medical attendant doubted her chastity as she had a discharge from her vagina, but he saw it was typhoid. Another case by same doctor was diagnosed gonorrhea, as the patient had ulceration of the prepuce, but it turned out to be typhoid.

I once had a case that had perforating ulceration of the larynx, and he suddenly became emphysematous over the body which "floored" him, but this case was shown to be, after death, ulceration of the larynx, occurring in the course of typhoid fever.

This disease, then, is not a local one, although the focus of the action is in the ileum. About the ninth day the mischief begins to show itself in the intestines, and at this time the deposit may open up a large blood vessel and thus give rise to severe hemorrhage, or, if it go still deeper, perforation of the bowel may take place; or the bronchial membrane may become affected, or the bronchial glands enlarged, which may give rise by reflex action to spasm of the larynx; every organ of the body is more or less affected if the disease is severe. Every part of the body may be affected through the nervous system. There is a tendency to reaction. There may be pleurisy; or the enlarged mesenteric glands may soften and suppurate, which may be followed by purulent infection, or the kidney may become diseased. In fact, any organ may become affected through the action of the nervous, venous or other systems. Potosi, Mo.

A. F. WATKINS, M. D. (To be continued.)

A Nine-Day Wonder.

On page 392, October BRIEF, 1888, Dr. A. H. Wilson, Huber, Tex., writes: "Nine days before her confinement, Mrs. H. was with her husband in the cowyard, helping him milk, when the crying of a child was distinctly heard by the husband, who asked his wife what that was. She replied it was her child." (Meaning child in utero.)

Dr. R. W. St. Clair, Brooklyn, N. Y., rather ridicules the idea of a child crying before it was born. If the two gentlemen will look in King's Manual of Obstetrics, third edition, page 362, they

will find this: "Respiration does not prove child to have been born alive, for it may have breathed (imperfectly, at least) and even been heard to cry in the vagina or uterus before birth was complete, as in face cases and retained head in breech presentations, etc. Exceptionally, a child may live and even breathe (by bronchial respiration only) for hours, and even days, with partial, and twentyfour hours with actually complete absence of air from the lungs. Cases: See Taylor's Med. Jurisprudence, pp. 335, 336, 337; Beck's Med. Jurisprudence, Vol. I., p. 517."

The doctor has a note at the bottom of the page, which reads thus: "It is said a child has been heard to cry in utero weeks before delivery. (Taylor, pp. 350, 351; Beck, Vol. I., pp. 537, 538)."

For over thirty-nine years, my invariable practice in such cases has been to do nothing but quiet, if possible, the patient's fears, assuring her or her friends that when the sexual system is sufficiently matured the menstrual function will be pretty certain to become established, never giving drugs so long as they "eat well, sleep well, and feel all right."

I could cite case after case, during these years, when the patient or her friends have duly expressed their gratitude for not interfering with the natural course of development of that function by making a drug store of the would-be patient's stomach. My advice, therefore, to all my younger brethren is, do nothing until some symptom of disease appears.

Your pocketbook may not be so fat, but your conscience will be clearer. EDWIN D. SWIFT, M. D.

Hamden, Conn.

"This is my covenant, which ye shall keep between me and you and thy seed after thee; every man child among you shall be circumcised. He that is born in thy house, and he that is bought with thy money, must needs be circumcised; and my covenant shall be in your flesh for an everlasting covenant.

"And Abraham took Ishmael his son, and all that were born in his house, and all that were bought with his money, every male among the men of Abraham's house, and circumcised the flesh of their foreskin in the selfsame day as God had said unto him. And Abraham was ninety years old and nine, when he was circumcised in the flesh of his foreskin."

It is well known to surgeons that peripheral irritation has a disturbing effect on the nervous centers of the body, manifested by various phenomena, of a peculiar kind. A nail thrust through the flesh of the sole of the foot has for many years been known to produce changes in the central nervous system, causing the most violent spasms, and rigidity of the muscular system, often ending in death; whether the changes in the nervous centers, producing these phenomena, are physical or mechanical, is not positively known.

Ingrowing toe nails often produce effects on the general system, and the different organs of the body most remarkable, viz.: Irritation of the lungs with a distressing hacking cough, pains in back of the head, along the spine, in the hips, and a general distressing feeling of the whole system. Removal of the cause, the effects vanish as if by magic.

Adherent prepuce to the glans penis of boy-babies, and a long contracted prepuce, is a most fruitful case of central disturbance, producing epileptoid convulsions. Many male children, in my opinion, who are irritable, fretful, and frequently have spasms, owe it to reflex from the urinary organs.

Professor Reverdin, gives several very instructive cases as the result of urinary reflex irritation.

