used; and this "faintness" cannot be entirely prevented by any anesthetic. I am all the more disposed to doubt that cocaine used judiciously inside the nose as a local anesthetic is capable of ever producing untoward effects, from the fact that in the office of one of our Philadelphia laryngologists, the cocaine bottle holding six ounces of a four per cent. solution needs replenishing once in every two or three weeks. This gentleman and his assistant use the four per cent. solution as an anesthetic in their nasal operations, as a means of diagnosis in nasal affections; and, also, in the treatment of acute coryza, when it is used in conjunction with a four per cent. solution of antipyrin, as described in a previous article recently published in the Philadelphia Medical and Surgical Reporter. Although thr large pledgets of absorbent cotton saturated with a four per cent. solution are sometimes placed inside the nose, one after the other, to secure complete anesthesia for the removal of a large ecchondrosis or exostosis, or for an operation on a deviated septum, still no untoward effects have yet been observed as the result of using the cocaine solution thus freely enough to secure complete absence of pain during operation. E. BALDWIN GLEASON.

Philadelphia, Pa.

stomach grew more irritable and nourishing enemas were resorted to, but with small success on account of painful hemmorrhoids. Pulse good; no head, lung or heart disease; urine darker and about 2 pints in 24 hours. During the last 5 weeks the bowels did not move, except very small quantities brought away by enemas. Stomach now retained only the whites of two eggs and a glass of lager beer during the whole day. The vomited matter the last three weeks was chiefly, greenish yellow mucus and very offensive. A peculiar odor from the patient permeated the whole house. Pain being almost constant, anodynes were administered by the mouth and hypodermically. Death ensued from exhaustion on March 19, 1889. Post mortem revealed a soft cancerous growth, commencing about 5 inches below the pylorus, extending down four inches, enveloping the duodenum and producing a narrowing or constriction of the intestine. The mass would have weighed 4 to 1⁄2 pound. The liver was normal in size and dark color; the stomach somewhat enlarged; the veins prominent, and the mucous coat covered with a thick ropy, greenish matter. The pyloric and cardiac orifices were normal. The thorax and urinary organs were not examined. As cancer of the duodenum (verified by post-mortem) is infrequent, I report the case for the interest of THE WORLD'S household. L. J. P.

Cancer of the Duodenum.

Editor MEDICAL WORLD:

Mrs. A., aged 72, consulted me in January, 1887. Except for a slight jaundiced condition of the skin, she was a strong and apparently healthy looking woman. Her principal symp toms were nausea, with occasional vomiting and constipation, urine small in quantity, dark in color, sp. gr. 1028, and a trace of albumen. The patient grew worse for two months and then changed for the better; under the use of tonics and cascara sagrada, she gained 16 pounds during the summer, but kept up the use of anticonstipation remedies to December 9, 1888; then the old symptoms came on with renewed vigor, especially the vomiting; also much pain near the anterior border of the lower right ribs. From this date to January 1, the vomit consisted of undigested food, and an intense yellow liquid. The bowels were obstinate and required a dose equal to six comp. carth. pills to produce one evacution. After a careful study of the case I concluded that the trouble was with or near the duodenum, in the shape of a stricture or an ab normal growth, although such could not be detected on careful digital examination. The

Erysipelas or Septicemia? Conservative
Surgery.

Editor MEDICAL WORLD:

Allow me to report through the columns of THE WORLD the following cases which I believe will interest many of your readers.

1st. H. L. Single-25. Admitted to-: hospital on Tuesday, March 12th, 1889, with following history: Became pregnant in July, 1888, her last monthly being concluded the 7th of that month. Two weeks before admission, her right leg became swollen and edematous. She soaked it in cold water with the idea of reducing the swelling, afterward applying in succession salt and vinegar solution, ung. sulphuris and a soda wash. On admission to hospital, her right limb was greatly swollen, red, shiny, and showed several large pustules. Temperature 130°. She also gave a history of having previously nursed a sister who was suffering from blood poisoning. Taking into consideration the harsh treatment she gave the limb and the exposure to sepsis from the sister, it was somewhat difficult to positively diagnose between septicemia and erysipelas.

Linseed

poultices were applied to the limb, and an opilate given to produce sleep for the night.

On the following evening, the patient complained of slight and irregular pains about the abdomen and back until 12 P. M., when my partner, Dr. Dempsey, being called, found on examination that labor had begun. Knowing the great danger to be apprehended strict antisepsis was observed. The patient was first washed in a solution of Hycl, 1-2000, after which the diseased limb was smeared with an ointment composed of equal parts aq. calcis and ol. olivæ, with acid carbolic q. s. to render it antiseptic. Over this was placed a layer of absorbent cotton and over the whole a layer of oiled silk.

