No abuse is too severe for simulation. Nauseous doses, severe cathartics, threats of cauterization if recovery does not ensue within a certain time, are often efficient. In true hysteria no study and thought is too deep.

Treatment of Bunions,

Much more can be done for this painful affection than most textbooks mention or physicians practise. In the early stages, before the bony structures have become deformed, the soft parts may be brought to their normal healthy condition, and even extensiv osseous change may be remedied without operation. A shoe with a straight inside border and rounded toes, which will be roomy enuf to give free play to the foot, is a necessity. The deformed toes may be drawn inward by passing a strap of adhesiv plaster between the first and second toes, around the phalanges of the first and then carrying it along the inner border of the foot and around the heel to the center of the outer side, where it is held in place by circular bandages around the foot. Cotton wool pledgets are worn between the first two toes. Pockets may be made for the first toe and for the heel, and then attacht by a strip of elastic along the inner side of the foot. Metal sole plates and "bunion springs" are of service in many cases, and may be obtained from any instrument dealer. If the case has not passed beyond the primary stages of effusion and thickening, it may be treated by repeated applications of mild blistering agents, like tincture of iodin, fly blisters, or nitrat of silver (a dram to the ounce). A wet dressing of lead water and laudanum makes one of the best agents to reduce inflammation and relieve pain. Frequent hot foot baths aid any of the treatments greatly.

If the case fails to yield to warmth, constant elevation of the foot and the above measures, operation may be considered. The confinement incidental to the operation is its worst objection, as it is generally successful if properly done.

passionate desires, many couples, of whom one or both are consumptiv, coax pregnancy.

While it is true that in many instances Nature suspends the dread doom for the sake of the unborn child until after delivery, it is also true that frequently before the accouchement two lives pay the penalty demanded of ignorance and lust since the world began, and that even if the "great white scourge" be temporarily checkt, the penalty is soon demanded with interest compounded-and what does that mean? shortened life for the mother, and a defectiv child thrown upon the mercy of its friends and the charity and expense of

the state.

It is now an establisht fact that neither father nor mother can transmit tuberculosis to their children; but that, tuberculosis existing in either parent in activ or latent form, the offspring have an acquired tendency toward the disease; hence, those predisposed to tuberculosis before marriage should not marry, and those who are married should avoid conception. "Labor is generally rapid and easy in the phthisical, but does not fail, nevertheless, to augment the weakness of constitution, vitally impaired, and to increase the congestiv dyspnea on the part of the lungs " (Gaillard). Even if the wife, who is predisposed to tuberculosis by reason of heredity, has never developt the disease, may we not assume that the repeated miscarriages, labors, and lactations would exert a strain which must aggravate Nature in a certain period? The sword is two edged, for it strikes both mother and child; it cuts on both upward and downward stroke, for it destroys lives and burdens the state.

Relief from legislation seems well nigh hopeless. Let the WORLD family do what they can to discourage the marriage of any who have the tubercular diathesis. The doctor may often speak when the father and mother and pastor cannot. Gentle, professional, friendly, advice may do much to help both individuals and humanity. Every practician must know his duty, and if it were but done, the plague would almost vanish, unaided by bacteri

absorbed with moral and sexual suggestions.

mouth for foreign bodies, and place the patient Never neglect to auscult the heart, examin the

in the dorsal decubitus before starting an anesthetic.

Just a Reminder for You.

Our forms close on the 12th of each month; that is, if you want an article publisht or a query answered in the December issue, you must get it in our hands before the 12th of November. Many are disappointed because of tardiness or forgetfulness of this rule, and many valuable articles are either held over a month or are entirely unavailable. We must now get into winter work. Recall your successes and failures of last winter and report tersely. What was your proportion of deaths in lobar pneumonia and how many cases did you have? How do you "break up" an incipient cold ?-do not give a long article on this; just give your prescriptions and directions in a few lines. Do you poultice the chest of a child in pneumonia? and if so, why, and what do you use? What is your favorit counter irritant? Have you lookt up the new remedies for coughs and colds which have come out in the last few years? or are you following the rut your grandfathers tripped in? The man who is satisfied to take unquestioned what is told him by those who consider themselves authority will never advance himself, his profession, or the world. You must not only study, but you must work, and you ought to write if you wish to derive the fullest possible benefit from your endeavors. Do not attempt to teach that about which you yourself know nothing, for it is well said that "You can not help another higher than you stand yourself." Do not forget what you learned thru the summer and fall, but store it away and digest it well so that you may give it to THE WORLD in condenst and assimilable form next spring. The right thing in the wrong place is pathetic as well as ludicrous. Now for the winter: keep THE WORLD warm with interesting and valuable articles.

