The patient's diet was restricted entirely to vegetables, for the first week or so, till an improvement was apparent, when meat was allowed sparingly. Lastly, a bandage was worn day and night from the umbilicus, with the head of the penis downward, with the idea to prevent spasms and erections, which, in my opinion, is beneficial in helping the healing of the parts. All fermented liquors, excessive lifting, long continued exercise, etc., were strenuously forbidden.

Since that time, now ten years, I have experienced no trouble, except in one case, within a year, when I thought the peroxide of hydrogen diluted would perhaps be better; but I was obliged to give it up and return to the acetic acid as my sheet-anchor.

This treatment is devoid of all risks and apprehensions. Begin always with a calomel and jalap purge, and repeat every week or ten days.

Betore closing I may as well add, that whilst in Half-Moon Bay, Cal., I cured a farmer of a wen situated near the sternum, between the fourth and fifth ribs, with acetic acid. I have at present a very elderly lady with a wen in close proximity to one of the dorsal vertebræ, as large as a hen's egg. The treatment consists in acetic acid six drachms, aqua four ounces; dip a small flannel, doubled, in the solution, place over a dry piece, and apply hot handirons above the part, as hot as can be borne, two to three times a day. The tumor is already diminishing; if it comes to a stand still, as in the first case, scarifying and beginning with a weaker solution will be gone through with, gradually increasing the strength of the acid.

In the January number, page 9, Dr. Engleman uses this acid for intra uterine injections, and is convinced of its possessing antiseptic properties. I have never used it for such purposes, but will give it a trial; certainly it is safer than corrosive sublimate, carbolic acid, permanganate of potash, and other drugs used for such occasions.

Santa Rosa, Cal. E. MAGUIRE, M. D.

Treatment for Carbuncle.

Editor MEDICAL WORLD:

As I have read much of interest and value in your journal, I wish in my turn to give my method in treating carbuncles, large or small, which is uniformly successful. The apparatus and material are simply a sharp. hard wood stick, and nitric acid. At the "point" of the carbuncle, where the pus is forming, apply the acid until you "deaden" the surface in area about the size of a copper cent. Then, with the stick gradually cut and dig out all the dead matter. It

will not hurt much. Continue alternately burning and removing until you clean it pretty well out. Then plug the surface with cotton saturated with a solution of one part carbolic acid to sixteen of alcohol, and bathe the surrounding parts w th the same. In about twenty-four hours you will see the surface begin to shrink, and the dead tissue to separate. poultice with flax-seed at night, and use the carbolic acid solution by day until it is healed. I have found this more success ul than any other method during the last thirty years. Wakefeld, Mass. CHARLES JORDAN.

A Question of Ethics. Editor MEDICAL WORLD:

Then

I am a physician practising at a seaside resort on the Pacific coast, and my best season is when the eastern tourists are here. Of late years it has become quite the thing for eastern people to visit California, and of course a great many invalids are among the visitors, and from them I derive the greater part of my income. This is, however, greatly curtailed, owing to the fact that among the visitors are eastern physicians from all the large cities east-who not only prescrible for their acquaintances (to which no objection can be made), but lay themselves out to catch other patients, even those who reside permanently in the town. These doctors violate our state law in not registering their qualifications, and when they are tired of one town, or there are no more patients, they move to another resort, and repeat their predatory operations.

I would like the opinions of THE WORLD Subscribers as to the ethics of this scheme. Is it the correct thing to travel from town to town covertly acting the traveling quack, and injuring their brother physicians in the towns in which they illegally practice? I say acting the quack, because in no case have any of these celebrated eastern doctors registered as required by California laws. Did they do so we would not grumble. We can't get along without THE MEDICAL WORLD, and the opinions of its subscribers are most valuable. A continual postgraduate course for one dollar per annum. Santa Cruz, Cal. YERBA BUENA, M.D.

Carcinoma of the Liver.

Editor MEDICAL WORLD:

Mr. F. C. T., aged forty-eight years, of a bil ious temperament and medium size; family history: father died from cancer of the stomach when sixty-two years of age; one aunt died from

cancer of the uterus at the age of thirty six; one half-sister had cancer of the tongue, but has been treated and apparently cured. About January 1st, 1887, he complained of chilliness and severe pains in the region of the liver, which lasted three or four days. At the point where the pain was loca'ed he said he felt a lump as large as his fist, which continued to increase in size, the pain continuing, but less acute. He was treated by different physicians without any apparent relief; was able to go about and do light work, but was unable to bend forwards.

