and brandy were given every four hours a part of the time instead of three hours. She took buttermilk as a drink all the way through, in quantities and times as I directed. Nothing occured, that I remember, in the course of the disease, more than what has been men. tioned, only there was, as might be expected where the vital powers are at such a low ebb, a constant tendency to cold extremities, which required constant vigilance, hot irons to the feet all the time, with occasional frictions of hot mustard to the extremities. Several times, and especially on the third day of my attendance, the joke like to have gone too far. I arrived at seven p. m., when the fever was at its zenith, 106, the pulse scarcely perceptible at the wrist, the extremities cold and livid, as also the nose and lips, the latter considerably puffed. As I entered I found them rubbing her extremities, and using all the appliances they could. Her mother fell back on a chair with tears in her eyes and despair pictured on her countenance, and asked me if I had noticed her mouth? Taking in the situation, I doubled the dose of brandy, and repeated as often as I thought it would do, keeping up the hot mustard applications to the surface, and especially to the extremities. To all appearance she was dying; she hung in the balance, as it were, between life and death, for over two hours, before there were any signs of reaction. It was on the tenth day of my attendance that she called for something to eat, for the first time, and I let her have a piece of tender rare broiled beef steak about two inches square by one thick. A tea was made of some of the beef, that she took occasionally till next morning, when she was allowed the steak again. By this time she had an ungovernable appetite, and had to be allowanced and watched closely all the time. Her convalescence has been steady until this date, August 16th. She gets up by herself, walks across the room and sits for an hour at a time. Now, as an author usually names his book after he has finished writing it, I have purposely given an imperfect history of the symptoms, course. and treatment of this case before naming it, and I unhesitatingly and unqualifiedly call it a typical case of "Enteric fever,"-used to be called typhoid fever-called by the laity here, and in some other localities, "slow fever." There is no doubt in my mind that her bowels were almost riddled with ulcers at the time I was called in, and if her diet had not been so rigid and

closely watched, she would have died of perfor ation of the bowel after convalescence had set in, as I have witnessed in several cases. The most notable feature in the case is the continued high temperature, and as has been said, there can be no doubt that the severity of a fever may well be estimated by the resistance which the pyrexia offers to an antipyretic treatment. There is more that I had intended saying of this case, especially of its treatment, but I feel admonished that it is already too long. It is open for criticism, and I am ready to answer any questions that may be a ked.

R. L. HINTON, M.D. Prescott, Ark., August 16th, 1892. Indications for Forty-Eight Varieties of Dosi. metric Granules for a Pocket Case.

(Prize List by M. F. DUMAS., M. D., Bald Knob, Ark, 1. Aconitine. Inflammatory conditions; adymania; facial neuralgia, etc. Dry-hot, surface; small, frequent pulse: hot flashes alternate with cold.

2. Aloin. Constipation.

3. Anemonine.-Nervousness, sadness, disposition to look on the dark side, fear of impending danger, dizziness, wart of perfect control of the voluntary muscles, mental depres sion (in the absence of pain and inflammation). Amenorrhea and dysmenorrhea from cold, ovaritis, orchitis, hasal, faucial, and bronchial catarrhal conditions.

4. Antimony Arseniate.-Dry cough, scant expectoration, in pneumonia, bronchitis, etc. Tightness across upper thorax.

5. Apomorphine.-Scant expectoration, in pertussis, bronchitis, and pneumonia.

6. Arsenious Acid.-Intermittents and all malarial fevers, with incurved edges of the tongue.

7. Atropine-Sulphate. - Rigors, congestion of nerve centres, impaired capillary circulation, dilated pupils, dullness, tending to coma, sleepy, dull face.

8. Adonidin.-Weak heart and indigestion. 9. Agaricin. -Thirst, colliquative sweats of phthisis, nocturnal sweats, sweats of pernicious

fever.

modic, of the broncho-pulmonary organs, asthma, dyspnea, from cardiac trouble.

14. Boracic Acid.-Aseptic. Fetid smelling sores, catarrhal inflammations of the mouth, throat, ear; cystitis ammonialis. Locally for excessive suppuration of wounds, ulcers, burns, scalds.

15. Barium Chloride.-Sthenic hemorrhage, aneurisms, cardiac debility with arterial relaxation, acute congestion, deficient intestinal secretion, atony of bladder and bowels, scrofulous indurations of the cervical glands and tonsils, locomotor ataxia, phlyctenular conjunctivitis.