Black-list in Rock Island and Moline, Illinois,

The physicians of Moline held another meeting, September 9, to complete their plans for the compiling of a blacklist. Nearly all present submitted lists of people considered dead-beats, and the others are to hand in their lists soon. These names will be arranged in proper form and each physician in Moline and Rock Island will be furnisht a copy.

This is good work. Whoever renders a valuable service should be faithfully rewarded for it; but some people think that doctors are an exception to this rule. Wonder if they think that doctors can live on air? If they think so, or if they are in the habit of neglecting or evading doctors' bills, they should speedily be convinced of their error. In this connection, what shall we say of the doctor who neglects to pay his subscription to medical journals that are rendering extremely

valuable service to him? Shall we "black-list" doctors that get in arrears, and neglect every bill or letter sent to them? Can medical journalists "live on air" and pay the printer besides? Let us all live square, whether laymen, doctors, or medical journalists.

Don't neglect your bed-ridden patients. Insist upon frequent change of posture, clean linens, alcohol baths, massage and a nutritious diet.

ORIGINAL COMMUNICATIONS

Short stories 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 Ma 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 anything else.-BUSKIN. READ. REFLECT. COMPARE. RECORD

Experience With Diphtheria Antitoxin. Editor MEDICAL WORLD:-In October WORLD, page 427, Dr. O'Ready wants to know the truth about diphtheria antitoxin; and as I have had considerable experience with it, I will offer a reply, which will not be based on scientific research, but on experience with it.

I left college an ardent supporter of diphtheria antitoxin, because our professor of diseases of children, Dr. J. H. Taylor, of Indianapolis, found it to be the best treatment for diphtheria. I soon located in a small town in Southern Indiana, where I bought the practise (?) of Dr. J. W., who in course of conversation told me of his cases of diphtheria, and remarkt that they were of the most malignant form, and that he had lost a great many cases. I askt if he used antitoxin. He answered: "No! Well, I used it on a few cases, but they all died, so I quit using it." I soon learned by report that most of his cases did die. One layman remarkt that when Dr. J. W. diagnosed diphtheria, they always sent the measurements to the undertaker.

I saw no cases of diphtheria until the next winter, when a case developt in a boy four years old in the practise of another doctor, who would no use antitoxin, or allow it to be used if he could prevent, by telling of its "deleterious effects,' and "horrible results," etc. However, as the case continued to grow worse, this doctor was discharged and Dr. M. L. Arthur was called. I saw the case with him. We advised antitoxin. Family objected on the grounds that it was either kill or cure," left child in bad condition, etc. However, seeing that it was the only chance, they agreed, and 1,000 units were injected one afternoon with the happy result of noticeable improvement in child's condition next

66

morning. In forty-eight hours membrane was gone, temperature normal and child made recovery.

Altho I did not keep an accurate record of my cases, I recall that diphtheria was quite prevalent, and that I treated quite a number of cases in the three years I remained there, in all of which I used 1,000 units of diphtheria antitoxin just as soon as the diagnosis was made, and without exception in from twelve to forty-eight hours the membrane was gone, temperature normal, and recovery followed. Some may say, as has been said, that the disease had lost its virulence; was not in such malignant form, etc. Possibly that is true, but let me report two cases that occurred in the practise of the aforesaid doctor.

Case 1: A child eighteen months old, developt diphtheria and was treated for two weeks; then developt suppurativ parotiditis which was lanced, which remained a fistulous opening until death, about two months later, of post diphtheritic paralysis.

Case 2: A young man, age 19, attending town school, came into our office one morning with burning fever and sore throat. Dr. M. L. Arthur made the diag. nosis of diphtheria. I saw the case and confirmed the the diagnosis. Dr. Arthur advised antitoxin. Young man declined, saying that he would go home and let "Uncle Doc." treat the case, which he did, for five days, until he was a corpse. And when a few days later his father came into our office, with his eyes filled with tears, and remarkt, "Oh, if he had only let you use the antitoxin," I could hardly refrain from saying what was uppermost in my mind: he would be alive and well today.

In my opinion, antitoxin bears the same relation to the toxin of diphtheria that water does to fire; when the two are brought in contact the water overcomes the fire, renders it inert, but cannot repair the damage done. So the antitoxin renders the toxin inert, but cannot repair the damage done to the cells. And as we use water early to prevent damage, so we should use antitoxin early to prevent damage to the cells.

