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tutional symptoms; while smallpox is a sys- ity, that had not been quarantined. It makes temic disease, and does produce constitutional no difference what name we call the disease, symptoms.

the condition remains the same. It is a loathBoth diseases are contagious. Pemphigus is some, contagious disease, and should be quarinoculable in person affected. That is, by antined. If it is smallpox, the law says to rupturing a vesicle and inoculating an unaf- quarantine it. If it is pemphigus, the health fected area in same person, identical lesions laws should be made to cover it, and every will be produced in from 8 to 24 hours. case quarantined. The most severe case of Smallpox is not inoculable in person affected. smallpox I ever saw was contracted from a

Incubation period in pemphigus is from man that had it in such light form that he did eight hours to few days; in smallpox, from 9 not quit work.

H. M ARTHUR. to 17 days, or possibly 21 days.

Hazleton, Ind. Dr John S. Windesch (Journ. A. M. A., Jan. 13, 1900), in his study of pemphigus as it occurred in soldiers of the Spanish-American

Inflammation of Ear as a Result of Measles. war says: “There was no fever that could be Editor MEDICAL WORLD :-Having recently attributed to the disease."

Dr. Ross says

passed thru the most extensiv and severe epithere is no secondary fever, yet in his report demic of measles we have ever seen, and havof the affection in a lady, he shows that she ing had a large number of cases of middle ear had temperature 103, pulse 105, and general inflammation as a complication, I thought condition unsatisfactory, etc., one week after perhaps a few words on that subject might the onset. I don't see how he accounts for this interest the family. fever and the general conditions, unless he ac- These complications are usually light and cept his predecessor's diagnosis of grip, and progress to a perfect recovery; but some of considers the eruption and fever as distinct them become serious, and either produce death and separate affections.

or leave very serious defects. Dr. Ross does not give exact dates, but it Acute otitis media, either catarrhal or puruseems to me that the incubation period (two lent, may occur at any time during the course weeks) from time his first patient came from of an attack of measles, but generally during Medina to Cato, is too long for pemphigus. the febril stage. The catarrhal form usually His wife could have taken the disease from occurs with light attacks, but the reverse may him at any time thereafter, as, also, could be true. The discharge is usually turbid from baby have taken it from either of them at any the presence of epithelial cells, and viscid time, but the incubation period being about from the admixture of mucus. two weeks in each case, is very suggestiv of The purulent form is generally more severe, smallpox. Also the invasion by grip symp- and often results in the destruction of the ossitoms, followed by eruption in about four days, cles and tympanic walls. with decline of temperature and general im- The catarrhal cases are characterized by provement, and relapse in about one week pain, varying in character from a dull ache to from onset. However, I do not presume to one that is sharp and lancinating; little or no change his diagnosis in cases that he has made rise in temperature; the power of hearing is a study of.

diminisht. He says he vaccinated two cases after onset, In purulent cases the pain is more intense, but did not influence the disease. According often excruciating in character ; temperature to German authorities, which are the best we rises to 103° or 104°; vertigo, tinnitus, headhave on vaccination, a successful vaccination ache and anorexia. This continues until the on or before the third day after exposure will appearance of the discharge, when the above prevent smallpox; on the fourth day, will symptoms abate and the patient falls into a favorably influence it; on the fifth day, or quiet sleep. thereafter, will not influence the disease.

In severe cases the inflammation may extend So far as I know, umbilication is always into the mastoid, filling the antrum with pus, present in smallpox when vesicles and pus- and causing bone destruction from caries. The tules rupture and dry up; but it might be con- temperature in these cases shows some increase, cealed by dried crusts.

and the pain becomes more severe and more Very few cases of smallpox are followed by generally distributed over that side of the pitting. Remember Sydenham's statement: head. The discharge diminishes in quantity; * It is very rarely the case that distinct small- there is tenderness over the antrum ; that is, at pox leaves its mark.” We have had several the attachment of the auricle close to the cases of smallpox here in the last three years, superior wall of the external auditory canal. and the origin of every case could be traced to If there is a perforation of the mastoid cortex

socalled smallpox" in some other local. there is fluctuation. There is invariably preswill appear.

some

ent a markt swelling or bulging of the pos- The discharge, which is usually serous at terior canal wall.

first, may become purulent, when the process In one infant under my observation the pus above outlined should be repeated every four made its way thru the Rivinian segment and hours, and a saturated solution of boric acid, gave rise to a post auricular swelling, making or 1 to 5,000 or 1 to 10,000 bichlorid soluthe ear project out more prominently.

tion, should take the place of the steril water. A perforation may take place on the internal When the painful symptoms have stopt, insurface of the mastoid, and a swelling extend flation after the Politzer method should be along the sterno-cleido-mastoid muscle. Or practised to get rid of pus and prevent adhethe pus may pass to the cerebrum or cere- sions. bellum, and meningitis result.

