needs restraint," and I am positive, from cases under my care, that he is correct.

I think it, for many, notably the large and enlarging number of opium and alcohol habituès, the most fascinating and seductive, dangerous and destructive drug extant; and while admitting its great value in various disordered conditions, earnestly warn all against its careless giving in these cases, and especially insist on the great danger of self-injecting, a course almost certain to entail added ill.

To the man who has gone down under opinm and who thinks of taking to cocaine in hope of being lifted out of the mire, I would say, don't," lest he sink the deeper.

66

I have yet to learn of a single instance in which such an effort reached success; but know many cases where failure followed, or, worse, cocaine- or coca-morphia-addiction.

And the need of caution against free and frequent using obtains in other cases, for there may come a demand for continued taking that will not be denied.

To summarize:

Cocaine may be toxic, sometimes deadly, in large doses.

It may give rise to dangerous, or even fatal symptoms, in doses usually deemed safe.

The danger, near and remote, is greatest when given under the skin.

It may produce a diseased condition-in which the will is prostrate and the patient powerless-a true toxic neurosis, more marked and less hopeful than that from alcohol or opium.

Such being my belief, I regard DR. HAMMOND'S statements mistaken, and his conclusions rash and dangerous.

Correspondence.

CONSUMPTION IN DAKOTA.

In his address before the British Medical Association last summer, JOHN S. BILLINGS presented a chart showing the frequency of phthisis in different portions of the United States. The portion of the Northwest including the Red River country, was marked as to indicate a high rate of mortality from tuberculous diseases. Owing to the recent settlement and the inaccurate reports, the celebrated scientist must have resorted to a partial estimate, without knowing the exact figures. There are at present a great number of causes to produce a high rate of mortality from tuberculous diseases. The climate is unfavorable in the greater part of the year, to produce any beneficial effect on the disease. The cold is often arctic, and the thermometer has often registered as low as 58 degrees below at St. Vincent U. S. Signal Station. The frequent blizzards

with their all-penetrating winds, blinding snow, and often at a low temperature, are the causes of a great number of cases of bronchitis. Bad, and often poorly-prepared food, scanty clothing, hastily constructed houses and above all, hereditary proclivities to the disease amongst the Norwegian population. The disease would undoubtedly make greater ravages was not the summer very favorable to the recovery of a certain number of cases. In June, July and August, the temperature is stationary, and seldom as high as 100 degrees above. The air is remarkably pure, dry and clear; atmospheric changes are infrequent, the nights are always cold, and a refreshing night's sleep is never interrupted or impossible from any climatic causes. There are a number of celebrated physicians in the East who recommend the climate of North Dakota, and they often advise their patients to take a trip out West." In a few cases, where the patients possess a fairly robust constitution, with all organs performing their functions so as to be taxed without injury with increased labor incicident to a higher altitude, and who have means at their command to procure the best of the necessities of life, a summer residence would be beneficial. The region around Devil's Lake, with its large body of salt water and grand mountain scenery, recommends itself aside from having very good hotel accommodations, a convenience not often met with on the borders of civilization. To send a patient up here, suffering in the second stages of the disease, and who may be compelled to submit himself to the rigors of this Northern climate, is simply to hasten him to the inevitable. It must not be forgotten that any remedial agent that will benefit certain well-selected cases, will in others prove to be capable of producing dire results.

The aborigines suffer from phthisis to а frightful extent. DR. M. J. DRABELL, surgeon at Fort Totten Indian Agency, writes me as follows: "Tuberculosis is a disease which is most prevalent among our Indians, and I have at present about fifty cases on my record; scarcely a week passes without a death from that disease. Amongst the Norwegians, phthisis is very prevalent, being for the most part hereditary. For nearly one thousand years the peasants of Norway have lived in narrow valleys inclosed by high and often impassable mountains. The social · law' compells a man to marry in the settlement, and often one of his kin. The result has been what might be expected. Many of the robust and well-developed specimens of the Norwegian race carry embodied in their splendid physical forms a taint or a proclivity to phthisis, and sometimes leprosy. The royal sanitary reports of the Norwegian government, show that the death-rate is as high as 40 per cent. of the adult

