ence," although he had given her somewhere between five and twenty grains of morphine and kept her asleep and "pains ineffectual" with "no emotional or physical derangement" for nearly three days and nights.

Now, he proposes to "bolt" from one extreme of giving one-fourth-grain doses of morph. every two hours, to the other extreme of giving, every half-hour, fifteen-drop doses "of that much disputed, abused and misused fluid ext. of ergot." Then, fearing he would thus "lacerate" the machine he was so heroically driving, he "bolts" back to the other extreme again and throws on a brake of fifteen grains of chloral every twenty minutes, and thus "labor terminated in two hours from time of administration of first dose of chloral."

Give us all a rest, now! We're nearly gone!

He soon braces up, and triumphantly exclaims: "Now, you learned theorists, what say you to this administration of ergot in the first stage of labor?" Humph! Think it must have been about the last stage, since the woman had been in labor about sixty hours, and the ergot was only given in the last two or three hours.

This criticism might be extended over the remainder of the doctor's article, but that is enough.

The doctor was certainly lucky to come out as well as he did, but the woman would have been more lucky to have never called his assistance.

'Twas you and your morphine, doctor, helping the undertaker, and not nature.

I do not aim to be harsh or disrespectful to the doctor, but his practice, to say the least of it, was certainly an inexcusable blunder; and his air of description made his article a very appropriate subject for ridicule.

It is to be hoped that few of the women of our land will be the recipients of such so-called professional service. The doctor should have known more perfectly the indications for morphine, chloral and ergot. We all might learn, though, from the doctor's proceedings. His management was a fair sample of our proneness to do too much, and then accuse nature of assisting the undertaker. Let us all be wiser. P. A. SPAIN, M. D. Nevada, Tex.

Answers to Questions in Surgery.

BY ROBT. T. MORRIS, M. D., Instructor in Surgery at the N. Y. Post-Graduate Medical College.

Dr. Bridgewater, in the last number of the BRIEF, describes a method of removing warts and moles which is not so simple as another method in use in this vicinity.

The portion of skin on which the wart or mole rests must be rendered temporarily bloodless by pinching up the skin between the surgeon's fingers, or in any other way. A drop or two of ten per cent cocaine solution is then injected hypodermically into the base of the morbid growth. The skin becomes wholly insensitive in half a minute, if the circulation of blood was cut off well. The growth is then grasped with a pair of forceps, and neatly and deeply excised. A compress soaked in 1-1000 bichloride of mercury solution is then pressed on the wound until bleeding stops, and the margins of the wound are drawn together with eye-silk. The sutures may be removed at the end of three days, and the scar will be scarcely perceptible a few days later.

In Dr. Myers' case of cystitis, with concretions in the bladder, it will probably be necessary to open the bladder above the pubes, wash it out thoroughly, and drain it according to modern antiseptic methods until the wound heals. If the patient has an enlarged prostate, or urethral strictures, I should do the median perineal operation, and divide all constrictions at the same sitting.

Dr. Neel's case was one of peri-articular cellulitis, rather than one of synovitis, and the latter complication is not usually well marked in these cases. The patient being anæsthetized, the knee in a case of this sort should be scrubbed with 1-1000 bichloride of mercury solution, and then free incisions are to be made through the tense skin, in order to allow serum to escape, and thereby prevent sloughing and extensive suppuration. Just as we treat any other phlegmonous cellulitis.

In a case of acute synovitis proper, with much tension and pain, there is no harm done by giving relief by drawing off the fluid by aspiration, if the work is done under thorough antiseptic precautions. The limb is then to be fixed by immova

ble apparatus, and elevated by slings as the patient lies in the recumbent position. Alternate hot and cold douching, rubbing and "knuckling" are to be applied during the convalescent period, in order to obtain free capillary circulation in the vicinity and to develop the muscles of the limb which atrophy rapidly in these cases.

New York City.

Wanted-A Reliable Remedy.

Will one of your readers, who knows, please inform "a body," through the BRIEF or otherwise, just how he would proceed, provided a young woman sixteen or seventeen years old should call upon him to be treated for suppression of the menstrual function, from other causes than that of pregnancy?

This, to be sure, is a little thing, but after a fine-looking, red-faced, wellformed, plump little Miss has called upon you for forty or fifty times, more or less, and given the same old answers to your anxious questions:

"Good morning, Miss; how are you today?"

"Oh, just the same."

"Do you, at any time, have any of the usual symptoms of menstruation?"

"No, I can't say that I do." "You eat and sleep well?" "Yes."

"You feel all right, then?" "Yes, sir."

-The thing begins to get a little stale, and I half-way wish-deep down in my professional trousers-that more had been said about the little things, and not quite so much about big ones.

Now, I want a dead sure thing-none of your old "cut-and-dried" remedies and methods-have enough of them myself. I want something that will restore -and restore as speedily as restoration should be made other things being equal.

I may be quite alone in this great dilemma, but, if I am, just make known your remedy and say nothing about it, and the first time I get a chance I will cut your leg off or do some other great favor for you.

