Acidi hydrochloric dil...aa....drams iss
Potassii chloridi.....

..... drams ij Syrup simplex....q.s. ft.......ounces iv M. Sig.-Teaspoonful four times daily.

When fever came on, a few doses of acetanilide would cause perspiration and control it. He did well, and was able to run about until a few days after the medicine gave out, and there was a relapse. The same prescription was given, and is doing well at this time. had no untoward symptom except the fever. Two of his brothers were sick for a few days only.

Campte, La.

E. I. PERSINGER, M. D.

He

A Few Thoughts on Infectious Diseases; Tuberculosis in Particular. (CONTINUED.)

EDITOR MEDICAL WORLD:-I find that in tuberculosis the susceptibility or predisposition, whether inherited or acquired, can be annihilated only in cases where the volume of blood has not been reduced by fermentation and mal-assimilation of food in the intestines. Vitiated chyle diminishes the quantity and quality of blood, and compels the lungs to throw off secretions that otherwise should pass off through the bowels, bladder and skin. Fermentation takes place in the bowels (where all starchy foods and fat are digested) from a retention, and an inability to pass the ilec-cecal valve. The colon, especially the ascending colon, will invariably be found impacted more or less, and its contents in a dry, decomposed

condition. The person may have a small unsatisfactory defecation daily, but in many thousands of cases, but once or twice weekly. The greater the constipation and confined confined condition of the intestines, the greater danger of tubercular development in the mesenteric glands, commonly called consumption of the bowels. Where the soil is most adapted to developing the germs there will it manifest itself more fully. In all such cases there is perceptibly a clammy taste, beginning with a dry cough, possibly hacking occasionally, which will by and by develop into the regular morning cough. Some cough mostly at night on retiring, and towards day-break, while others cough more as soon as they begin to stir from their couches. This terrible annoying and most distressing cough is due to the vitiated chyle which is intermingled with venous blood in the right ventricle and thrown into the lungs every moment, ever and anon compelling the lungs to filter and renovate, oxygenate and prepare as best possible to be received by the left ventricle and sent out to nourish the body. The great head quarters of this life-giving eurrent-the lungs-is in a constant dilemma how to get rid of surplus excrementitious matter received from the duodenum. Some possibly passes on into the circulation, on its mission of feeding the starving tissues or the physical system, and more so perhaps because of the sedentary life. The lungs are seldom if ever expanded fully, and, as a result, but a fractional part of oxygen is inhaled that should come in contact with the blood in the lungs. The only way the lung can possibly eliminate secretions is by exhalation, cough, and expectoration, so it will be very readily understood that this condition of the system and circulation cannot go on long before damage will begin to appear in said organs. Possibly the lungs get on fairly well throwing off surplus secretions for a while, it may be for months, and in some cases even for years; but a bronchitis, laryngitis, catarrhal trouble or some air passage trouble will be the result, due to exhalation. It will be very noticeable now in the most of cases, the breath is offensive, said to be due to a foul stomach, but it will almost invariably be found to emanate from the vitiated chyle which has been forced to rely upon the lungs to get rid of its death dealing composition by exhalation. Even in other infectious diseases-scarlet fever, diphtheria, and fevers in general-this same condition of the glandular system and engorged alimentary canal will be found. Many attribute the fetid breath and coated tongue to be caused by the stomach or emanating from said organ. This is a great error, because the clammy taste, coated tongue, sore throat, deposits of all

kinds, and inflammations of the air passages are caused by exhalation from the vitiated blood, which is being renovated by the lungs. It will be inferred from what I have said already, and if I am correct in my assertion, resulting from over twenty years general practice, that the attention of the physician is directed to the alimentary canal, the malassimilation of food being the principal cause and beginning of tubercular trouble, from which throat, lung, and catarrhal diseases develope. Especially have I found it so in diphtheria, scarlet fever, and fevers generally. In acute infectious diseases I have invariably found that removing the contents of the bowels from the chyliferous vessels reduced the temperature at once, and that acting upon the glandular system with proper medications, in connection with flushing the bowels with hot water, entirely removed the original source or cause of the malady, that is, provided it is done before this condition of the alimentary canal has produced tissue change, lesions, etc., by a high temperature. The retained feculent matter surely generates the heat and is the fuel which must be burned up (consumed), or fatal results necessarily follow, unless nature comes to the patient's relief by diarrhea.

