Cholera Infantum.

EDITOR MEDICAL WORLD:-In this disease and allied disorders it isn't only medicine that the baby needs. Some poor babies are given enough medicine to float them, when the weak little stomach has more than it can manage in trying to digest a little bit of food. Physicians are not compelled to give medicine every time they see a case; why shouldn't we keep our hands off as long as the case is getting along fairly well? It is easier to give a dose of medicine then to sit down and by pareful questioning and examination find the cause, for the cause is what we must search for in order to do justice to the little patient as well as ourselves. So, instead of checking vomiting or purging by violent medication, find out where the trouble is. Is the stomach doing its duty? Is the nourishment at all suitable? Are the surroundings at all what they should be?

My experience leads me to believe that the above questions are more importart than that of medication.

In the majority of cases this disease occurs in bottle-fed babies, or the question of what food is best is early thrust upon us. Don't become so wrapped up in a preparation that you can see nothing good in any other. Be willing to try anything for the good of the little sufferer. I investigate by sight, smell, and taste the condition of the bottle. Don't rest satisfied with any statement made by nurse or mother. Some. times you can obtan from another mother one breast of milk a day which will go far towards helping baby through a particularly bad spell. It isn't generally very difficult to convince the mother that baby needs frequent baths, plenty of fresh air, little clothing, copious draughts of water, etc., etc., but the poor mother is driven almost wild by interested neighbors, who pour torrents of advice upon her, and cite case after case to prove the contrary.

But for the good of the case our duty is to battle all opposition, retain a hold on the case and insist on our ac vice beir g heeded.

Please remember, give the baby a chance. J. H. FAGER, M. D. Cor. Broad and Ridge Sts., Harrisburg, Pa.

DR. C. M. FENN, of San Diego, Cal., writes us that cholera infantum does not exist in his locality.

THE Medical Bulletin, Phila., says :-" Dr. Taylor has given the profession a book of great value. [The Physician as a Business Man.] He shows how much doctors neglect the business part of their work. It points out, in very many ways, how money can be made and saved." See order blank, page xx.

Salol in Children's Diarrheas.

EDITOR MEDICAL WORLD: The June WORLD is a good one, the article on page 220 unusually good. I used to feel like taking a vacation during the hot months, but since I have depended almost entirely on salol, bismuth sub nitrate and hot water by the bowels, in the treatment of summer diarrheas (have only had three or four cases of the true cholera infantum in the last fifteen years) I have not been so anxious to get away.

I am favorably impressed with sulpho-carbolate of zinc, and have kept some on hand for the last few years with the intention of trying it, should salol fail.

I remember an old physician who lived in Lockport, N. Y., when I was a small boy, who treated bowel troubles very successfully by giving something to move the bowels, and following it with a solution of chloride of sodium; and another whose favorite prescription was silt and vinegar, both excellent antiseptics. W. H. TEN BROECK, M. D.

Paris, Ill. Incidents in the Life of a Country Doctor.

EDITOR MEDICAL WORLD: -Having once had occasion to prescribe santonine et hydrarg sub. chlor. for a colored child two years old, I was not a little surprised on the following day to find that the child had discharged an ordin ary shoe button with a large worm, (ascaris lumbricoides) threaded in the eye so firmly as to render it impossible to withdraw the animal without breaking it in the middle.

A few years ago I was requested to visit a had suffered intensely for several days with lady who informed me very modestly that she what she supposed to be an hemorrhoidal tumor. She complained of a burning pain in the anus, and stated that she had located the offending tumor, as she "could feel it very plainly with her finger." An examination was proposed and made in the presence of the lady's husband, who was no less surprised, and at the same time amused, than this writer to discover comfortably attached to the margin of the anus a large sized tick. It was at once removed with the dressing forceps and presented to the astonished patient.

I was once called to go eight miles into the country to see a young man who had accidentally received from a fowling-piece in the hands of a companion, a charge of bird shot, inflicting an ugly, though not dangerous wound in the external tissues of the right breast and shoulder. After removing as many as possible of the shot, cleansing antiseptically, and dressing the wound, the patient was made comfortable by a subcutaneous injection of half a

course, it should be corrected as the first step in treatment.