The labor was natural and the child born

about 3.30 A. M. No ergot was given till the membranes came away, which did not take place till the following morning at 8 o'clock. The placenta was adherent to the uterus by a thick membranous pedicle, and required some force to remove it. The child at birth was cyanotic and was only resuscitated after several minutes inflation of lungs. After delivery, the temperature ranged 101°-102°. The case progressed finely. Several quite extensive sinuses formed in the limb, but by irrigation with Hycl, 1-2000 and drainage went on to a

splendid recovery. The mother of the girl

contracted the same disease while nursing her. Was it erysipelas or septicemia?

2d. Robert T. Brought to our office Feb ruary 4th, 1889 with crushed hand, caused by a heavy cog wheel dropping on it from some distance.

On examination, we found compound fracture of little finger, the bone being badly bro ken up and wound filled with coal dust, cinders, etc. At first it looked as if it must come off, and indeed the first physician to whom the patient went, wanted to amputate, saying it could not be saved. Desiring to save it if possible we cleared the wound thoroughly, making it aseptic, and dressed it with a palmar splint, absorbent cotten and idoform.

This

Fatal Hemorrhage Following Convalescence From Typhoid Fever.

Editor MEDICAL WORLD :

On the sixth of last October I was summoned to see a young farmer, aged 25, of German parentage, good family history, and living in the healthy hill region of Beaver county.

He had not been well for two days previous. The case was ly, making this the third day. evidently one of typhoid fever, confirmed by the further history The temperature range was 1022 morning and 103 evening, except about the tenth day, when in the evening it reached 105. A full dose of quinine brought it back, where it continued until convales.ence com

menced, which was complete on the 21st

day.

On the 22d he commenced to bleed from the nose, urinary passages and bowels, and had effusions of blood into the skin. From no place was the hemorrhage alarming except from the nose, and that was uncontrollable, even by plugging and injection of Monsel's Solution of Iron.

After forty-eight hours of continuous effort by consulting physician and myself to ghost as bloodless as a slaughtered bullock. stop the bleeding, the poor fellow gave up the

during the course of the fever:
The following was the treatment pursued

R Quinine sulph..
Sig. Morning and evening.

R Ammon. nitratis....
Elixir, simp..

M. S. Every five hours.

..gr. xv.

..gr. v. A. dr. j.

The latter was continued for sixteen days. As there had been no hemorrhagic tendency previously, and as it was unknown in the family, as he was not reduced' to where many patients are, and as there seemed to be nothing else to produce it, I ascribed it to the solut on of the blood by the ammonia, and have been paying

some attention to the same since, which has only helped to strengthen my views. I would therefore caution any who are pursuing the same treatment to be careful.

I should say that I learned the use of nitrate of ammonia, some three or four years ago, by its advocates in THE MEDICAL WORLD. Unionville, Pa.

H. J. NEELY, M. D.

[We are glad Dr. Neely has sounded this note of warning. Would also ask, as a suggestion what influence so much quinine had in contributing towards the production of hemor rhage ?-ED]

Intra-Uterine and Naso-Pharyngeal Syringe. Editor MEDICAL WORLD:

Nasal catarrh is the bete noire of the profession. The prime cause of this is the difficulty of introducing medicines to the seat of disease. I was led to invent or improvise the following described

HOME MADE POST-NASAL SYRINGE

for use in my own case, and it is far ahead of the usual atomizers and impossible-to-be-used hard rubber syringes. It is made as follows: Get, at a drug store, a soft rubber bulb open at one end, which is kept in stock for use on the old Mattison family syringe and others of like make, and which costs but a few cents, and insert a gum catheter of the proper size, having first removed the bone tip. When this is done you have a capital and

CHEAP INTRA-UTERINE SYRINGE,

with which any medicament may be used, even oil, which destroys the elasticity of soft rubber if not well washed with soap and water immediately. Cut off the eye end of the catheter and insert it into the post nasal tube of the usual hard rubber syringe sold, but seldom used, for treating catarrh. If you do not have one of these, take the female or vaginal tube that comes with the common soft rubber family syringes sold in the stores, and heat it in hot water or oil, and bend the tip at right angles. A metal pipe may also be used. In an emerthe catheter can be tied down at the end gency and pricked full of holes, and be used without any tip. In that case, bend a small wire and tie the catheter to it, so it will throw the spray back of the velum. These instruments are practical and cheap, and can be made in a few moments. If a bulb is not at hand use a large penis syringe, by inserting it into the

catheter.

Ferndale, Cal.

