Six Cases of Dropsy.-Successful Treatment. Editor MEDICAL WORLD:-Perhaps it is time that one who has profited for over a quarter of a century by the contributions of his medical brothers should begin to reciprocate; so here is my first article, and I shall offer it to this journal, that has been my greatest helper.

Case 1st. A young white girl, delicate from early childhood, gradually became dropsical and her health entirely failed. She was so weak and troubled with dyspnea from general anasarca that she could not get in and out of the house with only three low steps to climb. Her uncle, a very successful practitioner, said he could do nothing for her-that she would have to die. (Her home was in a very malarious locality near the Santee river.)

A negress told the mother that there was a plant near at hand that would surely cure her daughter. A quantity of this modest, lowly plant was procured from the neighboring forest and was steeped in cold water, a fresh supply being had each day or two, and was given the girl freely as a drink in place of water.

In three days there was a most marked im provement from free diuresis induced by the drug. The anasarca rapidly subsided, appetite improved, physical strength and her spirits returned, and at the end of two months her strength was entirely restored, and she is to day a healthy, robust woman.

Her mother tells me that as the dropsical effusion disappeared her skin contracted and cracked till it reminded her of an alligator's hide. No other drug was given. What was this wonder working little plant? Has any reader guessed? Pipsissewa!!

I was once told by an old lady patient that she had derived great benefit from the use of a wild-wood plant recommended by a friend. I asked what it was. She said it was the " waspecific." After puzzling over it I at last translated it Pipsissewa. She had heart dis

ease.

Case 2. A negro man, for several years the subject of a very marked dropsy, was, while out hunting with some white friends, bitten by a genuine rattlesnake, and was in great terror till treatment could be had. There was soon set up a most copious, free and excessive action of the kidneys, resulting in a short time in complete relief of the dropsy. My informant was a personal witness of this fact and says that the negro lived beyond middle life and had no return of the dropsy. The cure in this case must have been wrought by fear.

Case 3. Dr. David Ramsay, the early historian of South Carolina, related the case of a German who, while concealed and in imminent

danger of being caught by the Tories, whom he heard declare their purpose to hang every one they caught, while undergoing this mortal terror, a very free diuresis set in-he passed an enormous quantity of urine and was completely cured of a very intractable dropsy.

Case 4. A negress, the subject of marked ascites. Dr. K. ordered for her nitrate of potassium, one ounce; porter, one pint; a wineglassful to be taken every 4 hours. By mistake the patient took the whole pint within two hours. The doctor was recalled in great haste. as vomiting and violent abdominal pains set in which seemed to threaten speedy dissolution. But soon very free diuresis set in and continued until a very large quantity of urine passed-she was quickly and permanently cured.

Case 5. I once treated a half-witted colored boy for dropsy from malarial causes and made no impression on his case, and, as his surroundings were so very unfavorable, I left off treatment. Several months afterwards I met the boy on the road and to my astonishment he was well. His mother told me that she had given him small pieces of saltpetre in whiskey. I knew the boy for ten years afterwards and the disease never returned.

Case 6. A gentleman had dropsy and Dr. M., after exerting his skill for a while faithfully, told him that he could do nothing for him and withdrew, telling him to call in any. one he wished. A negro root doctor was called in who relieved him completely. Dr. M. asked him what medicine the negro gave him. It was simply a strong infusion of cotton root and it exerted a most prompt and powerful action on the kidneys. Dr. M. treated his next case of dropsy with the infusion of green cotton roots with entire success.

I regret my inability to report these cases more accurately as to the special forms of dropsy, but as they did not come under my immediate observation, except one, I hope I

shall be excused.

St. Matthews, S. C. L. B. BATES, M.D.,

Acute Bright's Disease.

Editor MEDICAL WORLD:-The following case may interest some of our busy, hardworking doctors:

Miss K., aged 16, of healthy parents, had always enjoyed good health with the exception of scarlatina in infancy and a severe attack of erysipelas at the age of 12. She consulted me for a puffiness of the face and general edema, involving the entire body. Had menstruated but once, which was apparently normal, was troubled with dyspnea and nausea and occasional vomiting and slight pain in the lumbar

regions, with lethargy and hebetude of mind and very anemic. The pulse was 120 per minute and the respirations often as high as 40 per minute, the temperature being normal. Had previously been very bright and studious, and was vigorously pursuing her studies with a view of at ending a medal contest, which was the only cause I could find that would be likely to pro. duce the disease, unless it was due to the establishment of the menses. The urine was in. creased in quantity and of a dark, smoky appearance, with low specific gravity 1.005. She would have to void urine frequently. By applying the heat and acetic acid test the volume of urine was over half albumen. I directed her to abandon her studies and prescribed as follows:

For the edema, Potassa bi-tart. drachm i, 3 times daily in lemonade. For the dyspnea and to sustain the heart I gave Prof. Hare's anti-asthmatic tablets, one every 3 hours when require. For the blood and to restore the action of the kidneys, Basham's mixture, one drachm 3 times a day after meals. A milk diet with some fruit.