16. Brucine. Same indications as for arseniate of strychnine; best adapted for children. 17. Bryonin.-Torpor of the large intestines. Any disease with a hard vibratile pulse, flushed right cheek, frontal pain extending to basilar region, irritative cough, especially in pleuropneumonia, pleurisy, rheumatism. In all rheumatic affections of the fibrous membranes. When pains are aggravated by motion.

18. Caffeine, Arseniate, Valerianiate, Bromide and Citrate. I prefer the citrate.-Coma, nervous headache, sunstroke, weak heart; along with disordered function of every organ, excepting vascular activity. depression of the circulation from various causes, increased arterial tension, stupor of uremia, opium narcosis, cartarrhal conditions of stomach and intestines.

19. Calcium Sulphide.-Diphtheritic exudations, leucorrhea, pyemia. To prevent and arrest suppuration and the formation of pus in local inflammations, to hasten maturation when pus has formed, in furuncular and glandular inflammations, mammitis, to prevent pustulation in variola.

20. Camphor Monobromated. - Hysterical convulsions, nymphomania, chordee, cholera infantum, infantile convulsion from teething, headache from anemia with erethism, extremities cold and circulation feeble, spermatorrhea. 21. Codeine Sulphate. Expectorant and anodyne in pneumonia, painful bowel complaints, abdominal pains; skin soft and cool, pulse full and without hardness, mucous surfaces moist, eyes dull and pupil dilated or immobile.

22. Colocynthin. Spasmodic constrictive pain, with tenesmus, in diseases of the intestinal tract.

23. Convallamarin.-Weak muscles of heart, valvular affections, when dropsy exists, weak heart in pneumonia, malarial fevers, worms, constipation, epilepsy.

24. Arsenite of Copper.-Intestinal diseases, with colic, cramps, diarrhea and dysentery, vomiting, discharges choleraic, cholera morbus, cholera infantum.

25. Digitaline.-As a cardiac tonic and stimulant to the circulation. Pulse open and feeble, urir e scanty, cardiac dropsy.

26. Elaterin.-Passive dropsy, apoplexy, as a cathartic, in chronic cystitis with violent cramping pains, sufficient dose at first to produce catharsis, then one granule, three or four times a day.

27. Ergotine. Hemoptysis, menorrhagia, post-partum hemorrhage, amenorrhea, dysmenorrhea, ovarian tumor, uterine polypus, locomotor ataxia, second stage of pneumonia, in cerebro-spinal meningitis. Used for its direct influence in causing contraction of the smooth fibres of blood vessels and of organs, through which they ramify. Also, to arrest hemorrhage by effacing the calibre of vessels, or compressing them through the contractile influence as above. When the tissues are full and inelastic, the patient sleepy, intellect dull, a stimulant to the capillary circulation, and to the nerve centres, should never be used as a parturient, as it will cause irregular and continuous contractions, thereby proving dangerous. After delivery, I use it to prevent hemorrhage and to assist involution.

28. Euonymin. - Indigestion produced by torpidity of the pancreas, torpid liver, constipation, periodic diseases, prostration, with irritation of the nerve centres, chronic splenitis.

29. Gelsemine Hydrochlorate.--In all fevers, idiopathic or symptomatic, cerebro-spinal meningitis, tetanus, puerperal convulsions, spasms in children, irritation of the nerve centres, stricture, suppressed urine, hysteria, delirium tremuns, in determination of blood and inflammation of the brain, in fever and inflammatory diseases in general. Special indications are: Bright flush of face and eyes, contracted pupils, increased temperature, increased heat of head, general head che, restlessness. It exerts a specific influence upon the brain, and to a less extent upon the spinal centre and sympathetic. 35. Glonoine, Nitro-glycerine or trinitrine. --Accelerates the pulse and respiration, and lessens the blood pressure, indicated in angina pectoris, asthma, neuralgia, Bright's disease, during the climacteric stage in woman, with hot flashes. It directly influences the medulla oblongata, the functions of the pneumogastric and vaso-motor nerves, especially of the cerebrum; minute doses contract the cerebral arteries and change the rate of the pulse and respiration. Useful in headaches of a congestive character, with throbbing of carotid and temporal arteries, and feeling of fullness and pressure in head, worse from jarring, stooping, or from heat of the sun; large doses produce congestive phenomena as above characterized, and are employed to antagonize spasmodic nervous phenomena due to anemia of the brain,

as in epilepsy, spasmodic asthma. Will hold up a weak heart.

