Phosphorus.

There are some points in practice that should be more thoroughly understood than they seem to be at present. There are many physicians who do not seem to perfectly understand the difference in the action of the various compounds of phosphorus. Nearly all acknowledge that some of the compounds of phosphorus possess peculiar action on the brain and nerves, but they are at a loss to decide which preparation they shall use to the best effect.

Some years ago Thompson wrote a book on the use of "Free Phosphorus in Medicine" and for a while there were many physicians, who believing what he said, used phosphorus in the manner he prescribed, and for a while we had phosphorus in pills, in tincture, in elixirs, in oil and other preparations. It was soon found, however, that phosphorus itself possessed not the slightest nutritive value and not a shadow of remedial effect, that it was fearfully dangerous and needed the very closest watchfulness.

Then to the present, there are few who have not studied the subject, who administer phosphorus in pills, oil or liquid, as a last resort when everything else has failed. Generally in these cases, it is administered with other medicines, as strychnine, etc., and then its action is for a while lost sight of until the peculiar state of irritation, and poisonous condition that precedes kidney trouble compels an abandonment of its use.

Thompson acknowledged that he frequently met with this poisonous condition, but he attributed it to a portion of the phosphorus becoming oxydised and thus producing the poisonous state he met with. The difficulty is that phosphorus when in the system, does not become oxydised, as I have shown in many experiments on animals. The only known antidote to the poison of phosphorus is the free inhalation of oxygen, and the drinking of oxygen, or nitrous oxygen water so as to oxydise the phosphorus and make it perfectly harmless. Thompson acknowledges his ignorance of chemistry and yet wrote on a subject that requires a better knowledge of chemistry than any other article in the materia medica.

In the many experiments before my class, I have administered phosphorus to all kinds of animals: rabbits, guinea pigs, cats, dogs, horses, etc., and have never yet seen a case where phosphorus was given to its full effect, that fatty degeneration and softening of the kidneys did not take place. I have said that I could on a given day take 100 animals and treat them judiciously with phosphorus and I could afterwards give a dead animal every day for the 100 days.

It must be remembered that the dose of phosphorus is exceedingly small, the 1-10 grain making a very large dose. Even this small quantity gives the unpleasant garlic eructations and if it is repeated the breath becomes offensive.

After a few doses either to individuals or to animals there is a lack lustre expression to the eyes, and the countenance loses its animation; soon there is great irritability and restlessness, and at this point if the poison is not stopped and quick and efficient means used, there will be no possibility of saving the life, for there will be kidney disorganization, fatty degeneration and ecchymosed spots will be seen upon post mortem.

All that need be said is, that phosphorus is not a medicine and never should be used as such.

SAMUEL R. PERCY, M. D. 56 West 25th St., New York.

Antigmatism the Cause of Megrim.

In the February BRIEF, Dr. H. P. Monroe, of Harris, Kan., submits a case of megrim and asks suggestions as to treatment. His case is evidently one such as I meet with very frequently and am able to cure without the use of drugs. Simply by fitting the proper correcting glasses.

These is no doubt in any mind but what his patient's megrimis caused by an error of refraction, as he says "the only thing that has any influence in producing an attack is reading for some time, or any work that requires close watching." This error is probably simple or compound hypermetropic astigmatism, but may be mixed or myopic astigmatism, or simply hypermetropia.

In my practice, I very seldom meet a case of myopia that causes headache or pain about the temples. But cases complaining exactly as the one reported by

the doctor I meet daily, and find the great majority to be cases of either simple or compound hypermetropic astigmatism, or mixed or myopic astigmatism. Simple hypermetropia often causes headache and pain and discomfort about the eyes and temples, after close work, but is not as fruitful a source of megrim and sick headache as is the different forms of antigmatism.

I would advise the doctor to have his patient examined by a good oculist, which examination must be made both with and without the use of a mydriatic in order to secure perfect accuracy in adjusting the lenses necessary to correct the error. S. MITCHELL, JR., M. D. Hornellsville, N. Y.

A Case in Obstetrics.

I would like to join the august assembly around the consultation table of the best journal I take, and will do so by giving one of my experiences in the lying-in room.