HAMILTON H. WILCOX, M. D. Albert Lea, Minn.

Broken Catheter in the Urethra.

My case, page 495," Broken Catheter in the Urethra," is no more. Mr. A. K. was taken Friday night, Nov. 16th, with a severe uræmic chill, but soon rallied. On the 18th another chill, which left him speechless. He regained the power of speech for a short time on Monday, the 19th, but suffered great agony until Tuesday morning, 2:30 o'clock, when death relieved him. He was rational up to the time of his death. At first, he had great confidence in Dr. C., but towards the last blamed him severely.

I told Mr. K., two months before his death, that the only thing to be done was an operation, assuring him that there was some of the catheter left in the bladder. I explained the operation of lithotomy to him, but could not convince him that it was the thing, until the last week of his life; then he wanted the operation performed, but I did not think then that I would be justified in operating, my patient being too weak.

I am in receipt of private letters from Drs. H. G. Blaine, of Attica, O., and Robt. T. Morris, N.Y., and will say to them and others that on a post-mortem I removed seven inches of that broken catheter from the bladder. It was in four pieces, covered to twice its size with calcareous matter. The question is, where did Dr. C. get the piece that he showed Mr. K. and charged him $25.00 for? The doctor assured me, by private letter, that he had removed it with a lithotrite. Well, I have the four pieces, measuring seven inches. Any miracle here? Rossville, Ia.

S. C. MYERS, M. D.

Twin Monstrosities.

A peculiar case of deformities in twins occurred in my practice, and may be of interest to those who have had the misfortune to deliver other than perfect children. One of them had no cranium and no eyes, with one foot situated on the back part of the ankle. The other had neither mouth, nose, ears nor arms.

Can anyone, in the BRIEF, tell us the cause of such deformity?

May the BRIEF have a long and successful life. E. F. DODSON, M. D.

Knott, Tenn.

Do not use the metric system.

Write only on one side of the paper.

See how short and plain you can write. Only one article desired from any one writer in same issue.

The MEDICAL BRIEF will not be sent ANY LONGER THAN PAID FOR

Write articles intended for publication and matter for editor on separate pieces of paper.

The Editor of the BRIEF is not responsible for the articles of its contributors.

Use as few technical terms as possible; the best educated writers use the simplest and plainest language.

Articles sent for publication in the MEDICAL BRIEF must not contain more than seven hundred words. Short, practical, brief items always wanted.

The MEDICAL BRIEF is mailed on the first of each month. If a number fails to reach you we will supply it; provided, we are notified within a month."

MEDICAL BOOKS.

We will supply any MEDICAL BOOK, no matter by whom published, post-paid, on receipt of publisher's price. Send for our Catalogue.

Address MEDICAL BRIEF, St. Louis.

THE case that Dr. Mosena presented in the December BRIEF-that of the persistent headache that afflicted his wife-presents the fraternal feeling that pervades the minds of the patrons of the BRIEF. He states in his article on another page that from the issue of the December number to date (December 5th), he has received thirty-two private communications. While our office has received twenty more. Making a total of fifty-two answers to one request. The physicians who are isolated from the counsels that

can easily see that the BRIEF is their great counsellor in time of need. When you ask for help always give the diagnosis as complete as possible, or give the symptoms of the trouble as fully as you can and you need not despair of help from our thousands of patrons.

Answer to Dr. J. M. Mosena of Fairplay, Col.

The doctor seems to me to be in much distress, very near and dear to him, and with the true spirit of "brotherly love" and having some little pride myself in the matter, I venture to suggest the following formulæ to his consideration, and his good lady's relief:

Here are the formulæ which I have had much success with in my own hands, and which have gained for me some laurels over some of my older brothers,many of whom are now using it.

Doctor, if your wife is of the anæmic kind try nitro-glycerine 1-100 grain of McKesson & Robbins', or any other reliable make. I give it twice or thrice daily, according to indications, or if she is plethoric and full habit, I would suggest this:

Typho-Malarial Fever-Answer to J. D. Kelly, M. D.

Dr. Kelly seems to be at a loss to know why it is that doctors, who have practiced medicine in the West, claim the non-existence of typho-malarial fever.

Dr. J. R. Woodward, the father of the so-called (typho-malarial) fever, labored on the same delusion for ten years, and came to himself, repented, saying: I say positively now, there is no such a mongrel type of fever.

He, with others who followed him, contended against Bowling, of Nashville, Tenn., and Bartholow, then of Louisville, Ky., but finally yielded the point, as its non-existence was too plain: they could not maintain their position. If I was called on to produce testimony of the non-existence of the mongrel fever, I could not ask for a better witness than Dr. Kelly, and his case that he adduces to prove its existence. He is a witness against himself, and so does the case speak in thunder tones to establish what I have hitherto said.

If that was, primarily, malarial fever, why did it not yield to sulph. quinine in a week's treatment, as that is almost a "specific" for that class of fevers? The symptoms are all such as I should expect to find in a case of typhoid fever, during the first week of its existence. It, no doubt, would have been better off if it never had seen quinine at all. I think it is plain enough to any man that there never was any malarial element in his case at all-the sequel proves it.