Case I.-A boy, nine years old, well developed, complained for several weeks of severe pain in the right hip, and

walked lame. On examination in the upright position, nothing abnormal was found. If force was used in moving the leg, severe pains were felt, and the muscles were strongly contracted. The pains radiated toward the iliac fossa, the upper part of the thigh, and inside of the anus. The case seemed to be one of beginning hip joint disease. He ordered rest and extension for six months; there was no improvement. At the last examination, the great length and narrowness of the prepuce was noticed, although the patient had never had any symptoms referable to that, nevertheless circumcision was performed, and all the above mentioned symptoms disappeared as if before the wand of a magician.

Case II-A young man became morose, melancholy, apathetic, and showed a decided suicidal tendency. He was circumcised, his disposition changed completely and satisfactorily.

Reverdin does not pretend to explain the causal connection between the psychical change and the operation, although he says there was nothing in the patient's external relations to bring about the result.

Fleury published similar cases of hysteriæ and hypochondriasis by circumcision.

In the practice of J. L. Reverdin are the notes of two cases of epileptic convulsions cured by circumcision.

Sayre, Trousseau, and many others have from time to time called the attention of the profession to the importance of the genito-urinary reflexes, yet the importance of the subject, to the welfare of humanity, has not taken deep enough root in the minds of medical men.

Dr. J. G. Carpenter, in the American Practitioner and News, May 26th, 1888, describes a number of cases of adherent, contracted prepuces, the symptoms and phenomena, and the good results of circumcision, it would be well and profitable for any practitioner to read.

We are told by naturalist of rudimentary organs in different species of animals, where the use of a certain organ, by change of environment and evolution, was of no further use to the animal, that it gradually withered, and disappeared, only leaving a slight mark where it had once been. I can not but

believe that it would be a blessing to humanity if the process of evolution would eventually lop off the prepuce, and children be born with only the rudiments. Many animals are provided with a stink-bag, and other odoriferous qualities, presumably thereby to attract the opposite sex.

The animal man, through the process of civilization, education, culture and general refinement, seems to me has no further use for that fifth-gathering portion of his anatomy, called a prepuce. I firmly believe that the wonderful vitality, sagacity and get-up of the Jewish people is, in a great measure, due to circumcision and other hygienic principles taught them more than three thousand years ago. As a people, they have been, for two thousand years, ostracized, murdered, banished, every obstacle put in their way to destroy them, and no other race of people

could have withstood the assault and survived; yet, hands off, and in two generations, they will be the moneylenders of any country in which they may live. Let this suffice.

CASE I.-Dr. E. B. C., of Moniteau County, Mo., came to the city June 20th, 1888, to consult me about his little son, who had been afflicted with epileptoid convulsions, from the age of three months. The patient had been under the professional care of a physician of more than ordinary ability, yet, by overlooking the little things in diagnosis, he failed to find the cause of the trouble. He was a beautiful little boy, well nourished, physically perfect, had from three to five convulsions in a week. I examined him by the process of deduction and exclusion. I finally excluded everything but the genital organs, when I examined the penis, found a contracted prepuce, passing a probe through the orifice, and carefully moving it from side to side over the glans, found adhesion of mucous membrane on each side of glans penis. (See figure No. 1.) The dotted portion showing the extent of adhesion. I was satisfied that I had found the cause of the difficulty. I told the parents that I could find nothing else about the child that was the cause of those terrible convulsions, and advised circumcision. While I would not

guarantee a cure, yet I had known other children to be cured by the operation, and by all means to give the child the benefit of the doubt; they readily consented.

When the nervous centers are profoundly impressed by certain influences, there is a strong tendency to the development of a body habit in consonance with those impressions, therefore the cause being removed, the effects will continue until they are transplanted by a different set of impressions, hence the importance of the early removal of such irritations, before they became fixed facts in the organism.

ل الله

Fig. No. 1. Fig. No. 2. June 21st, I performed circumcision, and removed the adhesions. The convulsions ceased immediately, the child had a more cheerful disposition; more inclined to play; the countenance assumed a happy expression. In October it cut some teeth, and was afflicted with constipation, when there was a recurrence of the convulsions; these causes being removed, the convulsions ceased, and the child has had uninterrupted good health to the present time.

CASE II. In 1883, a young man, aged nineteen, was brought to me by his father, for advice, who had for several years been afflicted with the night horrors. He would have spells of the most unearthly screaming, and frequently jump out of bed, taking bed clothes with him, and frighten almost to distraction any one sleeping in the same bed, or in close proximity; when he would wake up, he had not the slightest remembrance of having had a spell, save from the disturbance around, and being told by others. These spells are evidently a

species of epilepsy, closely allied to somnambulism, the result of either central or peripheral irritation. The young man was well developed and the picture of health; it was very hard to divine what was the cause of this unpleasant state of things. I examined him carefully; there seemed to be no defect in any organ of the body; he was intelligent, handsome, gentlemanly and very anxious to be cured of his malady. I finally examined his genital organs. They were well developed, only there was a very long prepuce with a contracted orifice. (See Fig. No. 2, which gives a very imperfect representation). I advised circumcision, it was acceded to, and the operation was performed. The spells did not immediately cease, but they occurred at longer intervals; by giving potass. brom. for some time to break the habit of body, they finally ceased altogether.