F. A. ALFORD.

Typhoid Fever.

or MEDICAL WORLD:

In reply to a call from Dr. Leiser in the March number of THE MEDICAL WORLD, I will say that I had a similar experience in the fall of 1886. I was called to a German family about the 1st of September to see a young lady 20 years of age. She had been confined to her bed about a week. Temperature, about noon, 1042, frontal headache, vomiting, epistaxis, bowels tympanitic, yellowish liquid and very offensive diarrhea, very excitable and nervous, constant muttering delirium when dozing, circumscribed flush on cheeks--some

times one and sometimes both-tongue fiery red at tip and edges with brown dry coat in centre extending full length of tongue, skin hot and pulse forcible and very rapid. She was never without fever, but it was highest from 11 A. M. to 12 P. M. Her urine was scanty, high colored, and difficult to void. I diagnosed typhoid fever. This case proved fatal in one week from my first visit.

About the time of the death of the first I noticed two other girls of the family looking dumpish and feverish, and, upon investigation, found that they had an evening temperature of 1031⁄2, but insisting that they were not sick. Their bowels were constipated, tongue coated with white fur, spitting constantly, and occaaged 17 and 14 years respectively-going to sional epistaxis. I insisted on these girlsbed. I called counsel and we did everything we could, but they took on the same type of disease as the first case above described, and in fifteen or twenty days the silent churchyard received two more victims.

On my first visit I looked to the water supply, and found that the family used water from a well which was located in the center of a basin. To one side was the cow-yard and hog pen, and on the other was the stable. Several cess-pools were in this basin, and one within a few yards of the well. This had been the condition of things for several years. The summer of 1886 was a very wet one, and several times the well almost overflowed. I informed the father of my suspicions of the well and advised water from other sources. I did not know but that he had heeded my advice until he and four others of the family were put to bed just after the death of the third. I then found that they had continued to use water from this well. We now changed the water supply and treated the remaining cases about the same as the first, but they ran a much milder course and all recovered by Christmas.

I allowed the patients a liberal supply of water, and I think that this contaminated water added a malignant septic condition to the typhoid fever it had developed.

I like THE MEDICAL WORLD. It teaches us

something we can use every day. Portis, Kansas.

E. O. HENSHALL, M. D.

Nervous Aphonia.

Editor MEDICAL WORLD:

Mr. A. J. H., aged 60, a farmer and stockdealer, on April 23d, 1889, "lost his speech."

History. Sixteen years ago, while on his way from Indianapolis to Buffalo with stock, he was one of the unfortunates who almost lost

his life in a railroad accident, his arms, face and respiratory passages being severely scaled by water and steam from a wrecking engine. When consciousness was restored the surgeon, with dissecting forcep; and scissors, clipped shreds of mucous membrane from his mouth, pharynx and larynx. As recovery proceeded phonation was difficult, but gradually regained its normal condition.

Symptoms. At first, loss of voluntary motive power of the levator and constrictor muscles of pharynx, so that the act of deglutition was im perfectly performed. This, however, was soon regained.

Then followed the loss of the power of phonation. After 21 days I was sent for to see him at his home. Found him in moderately good health. Temperature normal, pulse normal, appetite good, bowels regular, no symptoms of laryngitis, and examination for morbid growth gave negative results.

Diagnosis-Nervous aphonia, or paralysis of the spinal accessory or recurrent laryngeal Was I correct?

nerves.

Treatment.—(1.) Moderate catharsis. (2.) Syrup roborans, prepared by Arthur, Peter & Co., of Louisville, Ky., teaspoonful ter die. After 21 doses he spoke bridal twice on Friday, then on the following Sunday, while company was singing, he "caught" the tune and sang through two stanzas; but could speak no more until the following morning, when, to his surprise, his voice was normal. What was the cause? Any remarks? be glad to have expressions. Belle Union, Ind.

Would

J. V. BASTIN, M. D.

A Home-made Operating Table. Editor MEDICAL WORLD:

In answer to Dr. Thomas B. Fowler's article, "How can we construct a Gynecoloarticle, gical Table," (May, 1889), I would say that for the last twelve years I have used a table according to the following description, which has answered every purpose as an operating table, besides which I use it in my study, as a writing and reading desk. It is fashioned after Dr. Sim's pattern. A plain table with four legs, fifty inches long, twenty-seven inches wide, thirtyone and a half inches high, including castors. At one end are two boards, forty three inches long, one seven and the other ten inches wide, which slide underneath the top of the table; when not in use, they can be drawn out any length desirable. I have two moveable stirrups to be hooked into the legs at one end for drawers lithotomy position. I have three underneath the top of the table to be drawn out at the side. Round corners, solid wood, oil finish. It has all the appearance of a center table, for which I use it as well as an operating table.

I have a rubber oil cloth pillow, stuffed with curled hair, being both cleanly and comfortable. Glenville, Pa. WESLEY C. STICK, M.D.

Double Pneumonia.