I

If this takes place soon enough the patient may pull through, but in danger of sequelæ to follow; a result of the decomposing, fermenting feces lying too long in contact with the mucous surfaces of the bowels, especially the chyliferous vessels. I refer now to all acute infectious diseases. I think I should be allowed to say what has been upon my mind for a long time in regard to my experience with infectious diseases. Before I arrived at the knowledge I have attained, I had lost four cases of scarlet fever, three of typhoid fever, one of pneumonia, none of diphtheria, small pox and erysipelas, two of child-bed fever, and none for the last ten or twelve years. The first seventeen years of my practice was in McConnelsburg, Pa. lived in the county seat, and practiced all over the county from twenty to thirty-five miles around. I had hundreds of cases of typhoid fever, scarlet fever, diphtheria, erysipelas, pneumonia, and thirteen cases of small pox, eight of which were of a malignant confluent variety and all in one family. (They were all terribly marked, because my directions were. not carried out in protecting the face.) My success in the treatment of these diseases led me to what I have discovered in the successful treatment of tuberculosis. I should have said that I have had no sequelæ follow during the last ten years of my practice in infectious diseases, for the simple reason that I removed the cause that produced a high temperature, and as a result tissue change, lesions, etc.,

were avoided. I refer to uncomplicated cases of my own and not the cases I saw in consultation, and after it was too late, and high temperature had done its work and all hope had fled.

I think it best to give my treatment of infectious diseases as fully as possible, so that I may be more clearly understood when I define my plan of treating lung, throat and catarrha diseases (tuberculosis). I have good reason for believing from the results derived from my treatment that 75 to 85 per cert. could be predisposition to consumption to such an exten: saved from premature graves, correcting their that they might live to die of some other cause.

Dr. Brobst, of Lehigh Co., Penna., who visited me in consultation with a very interesting case a few weeks ago, told me that while he was spending eight months in Europe, at Vienna, I think, he learned that my mineral treatment for tuberculosis gave the best results. This gives me encouragement to continue in its development. Washington, D. C.

N. B. SHADE.

ALUM used to whiten bread is detrimental to digestion, in that it renders phosphates insoluble.-Homan in The Medical Fortnightly.

IF I see an ulcer on the inside of the leg! suspect varicose veins, if on the outside I suspect syphilis. Gregory, Ib.

Test Questions.

1. What is the most useful, practical, safest, timesaving and money saving form for a prescription blank? See "The Physician as a Business Man," pages 119

and 120.

2. Illustrate the difference between the doctor and the merchant from the stand-point of public charity, See pages 18 and 19.

3. How do physicians' charities help the large captalists, and what is the logical remedy? See pages 27, 28 and 29.

4. What is the basis of the physician's fee? See pages 30 and 43 to 47.

5. What are average reasonable fees for different services? See pages 71 to 75.

6. How should physicians' Sunday work be regarded? See page 75.

7. How do medical fees compare with those of other professions? See pages 80 to 82.

8. What is the most practical bill form? See page 88 9. What do you think of cooperative efforts at co! lecting accounts? See pages 104 to 110.

10. What kind of account-books are most practical for physicians' uses? See pages 122 to 127.

II. How can the building association help the doctor? See page 128.

12. What obstetrical fee is charged by the profession in different parts of this country? See pages 48, 49. 55. 57, 63, 65, 68, 69, 72.

Price of "The Physician as a Business Man" is only $1.00. See order blank on page xx.

The great number of requests for private answers, for the information and benefit of the writer, makes it necessary for us to charge a fee for the time required. This fee will be from one to five dollars, according to the amount of research and writing required.

EDITOR MEDICAL WORLD:-Will some of your readers in Washington inform me through the columns of THE WORLD of the laws regulat. ing the practice of medicine and pharmacy in that State? WASHINGTON.

EDITOR MEDICAL WORLD:-Have a patient 85 years of age, who has constant sensation of burning of the feet. Has had it for six years. Feet are always cold, but the burning sensation Have tried chloroform, always present. aconite, belladonna, and cocaine, but without benefit. Would be glad to have the sugges tions of any who have had successful experience in similar cases. No cause can be ascertained. J. W. S.

EDITOR MEDICAL WORLD:-If any of the readers of THE WORLD have any explanations for the following, I should like to hear them:

In July 1887 I was called to attend a young lady who had taken, with suicidal intent, nearly two ounces of Paris green.