31. Gregory's Salt.-Preferred to sulphate and muriate of morphia, when these disagree.

32. Hyoscyamine.--In all spasms produced by a rupture of physiological equilibrium, associated with sulphate of strychnine, spasmodic asthma, hernia, as a parturient. Hyoscyamine allays irritation of the nervous system, and, to a considerable extent, of the sympathetic, gives rest, promotes sleep, and favorably influences the vegatative processes. Useful in delirious conditions and in adynamic fevers.

33. Hydrastine hydrochlorate.--Indicated as a stimulant and alterative in mucous membrane, in atonic conditions of the bowels, catarrhal affections, variola to prevent eruption, epithelioma, dyspepsia, menorrhagia, improves the appetite and digestion; it exerts a special influence on nutritive processes.

34. Iron Arseniate.-General tonic, indicated in cachexia, produced by malarial poison, also, in cancerous diathesis.

35. Iron Phosphate.-Nerve tonic, etc., in nymphomania, hysteria, chlorosis, restores the blood vessels, dilated by disease, to their normal condition, by dispelling the irritation, hyperemia (local excess of blood), which is the cause of all inflammations.

36. Iridin. Gastro-hepatic stimulant, indicated in torpid liver, jaundiced condition, dropsy, goitre; increases waste and improves nutrition. Alterative, especially valuable in constitutional syphilis. A specific for goitre.

37. Juglandin.-Indicated in scrofulous conditions, syphilis, helminthiasis, acute disease of the skin, and to relieve irritation of mucous membranes.

38. Leptandrin.--Indicated in all diseases where it is necessary to correct and stimulate the hepatic secretions without debilitating. Useful in typhoid fevers, and all diseases having black tarry passages from the bowels. Gives tone to the gastro intestinal mucous tract, and improves its function. Especially useful in chronic diseases of the digestive apparatus.

39. Lobeline.-Expectorant and anti-spasmodic, indicated in affections of the respiratory organs. Full oppressed pulse; sense of weight and oppression in precordium or chest, with difficult respiration. In minute doses a vascular stimulant. A single large dose relieves angina pectoris and disease of the chest from a similar character, congestion of the lungs. It favors dilatation of the cervix uteri, and is specific for rigid os and perineum, with fullness of tissue, doughy, and inefficient pains with sense of oppression. A special remedy in asthenic bronchitis of the child, with increased secretion. In obstetric practice repeat one granule

every 10 minutes until slight nausea. In pulmonary and cardiac congestion, a full dose.

40. Macrotin.--Indicated in rheumatism, chorea, neuralgia, gonorrhea, leucorrhea, variola, dysmenorrhea, retinitis, iritis, rheumatic neuralgia, muscular pains; pains increased by muscular contractions; uterine pain with sense of contraction. Also, for inflammation of fibrous membrane, to relieve after pains, false pains during labor, uterine rheumatism, sciatic pains, lumbago, etc. Unpleasant sensa tions in the pregnant uterus, for false pains and to aid true ones. It is the partus preparator.

41. Physostigmine Salicylate. In tetanus, delirium tremens, cerebro spinal meningitis, chorea and some forms of epilepsy. In disease of nerve centres, with weak pulse, cool surface, contracted pupils, and mental torpor.

42. Pilocarpine Muriate.-In effusions in serous membranes, pulmonary edema, puerperal convulsions, erysipelas, especially facial, in creasing the secretory action of the sudoriparous and salivary glands. Has removed serous effusions from whatever cause, and is valuable in asthma, bronchitis, albumenuria diabetes, chronic rheumatic affections, puerperal septicemia when no contra-indications exist. Where the heart is weak, strychnine and strophanthin should be given with it.

43. Podophyllin.- A stimulant to the liver and upper intestines, influences the ductless glands, and favors blood-making. Specially indications: Full face, full oppressed pulse, full tongue with yellowish coating, dizziness of head. In minute doses, a stimulant to the process of digestion and nutrition, to arrest chronic diarrhea and dysentery, with profuse mucous discharges.