November 8th, he applied to me for treatment, the following symptoms presenting themselves: general cachexia and hydremia firmly seated, appetite fair, some ascites, and marked emaciation. The liver was so enlarged as to elevate the lower ribs, showing itself quite prominently, extending from the right hypochondrium to the left, descending to the crests of the illi and os pub s, filling the entire front portion of the abdominal cavity; the lower edges of the organ were quite perceptible, as well as the body, and almost entirely free from pain and tenderness. The greatest suffering was confined to that portion between the right hypochondrium and the umbilicus. The urine was scanty and orange colored, specific gravity 1010, no traces of albumen. Patient had always been quite healthy up to this illness, and was becoming very much concerned about his present condition. I gave him very little encouragement, telling him the chances of recovery in such cases were not good, and ordered the entire abdomen to be painted with Lugol's solution once a day, and if it produced much soreness of the skin omit it until the soreness passed of, then continue using it again in the same way.

I also prescribed the following:

a day, gradually increasing the ammonia until the dose reached one drachm. The liver gradually decreased in its longitudinal and transverse diameters until its size was diminished twothirds. This treatment was continued up to March 1st, when he changed his location, drove his team and rode in a wagon over a rough road seven or eight miles, and was very much exposed, as it was a cold day. Relapsed. Ascites began to show itself again; placed him on the diuretic treatment again, which had but little effect; ascites gaining ground; feet and legs began to swell; digestion becoming very much impaired; the bowels were getting very inactive.

.grs. vi grs. vi Misce et cum aqua fiat massa et in pilulas sex dividenda.

One of these pills was to be taken whenever a cathartic was necessary, repeating the dose if it did not operate freely in six or seven hours. Also a wineglassful of the decoction of euonymus three or four times in twenty four hours. The cathartic operated well, but the case went on from bad to worse; emaciation, ascites, and general anasarca gaining rapidly every day; breathing becoming quite difficult.

April 8th, 11 A. M., I performed paracentesis abdominis, whilst he sat on a chair, removing four gallons of serum, which gave temporary relief. After that the treatment was symptomatic.

May 3d, 4 P.M. I tapped him again whilst sitting on his cnair, removing four gallons and a half of fluid. He expressed himself as feeling quite comfortable after its removal, but very much exhausted; slept well the most of the night following, his intellect remaining clear until about seven o'clock the following morning, when his pulse began to flig, his mind wandered, and at eight o'clock he expired apparently from exhaustion. Did not get a post-mortem examination. T. G. STEPHENS, M.D.

Sidney, Iowa.

[This case would have been much more valuable to the profession if a post-mortem had been obtained.-ED.]

Water the Cause or Origin of Contagious and Infectious Fevers.

Editor MEDICAL WORLD:

The agency that water may assume in the propagation of fatal diseases has received of late years much attention.

Investigation has confirmed the belief that water has in a large number of cases been responsible for epidemics of typhoid fever, scarlet fever, malarial fever, etc.

The water may appear clear and limpid as the purest spring water, and may still be contaminated with organic matter of vegetable or animal origin.

It makes no difference whether the water is obtained from shallow or deep wells, the common or artesian wells.

The common and accepted belief is, that artesian well water is absolutely pure and free from organic matter, and hence free from infection.

This motive is wrong. Artesian wells have been bored to the depth of over two thousand feet, passing through the different geological rocks down through the St. Peters Sand Stone (this sand stone is on a level with the Mississippi River) and even down to the Pottsdam Rock, which is some two hundred feet below the St. Peters Sand Stone.

Investigations have demonstrated that all of the layers or strata of rocks contain organic life.

It is only in the Azoic region where no organic life is found. To get a more definite idea how water becomes fouled or contaminated, one will have to study the chemical and mechanical action of rain water as it falls on the surface of land.

The rain acts upon the surface of the earth in two ways, chemically and mechanically.

The chemical action of rain arises chiefly from the solvent power of carbonic acid, which the rain absorbs from the atmosphere, and which acts upon rocks and organic matter

The mechanical action of rain is shown by the way it washes off the finer particles of rock and soil, and carries them down into the gravel and streams.

Results of rain action in the decay of organic matter, though general and constant, is not uniform. When the rain falls upon land, and, instead of running off in brooks or rivers, sinks into the ground, it, after a more or less circuitous journey, returns to the surface in the form of springs. These springs may be cold or hot. If hot they are deep seated.

Rain water or snow contains only a small quantity of carbonic acid derived from the atmosphere but acquires more in sinking through the soil, and then easily dissolves the carbonate of lime, and magnesian rocks. The constant removal of carbonate of lime and magnesia from underground rocks gives rise to the formation of long subterranean tunnels, cavities and caverns.

The roofs of cavities have been known to fall

in and engulf brooks and rivers. In this way mud, sand and gravel, with the remains of plants and animals are swept below ground, and accumulate the deposit there.

