plain the philosophy of its action. Let it suffice to say that I am well satisfied in my own mind regarding its great benefit-a number of young men and women being alive to day who must otherwise have succumbed in infancy to the dread cholera infantum. I learned this important fact in the mountains from some of the good old women who were great on yarbs.

G. H. MARSHALL, M. D. 190 2nd Ave., Pittsburg, Pa.

Treatment by an Intelligent Homeopathic Practitioner.

BY PROF. Cummings,

Of the Homeopathic Medical College of Missouri. [In an explanatory note to the editor, the Doctor states that all he asks for his line of treatment given below is an unprejudiced consideration and a fair trial at the bedside. We deem, however, that no explanation at all was necessary, as the Doctor gives medicine generally in appreciable, although small, doses, and is guided by an intelligent understanding of the diseased condition present in their administration. Scientific medicine is only benefitted by an impartial comparison of methods and results.-ED.]

EDITOR MEDICAL WORLD: Your proposal to have a special Cholera Infantum number for June is good.

All students of Dr. Dobell," On Diet," and Dr. Wm. Roberts, on "Digestion and Diet," know that the predisposing cause of all bowel troubles of children, not fed exclusively on milk, is starchy food, arrow-root, crackers, white bread, potatoes, etc. These foods must be digested by saliva. In teething children, a great deal of the saliva dribbles out, and is lost as a digestive ferment. The salivary glands are not sufficiently developed in young children to be of much service. Hence the importance of keeping starchy foods from childTen under two years. The exciting cause of holera in antum is intense and prolonged heat. There doubtless are microbes in cholera nfantum, as well as in Asiatic cholera ; but, if the conditions are unfavorable for their development and growth, they can do no arm. While it is necessary to keep children cool during the heat of summer with thin lothing, and out of the hot sunshine, and in well ventilated rooms, still, some children are very much injured, if not killed, by too much bathing in water, either cold or hot. Scrofulus and tubercular children dread water, and ry when being bathed in water. Such child. en should be bathed with olive oil every day, nd only washed about the groins when soiled.

Perhaps once a week a soap and water bath might prove beneficial. During rainy, changeable weather, thin flannel clothing would be

more conducive to health than cotton or linen.

Treatment.-in genuine cholera infantum, the child may die in a few hours, just as an adult may die in a few hours with cholera morbus. The treatment must be prompt.

When so much serum is lost from the blood as is the case in this disease, the patient may die from congestion of the brain. Then why give opium in any of the forms, when it is so liable to produce this condition? We might as well attempt to stop a flood by damming the stream as try to cure cholera infantum with astringents, or by plugging the rectum. Treat the conditions.

In the commencement, if vomiting is the predominant symptom, very small doses of ipecac will sometimes do good. If the child is sleepy and very fretful, then the one five hundredth or one thousandth part of a grain of crude antimony, triturated with sugar of milk, will be the remedy. Dose to be repeated every fifteen minutes until better, then lengthen the interval. When the child is in a cold sweat, or the skin is blue with cold, with thin watery stools, give veratrum album from the first to the third dilution-12 drops in 2 glass of water, teaspoonful every third stool.

For great restlessness and intense thirst, drinking little and often, a trituration of arsenicum album, five hundredth or one thousandth part of a grain, given every hour, will prove beneficial. When reaction takes place, and fever occurs, then give a tenth of a drop of aconite in water, every hour.

Patients should be allowed all the water they want. For nourishment, give milk Idiluted with hot water. Wash out the bowels with warm water, then give a pancreatized enema of milk. The milk should be injected very slowly.

I direct a half tube of Fairchild Bro. & Foster's pancreatic extract, to be dissolved in two tablespoonfuls of water, to a half pint of milk.

Let this stand in warm water one half hour, and then slowly inject into the bowels. Children who perspire a great deal about the head while sleeping, are very liable to cholera infantum, and bowel troubles of all kinds.

To these children I give phosphate of lime (calcarea) sixth trituration night and morning. Sidney Ringer, in his hand-book of therapeutics, speaks of the uselessness of giving this medicine in large doses.

J. C. CUMMING, M. D. 3514 Olive St., St. Louis, Mo.

KBBP your journals in a MEDICAL WORLD binder.

