ered. Passive and active movements of the hip are daily practiced until muscles are greatly wasted and require daily massage until fully recovthe leg can be brought into line with the body. This is the most anxious part of the treatment, and much depends on the way in which it is carried out. The course of treatment varies from 1 to 2 years. NEW FEATURES OF THE OPERATION. The most important step in the manipulation is the complete relaxation or severance of the adductor muscles, for without this, the leg cannot be hyperextended or hyperabducted. The manner of dressing and the position of the leg are entirely original with Lorenz, and perhaps to this feature alone is due the success of the operation. The leg is set in complete abduction and hyperextension. In this position the head of the femur is retained in its socket, and an imaginary line drawn from the trochlear surface of the femur through the head and acetabulum would terminate at the crest of the ilium on the opposite side. The leg is kept in this position for several months, during which time the patient is supposed to use the leg in the act of walking. The theory advanced by Lorenz, and which has been proven correct by hundreds of cases, besides post-mortem opportunities upon cured cases, was that the continued use of the leg in this deformed position, assisted functionally in developing the acetabulum, which was immature; that the pressure on or in the cotyloid cavity brought about by the weight of the body on the abducted leg, deepened the cavity, while nature in her efforts to form a joint, would build up the acetabular rim, particularly the superior border. As long as the femoral head was without the acetabulum, that anatomical structure would cease to develop, and after a certain period, atrophy and disappear from lack of use; and that the presence of the head of the femur in its normal socket would stimulate an activity of development, resulting in a stable articulation. AGE LIMIT. With the experience of over 1,000 cases, Lorenz places the age limit for successful treatment at 9 to 10 years for unilateral cases, and 6 to 7 years for bilateral. He has, however, exceeded these limits by preliminary treatments of extension and tenotomies, and in one case was successful at the 23rd year. ΤΟ 6. Margary, "Dict., Encyc. des Sc. Med.," Art. Hanche, p. 219. 7. Lorenz. Pathologie und Therapie der Angebormen Huft Verrenkung, weir 1895; Ueber heilung der Angebormen Huftgelend Verrenkung, Leipzig, n. Wein 1900. 8. Kronlein, loc. cit. 10. Report Thirteenth International Congress, Paris, August, 1900. CLINICAL MEDICINE. BY W. W. GILBERT, M. D., ST. LOUIS. Professor of Clinical Medicine, Homeopathic Medical College of Missouri. Try cocaine hydrochlorate in severe cases of chorea. When the potency is high the best results should be obtained. To antidote cocaine poisoning, strong black coffee will stimulate the benumbed nerves and keep the heart nearly normal without the use of other stimulants. Cocaine in poisonous doses produces great constipation by stopping the peristaltic motion of the intestines. Rectal enemas of coffee will overcome this trouble. When the heart's action cannot be stimulated with coffee in these cases amyl nitrate by inhalation will have the desired effect. Chloral hydrate will be of value in hives in which the eruption is more or less diffuse. This of course should be in small doses-about eight grains to the ounce one drachm every two hours. Arsenicum iodide will be useful in goitre occurring in girls at puberty. Iodine 6x cures every ailment of a boy whose father had locomotor ataxia, from syphilitic origin and mother had gastric ulcer when the son was born. Cod Liver oil should be used in severe cases of rickets. Those preparations containing bypophosphites being given the preference. Calcarea iodide is indicated in children with soft bones, open fontanelles, enlarged glands. The child's mother nearly always has a cough or sore throat. Study faces the pathological conditions are always mirrored there. Dr. Nothdurft, of Kansas, recommends Merc. Cor. 6x internally as a prophylaxis in diphtheria. It has made him quite a reputation in handling this dread complaint. Keep neurasthenic patients from sympathetic friends. Change their mode of living and environment if you would be successful in the treat ment. Hypericum should be administered after injury to parts well supplied with nerves. It will often prevent tetanus. Use it locally and internally. Calendula after burns. External and internal use will prevent high fever and severe shock. Before severe operations give arnica and china for two days. It prepares the patient for the ordeal through which he is to pass.-S. B. Par sons. Use arnica after injuries in highly vascular parts supplied by capillaries. Contusions with hard, hot swellings. Adhesive plaster will be the splint that will stop the pain in pleurisy, when the plaster entirely covers the affected side and is put on tight enough to stop the respiratory movement of the chest muscle. Dr. H. E. Roberts reports in the North American on the proving of Iridium Chloride "that the symptoms first produced were the salivation, and stiffness of the jaws, which increased for two days, and then subsided, as the head and nervous symptoms gained in prominence. The nervous symptoms were of some days' duration and did not disappear until the congestion in the pores and bronchi had gotten well under way. The cough was the last sign of its effect." The proving in the case outlined very much resembles arum tri. * * HYPERICUM PERFORATUM. (St. John's Wort.) In the daily routine of our practice, we occasionally run across a case somewhat out of the ordinary, and also in the apparent unexpected results that are sometimes derived from remedies in cases, where without them we would be entirely helpless in bringing about the recovery of our patients. "Confession is good for the soul," said a wise man, so I must confess that my faith in the curability of remedies in cases of tetanus was very weak. St. John's wort was of some ancient renown in medicine. Dioscorides praised it for sciatica and agues. The following extract from Johnson's edition of Gerarde's Herbal will show the account that was made of it in 1633. "St. John's wort with his floures and seede, boyled and drunken, provoketh urine, and is right good for stone in the bladder, and stoppeth the laske, whatever that may be. The leaves stamped are good to be layed upon burnings, scalds, and all wounds, and also for rotten and filthy ulcers. The leaves, floures and seedes, stamped and put into a glass jar, with oyle olive, and set in the hot sunne for certaine weeks, together and strained from these herbs, and the like quantity of new put in and sunned in like manner, doth make an oyle the colour of blood, which is a most precious remedy for deep wounds and those that are thorow the body, for sinews that are pricked, or any