The contamination of rain water becomes still greater, should it circulate through or drain off peatty grounds or alluvial deposit formed by rivers wherein are entombed plants and animals.

In case of cities or towns having no sewerage system or an imperfect one, the rain water would carry the sewerage into the wells, whether deep or shallow. Privy-vaults would also drain into the wells within the town limits.

From the above it appears clear enough, that the waters falling upon the surface are the real feeders of deep and shallow wells.

Chemically speaking, the silicious sand stones and granite rocks of the Azoic age furnish the purest water, while the lime-stones and magnesian rocks of the same furnish an indifferent water, derived from soft surface water filtered through many thousand feet of the contorted strata of the magnesian lime-stone becoming by absorption and filteration saturated with carbonate of lime and magnesia and organic matter, and this organic matter is the cause of infection and contagion.

In conclusion, I will refer to a recent epidemic which occurred in a New Jersey suburb, where the milk was accused of having acted as a disseminator of typhoid fever.

On investigation of the water supply of the milk man, who furnished the milk, a well of unquestionably bad water was found on his premises. The water supply in the meadow where the cows were pastured was contaminated with sewerage.

What was the cause or demic? Was it the milk? in the milk?

Igo, Shasta Co. Cal.

origin of the epi Or was it the water H. SCHAFER.

Retained Placenta-Ergot.

Editor MEDICAL WORLD:

I have read so much of late in your valuable journal in regard to the bug-bear, retained placenta, that I cannot refrain from contributing my mite. One thing I admire in your journal is the free and easy intercourse of ideas among its contributors. I trust that this letter may be of some benefit to some one, though I cannot expect it to be appreciated by those who contend that my practice comes under the head of “Meddlesome Midwifery."

I am not an advocate of hurriedly removing the placenta, by any means; but, when we wait for nature to assert herself, give ample time for the detachment of the placenta, and for coagula

to form in the uterine sinuses, which is the better plan, to use all the necessary antiseptic precautions and remove it, or let it remain to slough away, and probably produce post-mortem hemorrhage, puerperal septicemia, or the many other serious results likely to follow ?

If either could be considered "brutal," it occurs to me that the term is more applicable to the latter. We cannot rely upon nature too much; we often find that she needs assistance.

I was called to a young woman, 18 years old, primipara, attended by a very good midwife, early in the morning. Late in the afternoon I was sent for to "clear her," as they termed it. Upon arriving I found the patient, and entire household, very much alarmed at her condition. I examined her closely and found the uterus firmly contracted, and could find no trace of the placenta, though the midwife assured me that she had made several unsuccessful attemp's to remove it, and in her efforts had torn the cord loose.

I used all the necessary antiseptic precautions, administered chloroform, and as the parts very readily relaxed, I succeeded in removing a hard substance-about the size of a lemon-which, upon close examination, I found to be the placenta, but with not a half dozen drops of blood in it. In an hour I left her comfortable, and she made a speedy recovery.

Soon after this I was hurriedly called to a case with the information that the lady was bleeding to death.

Upon arriving, I found a pool of blood on the floor, and the bed saturated; patient al most exsanguined; pulse very weak. She had fainted once or twice before I arrived. Upon examination, I four d the placenta torn half in two by too forcible traction by the midwife. I did not hesitate one moment, as the faint spark of life was fast flickering. I remove the remaining portion, administered ergot and brandy, and in two hours left her comfortably sleeping. A rapid recovery ensued.

In the two cases, what would nature have done if left alone? I find it necessary, also, very often in a large, roomy pelvis, after the uterus has expelled the placenta, to introduce the hand and remove it. Experience is the

best teacher.

ERGOT.

I concur fully with Brother Morrill, page 115, March number, in regard to the administration of ergot, and though my supply of the second ingredient of his most excellent prescription is decidedly limited, I prescribe it in such quantity as will give me the happy assurance, as my late lamented Prof. Flint

says in giving quinine in pneumonia: "If it does no good, it will do no harm.'

I always use ergot, but not till after the third stage of labor, and have never had the least undesired effect. I don't think trouble is likely to follow when it it used properly. I used it, also, in a case of enlarged prostate, patient sixty years old, with the very best result. The obstruction was so great as to necesitate the use of the catheter for ten days. I put the patient on ten drops, increased to twenty, three times a day, and complete recovery followed.

Just a glance at the acrostic on amputation, by Prof. Dennis, told me from whose pen it was, as it was familiar to me, being a student of his, class of '86.

The manual of treatment surpasses my expectations, and THE MEDICAL WORLD I can't do without. May it live long and prosper. DR. W. B. CRAWFORD.

Lexington, N. C.