The dyspnea disappeared as if by magic and, after a few days, the edema gradually commenced to disappear, the color returned to her cheeks, the albumen gradually grew less and recovery was complete in six weeks.

Reedsville, Penn'a.

B. R. KOHLER, M.D.,

Enuresis,

Editor MEDICAL WORLD:-In reply to Dr. Thompson (page 452), would say that possibly

the trouble with the children alluded to is not a wrong of the kidneys, but rather an irritable state of the neck of the bladder. I am inclined to this opinion from his assurance that in every other respect they are enjoying good healthsomething assuredly they could not boast of had they diabetes insipidus or diabetes mellitus. For that form of enuresis recognized as nocturnal incontinence, I should restrict fluids at the evening meal, and have the rule adhered to of emptying the bladder before retiring. And for a child, say four years old, would prescribe as follows:

balsam copaiba administered three times a day. Dissertations on the local use of carbolic acid, especially in the treatment of burns and scalds, would no doubt be of great value. Will those of THE WORLD family who have had experience along this line give us the benefit of their observations? J. P. DILL, M.D., Hale, Mo.

Treatment of Diabetes.

Editor MEDICAL WORLD:-I wish to give my treatment for a case of diabetes. I was called in August to see Miss H., age 14. She was passing daily about three quarts of the most offensive urine that I ever smelled, containing sugar, albumen and the earthy phosphates. She was losing about five pounds in weight pounds of cut loaf sugar, instructing her to eat every ten days. I sent her father after twenty all she wanted. It lasted her thirty days. I put her on the following prescription:

R. Fluid ext. ergot

Flud ext. sarsaparilla

Of each equal parts

Dose. Teaspoonful an hour before meals.

R. Fluid ext. mandrake

Fluid ext. hydrastis
Aromatic sulp. acid

Of each 3 drams

Spts. nitre to make 6 ounces

Dose. Teaspoonful in water an hour after meals.

This is all the treatment. She weighed when I commenced 68 pounds. To day she weighs 97; urine normal. She has been picking cotton every day for two months and looks the picture of health. She continues to eat cut loaf sugar every day. M. S. MOORE, M. D.,

Florence, Drew Co., Ark.

Dermatitis Exfoliativa.

Editor MEDICAL WORLD:-There recently came to me a rare case of skin disease, a report of which may perhaps prove interesting, at least to some one of the many readers of your journal.

G. W. F., male, age 17; nativity, Utah; family history good. The patient's health up to the time of present illness has been excellent. The major part of his life has been spent on a cattle ranch, excepting the winter months for the past four or five years, which he has spent in the public schools. September 18 of this year he entered the Agricultural College, this city, where he found it necessary to study "early and late" to keep up with his class. Six days previous to the time he came to me for treatment he found it necessary to leave school, but thought his ailment not serious enough to require medical aid.

On presenting himself my attention was directed to the very peculiar appearance of his skin and the odor emanating from it, which much resembled the "mouse-nest odor" of favus. On inspection I found the entire surface of his body (excepting the hands and feet) covered with scales and crusts, the former being in profusion. The primary lesion, the macule, was still to be seen extending to the hands and feet; this was followed in order by slight papular elevations, which seemed to discharge without any mared vesiculation. From the beginning there had been a slight malaise, with attendant symptoms of chilliness, febrile move ment, anorexia, coated tongue, constipation and quite marked insomnia I diagnosed the case as one of dermatitis exfoliativa, and ordered a hot bath to cleanse the skin, to be followed by daily sponging, gradually reducing the tempera ture each day till 70° F. was reached. The following prescription:

Water Treatment of Scarlet Fever.

Editor MEDICAL WORLD:-While perusing the pages of THE MEDICAL WORLD I noticed in particular a short piece on treatment by wet wrapping. Now. I wish to give a few facts of my success by bathing.

