When I had occasion to examine her, she said if she had known I was coming she would have taken a bit of butter about the size of a pea for breakfast and had her circulation in an uproar. Says she can feel the effects of the alcohol in fifteen drops of ergot.

I should have stated that recently there seemed to have been a small tumor on each common carotid, which gave some pain, but they have gradually gone away.

The symptoms are very favorable for aneurism; but would aneurism of the abdominal thoracic aorta be likely to last forty-five years?

Most of the doctors say she suffers from aneurism, but some of them are (like myself) not proficient in physical diagnosis-though they may be right.

I write this to get the opinion of the readers of the BRIEF. It would worry the patient greatly if her troubles were made out to be anything else but aneurism, as she is intelligent and has read up on aneurism, and can tell you where the tumors are, and how they feel and look in her imagination.

Could not the soft roaring bruit of the circulation be caused from anæmia-the so-called abdominal tumor from contraction of abdominal muscles? The neuralgic pains, morbid pulsations, etc., from weakened digestion and spinal irritation, and, hence, a weakening of vasomotor nervous system, functional arterial dilatation and morbid pulsations? L. L. CLEMENT, M. D.

Mazeppa, Ga.

Minor Surgery at the New York

"Deutsches Poliklinik."

Time here is too short to use anæsthetics. Cocaine too expensive. Insiration, succeeded by short spasmodic expirations is considered by the attending surgeons as beneficial respiratory gymnastics. After hemorrhage is controlled, all wounds are washed with 1-1000 or 1-2000 solution of bichloride of mercury, powdered with iodoform, then covered successively with bichloride gauze, absorbent cotton, and bandaged with gauze moistened in pure water. Where practicable, edges are first sutured.

Fingers may be ever so badly contused,

they are never amputated, but antiseptically treated, placed in splints and in no case has subsequent amputation been necessary. It is remarkable what useful digital members may, in this manner, be obtained.

Plaster of Paris dressings are used for all fractures, the results obtained verifying one's opinion that they are the bandage par excellence for the successful treatment of these surgical affections.

All pus-containing cavities are freely opened, scraped, washed with bichloride solution, drainage tube inserted, and covered with usual antiseptic dressings.

In the treatment of indolent ulcers exceptionally good results are obtained. Surface surrounding ulcer is spread with an ointment containing one or more of the following ingredients, in varying proportions: Iodine, iodoform, boracic acid, oxide of zinc and salicylic acid; lanoline or vaseline constituting the basis. To the ulcer itself, if stimulation is required, it is packed with chloride of zinc gauze; if exuberant granulations are present, they are touched with argent. nitrate, or if ulcers are doing well, powdering with iodoform, covering this with bichloride gauze and then bandaging the entire limb, is the modus operandi pursued.

In several cases of cystitis cures have been obtained by the internal administration of alkalies, combined with frequent washings of the bladder with weak antiseptic solutions.

Inflammatory swellings are kneaded with an ointment of iodoform, two grains, to twenty grains of vaseline.

All wounds, ulcers, etc., are inspected and redressed every second or third day. Antiseptics have full sway and the results obtained are attributed by the surgeons in attendance as due to their judicious use. MOSES KLEINER, M. D. New York.

Only a Country Doctor. Why is it that an M. D., who locates in the country, becomes a "Country Doctor" while if he decides to settle in a wilderness of brick he develops into a "City Physician?"

This subject has caused me much anxious thought. There is no intrinsic ditference at the start; no general law of selection separating a graduating class into" Doctors" and "Physicians." This is proved by the fact that a country doctor may, under favorable auspices,develop into a city physician, and vice versa. The material is the same to begin with but something in the atmosphere of green fields appears to lower the standard.

I would not care if the term was not used as a sort of reproach; just as we say of some man, "Oh, yes! a good fellow, but-"

Now, Providence has caused me to fill both roles, and a comparison will do no harm. The city physician has considerable advantages over his country brother. Unlimited access to libraries and journals; constant attrition with other medical minds; abundant instrumental facilities; and a drug store at every corner. He is not obliged to confine his treatment to the medicines he has in stock; nor to consider how his patient's pocket can stand some costly remedy; he simply writes his prescription.