No Lochial Discharge. Editor MEDICAL WORLD:

On April 16th, 1889, I was called to attend Mrs. A. in her fifth confinemei t. Arriving at the house, I found that the child had been delivered about ten minutes before my coming, under the care of a woman who had played the role of midwife. Inquiry revealed the fact that the labor had teen normal and comparatively easy. The husband told me that, contrary to his protest, the midwife had removed the placenta immediately, by pulling on the cord, and that its removal had caused severe pain.

The interesting feature now comes. On the following morning I found that there was no lochial discharge. Examination proved that the uterus was firmly contracted, and that there was no elevation of pulse cr temperature. Warm applications over the womb were applied and changed every fifteen minutes, and vaginal injections of warm carb lized water were given every four hours. This treatment was pursued for several days in the hope that the lochia would be established, but the result was a failure.

In the meantime the pulse and temperature remained normal. The patient was then put upon quinine, iron, and ergot, and warm carbolized vaginal injections twice a day were continued.

At the end of a week examination showed that the uterus was undergoing involution—in short, that everything was normal except that

there was no lochia.

Women Physicians in Kentucky Insane Asylums.

Editor MEDICAL WORLD:

Will you kindly give place in your journal to the following open letter? and oblige.

(MRS.) R. C. CHENAULT.

The Kentucky Senate has passed a bill providing for the appointment of women physicians as assistants in the insane asylums. Should this bill become a law, women physicians of other states will be eligible, provided they were born in Kentucky; and their names will be held in readiness when appointments are in order, if sent to Miss Laura Clay, at Lexington, Ky.

Peroxide of Hydrogen for Gonorrhea. Editor MEDICAL WORLD:

I intended for some time to give the readers of THE MEDICAL WORLD my favorite treatment for gonorrhea and gleet, and I will take the opportunity of Dr. H. E. Stroud's offer to do so now.

What I consider the simplest, quickest and least harmful treatment of gonorrhea is peroxide of hydrogen in injection Aj to the 3 of distilled water, three to five times a day.

Internally ten to fifteen grains of soda bicarb. every three hours to keep the urine alkaline.

Walking to be avoided as far as possible, also beer, coffee, pepper, etc.; keep the bowels regular; use a syringe with tapered end and soft rubber tip for the injections.

The peroxide of hydrogen is used a good deal in commerce for bleaching purposes, so that there are different qualities of it on the market.

For medical use it must be neutral to the litmus paper, odorless and colorless. This kind you may have from C. Marchand, 10 West Fourth street, New York City. It must be kept at a temperature below 65° F., and no metal must come in contact with it.

In writing to the above named firm you will receive a pamphlet on this valuable remedy well worthy to be studied.

I consider it the best germicide, as it is the least harmful and the most effective. For the past two weeks I am using it in the form of a spray, in one of the worst cases of eczema, of four years' standing, which had so far resisted the assauts of a dozen doctors backed up by as many drug stores, and is now almost well.

For syphilitic ulcers, soft chancres, diphtheria, ulcerated cervix, in fact, whenever there is pus or germs, this is the true remedy.

In gonorrhea, when the penis is highly inflamed, use the injection four to five times a day and the inflammation will rapidly be subdued, leaving the urethra in a perfectly healthy condition. The use of a suspensory is a great relief to the patient.

The fl. ext. of black willow is very good for the erections.

It is also the remedy par excellence in gleet, and there is nothing like its inhalation to cut short a paroxysm of asthma.

I don't claim the peroxide of hydrogen (H, O,) to cure gonorrhea in three or eight days, for I don't believe there is anything that will do so without danger; but it will cure it in three weeks and leave the unfortunate in the best of condition. R. CHAREST, M. D. St. Cloud, Minn.

A Home-made Light Reflector. Editor MEDICAL WORLD:

A law in the treatment of throat, nasal, and ear diseases that all physicians are familiar with is, that the completeness of the application of remedies has much to do with the

aggregate result. Experience with concentrators of light at considerable cost has led me to the use of a suitable cheap, convenient ap. pliance that can be transported and used whereever a common house lamp can be had. Taking it for granted that the physician has a two or three-inch concave mirror with head band and numbers 2 and 5 throat mirrors, tongue depressor, ear and nasal speculum, and other needed instruments for making a thorough examination, he must have in addition a good reflected light, and to be able to secure this at patients' houses is a satisfaction indeed. It somehow satisfies the patient that the "doctor knows his business and examines thoroughly all there is to the case, and is, therefore, better prepared to prescribe, which feeling is very agreeable to the patient and physician. This light concentrator I made from an old dilapidated police lantern that I had about the office, and had often "halted between two opinions," keeping or throwing out. The idea was not perfected until an accident to my Tieman's concentrator