population in certain localities, while in the cities, it is very low. The immigration to this country had on some a very beneficial result, while the change of food, habits, climate and social surroundings had on others the opposite effect. The tendency speedily developed, and thirty-five to forty per cent. of the death rate of the adult population up here is from phthisis. I believe there are a larger number who suffer from the fibroid form of phthisis up here, in proportion, than the tuberculous variety further south. Cases of fibroid phthisis are not rare, and by judicious treatment, the disease is often arrested in its course for a long time. The treatment of the tuberculosis variety during the greater part of the year, give, as might be expected, unfavorable results. After a number of years, I am justified in my belief that a better report can be made. The people will learn to protect themselves by better constructed houses, warmer clothing and consequently less unnecessary exposure to the extreme cold. The intermarriages of the Norwegians will be lessened, new blood will give vigor to the race, and the hereditary taint will be reduced to the minimum. Then we may be able to give a more satisfactory report. J. E. ENGSTADT, M. D.

GRAND FORKS, DAK.

CASE OF CEREBRO-SPINAL MENINGITISDEATH.

MR. C. came to my office March 11th to get medicine for his daughter, aged seven years, who, he informed me, was suffering from indigestion, torpid bowels, and headache. I had a year before seen the little girl, with another physician; we found her then suffering from mitral regurgitation, the effects of an endocarditis contracted during rheumatic fever, three years previous. I prescribed a mild mercurial at bed-time, one of the mineral acids, and lactopeptine after meals, with some quinine in capsules for the headache (which the father described as periodic), should it not be relieved as the digestive troubles improved. Heard nothing further from the case until March 17th, when the father reported the appetite, etc., had been much improved, but the headache was still present, in spite of the exhibition of the quinine; that there was now vomiting and great prostration, and requested me to call. Upon reaching the house, I found patient in bed, the vomiting somewhat abated, tongue coated a moist brown, pulse 130, temperature 101, bowels constipated, pain complained of nowhere but in the frontal region, her lungs were sound. She had, up to March 11th, been in her usual health, which was always indifferent since her rheumatic attack, the child being dull, with poor appetite, easily excited and fatigued. Her surroundings were excellent,

and she had been carefully looked after. I left her a mixture of bismuth sub-nit. and hydrocyanic acid dil. to control the vomiting, and calomel and magnesia for the constipation. She appeared rather deaf, but this I attributed to the quinine she had lately taken.

March 18th, the child being no better, though the vomiting had ceased, DR. J. F. SPINNER was called in consultation. We met about 6.30 P. M. The child was now quite deaf, pulse 135, temperature 102°, tongue slightly coated, pupils normal, frontal headache still present; child restless and continually, calling for water; enemas brought away hard fecal matter. We could arrive at no definite diagnosis, but agreed to. await development of symptoms; patient passed a moderately good night.

March 20th, patient dull and listless, temperature 102°, pulse 135, still deaf, pupils slightly dilated and responds feebly to light, bowels regular. Suspecting grave brain trouble, we ordered ice to head, bromide of potass., liquid nourishment at stated intervals, as child remained indifferent, but swallowed anything offered.

sure.

March 21st, DR. J. F. SPINNER saw case in morning, and found symptoms about the same as at my last visit. The mother telling him the child had complained of severe pain at back of neck over cervical region, he ordered a turpentine and white of egg embrocation to be applied. No tenderness was discovered on presSaw case myself same evening; temperature 103°, pulse 145, pupils dilated, decided retraction of the head, the least bending forward, causing a cry of anguish; features flushed, head hot. The mother stated she had seen dark spots about back the evening before, but examination failed to reveal them. I diagnosed the case as cerebro-spinal meningitis, used counter-irritation by means of mustard over cervical vertebræ, added ergot to the bromide, continued the ice to head at intervals. The child passed a bad night, but managed to take some nourishment.

March 22d, we saw the case again in consultation, the doctor agreeing with the diagnosis. The temperature was now 104°, pulse 140, respiration 40, pupils widely dilated, head strongly retracted, child in a semi-comatose condition, rectum and bladder acting involuntarily. During early part of morning there had been two slight convulsive attacks. A blister was applied over cervical vertebræ, chloral hydrate added to the remedies already in use; otherwise the treatment was continued. I should add, however, that mustard baths to feet had been continually tried.

