Original Communications.

Short articles on the treatment of diseases, and experience with new remedies, are solicited from the profession for 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 at present more than thing else.-RUSKIN.

Editor MEDICAL WORLD:-On page 419, December WORLD, M. R. C. describes a case where the umbilical cord was three times around the child's neck, causing asphyxiation. Many years ago I had such a case, and there was also a knot in the cord. The child lost its life during birth. The shortening of the cord seemed to check the progress of the child through the pelvis. Several times since I have noted the presence of an obstacle, and found it was due to this cause. Once I managed to get the for ceps on and delivered in a hurry, and always I have had trouble to save the child.

That gonorrhea lessens the chances of pregnancy cannot be doubted. The gynecologists all call attention to the frequency of pyosalpinx and ovarian disease, necessitating castration in gonorrheal women. But women do become pregnant in spite of gonococci, and that frequently, so that the sterility is not absolute in such cases.

Dr. Sonn (page 427) asks why hepatic disease is attended with epistaxis. Obstruction to the circulation in the liver causes difficulty in unloading the veins, and hence engorgement of the capillaries. Nowhere do these bear distention so ill as in the nose, and hence the tendency to hemorrhage.

Wild hairs are extra sets of eyelashes, by an eccentricity of nature forming inside the lid, and causing no end of annoyance.

The malic acid of cider readily unites with zine to form a malate, whose properties resemble the acetate of this metal The treatment should be by demulcents, anodynes and stimulants, with emetics if the patient has not already vomited.

Has not Dr Mitchell's case (page 427) a urinary calculus? Salol, five grains every four

hours, relieves acute cystitis speedily, with hot cloths and anodynes as adjuvants.

For Dr. McDonough's case I would use antiseptic baths, wash the afflicted skin with pure soap and then rinse off with cold water; dry and apply ointment of red iodide of mercury, five grains to the ounce of lanoline. Then apply benzoated zinc ointment with a little oil of rose. Keep the general health in good order. If the case does not get well there is a local cause at work that must be destroyed by germicides, or else the general health is so far below par that healing processes cannot be instituted. This means iron, quinine and cod liver oil. Why not try keeping the skin wet with Bovinine, The effects of this on chronic ulcers are said to be remarkable.

Dr. Coates might get a clear solution (page 428) of benzoin by adding ammonia, making benzoate of ammonia; but the gum will precipitate in water.

In the Current Medical Thought, under the head of Requirements for Medical Practitioners, there is a mistake in regard to Pennsylvania. The registry law requires colleges to examine an applicant before endorsing his diploma.

In the December number I asked for reports regarding hemorrhage from quinine. (Why don't you reform the spelling of that word? It is worse than the diphthongs.) Dr. C. C. Stockard, Atlanta, Ga., writes to me as follows:

"Noticing your request in THE MEDICAL WORLD for reports of cases of hemorrhage from the use of quinine, I will give the following: I was called a few years ago to see a child whose urine had been bloody for several weeks. As it was in a malarious locality, I put it on iron and quinine. About a week later the mother informed me that it had gotten worse steadily. She said that before I saw the child she had given it a tonic and that, as several years before her urine became bloody after taking quinine, she thought the tonic she had been giving might have quinine in it, and after stopping it the urine had gotten clearer till she took the medicine I prescribed, when it immediately became more bloody. I told her my medicine contained quinine and to discontinue it. In a few days the urine was clear and I've never heard of any return of the trouble. I think the quinine certainly caused the hemorrhage."