She had vomited freely, and beyond giving or attempting to give an antidote of dialysed iron, I did nothing, from the fact that she resisted, and very effectually, everything that was done for her.

Twenty-four hours after taking the poison she vomited a piece of hard Paris green as large as a walnut, and covered with mucous. Why was not sufficient poison absorbed to kill the girl? She recovered without any inconvenience. Mt. Kisco, N. Y.

F. A. AUGUR.

EDITOR MEDICAL WORLD: -My patient, a woman, age 45, has had some cough during the past two summers. She has been under a physicians care for six months; her general health is improved, but there is no relief from the cough. Her present condition is as follows: She has very little cough but she expectorates about every five minutes; has some catarrh, but the most of the expectorated matWhat ter comes from the bronchial tubes. will cure or relieve?

Please also give treatment for spasmodic

croup.

Reed's Corners, N. Y. S. J. SMITH, M. D.

EDITOR MEDICAL WORLD:-I would inquire of your readers who live in a malarious region, what remedy or combination of remedies they have found to be the most successful in the treatment of malarial fevers, especially when quinine alone fails or disagrees with the patient?

Also, what is found to be the best mode of administering quinine, that is, in regard to dose, time of giving, and whether in solid or liquid form, in malarial fever?

W. J. HAINES, M. D.
West Farmington, Ohio.

EDITOR MEDICAL WORLD:—I have a patient, an infant four months old, suffering with hydrocephalous. I have been using iodide of potassium and mercury, with some apparent benefit. Will you or some of the brethren please give me the proper treatment of it. I also have a case-a lady fifty years old, mother of family, stout, who complains of a dead or numb feeling at times, tingling of hands and fingers. This

The Treatment of Acute Dysentery. (Editorial from THE MEDICAL WORLD of August, 1891.)

OUR only apology for introducing into these pages an article giving specific directions for the treatment of disease is the necessity we feel for emphasizing the importance of a line of treatment which seems to us to be greatly overlooked in the numerous articles which appear at this season of the year, regarding this very common disease. Foremost among single remedies administered for the cure of dysentery stand sulphate of magnesia and other salines, so long used as to be considered standard or classical treatment. This succeeds well and quickly with that large class of cases of simple catarrhal dysentery, which tend to recover in a few days even without treatment. Another favorite treatment with a large class of practitioners is the repeated administration of large doses of ipecacuanha. With this treatment remarkable success has been achieved.

But our object in writing this is to call the attention of our readers to a treatment which although too often overlooked, is at once rational in theory and successful in practice.

The local treatment of a localized inflammation is always rational if the inflamed area can be reached. So it seems more logical to apply remedies directly to the inflamed colon by

enemata than to use the more indirect and uncertain course of the entire digestive tract. Our method then is as follows: After a dysenteric passage, place the patient on the right side, and, by means of a fountain syringe, or other syringe which gives a continuous gentle stream, and does not throw water in forcible jets, let flow into the colon from two to four quarts of water, which has been very weakly salted, and is as hot has can be comfortably borne. When that has been retained as long as possible, perhaps as long as five minutes, and has been expelled, charge the syringe again with a half pint of water, in which has been dissolved five grains each of chloral and su pho-carbolate of zinc, and let it flow into the rectum, to be retained, the patient keeping the recumbent position.

This entire procedure is to be repeated afte each dysenteric passage.

With some patients the amount of water mentioned will not be borne without great pain. As pain should not be caused, of course you will use your judgment as to the amount to be used, according to the case. Also, in the case of children, the amount of water used would be proportionate to their size. So, as to the amount of chloral and zinc required in the second part of the treatment; a good general rule would be one grain of each for each year of the child's age up to five.

In regard to the second, or medicated injec tion, we have only mentioned the lotion tha we prefer to use. Any other mild and soot ing astringent-sulphate of zinc, alum, acetate of lead, or in the country a decoction of white oak bark, or whatever you prefer, will do fairly well, only that it be mild and unirritating. in fact, in the great majority of cases the second part of the treatment may be omitted entirely, one or two thorough flushings with the hot sal: water proving sufficient to cure.

This treatment does not preclude the use of any systemic treatment preferred by the physician. However, we believe that in very fes cases will he feel the necessity of giving any medicine, except to correct malarial or other coincident affection of the system. The flushing, if thoroughly done, seems to answer the double purpose of removing all irritating matter and arousing the bilary and other secretions.

