Original Communications.

Short articles on the treatment of diseases, and experience with new remedies, are solicited from the profession fo this department; also difficult cases for diagnosis and treatment.

Articles accepted must be contributed to this journal only The editors are not responsible for views expressed by contributors.

Copy must be received on or before the twelfth of the month for publication in the next month. Unused Manuscript cannot be returned.

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts al present more than ything else.-RUSKIN.

can bear much pain, and in the dark hours of their trial one must be merciful. I have just had a case in the course of which we have made what appears likely to prove a discovery of some importance. Every one who has treated these cases knows that there is little difficulty in reducing the daily dose to a grain or even to a quarter-grain; but it is in getting rid of the last hit that the suffering comes in. Nothing has hitherto been found to take the place of morphine. Ammonium bromide, cannabis, codeine, and all the rest have been tried and proved of very little value. The case I speak of was a young man, 26 years old, neurotic from birth, a periodic dipsomaniac and a morphine habitue of years standing, who had been "enred" by Keeley and several others, and returned like the canine mentioned in Holy Writ. He was

ism.-Replies.

Editor MEDICAL WORLD:--After three weeks' experience with the variety of grip prevalent in Chicago, I am prepared to admit that Philadelphia is not in it. At least, from personal experience I can testify that when the Chicago grip gets hold of an Eastern "tenderfoot," it assuredly has some fun with him. It took me suddenly with excruciating pain in the head and back, aching legs, profound debility, inability to eat, and a temperature of 104 degrees. Pulse feeble and from 100 to 112. In a week the symptoms lessened and I started off quite brightly, walking as rapidly as usual, for about an hour. Then the pace slackened, gradually to the hobble of an aged man, with every motion developing a new ache, and I was forced to take the arm of a friend. During the third week there has been a steady aching in the left temple and nose, relieved at intervals by small hemorrhages. I never quite comprehended the neurasthenic state before. I get up in the morning and tumble,into a cold bath, dress, and go out for a brisk walk, setting my teeth together with the determination that I won't be ill, but will throw the wretched thing off. In spite of myself in a minute or so I am simply incapable of dragging myself along.

Pardon me for talking about myself so much; but I have always thought that no records of cases are so valuable as when the patient is himself a physician And I want to acknowledge that I have not done full justice to neurasthenics, having had a lurking suspicion that they could work if they had the will. I am their friend and champion from this time on.

In treating of morphine habitues, I have spoken of the value of pain as a therapeutic resource, in developing that self-control that alone makes a cure permanent. But not all cases

force to which one could appeal, and no selfcontrol whatever. Nor had he the powerful incentive to fortitude possessed by a husband and father. There was no real desire on his part to be cured. Altogether this was a very unpromising case, and it was not at all likely that he would deceive himself as to the effects of a substitute. Nevertheless, one drug gave him such complete relief that he could hardly be persuaded that there was no morphine in it. One swallow does not make a summer, and I may not succeed so well with the next case, but as this remedy was selected as directly antagonizing the pathological condition present, I have hopes of it. It is a tonic, not a "habit-producer," and could be taken for any length of time with impunity.

Has not Dr. Campbell's case, (page 12), a vesical calculus? The discharge of mucus and blood shows something more than a simple cystic catarrh; for after so many years the mucus and blood usually disappear from the urine. Dilate the urethra, examine the bladder with the finger; and if there be nothing but catarrh, wash out thrice daily with hot water and hammamelis, or one grain of silver nitrate to eight ounces. Salol, hydrangea and hyoscyamus relieve the acute manifestations.

I wish I could put Dr. Hardey's case of hystero-epilepsy cured by quinine, (page 12), on record beside the hundreds of cases subjected to castration and not cured thereby. I am not opposed to any advance in surgery, but why do the ovariotonists not give us a record of their successes and failures? Up to the present, they have only classified their results as recoveries or deaths.