Was called, Christmas day, 1888, to a case of labor. Found the patient already three days in labor and exhausted with pains light and inefficient. The head on pelvic floor, the orifice of vagina rigidly contracted, with every prospect of complete laceration of perineum. Gave fld. ext. ergot, one drachm, after half an hour, as the head was impacted and made no progress, proceeded to give chloroform, preparatory to the introduction of the forceps. I will state that the patient was thirty-four years old, married seven years, and this her first labor.

Obtained a lock, with no difficulty, and proceeded to deliver slowly and cautiously, watching the perineum, which the chloroform failed to relax to the extent I could have wished. I soon found the sensation transmitted to my consciousness was like that of pulling at a lightwood stump, it took all my strength and patience, finally, to extract a fine girl, asphyxiated, the perineum lacerated and oceans of blood flowing, or it so appeared to my youthful imagination; with my right hand I applied styptics to the mother, and with my left I did all I could to resuscitate the child, and succeeded only when I put my lips to its, I

blew, and thus set up the normal action of the lungs, as told me by the welcome squall which followed.

I performed Emmet's operation then and there, and left my patient comfortable but weak. Saw her again in fortyeight hours, temperature 106°, pulse feeble, lochia suppressed, breathing hurried. Gave four grains antifebrine and repeated it in an hour, which in two hours brought the temperature to 103°. I then gave five grains quinine every six hours, which kept the temperature in bounds. The most remarkable symptom attending that high temperature was that the patient became stone blind. I tried to coax the lochia back with hot water injections, poultices and indian hemp, but only succeeded after four days, when the temperature had been at or near the normal for twenty-four hours previous.

The patient grew better, appetite returned, the rent healed kindly, only she was stone blind; after ten days I removed the stitches, put her on one-thirtieth of a grain strych. sulph., five drops tinct. ferri chlor., three times a day.

At present, she is up, sees clearly and suffers no inconvenience that I can discover. WM. R. HOOD, M. D.

Ridgeway, S. C.

Obstinate Acne.

I would like to ask some of my brother doctors for a treatment in a case of obstinate acne. A man of thirty, regular in his habits, a "teetotaler," uses no tobacco, no tea or coffee, apparently in best of health, but has a peculiar form of acne, which appears on the nose; comes as small boils, very tender and very red, will be two or three days in forming, a drop of pus can be pressed out and in a day or two the redness will be about gone, by that time another will begin to form and continue as the first described.

The redness would at times lead a person to think him a drinker, but he has always been free from that vice, "rarely knows that he has a stomach," so his digestion must be good.

Who has a treatment?

I am pleased with the BRIEF.
R. C. M. LEWIS, M.D.

Centerburg, Ohio.

A Peculiar Case. H. S. has been afflicted with protracted debility for two years and has been treated by several physicians without any permanent benefit.

The symptoms are as follows: Obstinate and protracted constipation, locomotor ataxia. When he attempts to sit down on a chair, he misses the chair frequently and lands on the floor beside it. The eyes are affected and he is unable to see objects in the proper position, and then only with a tremulous moving motion, pupils slightly contracted, but no other changes perceptible. Is affected with a peculiar hypochondriacal stategiven to thinking much about self and a certain lady who had once returned his affection, but no longer reciprocates it. Without whom he says he can not live.

He has been greatly addicted to venery-practicing the modern improvements in the art with perhaps great damage to himself. The stomach or digestion seems to not trouble him greatly, but examination of the urine shows that it contains phosphates in some form, the analysis not being completed.

There is no loss of flesh, or at least in only a small degree. The muscles being flabby and soft, and but little of that slimy coated tongue that we meet in dyspepsia, it does not strike me as a case of dyspepsia, in connection with excessive venery, although we have abundant proot of the latter. There is a continuous ptyalism, and when I first got the case, a fetid breath, which no longer exists. He has had gonorrhea once, but has never had a chancre or syphilis in any form. His throat is sore, and pharynx is dotted with red puncta, the soreness of which seems to be as continuous as his ptyalism, which is in an aggravated form. The pulse is soft and frequent, but not over 78.

He has gradually improved under syrup hypophosphites, nux vomica, pepsin, and iron, but the improvement is not satisfactory, for he does not gain sufficiently to steady up his gait, although taking the treatment for two months.

Any remarks from the numerous readers of the BRIEF, touching the betterment of the condition of my patient, will be thankfully received.