When the discharge becomes slight, the use In examining an adult I pull the auricle of powders, such as boric acid, iodoform, upward, backward, and outward, in order to

etc., may be used to good advantage. If the straighten the canal. In children the canal is condition become chronic, employ astringents, already straight, and the drum membrane is with a swab, or in the form of drops. Cauterize easily inspected.

granulations, remove polypi, and the case will There is almost always in otitis media a con

get well.

D. C. SUMMERS, M.D. gested condition of the membrana tympani, but Elm Springs, Ark. we must not be deceived if the membrane is a [The proof of this article was submitted to dead white color, due to a necrosis of the the eminent aurist, Dr. E. B. Gleason, of this superficial epithelium. This may be wiped city, who says that the advice to pack the away with a cotton swab, when the redness auditory canal is dangerous, as it frequently is

packt too tightly, daming the discharges back, The relief of pain is a very important part of which may cause mastoiditis. He sometimes the treatment of such cases, for which try the packs the auditory canal, loosely, but in consulmilder remedies, such as dry, hot applications, tation he never recommends it any more, as phenacetin and codein, or acetanilid. Gly- his experience has been that the ear sooner or cerin, with 5 to 10 percent carbolic acid, later will be packt too tightly, by an inexper. applied on cotton to the drum membrane, willienced operator, and mischief is done. He has often afford a very great amount of relief. All had several instances of this, in spite of the this failing, I resort to hypodermic use of the most careful and painstaking explanation as to king of all pain conquerors, morphin. Watery the proper method of packing.-ED.] solutions of cocain, morphin, and atropin are worthless, and oily mixtures cannot be too

Should Doctors Charge Clergymen ? strongly condemned. If the attack is not aborted, and the hyper- ground can it be affirmed that doctors should

Editor MEDICAL WORLD:~Upon no rational emia increases, the membrane loses its luster and bulging of the membrane takes place. It

not charge clergymen, except that of expedshould not be allowed to rupture sponta- iency, in the hope of obtaining their influence neously, but should be incised without delay.

in their congregations. Clergymen know this The canal should be rendered thoroly anti

and trade upon it, and most doctors do not septic by irrigation with bichlorid solution, i

charge them for this very reason ; for if they to 5,000, or by mopping well with peroxid of did, in most cases, one way or another, that hydrogen. Then, with a good light and a

influence would be used against them. With straight, narrow knife, incise thru the bulging exceptions of course, clergymen are in the portion. The knife should be very sharp, and

church as a profession, often a refuge for the should pass thru the membrane by its own

destitute, and are just as keen after the dollar weight. At the same time the mucous mem

or in taking opportunities of obtaining what brane of the internal tympanic wall should be they want without paying, as other people;

and it is certain that in many cases they do freely incised, for its depleting effect. If the membrane has ruptured spontaneously

take advantage of their “cloth” to accomand the opening is not sufficient to allow free plish this, of which I have seen instances drainage, it should be freely incised. Cocain

characterized by an amount of cheek which anesthesia is unsatisfactory; a general anes

might stagger the proverbial army mule. They thetic should be used. After the operation,

are no more entitled to our gratuitous services irrigate, pack lightly with steril gauze, put pad

than other persons, to whom, when worthy of of cotton over ear, and leave alone for twenty

our charity, they are given. four hours, letting the patient lie on the

J. FITZ-MATHEW, M.D. affected side. Then remove, irrigate, and re

West Sound, Washington. pack, repeating each day until it heals, which

A poultice of grated, cold, raw potato, frequently will generally be only a few days.

changed, is of pronounced benefit in quinsy.

