gave granules of codeine, and, if necessary, morphine. If delirious, I gave granules of hyosciamine. Every two hours one granule of arseniate of strychnine and the salicylate of ammonia mixture, so often referred to in THE WORLD this season (should now use the sulphocarbolate of zinc in alternation continually throughout the fever). After defervescence I continue the arseniate of strychnine, alternated with hydroferocyonide of quinine and quassine. The diet is highly important; an exclusive milk diet is the best. Regularly every two hours, I gave a glass of milk, or its equivalent. To those to whom it was impossible to administer milk I gave broths thickened with arrow root. Stimulants were resorted to in but two cases. (Plenty of cold water first, last and all the time. One hundred and nineteen years ago, when Dr. Buchanan wrote his then excellent work, blood-letting was in vogue in the treatment of almost all diseases, but to-day the use of the lancet and tape is almost a lost art, and my opinion is that in less than that number of years more the use of cathartics amongst the careful observers and thinking men in the medical profession in the treatment of typhoid fever will have been banished, and thereby many valuable lives will be saved. I think my friend, Dr. W. C. Abbott, does not correctly interpret nature's anguish ; instead of the small intestines crying because their contents are so nasty, they are crying because their mucous membranes are inflamed, and their tears are what produces the diarrhea. Now, instead of increasing the inflammation. with cathartics, soothe with the sulpho carbolate of zinc, and "flush" the colon with the chloral solution and relieve their grief. J C. CAMPBELL, M. D. Albany, Vt. Comments on Morphinism.-Cyanosis.- EDITOR MEDICAL WORLD:-I would suggest in Dr. Emory's case of morphomania (page 427), as to the amount used, to remember that an opium habitue, like one afflicted with syphilis, is always a liar. To tide him over the "pitiable condition," which I presume is caused by being deprived of the drug, I would give him Keith's avena sativa con. tinc. for the attacks of angina, inhalations of amyl nitrite, and do not spare it; his head will not burst! In the intervals give cactus grandiflora, or cactina pellets. Dr. Meigs' plan of treatment of cyanosis neonatorum, as mentioned by Dr. Dix, (page 420), will not avail in all cases, as I know by experience, but I will confess that I do not know of anything better. Dr. Cline's treatment of dropsy (page 417) may be as successful as it is unique. I treated two cases six months ago, one of anasarca and ascites, the other of anasarca. The former as follows: R Acet potass.... Tincture of digitalis ..ounce i ..drams iiss Fluid extract of Queen of the Meadow Fluid extract of corn silk (P. D. & Co ) Equal parts enough to make.. ounces iv M. Sig-Shake. Dose one teaspoonful, well diluted, every four hours. After I had run all the water out of him, (which took about one week), I put him on cactina pillets, one every one, two, or four hours, as required to control the heart pain, dyspnea and palpitation, conjoined with the following: R Fluid extract of sour wood Fluid extract of Solidago virgaurea aa M. S.-One dose repeat t. i. d. He told me yesterday that he considered himself permanently cured, which I much doubt, though he has been free from dropsy some five months. When I commenced treat ment he was water-logged from his toes to his nipples, and had to be propped up in bed to sleep. One thing which I do not understand about the first case was that the diuresis was all diurnal no rising at night to evacuate the bladder. Dr. Harrington (page 407) voices my opinion of Dr. Hurd's cases of anamalous fever both as to name and treatment. In the settlement of new territory, here in the West, fevers are of the intermittent and remittent bilious type. As population becomes more dense, we find a transition to enteric complications, and Woodward's misnomer a "typho-malarial," which is typhoid, and should be recognized and treated as such. Here in the Arkansas valley, sixteen years ago, it was the exception to have a fever patient in bed longer than from five to seven days. If intermittent, calomel and quinine sufficed; if remittent, when called to a case, you would load your patient up at night with calomel tamped down with Dover's powder, touch him off with salts in the morning, feed him on quinine for a week, and discharge him convalescent. Another fact as to the change in fevers here; our river bottoms are from one to four miles wide, with a sandy subsoil, and the people use drive-wells; that is, they bore a hole in the ground with a threeinch auger down to the sand or gravel, drive down a hollow iron tube, put on a pump-stock, and go to pumping. One half-day's work gives a well from twelve to