ous, and in others of a measles, character. It receded, and was followed by brauny desquamation, but I could not find a placque. It was all brauny. I kept close observation of the children. They all showed temperatures within 6 days from time of eruption, none before, or say 10 days from the time she began complaining. Showed catarrhal symptoms; some sneezing; a redness of fauces; with a few isolated macules. All developed a pronounced measles rash in shape, but color a pale rose instead of red. All had loss of voice. Tongues peeled off. Temperature, 104° to 105° before rash appeared, and all up within 3 days, the rash never remaining over 3 days, from time of the first spot appearing until all had faded. There was only brauny desquamation, where there was any. You might say I had a typical scarlet-fever throat and a very typical measles rash, with all but the first case, with which I had some trouble with the kidneys, and the heart's action is still poor.

My diagnosis in these cases was rötheln. The neighbors tell the father they have had the measles. I would like to assure him that they have if I could do so conscientiously, but, from my diagnosis, he will still be in danger should he be exposed to measles. If I am wrong, and they have had the measles, it would be quite a relief.

I had the children kept in a room with even temperature; cleared the bowels with a mild laxative, and had the temperatures taken frequently, and as soon as the thermometer showed 103°, had them given a hot bath, and the entire body anointed with:

more than a few hours in reaching completion. The temperatures began rising immediately upon its completion. The rash never remained stationary, as it would begin to pale in the face by the time that on the body was fully developed. My case-book shows about 140 cases of measles.

Upon the same lines of treatment, I have never had a temperature above 1032° before the rash would show beautifully. Ordinarily we look for a low temperature in rötheln. Chandle alone gives it at 104° to 105°, and I believe in virgin cases, i. e., parties never having had any of the exanthemata, that is correct. But I cannot see how both scarlet fever and measles could help modifying it some, as it partakes so closely of both, and its temperature should be between 104° and 105°.

JOHN W. HYATT, M. D.

Bellevue, Texas.

Chloral in Fevers.

TO THE MEDICAL COUNCIL.

In the last (April, 1902) number of MEDICAL COUNCIL I noticed a communication from the Cleveland Medical Journal with an experience of the effects of chloral hydrate. My own experience fully coincides with that of the author of that article as to the antiseptic properties of chloral, together with its further applicability in continued and all low-grade fevers of paludal or zymotic origin. For ten years I have been in the habit of giving chloral in those fevers, especially typhoid, of which we have more than our share here. It relieves pain, quiets the nerve-centers, largely influences favorably subsultus tendinum of typhoid, the bowels become less angry, the bloating diminishes, and the distressful trembling gives place to quiet, restful sleep. In fact, I do not believe that I could confidently treat many cases of typhoid, or low paludal fevers, or, in fact, any acute condition, where autointoxication or continued severe pain have strongly depressed the nervous tone of the patient, without chloral.

Consistent doses of the drug, masked with a bitter tonic, as nux. or gentian comp., very nicely comforts a patient in the particular expression of senile atrophy known as paralysis agitans.

I am emboldened to write this because of your invitation for reports "from your readers." S. D. YERINGTON, M. D. McBain, Missaukee Co., Mich.

Notes and Comments.

By C. KENDRICK, M. D. Kendrick, Miss.

Why will some people suffer through life on account of hemorrhoids when the trouble can be relieved by a simple operation? See page 88. Every general practitioner should have and use a rectal speculum, and be prepared to operate when necessary. I have no fixed rule by which to treat hemorrhoids, but decide what to do after a careful examination. In some cases I prefer the ligature, in others the hypodermic needle,

and sometimes the knife or scissors.

Like Dr. Ford, page 89, I think that nearly all cases of appendicitis can be treated successfully without the use of the knife. I have seen a number of cases condemned to the knife or death, that recovered perfectly without surgical treatment. Those who are too "handy" with the knife may not be able to treat a case successfully by any other means, but it does not follow, therefore, that others cannot do so. But there are some cases that require surgical treatment just as there are some injuries of the limbs that make amputation necessary.

To send coin by mail use padded paper used for packing glass, etc. Use the kind that is composed of three layers or three sheets of paper, with the middle one fluted. Cut a place for the coin between the outside layers and insert it. It is best to mark on the outside the location of the coin, or it may be overlooked. If you cannot get this kind of paper, cut a hole in a piece of card or pasteboard, and insert the coin, then paste a piece of paper on both sides of the coin to hold it in place. The first plan is very simple, and it is an easy matter to keep some of

the packing-paper in a convenient place, where it will be ready at all times for use.

Those who have troublesome cases of tonsillitis will be interested in the articles in the March number of THE COUNCIL by Dr. Lindsy on page 91, and by Dr. Bunnell on page 93, and the article on page 121. These articles have come in a very opportune time.

You need not be afraid to use ammonium chloride, page 100, first, last, and all the time in some cases of pneumonia. Sometimes I have cases in which I regard it as the sheet-anchor.