Let the Preachers Pay.

the custom thus begun has been kept up, partly DEAR “JIM":-In reply to your letter on because it was custom, and partly because the page 143, April WORLD, I would say that your clergyman and physician being so often thrown idea of getting at least half price from the together in charity work, this part of the clerclergy is right, and I hope that this discussion gyman's work was seen and appreciated by the may arouse our overworkt and underpaid physician, and vice versa, the clergymen adbrethren to the importance of this subject. miring and appreciating the work of the physiWhat earthly right has a man who gets $1,800 cian in behalf of charity, the two very often to $3,000 per annum (and usually his home becoming firm friends. free) to expect a physician to do his work free? However, the conditions now are much difWhy does this foolish custom prevail ? Who ferent. The clergymen and physician meet started it? Where is the common sense or less and less often in the work of charity, as justice in it? Let's quit such nonsense. In that branch of church work is more under the the first place, it is not best for the preacher ; charge of societies organized for that purpose. it certainly does not increase his self respect. The clergyman is not now dependent upon It is not fair to our other patients. It is not the charity of the people for his living, but fair to our families. Let us quit in the interest receives a stated salary, which is often larger of all parties concerned. The best preachers than the income of the physician who is giving I have known in the past have paid their doc- him his services. He pays for everything else tor's bills. May their tribe increase.” Of which he gets at the same rate as any other course there are some men in the ministry who citizen, with the possible exception of railroad can not pay a physician. They are preaching fare, which is given him yet by most railroads for poor country churches, or perhaps doing at half rate, but the sentiment is growing in missionary work. They may always count on railway circles that this half fare should be us to do anything possible for them. But the abolisht. Clergymen are recognizing the fact well paid, well fed, well housed preacher that under present conditions the receiving of should pay just like other men. Why not? these things puts them in a false position, and We all like the good men who devote their are asking to be relieved from it. lives to the ministry. They are usually very I shall always remember an instance which lovable characters. We honor them very

happened when I first began the practise of much, and believe in paying them (also believe medicin. I was treating the family of a clerthey should pay us). J. ČALHOUN WHITE. gyman who has an international reputation, Atlanta, Ga.

not only as a clergyman, but also as a teacher

and lecturer. He came into my office one Should Clergymen and Their Families be day and askt the amount of his bill. told Treated Free of charge ?

him it was customary in our profession to give Editor MEDICAL WORLD :-It has been the our services to members of his profession. He custom, I think, in this country, from the said: “Doctor, I have always received my earliest times to within recent years, not to salary and paid my bills, and please God, I charge clergymen for professional services ren- always will. I want to live on the same busidered themselves or their immediate families, ness level with my fellows, and then I believe and it can be readily seen, I think, how the I can do better work among them. Now, custom came.

Doctor, do not pauperize the clergy. You will The clergymen of the early settlement had find that we do not like it and do not want it. no luxuriant church in which to preach, he had Charge us the same as you do anyone." And no steam-heated house in which to live, no he insisted upon paying me for my services at railroad, or trolley, or auto to take him from my regular rate. I have since talkt with a place to place. He could not afford to travel good many clergymen on this subject, and find from Boston to San Francisco to attend a con- a growing sentiment of this kind among them. ference; but usually he was an earnest Chris- Therefore, I believe that in time this question tian, a faithful, humble worker, who did his will solve itself in the right way, and to the best with means at hand. His salary was nil; satisfaction of both professions. but his work was large and constantly toward The reform will be gradual, however, and in the end that his fellows might be bettered. the meantime we may each do something, perAltho his salary was lacking in money, his haps, to hasten it. My own custom, at pres. wants were freely and cheerfully supplied, each ent, is to charge the clergy half rates for medical giving of his store. The physician, having but attendance, and for obstetrical and surgical little more, gave his services.

cases full rates, or as we would arrange at the These conditions were being constantly re- time. When a clergyman employs me for the peated wherever a new settlement was started first time, I have a pleasant, explanatory talk as the frontier advanced into the West. And with him on the subject, and if I find that he