wound made with a venomed weapon." He then describes a "Compound oyle" prepared with Hypericum, white wine and oil of olives and turpentine, which he says is the finest balsam in the world. The repute of Hypericum as a vulnerary, after slumbering for some time, has awakened again in the Homeopathic school. Hypericum has relieved many cases where the patient complained of shooting pains extending from the distal part of the extremities towards the body, especially after punctured wounds or injuries to the tendons and nerves. Great nervousness and trembling after an accident or shock to the body; throbbing or piercing pain in the head after a fall or blow; attacks of vertigo and confusion of senses; after injuries to head, not only in recent cases, but also in those of long standing, are greatly relieved and often cured by Hypericum. The following case illustrates to some extent other symptoms indicative of Hypericum: Nellie G., aged 7 years, was brought to me for treatment by her mother; mouth sore, ulcers with a white base on edge of tongue, gums, and inside of Called my cheeks, difficulty in opening mouth wide, some difficulty in swallowing, muscles of mouth rather drawn, facial muscles twitching at times, nervous erythism in a small degree; temperature 100 F., pulse rapid at times, then slow again, sleepless on account of pain in jaw and mouth. attention to a puncture under right heel of two week's duration, caused by stepping on a splinter, which her father picked out with his pocket knife. The wound had healed, although some tenderness in place of puncture. At the time it did not occur to me that there might be any connection between the wound in the heel and the other symptoms described. Borax 3x pulv. every three hours; no improvement on second day; child very irritable, aggravated by the least noise or unexpected touch; nux vom. 200x, but no improvement. Was now called to see her at her home; found her temperature 103, pulse 120, rapid hard, face flushed, pupils dilated and contracted alternatingly, anxious look on face, slight "risus sardonicus," tongue coated white and dry, red at tip and edges, headache of a throbbing character, constipation, desire but ineffectual, thirst excessive, but pains in jaw worse after drinking; gave belladonna, 30x, for two days, but no relief. Examined child carefully again, found other symptoms besides those mentioned; breathing rather spasmodic, rapid at times, then slow, abdominal muscles rigid, slight opisthotonos, on attempting to move or sudden noise would cause an increase in the rigidity of the muscles, limbs rigid and feet extended, skin of abdomen and chest covered with sudamina; unable to open mouth, when attempting to do so was followed by a spasmodic closure of mouth and severe pain in the masseter muscles; marked "risus sardonicus," pupils widely dilated, sweats a great deal, especially on head, keeping hair wet all the time, wing like motion of the alae nasi; tem. 104 F., pulse 130, hard quick, at times intermitting, swallowing difficult. Hypericum, 1x 20 gtt, in four oz. of water, 2 dr. every hour; at first the symptoms seemed to get worse, and informed the parents of the diagnosis and the probable prognosis, and they did not expect anything else than the usual results of cases of that nature, of which the daily papers gave details of treatment by the anti-toxin method and subsequent death of the patient. I continued Hypericum in the 3x, after which there was a marked improvement from day to day till, in two week's time, she was able to walk, and temperature had become normal, tetanic spasms had entirely abated, though pulse remained rather rapid, irregular and excitable. Child continued to be nervous, but gradual improvement followed till complete recovery ensued by the use of Hypericum perforatum. 2909 Cass Ave. G. A. MELLIES, M. D. The Doctor's Wife-You are always talking about women having no capacity for managing things. Do you happen to remember that I started the first cooking school ever conducted in this town? The Doctor-I do distinctly. It was just after that happened that I began to have a good practice.-Chicago Tribune. D. M. GIBSON, M. D. EDITORIAL COMMITTEE J. H. MCCAUGHAN, M. D. SHOULD WE ADVERTISE? It may seem at first thought as if there was but one answer to the above question and that it is the beginning of the end when a doctor resorts to advertising to keep up his business, but let us consider and see. Do not all men advertise and does not the physician when he hangs the sign on the door proclaim to the public that he is in the business and does he not also imply that he is to have some remuneration for it; does he not when he hands a card to a friend, announce that he will be pleased to see him at his place of business, quite as much so as the grocer and the butcher? Who is there in the profession that thinks it wrong to have a patient send him others? From the very nature of our profession, and will I say, business, the recommendation that is most needed and sought is from those who have experienced relief at our hands, and we look on this sort of advertising and homage with a good deal of pride and satisfaction. To be sure we perhaps would not desire one whom we had benefited to parade the street as a "sandwich man" and thus proclaim that we had cured him and that all like afflicted persons should seek our aid. Yet we should advertise and do it well, the ethics of the profession admit and wisely that it is quite proper to have a sign on the office and it is a necessity; quite as much do we need cards with office hours and address neatly inscribed thereon and these should always be within easy reach. Then also there should be as soon as he is able to afford it a card in the local medical journal bearing the address of this same physician, his hours for consultation and the special work that he feels himself fitted for, announcing the field in which he claims to be advanced more than his brother practitioner, In this same journal or another of the same kind should from time to time appear an article from the pen of the practitioner; writing makes an exact man and who should be more exact than the physician. This will proclaim to the professional public at least the views he holds and the work that he can do. Such articles should be in the scope of reason and withal be truthful, for there is such a thing as blowing a horn until it bursts, and the concert ends in failure. Far be it from us to say that a doctor should spread his fame broadcast throughout the land by the use of the printer's ink, but it will be remembered that in the case of Lorenz the European surgeon, the ink and the press was not spared and grave, sedate men who would scorn the idea of having an article blowing their own blasts in the daily press sat down and calmly, smilingly announced to the suave reporter that "the" clinic would be held at such and such an hour." If this be the proper |