This treatment is original with us only in the minor details, the general principles having been advocated occasionally for many years. It seems to be one of those good things that are allowed to fall into disuse. We are very desirous of placing before our readers the results of this treatment in those severe dysen teries of the malarial regions. We should be pleased to hear the results from any who give it a thorough, faithful trial.-J. J. T.

Rectal Injections in Dysentery. From an excellent article by Dr. Rosenau, in the New Orleans Med. and Surg. Journal, June, 1892, we clip some extracts:

It is important to note that much of the success of treatment depends upon the care and thoroughness with which the method is carried out. This was well illustrated in a case of subacute amebic dysentery in the wards of the Marine Hospital at New Orleans last January. Injections of one pint of a ten per cent. solution of peroxide of hydrogen were given through an ordinary hand-bulb syringe once daily. This was continued almost a month. Improvement in all the symptoms followed, but no decided impression was made on the case until large injections were administered, high up, thoroaghly flushing out the lower bowel.

After several trials, I have settled upon the following plan of procedure. No claim of originality is made:

The patient lies on his left side, thighs lexed, hips elevated. An ordinary soft ubber catheter is passed its full length into the ectum. The fluid is delivered from a fountain yringe, held from two to four feet above the body of the patient. The finger on the deliverng tube acts as a governor to the amount of luid which is allowed to flow. The lowering or raising of the reservoir determines the mount of pressure.

If the fluid is injected slowly, no pain is caused-except the feeling of weight and ension in the abdomen. Sometimes patients complain of colicky pains about the umbilicus, hich pass away after a few moments interrup. on of the flow.

If there is much tenderness about the anus cd rectum, a cocaine suppository may be iven ten minutes before the introduction of me rectal tube.

The amount which different patients are ble to retain varies considerable. Adults sually hold four or five pints with difficulty. à some severe cases, where the patient's rength is exhausted and the parts are relaxed, e injection will run out alongside of the ctal tube at the same time that it is being rced in. In such cases I have used the ngest rectal tube and continued the injection til the return flow is as clear as the fluid jected.

The relief afforded is prompt and decided, sting from two to fourteen hours after the ema, the time lengthening as the case proesses favorably.

The solutions which have proven useful in hands are the following:

Sterile water is efficient, especially in the lder cases. It is best given warm, about

380 or 40° C. If in addition a more stimulating and astringent action is looked for, the water may be given cool or iced.

As a cleanser and antiseptic, peroxide of hydrogen has advantages not possessed by other articles of its class. It is not poisonous, seems not to irritate, dissolves pus and secretions and has antiseptic properties. It has given good results in from 10 to 25 per cent. solutions.

Salicylate of soda, 2 to 4 per cent., has given satisfaction.

When a decided astringen: is wanted in cases of large and repeating hemorrhage, alum in from 2 to 4 per cent. solutions ha; been found to act promptly.

The results in some cases of chronic dysentery are most gratifying. The following is an eloquent witness of what may be accomplished in long standing cases which have shown themselves proof against medication by the mouth. In this connection, it is well to observe that thickening of the mucous and sub-mucous coat in chronic dysentery is due partially to infiltration with new cells and partly to new formation of connective tissue. There is, however, less tendency to the development of new fibrillated connective tissue in chronic dysentery than in the chronic inflammation of most mucous membranes; hence, complete recovery is possible after long duration of the disease."

It is remarkable how long a time these chronic discharges may continue and be compatible with working health.

It is proper to state that much of the success of the treatment in these chronic cases depends on the absolute rest in bed and the careful regimen which is insisted upon.

That injections alone will not always cure was demonstrated in the case of a negro steamboatman who was allowed to be up and about during the treatment. A cure was not effected until the rest treatment was combined with the local applications.

An exclusive milk diet is preferred; the milk is peptonized when it is considered necessary. If there is exhaustion or much weakness a generous diet must be allowed. The hygienic surroundings should be the best obtainable.

In the grave or gangrenous form of the dis ease, injections are only palliative in their effect, and great care must be exercised lest the thinned bowel wall be ruptured.

The dysenteries of moderate intensity are the last class of cases to be considered. Here the results are uniformly good, as observed in the sporadic cases common to this country. The injections cause an almost immediate cessation of straining and blood in the dejecta. The evacuations remain fluid for a few days, when they resume their normal consistence