or its sheath, or by a myositis of the surround. The above treatment is applied once daily, ing muscles,--be the exciting cause syphilis, perhaps with the exception of one day of rest malaria, lead intoxication, cold or ove: exer

(each week), the length of each seance varying tion--is amenable to massage treatment. Sy from fifteen to thirty minutes (or more) accord. philis and other dyscrasies of course require ing to the reaction in each case. Pain may constitutional along with the mechanical treat increase at first, but that must not worry us; ment.

the patient will soon experience marked reThe most essential point in the massage lief. It is wise to practice all movements and treatment of ischias seems to be the stretching to apply massage to all those parts that are of the nerve, which is accomplished by plac- especially painful; they are certain to be in ing the patient upon his back and slowly enforc. volved most in the rheumatic process (Schrei ing flexion of the hip joint, the leg meanwhile ber). The patient is advised to exercise his resting upon the masseur's shoulder to lessen limbs as much as possible in the intervals of or prevent flexion of the knee joint. The force massage sittings. The cure may perfect in one of the flexion is to be regulated according to the to two weeks, while cases of long standing repain of the patient, and gradually increased from quire from three to six weeks. If the treatment

is reinforced by electricity, it is advisable to or diminish the total amount of the mixture try faradism first, because it has a quicker given, but he does not, and cannot know how effect, if any, than galvanism. It is best to use much or how little, if any, real medicine such a wire brush electrode at the positive pole and as he desires, is being administered. Even apply it at the most painful points (points dou- the assayed fluid extracts, valuable as they are, loureux) while the other electrode is moved present many difficulties that cannot, in the along the course of the nerve. It is neither very nature of things, be overcome. They useful nor desirable to apply electricity for are liable to change from various causes, such longer than ten to fifteen minutes each time. as evaporation, exposure to sunlight, heat or

F. DETLEFSEN, M. D. cold, a dry or a moist atmosphere, to precipi1027 Lincoln ave., Chicago, I.

tation of the active principle, to chemical

changes in the compound (for all such preAccurate Medication.

parations are very complex in composition.) EDITOR MEDICAL WORLD:~How much or

Some of these changes take place in dry or

solid extracts as well. Then, too, there is how little of a given medicinal preparation

much inert material to be eliminated, and a shall be administered in order to produce the

host of complex bodies which modify to a desired effect? This question confronts the practitioner every time he writes a prescription

greater or less extent, the active principle. or orders a dose of medicine as ordinarily pre

Why not eliminate all these in the laboratory

of the pharmacist or the chemist, and not atpared.

Much has been written and said upon the tempt it in the stomach of the patient? unreliability of the galenical preparations, and Active principle, or alkaloidal medication, there is a strong demand upon the part of the presents no new system of medicine. The profession for some standard of strength, the practitioner knows, or ought to know, the one most generally favored being that based therapeutic or physiological effect of his remupon the contained alkaloid or other active edies. Then, with a pure isolated drug of principle in the crude drug.

known strength, in soluble, convenient form, In an article published by the writer in The he may intelligently cope with the disease. New England Medical Monthly, for October, From a long experience, both pharmaceutic1891, the question of standardization was fully ally and clinically, I am fully convinced of discussed. I therein showed the extreme un- the superiority of active principle medication reliability of the galenical preparations of the over that by crude drugs, or unstable galenical U. S. P., and advocated a much greater ad. preparations. vance in this direction than the revisors of the

WM H. WALLING, M. D. U.S. P. had conceded. In quite an extended

2009 Arch street, Philadelphia. correspondence with representative pharmacists, both manufacturing and retail, as well as

[The above impresses us as the best arguwith our leading physicians, the same thought

ment we have yet seen for the use of isolated was expressed by all, almost without exception;

active principles in medication—the dosimet. a desire for some accurate method of arriving

ric form of medication. With these drugs the at an accurate dosage.

doctor practices his own well-known system of In fact, we must dispense with the crude

therapeutics with a new and vastly improved material in medication, and use only that

materia medica—truly rational therapeutics which is of undisputed value, namely, the

with strictly scientific remedies. active principles, the alkaloids, resinoids, glu The above article, coming from a man of cosides, etc. The physiological and thera wide experience and liberal ideas, who spent peutic effects of these substances are known, years in the scientific practice of pharmacy beand if we can have them presented in proper fore advancing to the study of medicine, is a form, accurate and reliable, it would seem that strong testimonial to the rapidly growing favor there was little left to be desired in that direc- of accurate medication. Now the physician tion.

must be especially careful that he purchases Active principle medication has most de- such drugs only where they are made with accided advantages over any other form of ad curate scientific skill and scrupulous profesministering drugs. The proper form being sional honesty. The time is rapidly approachpresented, as above referred to, we find that ing when every physician must pay some at. the dosage is accurate aud constant. It is tention to this phase of medical progress. -Ed.) known to the prescriber, and he may increase and diminish it at will, and with little trouble, SUBSCRIBE now and get full benefit of interesting still preserving his accuracy.

subjects for discussion now going on and about to le With the ordinary galenicals he may increase started.

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