Dr. Bronson, (page 19), should examine his wife's rectum for ulcer or cancer. A morning diarrhea in a woman of her age is suspicious. If

nothing is revealed by examination, give her very small doses of arsenic, gr. 1-120, before each meal, and an enema of a grain of silver nitrate in eight ounces of hot water once a day. Still smaller doses of corrosive sublimate, gr. 1-180, once acted well in a similar case for me.

I would suggest the same treatment for H. L. K., (page 20), adding that there is less likelihood of rectal disease. The old-fashioned mixture of rhubarb, hydrastis and potassium carbonate would probably be useful to him, as it usually is when there are fetid, unhealthy stools. With this a diet exclusively of hot milk, until his stools are normal; then returning very gradually to his usual diet. I think he has ulceration of the bowels, although the absence of fever is against this. Has he noticed whether there are mucous, semi-membraneous casts of the bowels in the stools? Mucous colitis presents such symptoms as he describes.

Dr. Lever's case (page 20), reminds me that I have often seen such an appearance in persons dead from consumption. The certain evidence of death is decomposition; but the fact that the heart has ceased to beat, and the pulsations cannot be heard by the trained ear of the physician is fully as positive. Some years ago I traced up every story of burial alive appearing in the papers, and found that all came from the same source the reporter who was in straits for something to fill up space.

Medicus, (page 20), could not improve on his local treatment, but why not give sulphide of calcium internally, one grain daily? Don't be discouraged, for furunculosis is often obstinate. Sedentary habits in a man whose body was designed for manual labor, coffee, beer, sewer gas or other foul air in the house, often keep up this affection. One of my cases resisted all my efforts till the plumber cured her by ripping out the "jerry" drain pipes and putting in good work.

In the negro, I have found it necessary to use hot applications for pneumonia, to treat the case vigorously at first, feed well, and lookout for collapse at the crisis. They rarely have the nerve or the resisting power of

the whites.

As to making a plaster cast, Dr. Barringer, (page 20), should shave the skin if it has any hairs, soap or grease it well, and then apply the plaster. Lay two threads or wires along the sides, and as the plaster begins to set, withdraw these and the cast may with care be removed entire. When quite firmly set, the inside is to be greased, the two sides placed together and plaster run in to form the cast.

Spasmodic croup is peculiar to infants under one year old. The treatment is uncertain; but

counter irritants along the pneumogastic in the neck, (mustard is best) should give prompt relief.

For the removal of a brown discoloration on the face, B. L. N., (page 21), may paint with corrosive sublimate solution, one grain to the ounce or stronger, till the epidermis is removed; then rub with compound iodine ointment, diluted, and then apply lanoline till the skin is restored.

X. X. X. asks what will remove superfluous hair from the skin, besides electricity. Nothing. Dr. Mantey, (page 21) will find alopecea areata likely to be of syphilitic origin. Mercury and potassium iodide internally, and cantharides, 30 drops of the tincture to an ounce of benzoated lard locally, would be pretty good

treatment.

I feel like asking "Medico" (page 21), what he wants to cure his patient for. He should notice whether the womb is tipped back. If not, let her take a full dose of quinine the night before the accustomed attack; or a full dose of atropine (gr. 1-100); or else teach her to catheterize herself.

I hope the two valuable letters of Drs. Stocker and Brodnax, in the January WORLD, will not be all we are to have on the subject of quinine causing hemorrhage. The MEDICAL WORLD family, with its thirty odd thousand members, in every State and Territory, could settle this important question if each one who has noted such cases would report them. the great fault I have to find with you is that you leave a few of us to do the talking and keep to yourselves experience that would be of the greatest value to your fellow doctors.

But

You will see by the new address that I have gone West to grow up with Chicago.

WILLIAM F. WAUGH, M.D. 834 Opera House Block, Chicago, Ill.

every case of malaria that has presented itself for treatment, and always with brilliant suc

cess.