Those who have kept up with Dr. Leuf's article on "Disorders of the Sexual Function," page 100, and who have read his other works, will be glad when he has completed this series and published it in book form.

It is well for all of us to "read up occasionally on abortion, and you will find nothing new better than Dr. Claiborne's paper on page 105. Some women die of hemorrhage, as did his case, in spite of all that can be done. In such cases look for disease of the kidneys. It is possible you may there find the cause of the hemorrhage.

Dr. Webster, page 114, strikes the keynote on chronic constipation. A regular time and an immediate answer to Nature's calls will cure most cases.

The answers to "Battling of Questions for Young Physicians" have interested me greatly. It is well for young and old to study to be able to give a satisfactory answer to all questions that may be asked. Sometimes much depends on a ready reply to even a silly question. In all cases try to be perfectly respectful in your answers.

A plaster splint or dressing for a compound fracture, page 117, is all right if you will make an opening over the wound. Why are plaster dressings so seldom used?

The suggestion, page 118, that every practitioner qualify himself in some particular branch is a wise one, and every doctor young and old should consider it.

Cancer and malaria can and sometimes do go "hand-in-hand" in hurrying a patient to the grave, page 90. Malaria

hastens rather than retards the visit of the dark angel. Malaria can "mix" with every disease that we can have, and still the disease can go on "to perfection" regardless of the malarial trouble. There are few if any diseases that are not made worse instead of better by malaria.

Repairing the perineum in country practice is easy, and the after-treatment no trouble, if the flap operation is done instead of the paring plan, page 92. It can be done in one-fourth the time required to do the paring operation, and the after-treatment will almost take care of itself. Any country doctor ought to be able to do this operation; he will not often fail to make a success of it if he will exercise even ordinary care.

There are many good things in the March number of THE COUNCIL, as there are in all other numbers, but I cannot notice all. If calling attention to some of these good things causes some doctor to go back and re-read his back numbers, my suggestions will not be altogether "wasted on the desert air."

Triplets with Unequal Arrest of
Development.

TO THE MEDICAL COUNCIL :

I desire to report a peculiar case, the like of which I never saw before, deeming it both interesting and worthy of record. I was called to see Mrs. P. on the 12th of March last, and found her in charge of a neighboring woman, who informed me that she had, four hours before, given birth to a dead child, which had been followed by the afterbirth, but that something was still wrong, as she had continued in hard labor pains ever since. Placing my hand upon the patient's abdomen, I noticed its largeness, and remarked "Twins." She suggested, however, that I examine the patient more carefully, as there was something unusual, "a big bunch the size of your cap, soft,

and so that it cannot be taken hold of." As she said, this could not be grasped, but with the help of a single forceps blade I was enabled, within a few minutes, to

bring it within handy reach, when I removed it. It was immediately followed by a live child, at full term, but poorly nourished, which lived only a few hours. This came away at the end of twelve minutes after my first manipulations, but there was still another chapter, consisting of the prompt extrusion of a dead fetus of five or six months' growth, with hydrocephalus and minus a cranium; in other words, an anencephalous monster. This was already partly decomposed. It was followed by a large blood clot and amniotic fluid, containing a five or six weeks' embryo.

I should like to ask whether this was a conception of triplets, or were there three different conceptions?

The mother made a good recovery.
S. L. KNEPPER, M. D.

Conklin, Mich.

[This was, in all probability, a case of triplets with arrested development in two, one much earlier than the other. Superfetation is possible, but not at such intervals as stated in this case. Under such circumstances, they may be two, and possibly three, months between the oldest and the youngest child, but in this case even the older of the two deficients was probably more than three months under time. We incline, therefore, to the opinion that all three were conceived at the same time, and arrested in their growth from some of the causes that may contribute to this end. It would be interesting to know the physical condition of the mother, with a view to determining whether defective nourishment may have caused the arrest of

development, first in one, and later in the other. Also, whether the five or six weeks' embryo was not also seriously defective as was the anencephalus. This would explain, possibly, why there was a selective nutritional diversion to the fullterm fetus. It would also be interesting to learn whether the mother had any syphilitic taint.-ED.]

An Unusual Recovery.

TO THE MEdical CounCIL :

That tuberculosis is a curable disease is no longer a tenet requiring defence or clinical evidence. The following case is presented rather to illustrate the ease and rapidity of recovery, without the aid of climatic treatment; in fact, change of location during the time of treatment was rather adverse than favorable, the patient having been removed from a country home on Long Island to the densely populated borough of Manhattan.

E. H., unmarried girl of 17 years; servant; father died of tuberculosis two years before; patient had severe attack of influenza in November, 1901, for which she neglected treatment; tuberculosis developed during prolonged convalescence, with apical foci in both lungs. Hard work, exposure and neglect contributed to a rapid development of cavities in upper lobe of each lung. She had been under short treatment by several local physicians, who diagnosed acute tuberculosis, and gave no hope of recovery. Bacilli crowded sputum.