Not to weary my readers, I will sum up as briefly as possible: From this time to the morning of the 24th, at 4.30, at which time our patient died, she never rallied, but remained in a profound stupor, her pulse varying from 130 to

160. The temperature gradually rose until two hours before death, it reached 1073°; during the last twelve hours a copious perspiration occurred. I would say, in conclusion, that there was uncertainity for a considerable time as to the diagnosis, but when the symptoms did develop they were recognized, and could be attributed to nothing but the disease stated. ROBERT O'HARA, M. D. CHARLEMONT, VA.

PHYTOLACCA DECANDRA IN COITRE.

I desire to testify to the (as I believe) correct deductions of DR. ELY, as published in your issue of March 10th, regarding the use of phytolacca decandra. Several years ago I saw it recommended, but not noting any confirmation I did not use it till about two years ago, for any special cases of the kind the doctor has called attention to. I first used it in a case of exophthalmic goitre of twelve years' standing, in which both thyroid glands were enlarged and constantly becoming larger. It was applied in full strength of the tincture. I prescribed various internal remedies as alteratives and heart tonics, etc., for some time, but finally settled upon a simple stomachic tonic containing small doses of cactus grandifolia, and oneminim doses of tincture of aconite, three times a day, as recommended in FLINT'S Clinical Medicine, page 236, and had the satisfaction after about nine months of nearly continuous treatment, of seeing the patient (a widow lady of about 40) restored to a very good degree of health. She then passed from my observation by removing to Dakota, after being married, perhaps owing to her improved appearance, as the bronchocele had entirely disappeared. She continued the treatment a while longer, but since reported herself entirely well.

In every case of goitre that has since presented itself, I have first and last used the pokeroot.

I have a record of eight cases, all of which I have successfully treated, with one exception, with that remedy alone. Five were young females, from twelve to twenty-two; two were males about twenty. These cases were of more recent date, having been affected from three months to as many years. I have prescribed the remedy in 1- to 5-drop doses, one to three times a day, in conjunction with its external application, in all but three cases, which have been cured by its application to the glands alone.

The exception is a case of 22 years' standing; under treatment four months. The first two weeks' treatment caused a decrease in size of one-half inch, but since that time it has only decreased as much, or another half inch, and seems likely to prove beyond the influence of the medicine to entirely remove it. It has,

however, materially lessened the sensation of constriction of the throat formerly present in this case. I am having patient still continue treatment as it does not seem to cause any unpleasant symptoms, nor has it in any case.

I have tried it with good results also in enlargement of other glands, particularly in the case of the cervical glands as an accompaniment or sequela of scarlet fever, in orchitis and in threatened "broken breasts"; in each case both externally and internally.

I would just call the attention of some of your readers to the fact that "scoke root" (the name that the remedy in question bears in some localities) has long been considered a specific by dairy men and veterinarians for "caked udder" of cows. I think very few disappointments are in store for those who use this remedy carefully in cases of simple glandular enlargement without cystic complication. I have added my testimeny simply to encourage its trial by others, as I find many of us get skeptical regarding new remedies, or new applications of old ones, unless pretty well convinced by our own or others' experience of their utility, because of the many disappointments we have met with heretofore. I would emphasize DR. ELY's caution about a reliable preparation of the plant.

PRAIRIE DU LAC, WIS.

J. V. STEVENS, M. D.

SYRUP TRIFOLIUM CO. IN SYPHILIS. Mr. S. age 25, unmarried, came to me on the evening of the 5th of March, 1886. The history he gave to me of himself was about as follows:

During the winter of '83 and '84, while working at his trade, that of a carpenter, in Richmond, Indiana, he contracted syphilis. He remained at work a few weeks after this, when becoming fully satisfied as to the nature of his trouble he came home to this place and commenced treatment with a physician whose chief reliance must have been (considering the young man's condition when I saw him) some of the various forms of mercury. He remained under this treatment about a year, when he finally became discouraged and gave up all treatment.