I treated it to large doses of nux vomica and regarded it as a case of vaso motor nerve derangement.

D. A. GOSHORN, M. D.

North Manchester, Ind.

What Was the Cause.

Was called, January 12th, to see a patient, aged forty-five, male, complained of slight headache, very sleepy. Tongue was coated with a heavy white fur and bowels very costive, pulse 50, temp. 97o, respiration normal, urine normal.

Jan. 13th, temp. 96°, pulse 45; says he feels very well, sleeps all the time. No change to January 18th, except pulse 40, temp. 90°. Almost impossible to arouse him to take nourishment. Bowels very costive. No change to the 26th, except temp. 90°, pulse 35. No change on the 26th. On the 27th, temp. 97°, pulse 45. 28th, temp. 98°, pulse 60; sleeping all the time. Died at 5 P. M.

My treatment from the first was stimulants and nourishment. Gave nothing to cause him to sleep. What was the matter?

Will some of the readers of the BRIEF please give diagnosis, and tell how they would have treated the case? Seligman, Mo. J. S. FOSTER, M. D.

Insomnia.

I wish some of the contributors to the BRIEF would give me treatment for insomnia in a man of about seventy, with a pulse of sixty. His physical health is good. Very intelligent man, of large brain and active mind.

W. W. BAKER, M. D. Bloomington, Tenn. [Try Bromidia, in small doses, at bed hour.-ED.]

Hydrocele.

Will some reader of the BRIEF suggest something better for injection into hydrocele than tinct. iodine? I have cured a number of cases with iodine, but have also failed twice in the same case in past year. It seems to be a normal case, but iodine has so far failed to cure. What about Tongaline?

The BRIEF just suits me to a dot.
J. A. MATTHEWS, M. D.

Caddo, Tex.

Elucidation.

Had Dr. P. A. Spain, Nevada, Tex., divested himself of all proclivities and written his article (page 25) so it might have embodied the first principle of refinement by containing one sentence which was not uncouth, it might behoove me to explain to him more fully the blunder to which he has so unconsciously fallen a victim.

Suffice it to say, one-fourth grain sulph. morphia was administered at 10 P. M., the 6th, and fifteen minims deod. tinct. opii at 12 M., the 7th. Not "between five and twenty grains morphia," doctor.

It must have been opium and its alkaloid intensified beyond any known chemical process if one-fourth grain morphia and fifteen minims tinct. opii (administered at intervals of twenty-six hours) "produced sleep and suppressed labor for ten days and nights."

The opiates, doctor, were given to procure a few hours' rest, from which the woman-already greatly exhausted by feeble and cutting pains, which began on the 5th and had thus far failed to effect any dilatation of the os-might awake refreshed, strengthened, and better fitted to bear the ordeal of a prolonged and tedious labor.

The combination of chloral and ergot was all that I claimed as in any way unique in the case.

Doctor, apropos of your declaration that opium "suppresses labor," will state that Mrs. Maggie D. (multipara) who resides within stone's throw of my office, July 31st, 10 P. M., was seized with pains in the abdominal region, which gave rise to the suspicion that she was again about to become a mother. Singularly enough, I was sent for. Found os not dilated; cervix apparently elongated, hanging loose (patulous). Thinking it a case of "false pains," prescribed one-fourth grain morphia.

At two o'clock, same night, husband, very much excited, called me up with the remark that "Mag. was right bad." Entering gate, heard infant cry, and found, on entering house, child lying between Mrs. Maggie's thighs. She assured me that she felt about two pains after the morphia put her to "sleep and suppressed her labor," and those when child's head

swept over perineum and viewed my "botch job."

You see, doctor, I was not there in time, that he might smile at what I had done; but mother was highly pleased at my "botch job," inasmuch as it was by far the least painful childbirth which any midwife's tansy-tea had helped her out of.

It is truly wonderful, doctor, the curious facts we are forced to encounter.

Now, my good doctor, as I did that which I thought right in Mrs. C.'s case, and it proves to be all wrong according to your valued opinion, what should I have done at the time the one-fourth grain of morphia was given? And, too, if after a little over three days' ineffectual attempt at labor, you had a rigid cervix to contend with; os dilated not larger than a silver quarter-dollar; pains without sufficient force to drive the offender out; patient very much exhausted, and appealing to you for assistance; what would you have done to dilate os and give uterus sufficient expulsive power to empty itself, and contract afterwards firmly enough to avoid the risk of postpartum hemorrhage?