I will mention one case only. Over three years ago, when I practiced in the country, a stout, able bodied man called to be treated for ague. He had had the disease three months the year before, and, although vigorously treated by two physicians, he did not get well until cold weather set in. He expressed a desire to be cured at once if possible, as he was a laboring man with a family to provide for. Having made an examination I accepted his own diagnosis, and expressed the opinion that I could cure him promptly if he did not object to being made right sick for a short time. I prescribed podophyllin in full doses, and explained to him the action the medicine was expected to have. He told me afterwards that the powders made him awfully sick, so he took four only, but when he recovered from the effects of the medieine he was well. He has not had a return of the disease since. Three years ago I treated a medical missionary sick of typhoid fever. He had been in the mission field, Syria, Asia, for twenty-five years. Malarial fever prevails in that country. He told me that elaterium in large doses was his sheet anchor in obstinate cases. The dose mentioned was very large.

Several of the WORLD's writers have had good results from the use of nitrate of potassium in such cases, and one used apocynum cannab, flu. ex. successfully.

Some three years ago two doctors, partners, in a Southern State (I cannot now find the article to name them), advanced the opinion that chills are caused by an excess of water in the blood. They claim that the sweat following the chill eliminates the excess of water, and in this way the patient is relieved until the water reaccumulates. Reasoning thus they prescribed acetate of potassium with results that confirmed them in their belief as to the cause. The articles of "Rhubarb" and Dr. W. B. Crawford, December WORLD, page 422, are the occasion of these thoughts being offered for publication.

It will be observed that all the remedies herein mentioned deplete the blood of water by acting on the bowels and kidneys, in this way effecting a cure; thus confirming the correctness of the theory of the doctors referred to above, unless, perchance, the poison be such that it is simply washed out by the watery discharges.

In conclusion I express the opinion that the cause of chronic chills can be removed by any remedy that acts strongly on the excretory and secretory organs, particularly the skin, bowels or kidneys.

Those of your readers who practice in malar

ial districts can test this mode of treatment and report results.

If any of the WORLD's family can reduce enlarged tonsils to their proper size by injections, please report how.

Of six medical journals which I take, I like the WORLD the best.

J. S. DODDS, M. D. 6224 Station st., Pittsburg, Pa.

Milk Sickness.

Editor MEDICAL WORLD:-The affection is not due to milk alone, but beef and butter from affected animals entail it as well as water from certain springs and seeps from the earth.

My first experience with the ailment was obtained through treatment of a family who lived on a farm about three miles south of the village of Harrodsburgh, Indiana, in 1857. The said farm had been abandoned in disgust by its owner, and its cabin became the stopping place of any who chose to risk it.

The evil was finally located in a spring near the cabin and fenced by the neighbors, when all again went well.

A little further down the ravine was another spring wholly free from the pest; 'but children ignorant and indolent, were trusted to bring water, which they procured from the nearest source until the mischief was done.

same

There can be no question as to the correctness of diagnosis, for leading physicians of Bedthis ford had treated other cases on farm, and among others, this same family, who this time recognized their ailment before sending for medical aid. This family could not have contracted the affection from milk, butter or beef for by confession they had neither, and the children finally confessed to having carried water from the "Milk-sick Spring."

Where the water from the two springs unite and mingle, stock may drink with impunity, and in winter and spring time when the earth is full of water, that from the "Milk-sick Spring" may be used without detriment. This all points to a poison in water which, when largely diluted, is not received in sufficient quantity to do perceptible harm; but in summer and in autumn, more or less early according to accession of drought, the poison is more concentrated and the so-called milk sickness results

In 1858, while living at Effingham, Ill., myself and wife had milk sickness, and the personal experience thus gained, together with its frequent occurrence there, led me to seek information from every available source and I here offer a statement of facts pertaining to the mat

milk sick regions may permit their cattle to run at large without evil consequences. And yet, if protracted drought sets in again, and especially so if warm days prevail, in which case cattle drink more water, and it being more concentrated, experience has taught that cattle must be put up, or milk sickness be expected.