Some twenty years ago I was a practitioner in a western town on the banks of the Wabash river. In this place there appeared, almost simultaneously, twenty three scarlet fever cases. By chance, of this number eighteen fell under my care. The usual symptoms developed, with severe putrid sore throat, dry, hot skin, delirium extending to coma, temperature from 103 to 107, pulse beats so rapid that it is was extremely difficult to count. I could not reduce the fever by medication, but I put them into water at a temperature nearly that of the body in health, adding a good handful of salt, which I believe in a measure prevents the taking cold. The period of bath was varied, longer for excessive high temperature than when the heat of the body was nearer normal. The time varied from five to twenty minutes, repeated every hour if occasion demanded. As soon as taken from the bath they were thoroughly dried with warm cloths, then anointed with oil, lard or vaseline. This bath was persisted in daily until the skin became moist and the body-heat was normal. The anointing was persistent until the scaling was over. This I have insisted upon, and I have never known a second case to develop in a house where the sick were kept in a separate room, no matter how many more children were living under the same roof This treatment. has for me immediately reduced the fever, quieted the restlessness and delirium, relieved the engorged throat, so that not in a single instance did any serious sequel follow. Of these eighteen cases, sixteen recovered; while of the other five, three died and a fourth was left quite deaf. They were treated without bath; in fact, the attending physicians did not think that bathing would do. The cases that had prevailed

previous to this outbreak had been terribly fatal, so that consternation prevailed in the town when this great number appeared. I went farther in my treatment. I had the clothing changed

once a day, and well washed and dried before being used again. The bed was also changed every second day, the feather bed or mattress put out and thoroughly aired, as well as the covers. The medication was very simple: An attempt to prevent gastric irritability the second week, as well as to prevent anemia a little later, and to ward off albuminuria the third week. I place much confidence in the use of tartrate of iron and potassium to keep the blood supplied. A tea of buchu leaves, taken every four hours as a drink, usually was sufficient to keep the kidneys in good working condition, so that the quantity of albumen did not reach alarming proportions. I was often surprised when, on entering the home and finding the little patient tossing with distress and delirium; the breathing choked; the skin intensely hot and bronzed; the breath rank with putrid exhalations; the parents frightened, having the gravest forebod. ing; to see, after th bath, the patient drop into a quiet sleep, the skin become moist, the breathing easy-all so pleasantly charged

This treatment I have pursued for over twenty years. It has been followed successfully by many of my medical associates, with the same happy results, as well in the malarious valley of the Wabash as in the great New England towns nestling among the hills and fanned by the moist breezes from the bosom of the broad Atlantic. JOSEPH SPALDING, MD,

Woodstock, Conn.

Cold Water in the Treatment of Scarlet Fever and Cerebro Spinal Meningitis.

Editor MEDICAL WORLD:-As regards the use of cold water in acute infectious diseases. I would like to cite a few cases occurring in our family before my own professional career be gan.

The

Two children, aged respectively ten and six years, were attacked by scarlet fever. little girl was scarcely sick, but her younger brother was seriously affected. Rash was scanty and bluish, skin cold, diminished secretion of urine, and a tendency to somnolency. He was a delicate, nervous child, and dreaded a cold pack above all things. Nevertheless, my pa. rents felt that he absolutely needed the stimulating effect of the cold water treatment. So he was given sitz baths instead, two or three a day at first, later only one. These were of water at 67°, gradually cooled down, cold water being applied to the head and the body, especially the immersed parts being vigorously rubbed by two

or three persons. There he sat contentedly for half to three quarters of an hour, "keeping time," watch in hand. After the bath he always appeared much brighter and better, while a bright rel rash covered the parts which had been immerse 1. For several days he did well, then his hands began to swell; but we attached no importance to this. He made no complaint, and, though he moaned in his sleep, we did not connect that with his hands. But one evening the swelling, heat and redness increased, and, though still able to sleep, he was very restless.

One of the cases (both fatal) from whom he had receive the infection had had such a swelling extending up the entire arm—a swollen, livid, discolored mass! The physician said that gangrene would set in if the child lived long enough! It was therefore with grave appre

hension that we saw what seemed the same condition developing in our little patient.

Since the hands were burning hot, we wrapped them in cloths wrung out of ice water. Instantly the moaning stopped, to begin again in a few seconds, however. To keep him quiet we had to change these cloths every fifteen seconds by the watch, at first, and in that short time the ice cold cloth would become steaming hot!