Second. Put the patient on a diet abundant in quantity but poor in quality, as regards its fat forming and heat producing properties. Fruits, turnips; etc., are examples.

Keep the bowels freely open with salts or

senna.

When the morbid desires are felt, have the patient bathe the genitalia with cold water and inject some cold water into the vagina; also, paint the vagina and clitoris with a mild solu. tion of cocaine.

Keep the nervous system under complete control by the use of camphor, bromide of potash and hyoscyamus: This is an important part of the treatment, for it controls that difficult portion of the case,-the thoughts, and should be pushed until it has the desired effect.

Of course, all available moral and social in fluence should be used to divert the mind from the one engrossing passion.

The permanent cure will depend upon find ing and removing the cause. Braymer, Mo.

J. G. DORSEY, M.D.

Reply to "Enlarged Prostate a Myth."

EDITOR MEDICAL WORLD:-I notice in the April number, page 131, an article by J. C. Campbell, M.D, speaking rather disparagingly of the attention given to the subject of enlarged prostate and exhorting physicians to pay more attention to "contractions and soreness of the urethra." I do not think there can be tco much attention given to that most distressing and often fatal disease of the prostate gland and appendages; two fatal cases having come under my observation within a year, reminding me most forcibly of what may eventually be the means of my "taking off." It is true that, whereas I was once young, but now am old," (nearly 80) yet never have I suffered my urethra to be impaired by the means he would have us believe. I am convinced that this affliction, diseased prostate, is much more prevalent than he would intimate, if I may judge from the inquiries from physicians that my article on the subject (Jan. 1891) called forth, no less than fifteen having written of their own cases. If the people throughout the country are afflicted in the same proportion, there must be a great many suffering with it.

The urethral contractions and soreness" he advises us to examine, are very simple ailments and easily treated compared with a real enlarged prostate, a fact that I think he would duly appreciate if he happened to be a subject. of that "enlarged prostate rut," he speaks of.

Now, Mr. Editor, it may appear egotistic in me to further encroach on your space or

patience, in reference to my own case, but as I have already given your readers something of my experience up to Jan. 1891, I venture to obtrude still further though the subject may be hackneyed. In that article (Jan. 1891), 1 brought saw palmetto into notice, as having helped me more than anything else I had ever tried, and felt very hopeful of its lasting effect, and can now say, that its action on the gland has been effective in preventing further enlargement but it failed to relieve, except tem porarily, i ritation of the neck of the bladder. and prostatic portion of the urethra; so I had to use the catheter occasionally.

Some four months ago my attention was called to a new remedy called "sanmetto,' composed of saw palmetto and santal. As a drowning man will "grasp at straws," so! grasped at a bottle of the remedy, and have been using it for about three months, with great relief, for I have no use for the catheter now, and the deposit of mucus, instead of being an inch or more thick in a quinine bottle of urine. as formerly, is now nearly nil, and no pain of irritation in urinating. I think the combina

tion of saw palmetto and santal is a happy idea --the former acting on the gland and the latte: on the mucus membrane of the bladder and urethra.

It may lose its effect, as other things have. but it commends itself to my judgment, 25 covering the pathological conditions better than any other remedy I have tried. For the benefit of those who have written me on the subject, I can say it is pleasant to take the dose. a teaspoonful about three times a day. Lathrop, Cal.

H. KNAPP, M.D.

Apomorphine for Hysteria.-Obstetrical Cus toms Among the Pawnees.

EDITOR MEDICAL WORLD:- Have any of your numerous readers ever used apomorphine hydrochlorate in the treatment of hysteria?

I have used it on several occasions, and find it to give the greatest satisfaction. It is espec ially indicated in the maniacal, paroxysma attacks, when the patient refuses to recognize any one, and persists in having rigors, opistho tonos, &c. It seems to give the patient "something to think about," and at the same time. acting through the sympathetic system, relaxes the apparently convulsed and rigid muscles.

I have seen it act splendidly where bromides, chloroform, valerian, asafetida, &c., have failed, and I advise the readers of THE WORLD to give it a trial.

One of the recent cases in which I have used it was a woman about 45 years of age, who had a history of having had several attacks similar to the one in which I was called to see her.