CASE III.-Was called to see Miss J., sixteen years old, large, overgrown girl. She was afflicted with an irritative cough. Coughed especially at night, complained of pains along spine, hips. and thighs. Had spells of dizziness; her mother was afraid to let her go out alone; when she went to mass, in the morning, the family were uneasy until she returned, fearing she had lost her way, or fallen to the street in one of her dizzy spells. Upon examination, found menstruation normal, heart beat regular, mucous roles in the lungs, countenance sad, disposition apathetic. The father and family supposed it was growing too fast. I could not see what was the cause, when finally the mother told me that her toes were sore, but that the doctor who had attended her before I was called, said that that did not amount to anything. Each big toe had an ingrowing nail, curved down, and penetrating the flesh nearly to the bone; large fungoid granulations, of a bluish cast, at the junction of nail and flesh. This was the peripheal irritation that produced the whole trouble. The ingrowing nails were removed; the cough, and all other symptoms disappeared as if by magic. S. B. HOUTS, M. D.

803 Pine St., St. Louis.

BACK NUMBERS.-We can supply the January and February numbers for 1889.

Diphtheria Treatment.

In the February BRIEF, Dr. E. F. McMillan, Prairieville, La., asks for some successful diphtheria treatments. The disease in question has caused many an argument for and against its being a constitutional malady. Probably just as well, if not better, that we do not always agree. Be that as it may, I am inclined to believe it to be constitutional, hence my treatment. And whether Bro. McMillan agrees with me or not, he is just as welcome to my treatment-a very successful one to me, and consequently I think a great deal of it-as follows:

M. Sig.: A teaspoonful every three hours. Now, for the throat, I use no gargle. I am more humane. Solution of acetic acid, one part to six or eight of water, use in continuous-spray atomizer, one to three minutes at a time, and every twenty to thirty minutes, if necessary, until membrane sloughs, which it will in an almost incredible time.

When I substitute sol. potass. chlor. et borac. sodii et hydrastis fl., used as needed, in case of obstinate inflammation or swelling. I use in addition lime fumes -slake small piece of lime in crock and put funnel over it, inhale by that means. By my Listerine-aconite treatment, I prevent blood poison, and with the iron I keep or maintain the strength, which suffers greatly at such a time. Should like to have the opinion of the readers, generally, on treatment. Trenton, O.

H. SCHOENFELD, M. D.

Excessive Sweating of Scrotum. I have a case that is giving me no little trouble, that I wish to report through the columns of your valuable BRIEF, and would like the brothers to give me some light and their treatment. I have a patient, Mr. aged about thirty-eight years, who has been troubled with excessive sweating of the scrotum.

This is the first time I have asked for help. Will some one respond and help me out of my dilemma?

Merriam, Ind. N. B. MOORE, M. D.

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Knot in the Cord.

I had an obstetrical case a few days ago where the cord had a complete knot tied in it midway from the child and its placental attachment. Child was alive and hearty. How many readers of the BRIEF have had similar cases?

J. A. LAMBERSON, M. D.

Lebanon, Oregon.

The Best Hypnotic.

Dr. N. Farren, Buncrana, County Donegal, Ireland, says: I have prescribed Bromidia in a number of cases and am much pleased with its effects. It is the best hypnotic, causing sleep in a very short time, and leaves no unpleasant after-effects.

Let Us More Thoroughly Understand the Action of Medicines.

In reply to Dr. Wetherbee's questions, I would say: If water was good in fever years ago, it is good now; if bleeding was good years ago, it is good now; if calomel was good years ago, it is also good now. Doctors were mistaken, years ago, in regard to many things. And we may not thoroughly understand all things at present. But it is our bounden duty to know all that is possible for us to know concerning the medicine that we use. I agree with the doctor, that we must spunk up and acquaint ourselves with the medicines we prescribe. For, without a thorough knowledge of their actions and uses on the human family, we would not be prepared to safely administer them.

We must know our medicines, and only give them when indicated. Better only use six remedies that we thoroughly understand, than use twenty that we only have a smattering idea of. I think that physiology and therapeutics are what we want more thoroughly to acquaint ourselves with.

Let us hear from the brethren as to what are the latest and best text-books on physiology and therapeutics.

Jerome, Ind. L.A. BAGWELL, M.D.

Treatment for Diphtheria Wanted. I wish those physicians who have investigated, and had experience in treating that worst foe of childhood, diphtheria, would communicate to me through the MEDICAL BRIEF, the best and most successful method of combating its ravages. Of course, I do not expect a specific as yet, but I wish there were one to be had, for I consider it one of the worst diseases with which physicians have to do battle.

CLINT L. LUCE, M.D.

Albert Lea, Minn.