Editor MEDICAL WORLD:

I had never seen until the middle of last month, in the course of ten years practice, a case of Progressive Consecutive Double-lobar Pneumonia, a long name, surely, but it describes the trouble precisely. There was a large area of the left lung consolidated. At first, rusty and bloody sputa, re piration of the panting character, dyspnea pronounced, face, pale and anxious; then, within a few hours, the inflammation was at its height; then came an amelioration of symptoms, so far as the left lung was concerned, and the right lung was attacked in a more decided form than even the left.

Matters now became critical; patient was utterly prostrate, fever ran high, great pain referred to the region of the right nipple. On the night of the seventh day I thought surely I would loose him. The next day his condition were a little better. On the tenth day matters were decidely improved, and, from then on, the improvement continuing, he became convales

terpert them. His heart was in good condition, except on the seventh night, when it looked at one time as if it would give out. I gave him at different times the various stimulants, whisky, carbonate of ammonia and digitalis. For cough mixture, fl. ex. yerba santa and glycerine, carbonate of ammonia and syrup of senega. I gave quinine in tonic doses and antifelrin. When temperature ran up I used beef peptonoids, eggnogg, etc., and milk diet nearly all the way through. Used croton oil in ment and blistered the right side. But the feature in the treatment I was most pleased with myself was the hyperderma ic injection in the side every 8 to 10 hours of morphia sulphate, gr. atropia sluphate. gr. 1-100. I got this idea from Loomis' Practical Medicine, in his treatment of lobar pneumonia, and I am much pleased with it. This gives your patient rest and at the same time is one of the best of stimulants.

We have a great deal of pneumonia in this section during the winter and spring, and the treatment is not the most satisfactory thing in the world, judging from results. The case first cited possessed, in some degree, the character of novelty, and I thought worthy of mention on that account. Patient was a white man twenty five or twenty six years of age. Jenifer, Ala. W. T. HAMILTON, M.D.

Nevus Cured by Vaccination. Otorrhea Cured by Fumes of Black Sulphide of Mercury. Editor MEDICAL WORLD:

Observing in THE MEDICAL WORLD suggestions on the most appropriate plan for the removal of nevus reminds me of a very simple plan I once (45 years ago) successfully adopted.

The nevus was on the scalp of a child aged eighteen months, the size of a grain of corn. With a thumb lancet I made five or six insignificant punctures around its base, and another on its centre, and introduced vaccine virus; when the pustules matured the entire nevus was incorporated in one scab, and simultaneous with the disappearance of the scab was also that of the nevus.

In 1843-44, Dr. Thos. D. Mätter prescribed for two cases of otorrhea, at the Jefferson clinic; about two weeks aiterwards I asked Prof. Mätter for the result of his treatment in these cases; his answer was quite unsatisfactory, for he said he never heard of them after they left the clinic.

At this time I had a very obstinate case of this character in a boy nine years of age, whose mother told me he had the discharge from the time he was three weeks old. It had resisted a number of remedies, and now was so extensive

and so exceedingly offensive as to exclude him from school. I engaged a tinner to bend an ordinary tin horn in the shape of an ear-trumpet, through which I gathered and conveyed the fumes of the black sulphide of mercury into the ear by gravitation, after having them generated by placing the powder on a piece of red hot iron. Two weeks daily treatment controlled and arreste 1 the discharge. At the end of six months it returned; but was permanetly controlled; in a few days similiar treatment; it never again returned. The man is living in Reading, Pa., to day, a butcher by occupation.

Drs. Samuel and Chas. G. Strohecker and myself have had about twenty cases similiar to this, the result of scarlatina and measles, all of which were treated and cured by this same process of treatment. G. S. GOODHARŢ, M.D. Harrison, O.

Gonorrhea Treated with Acetic Acid-Wens Removed by Acetic Acid.

Editor MEDICAL WORLD:

This disorder in the male was a very intractable malady to me some years ago. A great many cases did yield permanently from the start to treatment, and became cured effectually; but now and then a case would come that, do what you would, the patient would continually present himself at the office, with about the same answer every time, to my no little disgust and chagrin.

The treatment consisted of about the following: Sulphate of zinc, acetate of lead, morphia, carbolic acid, either singly or combined for injections. At other times balsam copaiba, cubebs, flax seed tea, etc., internally. In the worst cases all these were failures. One of the patients passed off to other practitioners, and, being discouraged, he took the advice of an outsider, who recommended strong doses of turpentine in gin several times a day as a sure cure. His wife related his sad story in broken English, and I at first refused to go, but finally consented. I found the patient with gastric disturbance, diarrhea, retching, tenderness over the bladder, the penis and testes very much swollen and inflamed. Ordered full doses of morphia, with hot fomentations to the parts. When the inflammation subsided some what I began for the first trial with acetic acid, commencing with as low as a one per cent. solution six to eight times a day as an injection, and in increasing the same to four per cent., with all the results that could be wished or desired, the penis and testes being also washed in warm water two or three times a day.