In no case have I had to repeat the injection, which should be done in twentyfour hours if there is no improvement, or if the spreading of membrane has not stopt. As to the reported bad results fol

lowing its use, I have never seen any. Have used it several times to immunize children in the same family, without the slightest ill effect. Have never seen diphtheria develop in a child that had an immunizing injection. Have also used antitoxin with good effects late in scarlet fever, when throat symptoms were alarming. Of course these cases were complicated by the Klebs-Loeffler bacillus.

Other treatments may be as good so far as the ultimate result, saving life, is concerned, yet so far as I know, none of them will shorten the course of the disease as much as diphtheria antitoxin, which is quite a desideratum. Hazleton, Ind. H. M. ARTHUR,

Experience Both With and Without Antitoxin.

Editor MEDICAL WORLD:-The paper by James O'Ready, M.D., in the October WORLD suggests the following:

My experience of about forty years, thirty-five of which have been spent in this city, has led me to believe that the Doctor's treatment is most excellent. In the New York Medical Record, for March 18, 1876, was publisht a paper by Dr. C. E. Billington, giving a treatment which he claimed to have found most remarkably successful. At that time I was at sea in regard to the treatment of that dread disease, having lost three cases in one family which I attended with a consultant from St. Louis. Since that time I have followed substantially the Billington treatment with such modifications as each case

might require; and with such success that when antitoxin was introduced to the profession I could say with truth that the Billington treatment gave a larger percentage of cures than was claimed for antitoxin. And yet I adopted antitoxin in connection with the Billington treatment as soon as I had an opportunity after it came upon the market.

When called to a case I wrote three prescriptions:

Directioned to keep up the medicins day and night without fail.

Of course, in particular cases I used other means, such as chlorin water, peroxid of hydrogen, alcohol, etc., locally, but the use of the three prescriptions was never stopt. For some years I have not used the chlorate of potash prescription (No. 2) and find the results just as good. Now I use the same treatment in conjunction with antitoxin, with this difference: I do not give nearly as much medicin, and I allow the patient to sleep one or two or more hours at night without awakening him to give medicin.

The point I want to emphasize is this: Under the Billington treatment alone cases required from four to five weeks sometimes before the last patch of membrane disappeared, while under the use of antitoxin the membrane would begin to melt away by the second or third day, and would disappear entirely within one week.

One case I will relate: The patient had been sick a week when I was called in. Saw E. T., a girl of nine years, at 10 p.m. Fauces completely covered with thick, firm, yellow membrane, the uvula as large as my finger, a hard inelastic mass completely filling the opening of the fauces. She could not sleep, as she would immediately choke on losing consciousness. It being Sunday night, I could not get antitoxin until 3 a.m. of the 3d, when I injected 1,000 units all I could get. In twelve hours I injected 1,500 units, and the next day 1,500 more. It was at this last injection that the father, despairing of her life, begged of me not to worry her any more and to let her die in peace. Suffice it to say that, at my last visit on the 8th, just six days from the beginning of treatment, there was not the smallest shred of membrane to be seen, and I dismist the case.

Now, cases similar to this, many of which I had before the advent of antitoxin, required from three to four or five weeks before the last patch disappeared; and during all this time there was anxiety, as occasionally I would find on my morning visit that, instead of receding, the membrane was advancing; and then I instituted more vigorous treatment.

I have had the good fortune never to have lost a case in which I have used autitoxin; and I must say that with the Billington treatment alone I have been

successful in some very bad cases, even when the membrane had invaded the larynx. In my early cases, twenty-five years ago, I used alcohol as a stimulant in accordance with the advice of Dr. Chapman, of the Long Island College Hospital; but of late years I never use whisky or brandy, as I could never see that they did the slightest good. I could give experience to show that paralysis and urticaria follow cases in which antitoxin has not been used; but I once treated two cases in the same family, one with antitoxin, the other without, and both had urticaria. Webster Grove Sta., St. Louis, Mo. B. J. BRISTOL.

Mostly Theories, and Those Not Well ] Founded.

Editor MEDICAL WORLD:-If it pleases you, will you kindly publish the following inquiries that some of your subscribers may answer them?