-

How Intestinal Disturbances are Regarded and Treated in the Creek Nation. EDITOR MEDICAL WORLD: - I commend highly your idea of devoting the June No. of THE WORLD to the subject of cholera infantum, and will contribute my little mite. Prevention is the most important measure, and should receive the first consideration.

I am confident that indigestion is at the bottom of the majority of the cases, and hence it is the key-note to treatment.

In

All aliment should be avoided that will damage the stomach or irritate the bowels. Insure digestion by the administration of pepsin to those that are prone to attacks. these cases, the greatest care should be exercised to prevent the trouble, and if cleanliness, proper diet, and pepsin will not suffice during the hottest months, when the stomach is incapacitated, the child should be taken to the country, if the parents live in the city.

In treatment, for a mild case, I usually begin with oil and a little turpentine to expel the irritating contents of the bowels, and attend to the diet and surroundings.

As soon as the oil acts on the bowels I give sub-nitrate of bismuth and carbolic acid in peppermint water.

When the colon is much involved I give rectal injection of lead water, starch or milk.

I don't believe in giving opia'es in these troubles when it can be avoided, for it always deranges the stomach, a thing which we can not afford to do.

I think sulphate of quinine and tanic acid makes as good an astringent and is more generally indicated.

Eufaula, I. T.

GEO. W. WEST.

Treatment of Summer Complaint With
Granules.

EDITOR MEDICAL World:—I was called on one evening to see Miss S-, aged two; I found that her previous health had been good (the mother stated that the child had never been sick before). Her pulse was very rapid; she had high fever, with an intense thirst; vomiting and movement of the bowels occurred at short intervals, the passages being watery and of a greenish yellow color and fetid odor. The child was in a semi-comatose condition between the spasms of pains. She had been accustomed to eat of everything that the family did. The attack came on in the morning.

Treatment. I gave arsenite of copper (1-75 milligr.) arseniate of strychnine, hyoscyamine, narceine, cinchondine sulphate, one half granule of each every half hour. (The granules were put on a damp cloth a few moments, then cut in two), given with a little boiled milk,

until relief, with a restricted dict composed of milk, boiled and given hot for breakfast, dinner and supper; between meals the boiled milk cold.

After she had taken the third dose her stools were reduced in frequency; when the tenth dose was taken she fell asleep. The next day her mother gave her something to eat that I did not advise. The consequences were that I was called again in the evening. When I arrived the mother admitted her guilt of disobedience by telling me she had fed her some boiled tomatoes; she promised very faithfully to obey me in the future, when I prescribed the same treatment as before. After she obtained relief as before I continued giving the granules at longer intervals for several days, with the same diet of boiled milk.

CHAS. W. HATE, M. D. Eleventh St. and Susquehanna Ave., Philadelphia, Pa.

Cholera Morbus.

EDITOR MEDICAL WORLD:-On December 28, I was called hurriedly to see Mrs. G., aged eighty-five years, the messenger stating that she was probably dying; she had been vomiting and purging for three hours. I found her in a collapse, pulse almost imperceptible at the wrist, extremities cold, skin wrinkled and covered with cold perspiration, and shaking like one in an ague chill.

I gave her at once a granule of arsenite of copper (1-1000 grain), and a granule of Greg ory's salt (1.67 grain), both together, and in fifteen minutes a granule of sulpho-carbolate of zinc (grain), and a granule of arseniate. of strychnine (1-134 grain), and in fifteen minutes a granule of glonoin (1-250 grain), and a granule of arsenite of copper, applied a cayenne pepper paste to the epigastrium, and hot-water bottles to the extremities. Then I arranged four sauce-plates wtth granules as follows: Into the first sauce-plate I put granules of arsenite of copper, into the second granules of Gregory's salt, into the third granules of arseniate of strychnine, into the fourth granules of sulpho-carbolate of zinc and digitaline, and directed the nurse to give them every fifteen minutes in turn until the patient was better, and if sleeping not to awaken her. At my morning visit I learned that the patient vomited but once after I saw her, and was in every way as comfortable as could be expected. I do not remember ever having controlled a bad case of cholera morbus so readily and satis factorily to myself and the patient before. I think this plan was better than if I had given seidlitz salt to clear the alimentary anal, when disease had done that already too well. Albany, Vt. J. C. CAMPBELL, M.D.