I think so, too. My reason for asking was that I had a case of purpura hemorrhagica from quinine. I am inclined to credit this drug with causing hematuria sometimes. I have also received the following letter from Dr. Ben. H. Brodnax, Brodnax, La.:

"In 1868, while in Mississippi, I was troubled for the first time with chills. Dr. Hart made

me a solution of quinine (by mistake) of one hundred (100) grains to two oz. dilute acid and water; directions "to be taken in four doses." I took three doses, one hour apart, but lost conconsciousness before the fourth dose was taken. Was insensible for twelve hours, but on returning consciousness found my drawers saturated with blood. On getting up to urinate I passed about two ounces of fluid blood that clotted in the chamber. This passed off. I had taken no quinine previously nor afterward; had no return of the hemorrhage. In 1879 I took twenty grains of quinine in four doses. Result, I passed blood from bladder three times in twelve hours-about one half pint in all. Took no more quinine; bad no more bleeding. In 1886 had charge of several cases of chills. In four of them (three in one family) a three-grain dose of quinine was followed in about three or four hours with pure blood from the bladder. Other antiperiodics, arsenic, strychnine, pipirine, etc., produced no hemorrhage.

In 1878 I had a case of congestive chill, boy 6 years old. The mother had given him three doses (three grains each) of quinine before the chill came on. When I arrived I gave a small dose of chloroform by mouth. In a few moments (five or six) he got up, passed from the bowels a coffee cup full of clotted and fluid blood. Half an hour afterward he was perspiring freely and recovered under other antiperiodics.

These are all the cases I know, or can now remember, of hemorrhage which can be directly laid to quinine, except, I may add, several (about eighteen cases) of so-called swamp fever.

This disease as I view it, is not a distinct disease, but really a hemorrhage brought on by the injudicious use of quinine. Idiosyncrasy prevails in these cases. Some can stand quinine, some cannot, and these are the ones in which quinine is the systemic poison, showing itself in its action on the kidneys. True Congo or Egyptian swamp fever I don't think has existed in this section. I don't think the peculiar filuria has ever been found. The malarial hematuria, so-called, is, in my opinion, an idiopathy-a blood poison by quinine. Allow me to express my admiration of the articles written by you that have come under my notice in THE WORLD."

A curious case has come into my hands lately. A lady, aged 44, whose mother died of cancer, began to run rapidly into a condition of great debility. In six months she had lost sixty pounds, became quite pallid and so weak that she had to be helped into her carriage. She was pronounced a victim of cancer of the stomach. Nevertheless, there was no vomiting, no tumor, nor was there any symptom of cancer in

any internal organ; nothing but this singular and apparently causeless depression. Such a state of things certainly pointed to cancer probably imbedded deeply in the liver, and I waited in the expectation that it would declare itself when the disease reached the surface. One day the lady remarked that she had eaten some raw oysters and had thrown them up two hours later.

Knowing that raw oysters should be digested in an hour, I asked what was their condition when vomited. She informed me that they were just as she had eaten them, not digested and not even acidulated. There was evidently a total failure of the secretion of gastric juice. I gave her acid and pepsin and a few days later some "malted beef." She at once began to improve, and that so markedly that we are now satisfied there is no cancer.

WILLIAM F. WAUGH, M.D.

Permanent Cure of Rheumatism by Osmic Acid.

Editor MEDICAL WORLD.-I will give what in my hands has given the best results in complicated cases of sciatica with rheumatism. My cases have been from all classes, ages and conditions and from all parts of the country. I am indebted to my medical brethren for the most of my cases at this watering place.

I had been treating cases with varying degrees of success and failure up to three years ago, when I thought I would try the effect of osmic acid in connection with the waters here. I used osmic acid on two cases at that time, when I received a report of another experimenter who had very bad results from the same. My two cases had five and seven hypodermic injections respectively at that time, and were apparently cured. I then discontinued the acid and commenced galvanism and had fair success for a time. In some cases morphia, atropia and chloroform were used, and in some only the salt bath. I then had other cases that did not improve as I thought they should.

In cases one and two osmic acid was used. In September, 1890, in case one, six injections were put in, when the gentleman was called home, saying that if he had further pain he would return. Six months afterwards he wrote

me a line saying that he had not had any further pain. This gentleman had been under the treatment of three or four of the best physicians of this State for nine months, before this time.