1. Has horse serum, previous to its being incorporated with its keeper (carbolic acid, etc.), been used in order to prove that it is "it" (the serum pure) that cures diphtheria? Others and I have used "phenic acid " alone in this disease, and our cures have been as effectual as with the antitoxin of the market. 2. Since one of our good" men has proved recently that sanitary measures have worked better in one of our largest cities to prevent smallpox than vaccination, would it not be advisable to stop compulsory vaccination and give hygiene a test in each and every locality of our land where smallpox breaks out?

3. Where can we find a "reasonable" reason to make surgically aseptic a local area where we inject " polluted" matter?

4. Since our best authorities of today tell us that micro-organisms have no effect upon our economy until the latter is weakened to the point where the former have their deadly influence set free, is our therapeutic adjunct in correspondence with the above theory? What would result if instead all sorts of antipyretics and antiseptics we generally use we tried to strengthen the backbone (vitality) of the patient?

5. Our physiologists of this century teach us that life is the result of the activity of the cells. But where does the "force" lie that puts the cells into activity? And when that "force " is at fault, are all the cells deranged? or but one 66 organ "? Are we (in disease) to treat

6. Since in mostly all skin diseases we see an effort of nature to throw out any deadly element present in the economy, will any one give a scientific reason for using external adjuncts to dry up the 66 abnormal excretions?

7. Our drugs have been physiologically tried upon the healthy cells to know of their virtues, be they chemical or mechanical; and have been tried "singly ;" but do we have laboratory experiments to demonstrate the action of 66 mixtures as a whole upon the healthy and the sick, and of single remedies when incorporated with half a dozen or more? Are we merely empirical in our practise? Is this medical age one of facts or one of delusions? Is polypharmacy a science?

8. We beg to set here a corollary to Question 4: Since we admit that contagion develops only in those predisposed to it, that is, in those whose vitality is lowered, in whom primarily there is disorder, derangement (not pathological yet), the germ development must be "a result and not a cause." And, while the primary (disorder) and secondary (malnutrition, either general or local) conditions continue, is it possible to kill off the germicidal influence? Must we not say that susceptibility is the etiological factor in infectious diseases, and bacteria the sequelae? Now, are we to treat the patient, his state of disorder and malnutrition, in order to cure him? or shall we simply direct our attention to the microbes ?

9. Since after the death of the body bacteria develop subsequently to the formation of an alkaloidal ptomain poison, has any of our brethren proven the reverse to be true during life?

10. Is not pure blood the best germicidal agent on earth? Is it good policy to bring down the temperature in fevers when the germs are present since, as Abbott says, bacteria will grow and develop most favorably when the temperature is slightly above the normal, and become inactive as soon as the thermometer registers three, four or five degrees above normal temper

ature? We take exception to what is called the danger point. Then, if we must not stop heat, can we not take it awaywhen it reaches the danger point-by stimulating mechanically the sweat centers? Can we not increase the number of white corpuscles by stimulating the lymphatic system, thus aiding nature in killing the germs and removing their products?

11. Is serumtherapy based upon the "contraria" or the "similia" principle? R. DEL MAS, Ph.D., M.D.

Centreville, Minn. (Marquis of Villena.) ▼ [Marquis, give us your experience, not in general, but specifically, by a recital of a number of cases, with phenic acid injections in diphtheria. As noted in our October issue, pages 414 and 427, the value of diphtheritic antitoxin is now beyond question. See the latest editions of works by our highest authorities. This conclusion was reacht by extensive bed-side experience on the part of many observers. You cannot controvert a conclusion so

reacht, by vague generalities nor by theories. Send us your actual experience and the facts brought out by the same, but touch a little more lightly on theory. The way in which antitoxins act is well known to all who have studied this subject, and has been given many times in these pages.

In regard to sanitary measures vs. vaccination, you doubtless refer to the experience of Cleveland. Early in September I met a prominent city official of Cleveland and his wife. Upon inquiring how the children were they told me they were all at home, having recently been vaccinated; that smallpox was already on the increase, threatening a worse visitation than ever this winter, and that vaccination was being done very extensivly.

Space is given to the above article in order to illustrate a certain class of theorists. The writer is not a typical WORLD reader. The ideal doctor is one who studies carefully the recognized authorities; and while keeping ever in touch with them, also reaches out into the so-called "irregular" fields of medical thought. So much for studying. And when he reaches the bed-side, he will do all in his power, all in his knowledge thus gained by wide and unprejudiced study, to cure his patient. It must be recognized that the "highest authorities" are honest men, with large experience and ample opportunities for observation, and they are as anxious as anybody else to cure patients. They have