It is strange, indeed, that we never have intermittent or remittent fever to contend with whenever typhoid fever is rife. We had advocates for typho-malarial here two years ago, but since there is so much hemorrhage from the bowels, which puts the facts beyond all controversy that it is typhoid, we never hear typho-malarial mentioned.

I would just as readily expect my apple trees to bear apricots as to see malarial change to a typhoid fever-all "bosh" to my mind.

As long as the doctor uses a large amount of quinine, he may expect hemorrhage and every thing else that is bad. If he will treat a little more on the expectant plan, and sustain his patient from the start, and await future develop

In reply to Dr. Smith, I would say that his case seems to me to be of a hysterical nature, and the hard lump a "phantom tumor," due to spasmodic contraction of abdominal muscles. Weir Mitchell and Gowers report similar cases. In Dr. Smith's case, I think a relaxed rectum and a contracted diaphragm produce the "lump" and accompanying pain. This being the case, the treatment for hepatic disorder is scarcely correct, but sedative applications to reduce nervous irritability would be better.

If anything is to be done, I should suggest faradism to the relaxed muscle, careful massage. A moderate hypodermic would hasten the abatement of the spasm.

In spasm of the diaphragm, I have known hot water fomentations to be prompt in giving relief.

I hope that this diagnosis will prove as satisfactory as one previously sent to the BRIEF. H. S. DRAYTON, A.M., M.D. New York.

Hemorrhoids.

Hemorrhoids have a surgical and a medical treatment, when there are distinct polypoid tumors the case is surgical, and when the circulation of the parts is involved and the entire mucous membrane of the rectum, and where the tumors are flat and broad based, medical treatment is indicated. There are hemorrhoidal conditions as well as hemorrhoidal tumors.

The first method of cure is to remove the obstructions in the course of the hemorrhoidal veins, this is usually from constipation and accumulated feces at the sigmoid flexure. There can be cases where the obstruction is in the liver. Two grain doses of calomel every four hours, or crab orchard salts and sulphur (six parts salts to one part sulphur) a teaspoonful twice daily. When the parts are hot and swollen, soreness with a burning sensation, I use:

R. Tinct. Collinsoniæ...

Aquæ...

:

.10 drops. ......4 ounces.

M. Sig. A teaspoonful every three hours. When there is a constant feeling as if something should be forced from the rectum, I use a tincture of the buckeye (æsculus glabra). If fullness, weight and a sense of weakness of the parts and an examination shows a relaxed perineum and varicose hemorrhoidal veins, then prescribe Pond's Extract of Hamamelis in ten drop doses every four hours. For a local application I use sol. persulphate of iron, tinct. opii, of each one ounce, to be applied with a brush.

Mr. B. H., age fifty-two years, has been suffering with hemorrhoids for nine years past. In the present attack he has been confined to his room for three or four months, there are three well developed pile tumors that should be removed by the surgeon. The entire lower rectum is engaged in the disease and very much swollen from venous engorgement. I prescribed Pond's Extract of Hamamelis, fifteen drops every four hours. Solution of persulphate of iron and tinct. of opium of each one ounce to be applied to diseased parts. In four days he was able to go on the streets; the third week he was well. Three years have elapsed and the disease has never returned.

Barker, Ark.

H. J. W. BARKER, M. D.

Subtitution by Druggists of Medicines Prescribed.

If there is a practice among any reputable pharmacists or druggists that should be denounced, it is that of substituting the manufacturer of some other druggist for that which is prescribed. It is none of the business of pharmacist or apothecary to dictate to the doctor what he should prescribe. If the honest apothecary has not the preparation the doctor has prescribed, and can not supply it, it is simply and plainly his duty to say so, and not undertake to furnish a substitute without a free consultation with and the full consent of the doctor.

What would the apothecary think of his stationery dealer if he were to send him a box of "Falcon pens" when he had ordered a box of "Spencerian pens?" Is it honest in the stationer to undertake to palm off the brand not ordered? And if the stationer were to establish it as the principle of his house to thus "work off" his stock on the pharmacist, would not that pharmacist soon say that he would discontinue dealing with that stationer, and furthermore, expose him to his friends?

If this principle is regarded is dishonorable in so trivial a matter as the selection of a pen, it should certainly be held as more disreputable for the pharmacist to substitute a medicine not ordered for the one that is prescribed.

The apothecary concedes the whole thing when he says he supplies only Squibb's chloroform when this preparation is ordered. If he is honest in filling the prescription of the doctor strictly when that article is prescribed, why should he not be equally as honest when the preparations of Wm. R. Warner & Co., Rio Chemical Co., Battle, Lambert, Merrell, Peacock, McKesson & Robbins, Schieffelin, etc., are prescribed?

Is it not dishonorable in principle to do otherwise?

Amputations.

Will our surgeons, in writing to the BRIEF, give some idea as to time required to perform amputation of thigh at middle third? J. A. MELTON, M. D. Aurora, Mo.