Cholera Infantum.-Treatment From a Dosimetric Standpoint,

ELTOR MEDICAL WORLD:-This dread cognomen is aptly applied to the various intestinal disturbances occurring in early life, more often during the neated season of the year. The various grades of disturbance from simple diarrhea to choleraic collapse being simply different degrees of intensity of the same primary condition.

While desiring to deal only with the indications for treatment, you will pardon me if I refer briefly to the causation of this condition, upon a clear comprehension of which a rational method of treatment can alone be based. Numerous things, chief among which are errors in diet and exposure, through the action of the sympathetics, bring about a disturbance of the physiological relation or balance existing between the circulation of the external and the internal skin. Fortunately, nature is extremely tolerant of abuse, or trouble would arise more often than it does. The great law of compensation under which certain parts are called upon to perform the work belonging to others temporarily in a state of imperfect activity saves serious calamity more often than we are apt to suppose; meanwhile, the forces of nature are brought to bear to set the wrong right, and if successful all soon goes on as before.

Here is where the work of the physician comes in, to hold out to nature a helping hand. How necessary it is that one should not only clearly comprehend conditions but be able to select and apply the best means of assistance. The relation above noted is a veritable physiological see-saw, a cutaneous vaso-constriction or chill means an intestinal vaso-dilatation, while irritating substances in the alimentary canal bring about the same condition in a reverse order, and we have a choleraic flux, first from external and second from internal causes. Mental emotion may bring about the same order of things, as noted in the effect produced by fear, and should be classed among external causes. These two main points in causation must not be lost sight of, as they require entirely different means for their removal. In the first, the cause of excitation being removed, the exhibition of brucine, one or two granules hourly along with one of phosphoric acid, will quickly remove the temporary paresis of the vasomotors of the intestinal tract, with entire relief to the condition.

If the loss of balance is caused by a chill, the use of glonoin, with external warmth, one granule every fifteen minutes till effect, is the quickest possible way to dissipate internal congestion. In the second, abstinence and the

removal of the fermenting material in the alimentary canal with colon flushing and small doses of seidlitz salt will to prepare the way that brucine will again effect a perfect cure. If brucine is not at hand, salts of strychnine may be used, preferably the arseniate, but brucine is to be preferred. We have now touched simply upon the causes and treatment of this condition in the simplest form. As we have said before, the various phases of choleraic flux are simply different degrees of intensity of the same condition. Let the causes continue, wearied nature wavers, helpful compensation becomes a pathological condition, the natural function of the canal is suspended (over-distension causing paresis), bacteria generate, and soon we have a seething mass of intestinal putridity reeking with odors and teeming with the vilest poisons. It is no wonder that the mortality is so great. It. is more wonder that with the incendiary treatment of the past it has not been greater. Here is a serious condition; there is no time to lose, for unless relief is at once obtained, a life will go out surely and speedily. What shall we do? Shall we give opiates and astringents to further irritate the mucuous surfaces, to lock up this vile mess of abomination while the death sentence of our patient is given in the absorption that is sure to follow? I hear an echoing "No!" Good! Now, in the light of systematic therapeutics what shall we do? We will meet the indications and first give our best intestinal antiseptics is such doses and frequency as is necessary to destroy the multiplying microbes, and thus remove the local irritation and stop the septic absorption.

Arsenite of copper, grain 1 1000, one granule every fifteen minutes until effect, and then at longer intervals, one to two hours, is a precious remedy; so also is sulpho carbolate of zinc, grain 1-6, used in the same way, but it is probable that none excel, if any equal, calcium sulphide. grain 1-6, to which the same directions will also apply. These three are readily tolerated by the system, even beyond the amounts required to produce the desired local effect. Their action peroram may be supple. mented by colon flushing of the same in hot solution, and if retention of fermenting residues is suspected, seidlitz salt in small doses should be used, paradoxical as it may seem. For a child, one or two heaping tea spoonfuls in halt a glass of cold water may be given in teaspoonful doses every five or ten minutes to allay thirst, and continued till effect.