Some of his friends, after a time, prevailed on him to again commence upon a course of medi cine. Accordingly he came to me on the date above mentioned. His condition at this time, was pitiful; his mouth was almost a mass of ulcers, he had a large and deep frontal nodule and more or less superficial ulcers of the scalp. Besides this, he was almost unable to walk and suffered terribly from rheumatism; the latter however, was I think more of a mercurial than syphilitic origin.

I undertook the case and put him upon a treatment consisting of syr. stillingia com. and

iodide pot. in the usual doses, together with various local applications to the nodes and ulcers. With this treatment continued for two months, he improved slowly, but not as fast as I desired; so, about the first of May I put him upon the syr. trifolium compound, as the alterative. He improved so much after using the first bottle that I procured more and kept him upon this mainly through the summer and fall, and was well satisfied with his improvement. He commenced working at his trade in June, and continued to work during the summer and fall. At present he is in good condition to labor and is only idle at times through lack of employment. While not, as yet, absolutely cured, his improvement has been so marked that I am very hopeful of his complete recovery, providing I can control his tendency to dissipation, which has, more or less retarded his case from the commencement, and which has made it a peculiarly hard one to treat. I have at times had to make some temporary changes in his treatment, but I attribute his improvement almost entirely to the use of the syr. trifolium compound, and from my experience with it in this case I believe it to be a meritorious remedy in syphilis and kindred diseases.

DALTON, IND.

S. G. ROGERS, M. D.,

PHYSICIANS' FEES.

I have read with much interest the articles in THE AGE upon this subject. The subject should not be allowed to drop, but should be discussed and agitated until general and permanent results are obtained.

In some states it is impossible for a physician at present to collect a bill from a majority of the people unless they are disposed to pay. If a man holds no property in his own name, and is earning $15 a week, under the system of weekly payments, nothing can be collected, for the law allows him $10 a week, not subject to process, and the lawyer will take the other $5 at least, leaving the physician nothing if he resorts to the trustee process, which, by the way, is recommended to be abolished altogether by some philanthropists--the general result offering great inducements to dishonesty.

Generally speaking, a man earning fifteen or twenty dollars a week ought to pay all ordinary bills. Physicians must organize and secure combined action for self-protection. There is no reason, in religion or humanity, why the burden of lugging all the poor, and the far more numerous "dead beats," should be saddled upon one class of people-the physicians. And it is our own fault if we tamely subm to it It is as much the duty of a state, city or town to provide its poor with proper medical attendance, and pay for it, as it is to provide them with food, shelter or clothing. To this end

money should be raised by taxation and the burden thus uniformly distributed among the people to bear it.

Laws should be enacted which would enable physicians to collect their bills from those who are able to pay, but would rather not, at least not until every other bill under heaven has been disposed of and vacations, theatres, etc., have all been provided for.

The profession should be aroused through the press, and the subject should be brought up at our meetings and united action taken to procure the enactment of such laws as will secure to pysicians their just rights in common with other people.

Meanwhile, let us be justly kind to the honest poor, and send our bills as often as monthly to all. Until better times, every physician should keep a list of his "black sheep," which should be occasionally incorporated in a general town or county-list, by common agreement, for the benefit of the profession. There is a numerous class of people who will find means to pay their doctor's bill as readily as any other when once they are given to understand that they must, or go without his services.

SOMERVILLE, MASS.

E. A. SANBORN, M. D.

WHERE IS THE PUREST BLOOD? Within itself this is a question of no vital importance, but we know that sometimes great things depend upon the aggregation of a number of minor points; hence I would like to know the views of some of the professional brethren on the subject. I remember, when i graduated, having to answer one professor: In the pulmonary vein:" another, "In the renal vein."