In those parts of Effingham, Clay and Jasper counties covered by my observation, many low boggy places, (there are no springs) were fenced up and milk sickness at once ceased except in the case of breachy stock which broke into the enclosures now and then or strayed to other sources of the evil.

Then again, if cattle are kept up in the morning until the dew has dried off and then returning to the pen before nightfall, they may run at large during the day time throughout the year with perfect impunity, provided there be no opportunity to drink from the poisonous seeps.

Or, cattle may be put into the milk sick patches after the dew has dried off and eat every vestige of vegetation and no harm comes of it if there be no surface water to drink.

And then, if removed before night-fall and sheaf oats be spread over the ground and allowed to receive the dew deposited from condensation of warm vapor arising from the moist earth beneath and this be fed to a calf in the stall, milk sickness follows as certainly as any other effect follows a sufficient cause.

This points clearly to a poison in the earth, soluble in water, and which is finally removed by drainage and cultivation.

The two prominent characteristics of milk sickness are persistent vomiting and obstinate constipation.

The red, pointed tongue, the intense gastric irritability, the persistent nausea, the nasty metallic taste in the mouth and the greenish acid vomit with tenacious mucous, often streaked with blood, is an exact counterpart to arsenical poisoning, but strangely, more persistent and less dangerous.

The obstinate constipation recalls a chief symptom of lead poisoning, but the characteristic blue line, wrist drop and all other objective signs and symptoms are lacking.

In treatment, the stomach, above all things. requires rest, and nothing secures this so quickly and efficiently as a thorough evacuation of the bowels; but the stomach itself being sick must not be called upon to labor in their behalf. The rectal tube now in use will probably supersede the ungraceful plan I had of turning "the other end up," while using the syringe, but must be used persistently to the end that nature shall have a continuous outlet through which to

rid itself of the poison. I have never known a case to get better until this condition was brought about, nor fail in doing so after it had been accomplished.

A mixture of neutralizing cordial and brandy equal parts given freely, was my most popular medicament. The cordial neutralized the acid fluids in the stomach and gave a short but grateful feeling of relief, while the brandy abated the nervous prostration and feeling of "goneness" so persistently present. Minute doses of morphine with bismuth was also popular with most patients, but I would now suggest cocaine instead.

Diet, of course, should be light and bland, but there being the most utter disgust for food, little restraint will be required. The fact that milk sickness is chiefly confined to malarial districts and prevails at a season when that disorder is most prevalent, would seem, during the stage of convalescence, to call for quinine, and the nervous prostrations (trembles) to demand nux vomica, and in actual practice I have found these articles exceptionally useful.

It is a common belief that persons who have milk sickness never fully recover, but this is erroneous. Still, many persons of feeble constitution take on dyspeptic symptoms which last through life, and the "trembles"-continue as a consequence of defective nutrition.

DeLand, Florida.

U. N. MELLETTE, M.D.

Diphtheria.

Editor MEDICAL WORLD:-In the March number of THE WORLD for 1893, the subject of diphtheria was pretty thoroughly ventilated, and one ought to be benefitted by reading that number. But then, one must confess, after having read it through, that he is somewhat bewildered what plan of treatment to adopt, if he has none of his own. It is somewhat strange when we read of the experiences of those lights whose articles appeared in that number, where they state so many cases and no deaths under their plans of treatment, and when some one else tries that treatment to find his success quite different. On page 83 of that number J. M. Waters reports sixteen cases, without a death. On page 424, December number, W. S. Ramsey reports six cases with recovery. On page 431, of the same month, Dr. Stroell reports twenty-two favorable cases. On page 99 of March number, 500 cases are reported with a mortality of less than 2 per cent. All of these cases are reported as having been treated in different ways. Can it be possible that all these were cases of genuine diphtheria? We read almost daily, in the public prints, reports of the