gr. 24 gr. 68 . gr. 48

has never been in the habit of paying anything Charging Clergymen.-Acetanilid Mixture. for medical services, I explain to him that Editor MEDICAL WORLD :-I see in April where I live and do business a physician and World that “ Jim" wants to know about charghis family is not only expected to, but is will- ing clergymen and their families for services. ing to, contribute liberally to the clergyman's Well, there is but one way which is business salary, to the support of the church, and to be and at the same time free from suspicion : activ in all church work; (and, by the way, Charge them just the same as you do others. this, all right-thinking and right-minded physi. Then if you want to contribute to the church cians will do); also attend church doings, such or the support of the preacher, count your as entertainments, socials, etc. (This, of bill in as a part of your contribution. course, applies more to country and village Looking over the various formulas for churches than to those of the city.) Usually, acetanilid comp., I will say that they are all in about fifteen minutes we come to a thoro and very good, but why not make them soluble by friendly understanding; and, I think, if that adding a little tartaric acid ? Allow me to clergyman is the right kind, he will never after suggest the following formula : accept free medical services except under most

R adverse circumstances; and his relations to Acetanilid.

gr. 340 physicians in the future, in all respects, will be

Caffein cit.

Soda bicarb. more satisfactory to both, and each will better Tartaric acid appreciate the other.

Mix thoroly. When the physician gives his services to the St. Joseph, Mo. S. S. BEVER, M.D. clergyman, he does it in great majority of in- [Would not the soda and acid effervesce ? stances grudgingly, and with the feeling that he The acid would be consumed in this way, and had thereby put the clergyman under obligation would not aid solubility of the acetanilid. to him, and perhaps he has; and when he learns If you want the acid to aid in the solubility of in a few days, as he is very apt to do, that the acetanilid, better omit the soda.-ED.) Mr. Clergyman has recommended his dearest chronic to try Blank's tonic, or So-and So's Ammon. Carb. Instead of Ammon. Chlorid, cough syrup, he does not feel that the obliga

in Acetanilid Mixture. tion has been discharged, or that the clergy- Editor MEDICAL WORLD :-In May WORLD, man has even kept faith with him. And the

And the page 184, L. C. Laycock, M.D., states that fact remains that the clergyman and his familyfor ten years I (he) have been using this are very free users and advertisers of patent same combination which you publisht in the medicins and secret nostrums; and, indeed, March MEDICAL WORLD, page 102," and also why should they not be, when their publica- that he “first saw the formula in THE MEDICAL tions, the socalled religious press, are filled World for November, 1893, page 377." with such advertisements ? Edward Bok says, Permit me to call attention to the fact that a "there are

no papers publisht that are so close comparison of the formulae will show that flagrantly guilty of admitting to their columns they differ somewhat, as his contains chlorid, or the advertisements, not only of alcohol-filled muriate of ammonia, whilst that publisht in medicins, but preparations and cure alls of the March has carb. ammon. in place of muriate, and most flagrantly obscene nature.

Be- a larger proportion of soda bicarb. The formula side me, as I write, lie issues of some twenty in March World is 6 parts acetanilid, 3 of soda different religious' weeklies, the advertising bicarb., and 1% each of carb. ammon., and columns of which are a positiv stench in the caffein cit. I also saw, and noted the formula nostrils of decent, self-respecting people.” publisht in World for November, 1893, and Strong language, but true.

while I consider it very good, I prefer the one Finally, in his charges for treating clergy- containing the carb. ammon., as it is more of a men and their families, each physician must stimulant, and so would aid the caffein in preuse his own judgment and be governed by venting any depressing effect on the heart that circumstances he finds in each case, bending the acetanilid might perhaps cause when given his efforts constantly to the end that sentiment in large doses, or where the dose, tho smaller, will be aroused or fostered which will in the is closely repeated, as sometimes is needful. end tend to overcome the abuses under which This is by no means a criticism, but simply we labor, and remembering that, usually, re- calling attention to the error in the Doctor's forms are brought about slowly.

statement of the facts. WILBER G. Fish, M.D.

R. B. ELDERDICE, M.D. Ludlowville, N. Y.

McKnightstown, Pa.

Copper sulfate, two grains to the ounce of water, cautiously and judiciously increast, is efficient in subacute and chronic gonorrhea.

Nitrate of silver is the caustic of selection when we wish to remove excessiv granulations, but its superficial action is to be remembered.

Acetanilid.