My store of medical knowledge is meagre, compared with that of the two professors who disagreed, but it seems plain to me that the purest blood may be found in the renal vein. I give my reasons, and would like to have them criticised if need be:

We know that the blood in passing through the lungs takes on oxygen and gives up carbonic acid gas. This being the only change of importance, we find still retained in the blood of the pulmonary vein the waste product of the nervous system and the nitrogenized tissues of the body cholesterine and urea. We know that all arteries, except the pulmonary, carry blood free from carbonic acid; we also know that the blood, in passing through the kidneys is divested of its urea, but not of its oxygen

It is now narrowed down to this, viz: We find poisonous principles in the blood everywhere; we find only one-cholesterine-in the blood of the renal vein. Everywhere else in the body, from two to three poisonous

CHLORAL HYDRATE IN LABOR.

For a great many years I have been using hydrate of chloral in cases of labor, with remarkable results. When I am called to attend a woman in labor and find the os undilated or rigid I invariably inject into the rectum 30 grains of hydrate of chloral dissolved in about four ounces of warm water, with a little starch added. I have used this means for such cases for eight years, and have failed to get any but the most flattering results; in fact I can not praise the method too highly. On the 28th of this month I was called to a case of placenta previa; the woman had been flowing all night, and when I got there, at 6 o'clock, A.M., she had lost much blood. I found the os rigid and undilated. I immediately injected my favorite remedy, and in less than three minutes the os was dilated so that I could readily pass my hand into the uterus, and it relaxed also the rectum, vagina and perineum. The drug never failed me yet in this connection, and I would like to commend it to others who may not have used it.

I have had excellent results with it, also, in cases of dysentery. Injected into the rectum, it will surely relieve tenesmus, either of rectum or urethra.

I do not claim to be the originator of this method of using chloral in labor, having seen an article on the subject in the Therapeutic Gazette, I think nine or ten years ago. I have forgotten who wrote it, but the author recommended it for dilatation of the os. I tried it then and found it all he said, and have used it always since.

SCANDIA, KANSAS.

J. Z. SCOTT.

ten-pound boy, and made a good "getting up." In her former confinements, she told me, that for three months afterwards she was an invalid. This is the only case in which I have had an opportunity to use the drug, and certainly it proved a great satisfaction to me, and, as my patient put it, an unspeakable benefit to her.

GRINDELIA SQUARROSA.

This drug I have used for such a length of time that when I prescribe it I don't feel that it is an experiment. In this malarial district hypertrophy of spleen is quite common, and the former treatment of it was unsatisfactory, but now, with grindelia squarrosa, and whatever adjunct treatment that may be indicated, it is quite an easy matter to effect a cure. Men, particularly, come in from quite long distances to get treatment, and I find that the drug is not known or used by the profession as it should be, especially in ague districts. If it were used only for this one condition, the value and satisfaction of the result to the physician would be an item not to be overlooked.

PADUCAH, Ky.

WM. SEMPLE, M. D.

ADONIS VERNALIS.

My attention has been called to ext. adonis vernalis fluid. The drug itself (the herb) was referred to me for trial, which I prescribed in infusion of 3 ss. to 6 oz., in heart troubles, with good results, finding it to act like digitalis and more reliable as to its action. Adonis vernalis has more of the good effects of digitalis and less of its evils. The heart-beat increases in force, and the heart sounds of defect may easily be noted. The pulse also shows its action. I am so far satisfied as to its virtue, and also prescribe it in asthmatic trouble, so far with good results.

ST. LOUIS, Mo.

G. J. HERRMANN, M. D.

STYLOSANTHES.

MRS. T. B., five months advanced in her third pregnancy, complained of great irritability of uterus and almost continued pain, like severe neuralgia, severe enough, as she expressed it, "to drive her crazy." Had suffered similarly in the two previous pregnancies without getting any relief, except temporarily, from opium. On her applying to me, I had, fortunately, a sample of stylosanthes which a representative of Parke, Davis & Co. had left me. I put her on it, and almost immediately she was relieved. She went through most comfortably to her confinement, was delivered of a

The emeute at Ann Arbor has been quelled, and an armed peace again prevails. The “regular" professors, instead of furnishing the homœopathic students with certificates of their proficiency in the branches in which they have taught them, will in future furnish the President of the University with such certificates, and on the strength of them he will certify to the homeopathic department.

The relation of the two schools at Ann Arbor is unnatural, and the interests of each would be subserved by a complete separation. It would, at least, prevent many embarrassing situations.