If he gets in a tight place, a dozen willing friends are ready to help him out. Night calls are not an abomination to him, for a well-paved and lighted street leads to his destination, or a close hack saves his own horse from exposure and himself from the storm.

Now, for the other picture: The country M. D. must rely upon his own books for reference in all cases; his journals are only those he can afford to take. His instruments necessarily few, and often applied to uses their maker never intended. No blessed chance to borrow from a friend or hire from a drug store, some instrument rarely used. No brother physician to talk his cases over with and borrow ideas as well as instruments from. (This want is now supplied, thanks to the blessed BRIEF.) No trained nurses to carry out directions and keep a record of symptoms. No drug store round the corner, and a constant necessity of con

sidering his patient's pocket, as, if he does not, his own will suffer.

Then the night calls; oh! those night calls. My dear country brother, have you ever noticed: that the darker the night, the farther you will have to go, and the meaner the road is certain to be? No paved streets for you, but a tired, or wild horse must be backed, or driven, and a rubber coat is all the protection you can expect to get. It is needless to touch on the subject of pay, as that is a foregone conclusion. Even the country doctor's patients, will pay a city physician a bill, that would cause a war if presented by him.

Now, what effect does all this have upon the different men? I claim, boldly, that other things (brain and energy) being equal, the country doctor is the superior of his city brother. I do not mean to detract from the large class of my brother M. D's. who are doing noble work in our cities; they ornament the profession; but I claim that my position must be a correct one from the very nature of the case.

The country doctor must rely upon himself in all emergencies, and having few books, he must study them well. He does not use many new remedies, but handles the old with the precision of a workman used to his tools. Having no one to consult, he must think out his cases carefully, as his responsibility is great.

Very many of the advances that have been made in medicine have originated in a country doctor's office. True, the originator soon sought the wider field of the city, but only to practice what he had already found out. Sims, Long and a seore of other brilliant names, bear out this assertion. All over this broad land of ours the country doctor is riding today. Through Summer's heat and Winter's cold, sunshine, or storm, he speeds on his errand of mercy. True, he is working for his living: but how little can the mere money compensate for the toil, anxiety and constant danger he is exposed to.

I knew one who left his family, to attend a call at some distance, on a dark night. He never reached his destination, and after days of search was found crushed, with his faithful horse by a falling tree. He had taken a short

cut through the woods to arrive at his destination sooner and met his fate. Another, a class-mate of my own, left his bed while suffering with a severe attack of bronchitis, to attend an urgent call. The exposure brought on pneumonia from which he never recovered. Another did his full work, during a very sickly season, with a succession of carbuncles on his back that nearly killed him. The list might be lengthened indefinitely, of these heroes who have worked and died at there posts without even knowing that their actions were heroic.

Another phase of the country doctor's life; partially shared with his city broth

er.

Often his patients are his dearest friends; he can not regard their cases with a purely professional eye. He has heard the first feeble wail of some sweet woman whom he is now called to help through her hour of anguish. To her he is almost Godlike in his power, and eye, voice and lip must be carefully guarded or harm will come. This call upon his affections quickens his perceptions and not unfrequently he is rewarded by sights that angels might be glad to share.

He watches some young girl through her first labor. Though a wife she is only a girl still; motherhood has not yet been called in life. At last, after hours of anguish, her child is born: and the sweet face calms down into that rest that is like Heaven. As she rouses her baby is laid in her arms. In one second the girl is transformed into the mother. Her whole face is illumined with the wonderful light of a mother's love. All the agony forgotten in the joy that “a man child has been born into the world." Until one has seen this sight he can never realize all that the human face is capable of expressing.

Now, God bless the country doctor. He does not often wear broadcloth, and rarely reaches fame; but he nobly does a noble work and need bow his crest to

none.

All this has been called out by a remark heard some time ago, on a visit to one of our cities. "Oh, yes; he is doing pretty well, but is only a country doctor you know." That word "only" riled me, but I feel better now. In my next I

Climate for Consumptives.

Dr. F. Seeger has an article in the October number of the Medical Classics, in which he traces phthisis pulmonalis to great moisture, or a damp subsoil.