When first seen she was perfectly rigid, one arm pronated the other supinated, hands tightly closed, one thumb in the palm of the hand under the fingers, and the other over the fingers. The lower extremities were arranged in a similarly irregular manner; pupils normal and responding to light, teeth firmly set. Chloroform was given, and spasm of muscles relaxed; when she came from under the influence of the chloroform she would converse for a few minutes, and then willfully and deliberately assume another spasm, acting upon suggestions that had been made during the previous seizure, and put the arm or leg in the position spoken of by myself and assistant. I allowed her to indulge in several of these "spells" by way of amusement, and then gave her a hypodermic injection of one-eighth grain of muriate of apomorphine.

In about three minutes she began to show signs of uneasiness and soon called for a bowl to vomit into. The vomiting demanded her whole attention for about five minutes, and when she was through with it she concluded to have no more "spells."

I had a similar case a few nights ago, only in this case the patient, a young girl about 18, was maniacal, tearing the bed-clothes and pretending to be under the delusion that she was pursued by some one, begging her lover (who was present) to rescue her.

She would not answer when spoken to or give any sign that she heard what was said to her, and in the interval of the paroxysms, which lasted about twenty minutes, she seemed in a comatose condition. Chloroform, and cold water dashed in the face, with other remedies, had no effect, but a hypodermic injection of one-eighth grain of apomorphine hydrochlorate brought her to her senses in about four minutes, greatly to the relief of the relatives, who thought she was going to go crazy or die.

While writing, I will state a novel procedure for the delivery of retained placenta as practiced among the Pawnee Indians, among whom I have had some experience.

After the cord is tied and the child removed by the midwife, a stone, weighing from fifteen to thirty pounds, is fastened to the end of the cord, and the woman walks up and down the odge dragging the stone after her, until the placenta is pulled away; they then walk to the river and wash themselves, after which they lie down and rest; and strange to say, after this mode of treatment there is very rarely any bad result. Another peculiar feature among them is that they usually isolate themselves from the tribe while menstruating, a separate lodge or tepee being set aside for that purpose. Sparrows Point, Md. J. S. WOODWARD, M.D.

Puerperal Eclampsia.

EDITOR MEDICAL WORLD:-In THE MEDICAL WORLD for December, 1891, page 460, I detailed a case of this disease and its termination. In THE MEDICAL WORLD for February, 1892, page 59, Dr. Alford reviews my treatment and, as the Doctor, has "appealed to Cæsar" in his citation of authority, I desire to go with him to the highest and most recent authorities obtainable. The doctor says that my treatment "is so at variance with modern teachings." He also eliminates all causes of this condition as irrational except "apopletic," "epileptic" and "hysterical," and then tells us how to relieve all of these conditions. Prof. Reichart, (University of Pa.) in a recent review of this subject, (Nov. 14, 1891) presents in a clear and concise manner the views of eminent clinicians as to the cause of puerperal eclampsia. We find that they do not agree as to its cause, but, since 1842, when Lever discovered that in the great majority of cases of eclampsia albumen is present in the urine, and since that time the condition of the kidneys has been considered one of the most important factors in its etiology. We also have the theory of Dr. Blanc, of Lyons, of a specific bacillus that he has isolated from the urine of patients having eclampsia. The pure culture of his bacillus, injected into pregnant rabbits was followed by eclampsia, dyspnea and death. Dr. Galabin rejects this theory and prefers to believe in the uremic origin of the eclampsia. Leydon considers the kidney lesion associated with puerperal eclampsia as a special form of nephritis due to the prolonged arterial anemia, the primary causes of which he thinks is the altered intra-abdominal pressure. Stumpf thinks that a toxic nitrogenous product, probably acetone, is developed in the blood and this, in its elimination gives rise to nephritis. Dr. Braxton Hicks advances the view that the convulsions themselves cause the albuminuria. Santos attributes it to the straina nd irritation of the uterine nerves during the enlargement of the uterus. Winckel conjectures the existance of several poisons. Paget considers the fits reflex. The Traube Rosenstein view is that the convulsions depend on cerebral anemia, due to edema of the brain, which is caused by the hypertrophied heart of pregnancy pumping watery blood under high pressure. Dr. Auvard, of Paris, who has made a special study of eclampsia, claims that it is produced by a poisoned condition of the blood due to dimin→ ished elimination. Strumpell, in his text book of medicine (1889), says that eclampsia gravidarum is to be regarded as entirely analogous to uremia, and that death ensues in about onethird of the cases. Evidently a "combination of morphia and veratrum aided by chloroform"