Now comes the second indication, to stimulate vitality by every possible means, that the paresis of the intestinal vaso motors may be relieved and their functions restored as soon as

A

possible. On this, the first indication having been met, success or failure depends. Here again we have brucine, the salts of strychnine and phosphoric acid, precious remedies and sure to win if the case has not been so long neglected that exhausted nature cannot respond. Brucine and phosphoric acid, one of each together every one-half hour, for a child of four to ten. The same in divided doses for an infant (dissolve in boiled water and sweeten slightly), or the salts of strychnine if, by the urgency of the case, a more powerful stimulant is demanded, will soon restore this lost vitality upon which all other symptoms depend. rapid fatality is thus summarily arrested, and we have left but a simple case of slight fever, malaise and depression, which will quickly be overcome by continuation of the remedies with which we have met the two indications, in less frequent and alternate doses, and suitable food and care. If, from the extreme virulence of the case, it is suspected that the intestinal nerves will not respond to excito-motors given by the mouth, the same should be used by hypodermic injection, repeated every half hour till some indication of returning energy is noted, when their exhibition per oram may be depended upon. I would not say that astringents are never indicated, but remedies which do not act on the vitality are at best uncertain ones. If indicated, use them. If pain demands the use of opiates use morphine, and stop when you have got enough. sure you are right then go ahead.' treme collapse the two indications may be met simultaneously by a judicious combination of the above named remedies. Should they be rejected by emesis, resort at once to hypodermics of the excito motors, give one granule of camphor-monobromate to dissolve on the tongue every ten minutes till relief, and then return at once to the remedies necessary to meet the first indication. The great variety of empyrical discoveries go for naught in the light of therapeutic certainty.

"Be

In ex

DR. W. C. ABBOTT.

Ravenswood, Chicago, Ill.

Hints on Treatment of Cholera Infantum.

EDITOR MEDICAL WORLD: -My usual manner of treating cholera infantum is to give minute doses of corrosive sublimate, if liver is torpid, then either arsenate copper, or alol and bismuth tɔ control the bowels. One great factor is to cover the bowels with several fold; of flannel, or to wear a long flannel shirt below the hips. Morning and evening have the child carefully carried and hauled in carriage in order to get as much fresh air as possible. I

have followed the above, in children brought from the city, with success in every case. Woodstock, Va. W. S. CLINE, M.D.

At

JOSEPH SPALDING, M. D., formerly of West La Fayette, Ind., now practising in Woodstock, Ct., writes:- Cholera of infants, that dreaded summer disease, is the cause of more deaths in this land than are produced by any other affection to which milk-using children are liable. Its causes are, first, sour and imperfectly digested milk, then a putrid change, causing pain, inflammation, and offensive discharges, and consequent lower vitality. Now is the time for the physician to do his good work Remove all offensive contents from the bowels by liberal cathartics, and, as far as possible, use those that are non-irritant. the same time use heavy calcined magnesia, with small doses of hydrarg. cum creta, and use but little food but plenty of pure water. Use fresh cream mixed with water and magnesia. Lime water is too uncertain, and astringents are a curse. Sweet oil as a laxative usually does well by relieving the irritation of the mucous surface and also acts in a very pleasant way, as it diminishes the frequency of the discharges. Be sure to taste for yourself any oil used by children, and if you find that a half-teaspoonful makes your throat feel like it was full of nettles, you would better not give it to the child, as every dose of rancid oil will increase the already serious condition of your patient.

This treatment I have found in the early stages of cholera infantum to be of the greate.t benefit in my hands. I have had an experience of twenty five years in the most sultry malarial regions of the Certral States, and can rely on this simple treatment with the greatest conI have fidence, and but a very little fatality. recommended the mothers to keep magnesia at hand in summer, and get pure olive oil to use on the first symptoms of sour stomach. Women who were careful to follow directions rarely ever had any trouble with summer diarrhea."

Dr. Spalding says that in the latter stages of summer diarrhea, where all remedies seem to be of little benefit, he has seen rapid improve. ment begin upon the use of a tea made of Mullein leaves, and mixed with a small quantity of cream and given to the child.