thirty feet in depth. No dirt or trash can get into such a well. Out on the uplands they use open dug wells about four feet in diameter, walled with stone—a veritable catch all for crickets, toads, snakes, and rabbits. Now, as to the origin of typhoid, in my medical career, dating from 1874, I have never seen or treated a case of typhoid in the valley. They have always been on the upland, where open wells are used; and in every instance where I have prevailed upon them to clear out their wells, the debris has been crickets, toads, snakes and rabbits, some or all of these. I have come to the conclusion that typhoid does not originate spontaneously, but that it is the digestion and maceration of septic animal matter carried into the digestive tract by polluted drinking water, that causes it. also believe that once started in this way, the dejections of a typhoid patient, by being carelessly thrown out on the ground, can be carried to well-water and thus perpetuate the poison. Our typhoid fevers occur in dry years, when wells are low, and the sources of infection concentrated. I Reflex Genital Irritation. EDITOR MEDIGAL WORLD: About two months ago I was consulted by Mr. J., aged twenty-one, who had, for the last two years, been troubled with frequent seminal emissions, two or three per week, also troubled with too frequent micturition, sometimes every two or three hours during the day and once at night; at other times only three or four times during the day and not at all during the night. There was a dribbling after urination, especially if he coughed violentiy or bent over suddenly. The stream of urine was somewhat twisted and the water did not start readily. He has never had gonorrhea or practiced self abuse. He has been treated by several different physicians but without success. One physician suspecting stricture, tried gradual dilatation by means of soft bougies. He claimed that there was an obstruction about five inches from the meatus. Upon examination I found a rather diminutive penis. The prepuce adhered to the glands slightly, but I pushed it back without much difficulty, and found the sulcus completely filled with smegma, which was with difficulty removed. I told him that the filthy condition of the prepuce was probably the reflex cause of all his trouble; but to quiet his fears of stricture I passed a full sized steel sound easily into the bladder, showing that the deep obstruction was spasmodic. I told him to strip back the prepuce every evening and wash thoroughly with warm water and soap, and to cease all internal medication, as well as dilatation with bougies. As the patient lived at a distance I told him to come in again in a month. A month later I received a letter from him, stating that he had had but one seminal emission since seeing me, that he could retain his urine five or six hours during the day, and all of the night. He also stated that the dribbling after urination had ceased, that he had no trouble in starting the stream, and that he felt entirely well. I send you above for publication in THE WORLD, thinking it may interest some of its many readers. I would like to hear through THE WORLD from some of the other members of the medical profession if they know of any instance where retained smegma has caused such a train of symptoms. Cincinnati, Ohio. R. P. KING, M. D. Injury to Cervical Region of the Spine. -Pulsating Abdominal Tumors.-Quinine Pills.-Treating Nasal Catarrh. -Formula for Lumbago. EDITOR MEDICAL WORLD: About six months ago I was summoned in haste to the country to attend a Mr. L., some 68 years of age, who, in descending a flight of stairs leading from his barn floor to the feeding room, had suddenly lost his balance and fallen, striking his head on the floor some 8 or 10 feet below. In falling, about half-way down, his head struck the side of a manger and glanced therefrom to the floor below, where he was found by his son a few minutes after, crowded in between stairs and manger, head flexed on chest and for the time insensible. He soon regained consciousness, however, and was carried to his home, where, on arriving, I found him sitting up in a chair, head flexed on chest, totally unable to move it in any direction or to assume the recumbent position. complained of numbness in the left arm and side, and of so much pain in the top of his head that I feared injury to the skull, but, on examination, I found nothing more than a severe bruise of the scalp. I now found, however, his most serious injury to be in the cervical region opposite the third or fourth cervical vertebra, where a distinct swelling or prominence appeared, hard and unyielding on pressure, and from which the patient complained of sharp shooting pains, radiating to the side and top of the head. I gave him an anodyne, ordered him kept quiet and hot application