44. Phytolaccin. -Restrains incipient inflammation and prevents suppuration. In acute tonsilitis, mammitis, rheumatism, for sore mouth of nursing children. For some cases of nursing sore mouth, sub-involution of the uterus, enlargement of the sub-maxiliary and cervical lymphatic glands from sore mouth and throat and for diphtheria. It is an epidemic remedy; syphilis, etc. Special indications: Pallid mucous membranes sense of irritation and burning; when epithelium is removed vivid red, exudation in patches, mammary fulness with pain. In ordinary cases, pallid, somewhat leaden colored tongue, very little coat, and looking sticky, as if covered with glutinous material.

45. Sanguinarine Nitrate-Errhine and tonic to mucous membrane. A stimulant to diseased (atonic) mucous tissues, bronchitis, laryngitis, with cough and tickling, or dryness of the throat, nasal catarrh with little or no discharge, and in derangements of the digestive organs.

46. Sparteine Sulphate.-Heart regulation and tonic. It is a safe and efficient regulation and tonic for the heart.

47. Strophanthine.-This slightly contracts the arterials only, thereby sparing cardiac force to overcome their resistancc. It is a heart tonic rather than a heart stimulant, and is indicated in almost any irregularity of the heart's action. Especially valuable in precordial pain, palpitation, dyspnea, and valvular diseases with regurgitation. From a decided diuretic action it is a very efficient remedy in edema, anasarca, and Bright's disease.

48. Veratrine.--Apyretic, cardiac sedative, specific in first stage of pneumonia; in erysip elas, internally and locally. The remedy in sthenic fever and inflammations. It lessens the frequency of the pulse or heart's action, and removes obstruction to the circulation. The remedy in puerperal eclampsia. It is to slow the pulse. Special indications: Full strong pulse, large pulse the prominent feature. The deep-red stripe down the centre of the tongue-marked-is a characteristic symptom. Fullness of tissue-not contraction--there is flushed surface. In chronic diseases with full tissues, full pulse and increased temperature. Associated with gelsemine, but not with aconitine. The indications for the two remedies are diametrically opposed. Aconitine small frequent pulse.

Let

I now have my 48 remedies, and have no strychnine nor baptisin, for this 48 vial case. Let arseniate of strychnine take the place of convalamarine, as we have spartiene, strophanthine and digataline for heart remedies. sulphate of strychnine take the place of adonidine, and let baptisin take the place of iron arseniate. We are all familiar with the indications of sulphate and arseniate of strychnine, so we will omit that part and treat of

Baptisin. This is a very important remedy. It is the remedy for cynanche maligna, and for any disease that gives this peculiar odor. It is indicated by fullness of mucous membranes, tongue, fauces, pharynx, by deep coloration of tissue, not red; also, in typhoid disease by a continued, moist, pasty fur on a tongue of normal redness. It is an epidemic remedy, and will cure typhoid fever, typhoid dysentery, typhoid pneumonia, typhoid sore throat, typhomalarial fever, or, indeed, typhoid anything. The specific indications for the remedy are a dusky purplish color of the face, like one exposed to cold, face expressionless, there is a similar color of tongue, fauces and throat.

Occasionally we find this unpleasant discoloration over an affected part, as the chest, liver, etc., and sometimes the entire surface of the body is thus discolored. In adynamic fevers, on conditions calling for baptisin,

arseniate of strychnine can be associated with it, to an advantage.

[This prize list was obtained by us for publication from the Philadelphia Dosimetric Co., cor. 20th and Market Sts., Phila., Pa.-ED.]

The Atmospheric Tractor.

EDITOR MEDICAL WORLD:-All your readers of one or two years ago will remember the "Battle of the Forceps;" but I am not going to write of "forceps" but of a device invented or brought out by Dr. P. M:Cahey, of Philadelphia, and called by him an "Atmospheric Tractor." It is a harmless looking rubber cup, which can be adjusted to the presenting part of the child and the air exhausted by means of an air pump. The tractor is capable of lifting by steady traction about thirty pounds, and when applied to the head of the fetus. and steady traction made, during a "pain" and during the interval hold the "ground" gained, almost any fetus can be speedily delivered. In many cases it works as well as the forceps, and can be applied so easily that it is destined to supersede them in all but the most severe cases. I have now used it in about a dozen cases during the past year and each time very satisfactorily.

Albany, Vt.

J. C. CAMPBELL, M,D.

Antikamnia Poisoning.

EDITOR MEDICAL WORLD:-I have just had a case of poisoning by antikamnia and have seen several cases recently, the drug having been prescribed by a quack, who probably does not know what the drug is composed of.

The said Dr. prescribes it in 12 grain doses, one as necessary for pain. The last case seen had taken three doses in the space of six or eight hours.