January 18, 1902: Examination gives record of suppressed menstruation; severe cough; characteristic expectoration; anorexia; great physical weakness; evening hectic; evening temperature, 102° F.; pulse, 120; extreme nervousness and irritability; insomnia (chiefly due to racking cough); severe night sweats; voice reduced almost to whisper from laryngeal implication; cold, clammy extremities; and all physical signs of rapid breaking down of the affected lung tissue. No microscopic examination of expectoration and none needed both on account of former examination and as the pathology of these cases is as plainly indicated by the "clinical picture to the naked eye" as a carbuncle on the surface. Until recent years the prognosis has been equally positive.

I commenced treatment by removing the patient from her untoward conditions to a hospital regimen in New York, under my constant observation. She was placed on a diet rich in proteids, and I gave her a prescribed amount of marrow

from beef bones daily. For several weeks complete rest was enjoined. The medicinal treatment was very simple. For the cough, Lobelia, F. E., gtt. x, night and morning, for a few days and later in gtt. iij doses as needed. For systemic treatment she was placed on Bioplasm (Bower) grs. x, after each meal and at bedtime. This was continued until January 28th, when it was suspended for three days.

January 28, 1902: At this time (10 days of treatment) she could sleep from

10 to 12 hours without disturbance from cough. There was 4 pounds gain in weight, her appetite had returned and the "clinical picture" was greatly improved. Bioplasm was resumed in the same dosage and continued. On February 9th the menses returned with some distress, which was relieved by Hayden's Viburnum comp. fl.drm. j; evening temperature, 100.4° F.; pulse, 105.

Her

February 22, 1902: Had now been under treatment precisely five weeks. I had several physicians join me in an examination, and we were united in declaring the patient recovered, with cicatricial spots in both upper lobes. temperature was normal and pulse 80-90. It is true that relapse would be imminent on exposure, and that her resistance was at low degree, but at this time she presented not a symptom of disease. What constitutes recovery? Does it involve a return to the former physical standard— with former resistive powers-without added predisposition acquired by the attack? If so, then all clinical data should have the recovery column stricken out. On February 22d, or after five weeks of treatment, my consumptive patient was wholly free from cough, nervousness all gone, voice had returned, catamenia reestablished, had been free from nightsweats after the first week, has had no hectic for over three weeks, appetite excellent, has gained over fifteen pounds in weight, hopefulness and ambition returned; in other words, she has been metamorphosed from a broken-down physical degenerate into a beautiful, active, ambitious young woman. All this without the aid of a "high, dry, ozonic

climate," or any assistance from the mountains. I shall continue treatment with Bioplasm, and a careful regulation of diet, clothing, and exercise, but previous experience with similar cases (and this is not an exceptional case, except in rapidity of cure), leads me to ignore any danger from relapse, except that which comes from the universal rule of additional predisposition as an inherent weakness after every pathologic storm.

What cured the patient? All the features of treatment I consider necessary, but the results obtained, I am frank to state, I believe could not have been secured without the organo-therapy. The systemic response to it was so plain and positive that it indicated it as the basic element in the treatment of the case.

Later examination, March 23d: Weight at this writing shows a gain of twentythree pounds. All signs of complete recovery confirmed. Energy and endurance equal to her best days, before the attack of influenza. No irritation at cicatricial spots. She also stood an exposure to a cold, drizzling rain while out walking, which soaked her clothing, and proved a shock to her, but without affecting the lungs or resulting in cough or any subsequent ill effect.

I must confess an inability to point out a rational theory of therapeutic action in this case, as I have found no predilection of this enzymic remedy for any definite pathology. In fact, my best average results with it have been in the neuroses, where sub-vitality and mal-nutrition were paramount indications.

achieved in the past few months, there will be permanently added to our therapeutic resources another powerful element in protecting the human family against disease.-ED.]

The Enema.

TO THE MEDICAL COUNCIL:

Without a syringe in my satchel I should regard myself as almost unfit to meet the emergencies of medical practice. In thirteen years I have never regretted giving a rectal injection. Many a time if I had not had a syringe with me I should have lost my little patient with convulsions. A high rectal injection is often helpful in menstrual pain. It also removes an accumulation that in any fever sets up an autointoxication if alThe lowed to remain in the bowels. negligence of all the most culpable in everyday medical practice is to prescribe and go away without attending to a required enema.

To leave orders with an untrained nurse as to an enema is a dangerous piece of carelessness. That which an enema brings away may be a deadly poison to the patient, particularly in a fever. There are some things so simple and commonplace that a mind wandering in the higher realms of science is apt to overlook them. So it is as to the enema. To give it is not an elegant task by any means, and if a physician gets too nice to attend to such a duty personally, he has in one. respect transcended the realm of usefulC. E. BOYNTON, M. D.

ness.

Los Banos, Cal.