of leal water applied to the back of the neck and left. He On returning next day I found him where I left him and in much the same conditiou, except that the numbness had disappeared, but the pains were still severe and aggravated on slighest movement of head or attempt to move the jaws. His temperature was 99.5°. The swelling on the back of the neck had subsided a little, but I now saw that the injury was of a very serious nature and did not give a very flattering prognosis of the case to the family. But now some six months have elapsed and the old gentleman is still living under symptomatic treatment and the important element, time. He has regained to some extent the use of his head and jaws, can be in bed with his head well raised on pillows, can move his head to a fair degree back and forth and rotate it somewhat. His appetite and general health are fairly good, but the prominence on the back of the neck still remains clear and distinct, and will remain, for it is a long one and, in my opinion, is caused by a dislocation forwards of perhaps the third cervicial vertebra. What say you, brother M. D's? I was somewhat surprised at the number of cures of abdominal aneurism lately appearing, and what I would say in regard to the same has been said by Dr. Waugh. I had a case some time ago in a woman of thirty of a pulsating tumor about two inches above and to the left of the umbilicus, with pulsations synchronous with the heart beat, shortness of breath and other aneurismal symptoms that disappeared very promptly under treatment for indigestion. Since then patients troubled this way have complained to me frequently of what they call a beating in the stomach. But don't be alarmed; cases of abdominal aneurism must of necessity be a rather rare occurrence, and in diagnosis here it is well often to apply a line of Longfellow that "Things are not what they seem." How many of the brethren give quinine in sugar coated pills, so convenient, you know, or gelatine capsules? I have done it, but don't do it now in fevers. True, a gelatine capsule will dissolve very readily in the mouth or in the secretion of a stomach free from fever; but in fever, where you want their effect most, the solvent power of the stomach is not equal to the task, and three times out of five you will find them in the stools as they were taken. If you don't believe it try yourself and see. How many of the brethren are satisfied with their results in the treatment of chronic nasal catarrh? Few, no doubt. But I think that the greater part of cases under forty years of age ought to be cured and that without destroying a good stomach while doing it. True, it takes perseverance on the part of the patient, but if he don't follow it up, don't take his case. The use of the steamer should be continued from one to four months, according to the severity of the case, and gives best results in summer seasons, on account of freedom from fresh chills. Try it and keep your patients from falling into the hands of the quack. To the doctor who had trouble in com pounding his lumbago liniment, if he will have the druggist put it up in the following order: Tincture of iodine, ammonia water, collodion; it will not solidify afterwards, though it will become colorless in a few hours, which does not affect its virtue. Success to THE WORLD, with its regular monthly clinic. Prospect, Pa. J. B. THOMPSON, M. D. Ulcer on the Leg. EDITOR MEDICAL WORLD:-In December WORLD, page 468, N. H. desires "first-class treatment" for a sore leg. I will simply say that I once had a sore leg on a man sixty five or seventy-five years of age. My treatment was as follows: I ordered six leeches every other day to the affected part, and in the mean time, cleansed the parts well with castile soap and warm water. I gave as an alterative, podophylin, sufficient to insure a free discharge from the bowels each day; also iodide of potassium, five grains three times a day; and in three months the sore healed and troubled no more. Freedom, N. H. A. W. HOBBS, M. D. Labor Complicated with Hydrocephalus. EDITOR MEDICAL WORLD:-In the December number I see a communication from Dr. J. G. Knox, (page 463) which calls to mind two cases of hydrocephalus of the fetus which oc curred in my practice some time ago. In the first, a woman of some forty two or forty-three years of age, who had given birth to elever children, all of them fully developed and sound, called me to attend her in the early morning. I found the breech presenting and I proceeded to deliver. All went well until the body was out. Then I labored. Finding a head enormously large, I sent for assistance, but none being at hand before evening I gave ether and, wrapping a cloth about the feet of the child, requested one of the women to pull while I was trying to find the most available point for a