Case two, May, 1891, was acute; an actor by occupation; was very much drawn to one side and with such extreme pain that he could not move. After the first injection of osmic acid there was a marked improvement, and

after the seventh there was no pain at all. I continued the baths and electricity for a week longer and then he resumed his work again. At this point I received the bad reports of others before spoken of, and discontinued for about two years. In that time there were some that went through my hands cured from the bath and two that were not. All were chronic cases. Then I ascertained that the cases which I had injected were still well and that no unpleasant symptoms had supervened. I commenced the use of osmic acid again.

Case three: I had used two injections when the fellow was so far relieved that he got on his crutches and went to one of the bath houses. One of his fellow bathers informed him that it was morphine and that it would only last while it was being used, and I did not see him again. Case four, was here in May of 1892, and remained two weeks. Bathing and morphine was used several times at that time. He returned home for one week, then came back and I used five hypodermic injections of osmic acid. There was no pain or soreness left, and he returned home with still a large amount of atrophy of muscles.

A

There

Case five was in August of this year. gentleman, age 65; it was of that form that the pain was the greatest when remaining quiet; while moving the pain was not so acute. was a great deal of atrophy; the pain was so bad that he could neither eat nor sleep without opiates. After taking baths for one week I commenced the use of osmic acid and five injec tions were used, and at the same time a down. ward current of galvanism. At that time I went to Washington for one week and left him in the hands of assistant my

He took the advantage

of my departure to go to the World's Fair at Chicago, and returned at the same time that I did, and reported no more pain. He took the He took the baths for one week more and returned home without the return of any pain.

Case six is a man of 70, now under treatment. In this case morphine has been used by the patient himself, which I think no physician

should recommend. He used from five to six quarter grain doses each twenty-four hours hypodermically, and at the time I first saw him he had used six in twelve hours and was scream

ing with pain. I then used at eight in the evening, one half grain of morphine and the osmic acid. He went to sleep in a half-hour and had no more morphine up to the next time I saw him, eight the following eveningwhen the second hypodermic of osmic acid without morphine was used. The following day at four o'clock his daughter used one quarter grain of morphine and the third injection of

osmic acid was used that night, and the next day five grains of antifebrine was given, and the fourth hypodermic in the evening. The pain is gone, but there is soreness and there is contraction of some muscles and atrophy of others. The case has now reached a point where galvanism can be used to an advantage. Under osmic acid the muscles relax so that the patient can use his limb as before. Of course, the number of my cases is small, and from others bad results are reported. I was afraid to use it excepting in otherwise hopeless cases. The mild cases I have said nothing about. They get well from the baths or with a very small amount of medication. But in these few cases I have hoped to establish the fact that osmic acid is of benefit in extreme cases It is safe to use in the hands of a conservative physician, at least I have found no ill effects in any shape or form. In case six there is no other treatment but baths and osmic acid. In the other cases there was galvanism used with it. In case two, tonics, in case five, galvanism and in the others, baths. A. W. SHOTWELL, M.D. Mount Clemens Springs, Macomb Co., Mich.

Sulpho-Ichthyolate of Ammonium in the Treatment of Rheumatic Arthritis.

He

Editor MEDICAL WORLD:-Mr. C., aged 83, had been treated for thirty days for rheumatic arthritis of left knee when I was called. had lain on his back until he had developed I found that he had been large bed sores. treated by hot cloths locally to the joint. I tried besides internal medication, most of the local anodynes and massage, without avail, and found the joint getting more swollen and painful, to such an extent that he could not have it touched. I, as a last resort, thought of ichthyol and, having a small amount of the medicine at hand, I made a thorough application with a feather, painting the painful joint and vicinity thoroughly. I saw him twentyfour hours later and found all the fever (local) and pain, redness and other symptoms gone. have applied the medicine twice since and find patient rapidly improving. I am led to believe, from this one case, that it may prove to be the proper remedy for inflamed and painful I would like for some of THE WORLD joints readers to give it a trial in similar cases and reW. A DORMAN, M. D. port success. Lebanon, Ind.