Please answer through BRIEF (next issue) that I may know how to meet such an emergency, without being forced to the extreme of seeking the assistance of a "midwife," as you have previously advised.

The BRIEF, doctor, is a good and useful journal. Do not let your subscription expire. J. F. NEWMAN, M. D. Tangier, Va.

J. F. Newman, M. D., vs. Bad Obstetrics.

I read with interest Dr. Newman's paper, "Uterine Inertia." I have often met with similar cases, and as often treated patient upon same principle. I sympathize with Dr. N. much. His reviewer ridicules, without mercy. I wish the experience and judgment of the entire profession of medicine could be had upon the points in Dr. Newman's case. I believe that a majority, at least, of obstetricians endorse the doctor's management of his case.

THOS. H. STEWART, M. D.

Dixie, Ga.

The Necessity of Careful Examination in Rectal Troubles.

During my term as house surgeon at the City Hospital, there came under my observation and treatment, two females of the sporting element, complaining of piles (?)

The laity, as a rule, are prone to call all affections about the rectum and anus, piles; and a great many practitioners, I am sorry to say, simply on account of the function performed by this part of the anatomy, or of their inability to make an intelligent examination of these parts, desist from the task and content themselves by calling the trouble piles and having the patient apply some form of ointment.

Upon making an examination of these patients, I found what appeared to be simply a fissure in the mucous membrane and encroaching upon the external sphincter muscle.

The constant contracting and relaxing of this muscle, and especially during the act of defecating, together with hardened feces passing over the abraded surface, rendered it very painful and was amply sufficient to keep it in an irritated and inflamed condition. Therefore, acting upon the advice given by Allingham, of forcibly dilating the sphincter muscle, paralyzing it and putting it at rest, I accomplished with Cook's tri-valve rectal speculum. A dressing of simply absorbent cotton, smeared with a little vaseline and introduced just within the sphincter, another pad externally and a T bandage constituted the immediate treatment. They were put upon a light diet, bowels confined three days and then moved with castor oil.

As a rule, the over-distention and paralysis of the sphincter, gives the fissure time to heal; but in both of these cases, the fissure instead of diminishing, had almost doubled its size. I again resorted to dilatation; this time dilating to the full extent of the speculum and continuing the dilatation still farther by introducing both thumbs. The same dressings as before were applied and bowels confined five days, then moved with oil.

Upon examination again, to my surprise, I found the fissure had been converted into an ulcer that very nearly encircled the gut. It here occurred to me

that there was "something wrong in the State of Denmark."

I questioned them closely in regard to primary and secondary syphilitic lesions, but of course, they knew nothing about it. In one, I found a distinct chancre on the left labia minora, and in the other patient I was unable to find a primary lesion, but found the lymphatic glands in the groin enlarged. Judging from this that it was syphilitic mucous patches in the rectum, instead of a simple fissure, I at once put them on anti-syphilitic treatment together with a rectal suppository of cocoa butter and iodoform and in a week, they were both discharged well of their rectal trouble.

J. T. BLACKBURN, M. D.

Louisville, Ky.

Wants to Become Pregnant.

As I have been a subscriber for more than a year, I find that through the BRIEF are the brains of the medical profession obtained, and, for this reason, I report a case for information:

Mrs. M., age twenty-eight years, has been married ten years. Her menstrual period is regular every twenty-eight days, though it lasts but two days and gives some pain. She has never become pregnant. At times, she suffers great pain in region of bladder and rectumhemorrhoids, and complains of dizzi

ness.

Has had a yellowish looking leucorrheal discharge all the time, since she has been grown. She is very nervous, and can not bear the slightest noise while asleep. For the last three months, has had a jerking of the muscles of the back and extremities.

When a girl, she formed the habit of self-abuse, and is now unable to enjoy sexual intercourse. During her menstrual period, she has nightly emissions which give her great mental trouble, and which I think is one great cause of her indigestion.

She is aware of her condition, and has read a vast amount of trash on the subject of pollution.

Now, doctors, I hope you will not merely scan over this and pass it by unnoticed, but give it some thought, and report the cause of all this trouble and the treatment for same.