Now and then the temperature in influenza Editor MEDICAL WORLD:-P. T. Barnum, is subnormal. In one case the past winter the Lydia Pinkham, or some other wiseacre was record was 941°. In this condition, or in authority for the statement, “a sucker is born any minus temperature, stimulation is indievery minute.” Some of us are not only born cated. suckers, but remain suckers most of our lives. Good drugs are the cheapest, and when After graduating in 1894 I paid one dollar ($1) procured from Merck & Co., or Lehn & Fink, for one ounce of phenacetin. When that ounce they are the best in the market. was gone I found I could buy acetanilid for 30 Physicians who are dealing out to their to 40 cents a pound from Robinson, Pettit & patients pills and tablets apt to be inert, Co., Louisville, Ky., wholesale druggists. instead of the more elegant and potent alkaHave since kept a can in office. It is danger- loidal remedies, are missing much (and their ous. So are all drugs in poisonous doses. I patients more) of the greater good found in have never had any bad results from its use. the newer school of medicin. I give from two to five grs. dry on tongue, fol- In the line of liquids, the Lloyd specific lowed with water. Give it in capsule. Give tinctures are far superior to the ordinary tinctit in combination with other drugs. And the

ures. best way to give it, if afraid of its depressing The spirit of catholicity pervading The effects on heart, is in whiskey well dissolved. MEDICAL WORLD is admirable. If you ever have a patient susceptible to acet- Harrisburg, Pa. S. M. WHISTLER, anilid, feet and hands become blue and cold,

U. of P., 1866. just try same dose next time in whiskey; you will be surprised.

Seeking Recovery from Tuberculosis in the Now as to antikamnia- just put them out

West. A Sad Story. of business. They seem to have tried their Editor MEDICAL WORLD: - I read Dr. best to ruin their closest friends, the doctors. Erskine's letter in the May WORLD, page 192, Let's all stand together and refuse to prescribe and agree with him in his conclusion that the antikamnia or any other remedy they persist in West as a resort for consumptivs is much over advertising to the laity.

rated. I will leave out of consideration his When you have a case of malaria with chills, criticisms of the doctors who advise their try 27/2 to 3 grs. acetanilid and 27/2 to 3 grs. patients to go West, for I expect the Doctor quinin every three hours.

has different ideas now than he had before he Middletown, Ky. SAM'l D. WETHERBY. left Maine. I think I know more about the

West than I did a few years ago, and Dr. Anent Analgesics, Pure Drugs, Etc. Taylor, if you think it worth anything to your Editor MEDICAL WORLD : Acetanilid I readers, you may publish it. My experience regard as a boon when wisely used. My has been a sad one, and I have not yet reacht favorit headache compound is :

the place where I can feel that I am safe. Acetanilid.

22 drams

During the summer of 1898 my son Fred Sod. bicarb.

1% drams served in the Navy. Returning in the fall, he Caf, citrat..

dram Codein sulf.

soon showed signs of tuberculosis. At the sug

15 grains Triturate thoroly ; fill both ends of a No. 2 capsule- gestion of Dr. Ingals, of Chicago, I sent him, 5 to 6 grains. Dose 1.

in care of another son, to Phoenix, Arizona. To relieve the malaise of grip, pneumonia, Before they left I instructed them carefully as the pains of difficult menstruation, etc., I use to how they should live, but when they got to a few doses of the above to take the keen

Phoenix they found every place crowded with edge off the pain.

invalids; and in order to stay there at all, had The persistent use of acetanilid to reduce

to occupy the same room and the same bed. temperature, I regard as fraught with danger.

They finally rented a house, and conditions for In uncomplicated attacks of influenza I pre- living were somewhat better. From the tone scribe more or less the following:

of his letters I judged that the presence of so Strych. sulf.

many “lungers" had a depressing effect on him. Acid arsen.

äā 4 grains

He failed rapidly, and when the hot weather Ipecac pulv. Resin podoph. .

äā 20 grains came on, and all were leaving Phoenix, in spite Triturate thoroly, then add

of the advice of the “ veracious nativ” who said Analgesic comp.

10% drams

“ stay,” he came home in June, a mere skeleQuin, sulf.

32 drams Ferri hydrocyanate.

He lived on until the ila drams

ton of his former self. Oil of wintergreen

30 drops following January, and then gladly left his Specific gelsem.

242 drams

suffering frame, and I laid it, together with a Mix. Let dry. Repulverize. Encapsule tightly the big end of a number two capsule filling nearly two

large part of my aims and hopes, in the tomb. hundred capsules. Dose, one three times a day.

My son George, who had been at Phoenix,

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