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The Swab in the Treatment of Diphtheria. Editor MEDICAL WORLD:--I wish to mention one simple little mechanical implement that has proven so able an ally, so trustworthy a friend in my experience with diphtheria, that I desire to offer a word in its behalf. This little mechanical contrivance is none other than the swab, whose enemies are bristling up about it, impelling me to its defence.

To successfully combat an attack of malignant diphtheria the case must be seen early, since, after the system has become saturated with the poisonous virus the likelihood of success is necessarily vastly lessened.

The extended and graphic arguments urged against the employment of the swab by physicians whose success is described in such arguments, are undeniable, if the physician permits an ill-advised use of the instrument.

I am sure it is possible to render a diphtheritic throat antiseptic, since I have seen the throat of a patient who was already in a dying condition from the systemic effects of this disease made clean, his breath rendered pure and sweet, and his condition in every way benefitted in twelve hours after the first application of the antiseptic by means of the swab.

In this family three deaths had already occurred in less than a fortnight, the cases being under the care of another physician. At my first visit, this young man, about sixteen years of age, was in an almost putrid state, emitting so foul a stench that attendance upon him, even from those who loved him, was scarcely endurable. I entertained no hope and offered no encouragement as to his recovery, warning the parents that death must almost inevitably result, though promising them to give him ease and clean his throat. In twelve hours he was so much improved as to express gratitude for the relief afforded, especially from the loathsome stench of which not a trace now remained. He made surprising progress for several days, but his system had become so poisoned from the disease before I saw him, that upon being raised to a sitting posture to receive a drink he expired.

Only two children of this family were now left and both had their turn at the disease, but a strict adherence to the treatment prescribed brought them through in short order and without a breath of offensive odor.

In another family the first stricken was a thirteen-year-old boy. Though I had the case early, the symptoms were all well developed. After warning the parents as to the nature of the disease and its danger, I urged upon them the necessity of strictly following the line of treatment in order to pull him through.

The treatment consists in swabbing the throat every two hours with a mixture of creolin, ferri subsulph. and glycerine, followed frequently in the intervals with a spray of hydrogen per ox. (Marchand) small granules of hydrarg-chlor. mitis, gr. one sixth, every hour until bowels move freely, and a granule, one-sixth gr., calcium sulphide every hour. If temperature runs high I give the defervescent granule with strych. ars. until lowered, whisky when indicated, with strict attention to diet. After using the swab, I instruct the nurse to cleanse it with a saturated solution of kali chlorate. For twenty-four hours this boy did well, but his objection to the swab, and the interference of an ignorant physician who assured the parents that their boy had "only putrid sore throat," and would recover without such diligent attention, prevailed upon them to relax their efforts. In less than twelve hours that boy was dead.

That was a sorrowful lesson and it served to convince those misguided people that I had not been in error. As another child, a girl of fif teen, was developing the disease, they consented to follow the treatment, swabbing and all, in spite of opposition. A competent nurse was placed in charge of this case and after a hard fight the girl was restored to health. In the three remaining children ranging from two and one-half to eighteen years, the same treatment was attended by the same satisfying results.

Cases innumerable might be cited in illustration, but these examples show both sides of the

matter.

In my judgment the swab has no rival as a means of applying the local treatment to a diphtheritic throat.

The operation should not be one of violence. It is the business of the physician to first obtain the confidence of the patient and let it know that he does not desire to hurt it After a few applications, even the youngest patient will learn, if you are gentle and kind, though determined, to submit quietly and get the business over as quickly as possible.

There need be no strangling, but if the swab happens to gag the patient a little that is no great hardship, since the expulsive effort only serves to cough up the membrane already detached and leaves the throat so much freer and the patient so much more comfortable.

The creolin, possessing powerful antiseptic properties, destroys the disease germs and stays their further growth, while it deodorizes and thoroughly disinfects the throat. The liquor ferri subsulph. exerts its powerful astringent properties and keeps the terminal blood vessels closed, cutting off the poisonous virus from the general circulation. It withers the accumulated

membrane, causing it to peel from the mucous surfaces of the throat and also prevents necrosis of the underlying tissues, affording them a resistence to the lodgment of the pathogenic germs. If any of the iron gets into the stomach it only serves to build up the system.