puncture, as I had decided to use my pocket knife and empty the encephelon, then apply the forceps (I did not then recognize the exact condition of the fetus) and compress the heart and deliver. I had told the woman to pull, and she did pull and, as I found a weak spot in the scalp, to my surprise and delight there was a great gush of water and the child was born, my assistant taking an involuntary movement backward against the wall of the room. The mother, after suffering from a little septic trouble, made a good recovery and, after about two years, I attended her in another con finement, when she was delivered of a good, sound boy baby. The The next one was the mother of two fine healthy children. When I was called to attend her I found a breech presentation. As she seemed in good condition and, not finding any reason for the delay of affairs, I suspected hy drocephalus and, as soon as possible after body was born, ruptured the coverings of the head, which, fortunately, were very thin. woman got up well and in due time I attended her again, when she was delivered of a fully developed healthy child. Two cases, both mothers healthy, both breech presentation, both had previously and have subsequently had healthy children. I have classed them in the same category as dropsy of the funis and spine, but the cause of the dropsy I can not give any more than can Dr. Knox. Pascoag, R. I. H. J. BRUCE, M. D. Umbilical Hemorrhage. EDITOR MEDICAL WORLD:-Articles in Dec. WORLD prompt me to write the following: On March 18th, 1887, I attended Mrs. S., in her sixth confinement, which was quite an ordinary one. The child was a vigorous boy, weighing 8 or 9 pounds. There was no hemorrhage from the cord at any time, and before I discontinued my visits, I was informed that the cord had come off, and it was all right. On March 30th, just twelve days after the woman's confinement, a messenger came for me, saying the child was bleeding. I went out in haste and found profuse hemorrhage from the umbilicus. Saturating a bunch of cotton in Monsel's solution, I pressed it down on the source of the hemorrhage. Afterwards I tried large compresses, pressure with the fingers, &c., &c. Sometimes thinking I had the bleeding stopped, but never getting it entirely controlled. After some hours I sent for a neighboring physician, who gathered up the abdominal skin surrounding the navel and put a ligature around it. This apparently stopped the hemorrhage and satisfied the parents, making them think that I was very stupid for not doing so sooner. The child died about two hours later. I wish some one would say in THE MEDICAL WORLD just what should be done in such a case. Carnot, Pa- WM. H. MCGEEHON, M.D. Hemorrhage from the Cord.-Hematuria. EDITOR MEDICAL WORLD:-Let me ask "Doctor" (page 422) if he is sure of the source of the hemorrhage in his case? In the evening of January 26th, I was summoned across the street, in haste, to attend Mrs. C., who was delivered, within thirty minutes, of a nine-pound boy. The loss of blood during the third stage was so great that symptoms of collapse followed, from which she recovered slowly by usual treatment and constant care during the night. My attention was called the next morning to a severe hemorrhage from the bandage, dressing of the cord, and the upper cord. Upon examination I found the child's bandage, dressing of the cord, and the upper part of the diaper wet through with bright blood. Knowing that, on account of the condition of the mother, I had tied the cord in haste, and thought that the knot had slipped, I tied it again. After securing the cord the hemorrhage continued wifh increasing amount, when I made a close examination of the cord, penis and anus, and was still at a loss to know its source. At first the color of the stain was bright, but as the case continued the amount of urine became excessive, and the color less bright. January 31 the child was too weak to nurse; had emaciated very much, pulse 39 and feeble, extremities cold. I had given large doses of ergotine, tincture of the chloride of iron and tincture of opium without benefit. The last hemorrhage had gone through its diaper, clothing and thirteen thicknesses of a folded sheet. I then gave three drops of oil of erigeron every three hours. Marked improvement followed during the night, with very little stain to the urine the next day, and much less in quantity. February 1st I collected a few drops of urine by placing a small vial over the penis and doing it up in the diaper. Examination showed it to be nearly limpid and acid; by microscope numerous blood corpuscles and a variety of epithelium and some water. In a few days the oil was discontinued, when the amount of urine increased to normal. A rapid improvement fol Umbilical Hemorrhage. EDITOR MEDICAL WORLD:-I have had three cases of