It has been observed by Dr. Simon, "that in fifteen English towns, the death rate of consumptives fell immediately upon the subsoil being drained and dried." In Salisbury the death rate fell 49 per cent; in Ely it fell 47 per cent, etc. The high death rate of the English Guard's army fell from 125 in 10,000 in the year 1858, to 16 in the 10,000 in the year 1875, on account of improved ventilation of the barracks, thus giving purer air.

Dr. Bowditch, of Boston, Mass., Dr. Buchanan, of England, and Dr. Pepper, of Philadelphia, each confirm the opinion that moisture in the soil is a fair measure of the relative amount of consumption in a locality.

The possibility of infection is receiving recognition also by some of the best medical writers. The hereditary nature of this disease is now almost universally admitted.

And it seems that the African race, formerly almost exempt, is now the most liable to this dread disease.

All houses should be well ventilated, and the cellars thoroughly drained. If houses are not well ventilated, and their cellars properly drained, phthisis may be looked for in all our large towns and cities, unless it be in the most elevated localities. Many so-called health resorts, situated in a low altitude, and with large bodies of water surrounding them, are disease-developing places, and should be avoided by all who wish to avoid this disease.

I was very strongly censured by a reviewer of my work on the Science and Practice of Medicine, for naming my own city, Marietta, Ga., as a home for consumptives, as it is a high, dry locality. But I am conscientious in so doing, as Marietta is 1133 feet above the sea-level, and surrounded with a porous gravelly and sandy soil, sufficiently undulated as to prevent any excessive moisture, and

with a highly ozonized air, which is very conducive to health, and very favorable to the invalid. And time has proven these statements to be true, as many persons can attest.

I have known many consumptives to resort to the humid atmosphere of Florida and California, which often. proved fatal. It is not alone a warm atmosphere that is desirable for the consumptive, but a dry, pure and elevated one, where ozone is plentiful, which does not remain in an elevation of one or two hundred feet above the ocean, but in dry and very light air of 800 or 1000 feet above the sea-level. I would not say that consumption can be cured by climate alone, but it favors other proper treatment to bring about that most desirable end.

In phthisis pulmonalis, there is both defective digestion and nutrition. The assimilation is so imperfect that great emaciation very soon takes place. And, not only is there a constant tendency to slow tissue formation, but a tendency to the development of abnormal tissue, and this leads to molecular death by necrosis. A softening process soon ensues, finally ulceration and suppuration, and this leads to expectoration of purulent matter, and thus cavities are the result.

At this stage, there is generally evening fever, loss of appetite, strength, and great emaciation. One great object in the treatment at this stage is, to tone up digestion and assimilation, to improve nutrition, etc.

I have found ptelia trifoliata a very positive tonic at this stage, as well as at the commencement of the disease. And to aid the tissue nutrition, and to conserve the neoplasm, the hypophosphites of lime, soda and magnesia are valuable. And to each dose of these, I have found creasote (made from the beech) to aid the above remedies in a very positive manner, in all the cases that I have tried it in, for several years.

My opinion is that the creasote, made from the beech, strikes at the cause of the disease, let that be what it may. I have noticed that it soon improves the appetite and digestion, and aids in checking night sweats and diarrhea.

The hypophosphites form a chemical food, essential in preventing the rapid tissue waste that characterizes the dis

ease in all its stages. Without improving the digestion and assimilation, the essential histological elements of lung tissue can not be rapidly formed.

The various functions of the entire vital system are made to act with increased vigor, by the restorative power of the hypophosphites, as they, by supplying a nutritive element to the nerve center, improve innervation to all the vital organs. And in case of anæmia the iron salt may be added. To get the value of the hypophosphites, they should be pure, and to secure that result they should be purchased from a reliable chemist, and immediately made into a syrup, to prevent change as they soon oxidize in the air. I. J. M. Goss, A.M., M.D.

Marietta, Ga.

Persistent Headache.

In the BRIEF for December, page 511, under the title of "Persistent Headache," I called the attention of its readers to the case of my wife, who is at times a great sufferer from headache.