Of the creolin it may be further said, it is not only superior to all other antiseptics because of its combined properties, but it is safer, because it is non-irritant and non-poisonous. I have continued its use several days after the throat had become entirely clean, and small children have swallowed it ad libitum without any bad effects.

The pus-destroying and general beneficial effects of spraying the anterior and posterior nares with the H2 O2 needs no comment here.

There need be no such horrible scenes attending the employment of the swab as are sometimes described. When the physician does not make the application personally the attendant should be thoroughly instructed in his sacred duty and only one who can be relied upon to use it in all gentleness should be trusted.

The absorption of the ptomaines being checked in the start, there is no exhaustion from systemic poisoning and the patient has a good fighting chance, and such enervation as must result from combating the local condition must be carefully watched for and met by the physician as its urgency shall demand.

Arguments in favor of the swab in connection with these remedies might be prolonged indefinitely. However, the proof is at the command of any physician who now decries the swab, since a test trial will surely bring the gratifying results that my own success warranted me in promising others. W. B. PARKINSON, M.D. Logan City, Utah.

Calcium Sulphide in Systemic Infection.
(FOURTH PAPER.)

Editor MEDICAL WORLD:-It is presumed that anything helpful in the treatment of diphtheria will be gladly received by the profession at large, as it is by the author of this paper, and it is with a desire to be helpful that we come before you with a few suggestions regarding the use of the drug under consideration.

There is no question but that diphtheria is, sooner or later, a systemic infection, neither is there any question but that calcium sulphide is one of our best, if not the best, of systemic disinfectants, hence its application to the relief of this condition is based upon rational grounds.

As will be seen by my previous paper (Dec. WORLD), I always use the calcium sulphide in every form of tonsillitis attended by the least

constitutional disturbances and get good results therefrom. The line of demarcation is often so slight that it gives a feeling of security to know that, whether the case we see in the night proves to be simple tonsillitis, as we think, or diphtheria, we occupy the vantage ground.

Many cases of diphtheria are, primarily, local, and it is here that the calcium sulphide gets in good work in preventing or modifying systemic infection. This leads to another valuable point and that is the use of this drug as a prophylactic for exposed persons. It is my practice in all such cases to give the members of an exposed family about one-third the amount we use with the sick one. This, in many instances, effectually prevents the development of the disease or so modifies its intensity that the attack is very light.

As will be inferred from the usefulness of this drug as a prophylactic, to be the most helpful it must be begun early. With the very first symptoms it should be begun in large doses, three or four granules, one-sixth gr. each, every fifteen minutes until the characteristic odor is smelled in the breath, the urine and the feces, after which it should be continued at less frequent intervals but sufficient to keep up the impression.

The above recommendation is for a child of ten or twelve years. For an adult a somewhat larger dose may be needed, while for younger children less will be required.

As a rule, children do not object to its peculiar taste, and even babies will take it nicely, triturated with sugar of milk. Don't depend upon the calcium sulphide of the shops but use your granules and attend to the trituration yourself. If this treatment is begun early you will be surprised to see how little depressed your patient will be. The drug so effectually destroys the ptomaines that little spanemia is produced.

Fever usually is present at first and calls for aconitine, in connection with which digitalin and strychnine are helpful. I know of no better combination with which to handle the general condition. Local treatment should not be omitted, as the first astringent applications are of service. I have used, to much advantage, lemon juice and tannic acid; later, as decomposition of the patches begins to take place, an active germicide is required, and here we may depend upon the solution of peroxide of hydrogen. In our anxiety for the wellfare of the pharnyx the nose must not be forgotten. Not long ago I was called to a case dismissed two days before by another practitioner as cured and found the nasal passages filled with exudate, with systemic infection just beginning.