The symptoms were cold and clammy, numb extremities, blueness of skin and lips, great prostration, suffocation and blindness.

I gave six ounces of whisky (to a delicate female) in the course of an hour, and she rallied in a few hours. Another dose would have finished her.

Technics of Practice with Dosimetric

Granules.

EDITOR MEDICAL WORLD:-Next to being able to make a correct diagnosis and knowing the possibilities of the remedies at our disposal, in determining success in practice, comes the handiness with which we use them, the ways adapted to make our practice easy for ourselves, and our directions readily comprehended by our patients. It is needless to say one should be well supplied with granules to the full extent of his knowledge of how to use them. In the the office they should be alphabetically arranged in a neat handy receptacle (one of which I will explain at another time) in bottles of 500 to 1000 each. This case should also be provided with drawers for 4, 1⁄2 and I dram phials with corks to fit, as well as small dispensing envelopes, say 278 x 134 inches, plain or printed, with name and address, office hours, etc., and a little box of gummed labels. A few gummed stickers the size of your thumb-nail are very useful as will be shown further on. Thus provided for you are ready for business.

We will suppose it is the morning office hours. A lady calls, not very sick; feels tired all the time; appetite poor but tongue fairly clean; bowels constipated. After due deliber

ation, for nothing should be done hastily, it is decided to give arseniate of strychnine and podophyllin. The granules are poured out on a clean piece of blotter or cloth (the heat of the palm of the hand will be apt to make them sticky) twenty-four of the one and twelve of the other, and as they are of distinct colors they are put together in a 1⁄2 dram phial closely corked. This is then put in an envelope on which has been previously written: "Take two white and one dark before meals." Meanwhile give due directions regarding diet and tell your patient "if stools become frequent to omit the dark granule at noon," not forgetting to tell her to consult you again in a few days.

The granules above mentioned are so very unlike that they may be safely dispensed together and so commonly prescribed that no case notes need often be kept. Suppose, however, instead of constipation, palpitation was the prominent symptom. In this case the strychnine arseniate and digitaline which would be do doubt prescribed, are so nearly of a color that you would put them in separate phials and use a "sticker" on each, which you would mark in some way intelligible to yourself but not to your patient. Now make a note in your case book with name, date and prescriptions; number them say, 1 and 2, and put the corre sponding numbers on the phial. Having directed on the envelope "two of No. 1 before meals and two of No. 2 two hours later," you can dismiss your patient, sure you will do her

good and that you will know what you prescribed in case she calls for a renewal or to consult you again.

Soon a small boy rushes in before school and says, "Annie has got cramps and diarrhea and mother wants some medicine." You know the child well, a little girl four years old, and start at once to fix the medicine, asking, meanwhile, "does your mother think Annie has any fever?" The uneasy messenger says, "I dunno, but she smells orful." Here, then, three indications are to be met: pain, fetor and diarrhea, accompanied, we are safe in presuming, by more or less fever, requiring several drugs and no end of detail. Let us take a short cut and in our record write :

"Annie B., age four years. Fetid diarrhea, with colic and probably fever.

Now select the granules determined upon, put them all together in a phial and direct on the envelope: Dissolve all the granules in twenty teaspoonsful of water, sweeten and give a teaspoonful every half hour till relieved, then continue in hourly doses. Be sure and tell the boy "If Annie is not better by the time the medicine is half gone they must send for you." You will likely never hear from this case again.

With office patients well known to me I often cut it short by making note of the prescription on the back of the envelope used and order it kept and returned.

Office hours are over and with a well filled case of 60 to 100 phials (with a good pocket for prescription blanks, and a thin note book) stowed away in a small hand-bag, in which are surgical instruments, dressings, a tin box of empty capsules (I carry No. 4), catheters, etc., etc., the morning round begins.

You first answer a call that came anxiously during the morning office hours. A sharp, pronounced fever with great depression, character unknown, very likely typhoid. Temperature 104, pulse 120, tongue white, bowels have not moved for three days, headaches badly-in fact, this young man is, as he expresses it, "all broke up." You will probably decide to give aconitine for the fever, strychnine for the depression and sulpho-carbolate of zine for the intestinal decomposition that is undoubtedly taking place as well as a flush with seidlitz salt. You will ask for two little dishes, individual butter plates I like best, sauce plates or saucers will do, cups inverted, small glasses, egg cups, in fact, anything at hand may be made use of.