To date (Dec. 5), I have received thirty two private communications from as many different medical ladies and gentlemen. Space will not permit a personal mention, but will for the present only say, many hearty thanks, dear friends. As you have given me many helpful suggestions in the treatment and management, I trust final cure of her case. Yet you suggest a very great variety of opinions and plans of treatment, from which I can select some valuable ideas.

Some one has remarked that in my description of her case I failed to give full history and present condition. In further interest of the case will add that her digestion is excellent in absence of headache. She has no uterine or ovarian lesion, pulse normal, about, as a rule, 76 to 80, per minute; her flesh and color is good, though not of a full habit, having grown more fleshy during the last five or six years. It was stated that the headache came on when she was nineteen years of age, and has undergone but slight change since. She became a mother once and did well (thirteen years since). I hope this will supply all omissions. Will await further advice, etc. Fairplay, Col. J. M. MOSENA, M. D.

Is it Possible for Buboes to Develop

Without the Initial Lesion?

While enclosing $1.00 to renew my subscription to your journal, I wish, for the sake of information, to state the following case and ask the profession at large some questions relative to it:

A. B., aged thirty-three, had been hauling corn, and in preparing his wagon had lifted a heavy wagon-bed to put it in position. Two days later, on rising in the morning, he noticed a tenderness in the left groin, with considerable pain when walking. A week later, I found that there was a swelling about the thickness of my finger, about two inches in length, quite tender, and a single enlarged gland discoverable to touch.

A week or two later, I had another opportunity for examination, and in the meantime the swelling had developed into a double ridge-like form, still tender, but the ridge next to the penis most susceptible. The lymphatics on the left side of the penis were also enlarged, and felt under the finger like a string of beads. A careful examination of the prepuce and glans penis disclosed no trace of sores, nor had the patient ever noticed any soreness or especial tenderness in those parts, and stated that he had examined himself every time he urinated for over four weeks before the swelling commenced, and had found nothing to alarm him.

By inquiry, I found that thirty days before the lameness set in, he had connection with a woman of the town at Paducah, Ky., and, being afraid that bad results might follow, he had, as he expressed it, looked at it a thousand times since, although he did not know whether the woman was diseased or not. In answer to my questions, he stated that he had never had any venereal disease whatever, that all his people had been or are now afflicted with scrofula, that an uncle had died from it a year or two ago and another uncle is so badly affected with that disease that he is unable to work. On further inquiry, I learned that one of his uncles had caries of the leg bones, and that part of the fibula had been removed from that leg.

Now, I would ask, fellow-practitioners, if it be possible for buboes to develop

without the initial lesion, if we suppose that the patient had contracted syphilis from the woman with whom he had intercourse thirty days before? My text-books are not clear on this, and my experience is limited in regard to it. Could there have been an inappreciable sore, curing itself without treatment, and the bubo form some time after the initial lesion had come and gone unobserved?

Further, could this be a case of scrofula, pure and simple, developed by the strain of lifting the wagon-bed, or shall we ascribe it to a syphilitic condition transmitted from the grandparent?

Like Dr. C. D. R. Kirk, of Shuqulak, Miss., I desire that we be, above all things, scientific; and, as I have met some local opposition to my view, I hope that a full discussion of the possibilities of such a case may disclose something of value in future diagnoses.

J. I. BRADLEY, M. D.

Sugar Tree, Tenn.

Study Therapeutics.

Dear Old BRIEF! Could not get along without you and keep up with the times, as you are equal to a course of lectures every year.

I have been interested in many of the discussions in the BRIEF, and would like to ask some questions, believing that a doctor should have good judgment and not stick too closely to theories.

If water was good in fever years ago, why not now?

If bleeding was good years ago, why not now?

If calomel was good years ago, why not now?

I have been in practice twenty-five years and have never used one particle of calomel in any form, but have had many cripples for lite from its effects. I think the doctor who gives it would be loth to take it himself. I think that doctors, generally, give too much medicine. A little good advice and sunshine often does as well. I think that doctors should get up a little spunk and acquaint themselves more with their medicines; then they will know what they are using. Inclosed find one dollar for renewal of subscription to the BRIEF.

M. S. WETHERBEE, M. D. North Haverhill, N. H.