MY DEAR DOCTOR TAYLOR:-I have used THE MEDICAL WORLD visiting list and ledger the past two years and find them more satisfactory than any I have yet seen. Very truly, E. CUMMINGS. 528 Fifth ave., New York.

[Price only $1.00 for the complete set. Address this office. See order blank, page 238.]

Bichloride of Mercury Spray for Cholera In

fantum.-Kakodylic Acid Again. EDITOR MEDICAL WORLD:-I would suggest the following treatment for "infantile diarrhea," "infantile indigestion," or "cholera infantum," as being rational and effectual. Sop all nourishmeut. Give a weak solution

of soda bicarb (dram i to a glass of water), teaspoonful every ten minutes. Keep the body and extremities warm, if necessary, using mustard water baths.

Make a 1 to 1000 solution of bichloride of mercury, and with a hand spray, douche or atomizer spray the child's mouth and throat every hour. It is astonishing how quickly this treatment will often change for the better an apparently hopeless case of this kind. Enough of the mercurial solution passes down the esophagus to arrest fermentation, and destroy micro-organisms. I suppose there may be danger of producing mercurial poisoning. I have not seen it occur. I wouldn't recommend this or any treatment for a blockhead to try. Infantile indigestion is one of the diseases that require skilful management.

"A NEW THERAPEUTIC AGENT."

I saw an article in THE WORLD relative to the use of "kakodylic acid." While I would not wish to detract anything from Dr. Lewis' fame in introducing a new remedy, I have to say that twenty-four years ago while a medical studert at Hanover, N. H., Prof. Edward Phelps, Professor of Theory and Practice, called our attention to its use as a remedy in tuberculosis, and in my graduating thesis I loyally advocated it, thereby making myself "solid" with Prof. Phelps at examination for degree. It therefore seems that Dr. Lewis' "new remedy" is really an old one resurrected. None the worse or better for that, however.

So

Although there is not another physician in this city that I know that uses the method altogether as I do, I must confess that under this treatment I have been more successful Children than under the former treatment.

will always take the medicine, and better results will follow. Let me relate an illustrative case:

On the 15th of April, 1891, I was called to see a child, William K., 2 years old, who lived about eight miles from my office, of which the parents had given up all hopes. They had employed another physician before I was called. When I saw the child I thought it must die. The case was cholera infantum of the worst type. The pulse was 155, temperature 105, and the child was vomiting every hour, with great prostration, and passing discharges every half hour of the most offensive character. The lips were of a bluish tinge, tongue darkly coated. and eyes apparently set, taking no notice of anything around it.

As is the custom with most physicians using this kind of medicine, I carry the medicine in my pocket with me. I gave the child one granule of narceine, one of hyoscyamine, one of aconitine, one-half milligramme each, every half hour. I saw the child eight hours after, and the vomiting had ceased, and the child was more quiet. I then ordered for the bowels one-half teaspoonful of seidlitz salt to remove any obstruction that might be in the bowel. Six hours after I ordered one granule of sulphocarbolate of zinc, 1-6 gr., one of brucine, and one of arseniate of strychnine every two hours, to keep up the tone of the system and to check the bowels. The next day I saw the child about 8 o'clock, and the pulse was

120,

temperature 102, no running off of the bowels, no vomiting, flesh moist, tongue in good condition. I ordered one granule of aconitine, 1⁄2 milligramme, and one of arseniate of strichnine, and one of hydroferrocyanate of quinine every hour, and ordered the child to be given Mellen's food.

On the next day I found the child looking better, pulse normal, temperature 101, tongue looking well, flesh moist, and the child I pronounced well.

So much for the Dosimetric Medicine. I am of the opinion that there is no need of losing so many children as most physicians have lost within the last twenty years.

TURNER TORREY, M. D. 708 11th St., South East, Washington, D. C.

THE Medical Bulletin, Phila., says :-" Dr. Taylor has given the profession a book of great value. [The He shows how Physician as a Business Man.]

much doctors neglect the business part of their work. It points out, in very many ways, how money can be made and saved.' See order blank, page 238.