hemorrhage from the cord, after ligating in the usual way. One proved fatal, the other two recovered. These cases led me to a study of its causes, and a series of experiments to determine a safe method of ligating and dressing the cord to prevent the possibility of leakage. An established rule of surgery is, that in ligating an astery, the ligature should be drawn. sufficiently tight to divide the internal and middle coats of the vessel, leaving only the tough, elastic outer coat in its grasp. There is then imme liate retraction, and contraction of the internal tunics, which favors the formation of a clot. In ligating veins, the walls or coats are not divided, but corrugated. The umbili cal cord consists of two small arteries and one large vein, imbedded in a dense elastic gela. tinous substance, surrounded by a tough membranous sheath-a reflection of the amnion and chorion. Tying all these tissues is a some what different operation from tying a single, isolated vessel, and requires a greater degree of force to divide the internal coats of the arteries. I am satisfied that the cause of hemorrhage in "Doctor's" case, (page 422, Nov. WORLD) was not contraction of the cord where ligated, as he reported, but that the ligature was not sufficiently strong and tightly drawn to divide the internal tunics of the arteries, leaving them patulous in the presence of all these tissues. This I judge to be the cause of hemorrhage in two of my cases. In the other case the hemorrhage occurred after separation of the cord, and was due to antecedent blood changes, evidenced by the development of purpura hemorrhagica. Authors classify hemorrhage occurring under the above conditions as being due to careless ligation, but fail to point out the peculiar environments of the vessels to be ligated, and the necessity of an extra strong ligature tightly drawn, From the moment the cord is cut till complete dessication there is loss of substance by exosmosis, which favors loosening of the ligature; hence the importance that it should include only the denser tissues of the cord and blood vessels in its grasp. I now use a linen cord the size of ordinary wraping twine. I want it long enough to wrap around my hands, that I may have an undoubted purchase. I want my hands and ligature dry that there be no slipping. In case the ligature is not the best, and well tied, two ligatures are safer than one. I prefer absorbent cotton for dressing the cord, as it hastens dessication by absorption, and prevents the introduction of bacteria, and thereby serves to avert certain diseases of the umbilicus. He As to the time of ligating after delivery, some recommend to wait till pulsation ceases in the cord, that the child may receive an abundant supply of blood. I believe this recommendation to be based on a false hypothesis, and to be misleading. This brings up another point in the "Doctor's" case. states that "The placenta was pumping blood into the child's circulation for some time." Let us see during the last throes of labor, when the child is being expelled from the womb and through the pelvis, the anatomical relation between the uterus and placenta is broken up by forcible contractions. Immediately after delivery of the child, the placenta will be found resting over the os, protruding, or wholly expelled into the vagina-except in cases of morbid adhesion. way. If this be so, there can be no further relation between the circulation of the mother and child. The pumping process goes the other To convince yourself of this fact, cut the cord while it is yet pulsating and observe the venous blood flow in jets from the umbilical arteries at each pulsation of the fetal heart. Notice the placental end of the cord, and see the blood flow without pressure till the small quantity contained in the blood vessels is drained away. The child should evidently receive our attention till breathing is well established. First, it should be placed on its right side for obvious reasons, have its whole body exposed to the air, mouth and nose well cleaned and free from obstructions, when a moment's attention should be given to the mother, to ascertain the possibilities of hemorrhage, twins, &c., and if nothing contravenes we may safely proceed to tie the cord without regard to pulsation. As to what the result might be if the cord be not tied at all, those who practice that method can best answer. I am satisfied that hemorrhage will not occur in the majority of cases; but to appreciate the possibility of its occasional occurrence, and the necessity of a safeguard in all cases, is but to refer to its primal causes, viz.: the hemorrhagic diathesis enlargement and imperfect closure of the acces sory blood vessels, inhibition of the function of that part of the nervous system that influ ences collapse and maintains closure of the |