does not relieve all cases in Germany, and Strum pell, not having eliminated from his mind the uremia idea, has not yet taken the "great stride in the directio of sensible therapeutics." We only trust that when he does the same wonderful results will follow as those obtained when aided by the glorious climate of California on the one hand and the great Japan current in the Pacific Ocean on the other.

In regard to the treatment, Dr. Auvard, of Paris, says "The therapusis of eclampsia conprises the three-fold indication, to favor elimination by means of purgatives, diuretics and diaphoretics, and the three fold indication of sedative by means of anesthetics, venesection(?) and emptying the uterus." (One of the highest authorities in France). Strumpell says chloroform is preferable to narcotics internally and in the plethoric, venesection, adding "this sometimes has a striking and instant effect as has lately been confirmed by various cb ervors." (One of the highest authorities in Europe). His Editor, Prof. F. C Shattuck, of Harvard Medical School, speaks highly of the use of pilocarpine in uremic convulsions. Dr. Samuel Wilks Veturein, physician at Guy's hospital, in a recent Lancet says:

"A young woman was brought into the hospital in a dying state, gasping for breath, and livid; there was a mitral bruit, engorgement of the lung with hemoptysis, albuminous scanty urine, and dropsy. We bled her from the arm and the effect was immediate, the breathing became tranquil, lividity passed from the face, and improvement continued from that time. In cases of uremic convulsions the effects of bleeding are very striking; the right heart is relieved, and poisoned blood is removed from the system. One case of this kind, indelibly fixed in my memory, is that of a dressmaker, who, I believe, is still alive. I was asked a few years ago to see this patient, who had been in convulsions all night. I found a middleaged woman in constant convulsive movements, froth issuing from her mouth, quite comatose, and almost pulseless. The whole body was livid and the extremities cold. The doctor said she was dying, and allowed me therefore to bleed her. I took away a small wash hand basin of blood, and while yet flowing, the lividity passed off, the convulsions ceased, the Her life was body gradually became warmer.

as clearly saved by the bleeding as if I had dragged her drowning out of the water, and this is more than I can say of drugs." With this, are other instances of the same tenor. (A high authority in England).

In Harris' Therapeutics (1890), page 531, he says to eliminate the poisons from the blood as quickly as possible and that this is met by venesection in the ordinary case with full pulse,

congestive head and the veins standing out upon the neck and face. He also places two drops of croton oil upon the tongue and uses chloroform, relegating morphine and veratrum to secondary places, using chloral and bromide of sodium for rectum.

To terminate the labor rapidly, ten cases of Cæsarian section are reported recently in Europe. I hope that Dr. Scarff's advocacy of sulphate of quinine will introduce a valuable addition to the therapeutics of this condition. Given in large doses it is a valuable stimulant to uterine contractions, and if it antidotes the poisonous condition of the blood may prove a two edged sword. I do not advocate venesection as a "panacea," neither do I believe veratrum a specific for puerperal eclampsia. Every liberal minded physician will use any and all methods-will

"Take the good wherever found

On heathen or on christian ground."

I have no desire to occupy too much space with this matter, but only wish to show that my treatment is not "at variance with modern teaching," and trust that every reader will give this matter his best thought and that, by a thorough investigation valuable lives will be saved. I close "with malice towards none," especially Dr. Alford.

H. E. W. BARNES, M. D. Macksburgh, Iowa.

[We admire the dignified and brotherly spirit in which this discussion is being carried on, as well as the thorough research evinced by the writers. It is a most interesting and important subject and one which has lately received increased attention. We trust that the two investigators (we do not regard them as disputants) will finally come to adopt very much the same views on the subject, based upon a clear understanding of the cause and pathology of the condition.-ED.]

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