So we continued for hours, his moans being the indication for a renewal of the compress. The intervals gradually lengthened. At two a. m. I had not changed them for half an hour, and he was sleeping quietly. That was the end of that trouble

About a week later an older boy came down stairs one morning with a throat like dark polished mahogany, a pulse rate of 180, and very high fever. He was immediately packed in a sheet wet in ice water, and wrapped in blankets. Ice water compresses were kept on the head, and changed on the throat every two or three minutes for hours. In the course of the day he was packed seven or eight times, from one into the other, and generally in icy sheets, as it was winter. In the last he had a chill, so he was packed about with hot bricks and bottles, but left in the pack. He soon went to sleep, and so did every one else. The next morning he was found sprawled out over the bed, entirely naked, and covered from head to foot with an extremely abundant eruption. The cold packs were continued, three a day, for a week, when he went out, though there was snow on the ground. After that he had a cold pack once a day during the period of desquamation.

Five years later this same boy cleaned out a cistern one day. Two days later he "slept," we thought, all day. When moved he complained of violent headache.

The next morning, on being spoken to, he

roused into violent delirium, in which it took several people to hold him. With great difficulty (and to the horror of the neighbor who assisted us) we got him into a sitzbath of 70°, poured cold water over his head almost continuously, and rubbed his body vigorously all over. In ten minutes he was conscious, but complained of the most agonizing pain in head and neck. He was kept in the bath for half an hour or more, and the pain was much relieved. The physician who came later, an experienced, well educated man, pronounce it cerebrospinal meningitis--not infrequent in that locality, and all cases there, so far as I know, excepting my brother, ended in death or permanent maiming or crippling of its victims. The doctor gave quinine and salicylate of soda, and we used, with his consent, wet packs and sitzbaths, as we deemed necessary.

Double vision, strabismus, "risus sardonicus," all appeared, and confirmed the diagnosis, if that had been necessary, but in ten days or two weeks he was convalescing.

In the early part of his convalescence, and co incident with marked improvement, an eruption of small furnucles appeared upon his back. There were, perhaps, ten or a dozen, all coming about the same time, and reaching about the same size, on both sides of the spinal column and within two inches of it, reaching from two that were within the border of the hair, down to the lumbar region - not below

This is an unusual part in the history of this disease. There can be no reasonable doubt, however, I think, that the vigorous stimulation which the patient's skin received, both by the application of cold and by friction, was the direct cause of the elimination of poisonous matter by this unusual route, and that, had the pus from the boils been examined, it would have been found to consist mostly of cultures of the microorganism of the disease. Pomona, Cal.

T. WILKINS, M.D.,

Acetanilid in Practice.

Editor MEDICAL WORLD: -Much mention has lately been made of acetanilid, and in connection there with I should like to mention a circumstance that occurred in the practice of my preceptor. He had been called to a case in which the fever had run very high, and had prescribed acetanilid, without, however, informing the nurse (inexperienced). as to what the effect on the heart might be. Symptoms of cyanosis appearing early next morning, the other physician of the little burgh was called, who pronounced it a "most beautiful expression of erysipelas-very grave prognosis; but I think

Acetanilid in Typhoid Fever.

Editor MEDICAL WORLD:-During 1893and 1894 I have treated twenty-three cases of All typhoid fever, all resulting in recovery.

of these cases were seen within one week after they were confined to their beds. No reasonable doubt as to diagnosis in any case. The average duration, from date of taking the bed to the day on which temperature remained normal for twenty-four hours, was 21.7 days.

Treatment.-Nurse was carefully instructed in the use of fever thermometer, and impressed with the necessity of absolute cleanliness of clothing and bed of patient, the great importance of thorough ventilation, and, finally, the instructions for giving a hot sponge bath to the patient as needed.

A good, easily read thermometer was left with every case, and patient charged up with same, to be credited when returned.

I usually began treatment with calomel and bicarb. soda, tablet trituate, gr. calomel and 1 gr. soda bicarb. in each tablet, and one given every hour until ten are given.

Temperature taken every hour or two, and record of same kept for my inspection at future visits. If temperature is above 102 sponge bath ordered at once, and repeated every hour until temperature is not more than 102). If. this fails, acetanilid, in from 3 to 8 grain doses, is given every two hours, until temperature is down. I have always used care, but never have hesitated to bring the temperature to 102, or lower, and keep it there. Nurse always instructed what to do in case there should be cold feet and other evidences of too much acetanilid being given, but I have never had any trouble in this regard. I have proceeded on the theory