causes a temperature once reached to be maintained so long as the heat is unchanged.

Sterilization is accomplished by bringing the object to be sterilized to the temperature of live steam, and maintaining it at that temperature for about fortyfive minutes. Boiling for the

same

length of time, in a vessel the sides of which are exposed to the air, is not efficient, as the temperature in different parts of the vessel is found to vary considerably. This is the main objection to Soxhlet's apparatus, the principle being that of a water-bath. While in the cooker, we have a steam-bath, in which variation of temperature is prevented.

Numerous tests have shown that with a single Bunsen burner, and ordinary gas pressure, the temperature of 100° C. is reached, in all parts of the receiving vessel, in less than ten minutes. The time required to raise the fluid to be sterilized to the same temperature is found to be directly proportional to its bulk. So that less time is required when the food is in divided quantities. When the temperature of 100° C. is reached, sterilization has commenced, and should be continued for the time specified, fortyfive minutes, which time is necessary on account of the great resistance of the spores.

As a sterilizer, the cooker presents these principal advantages: 1, its effectiveness in sterilizing; 2, economy, both of time and fuel; and 3, great convenience, on account of its portability.

The recommendations to any who might use it are as follows:

That the food be prepared as it is to be administered, and that the quantity required for twelve or twenty-four hours' feeding be distributed in eight-ounce flasks or nursing bottles, providing one such bottle for each feeding, so that no unnecessary exposure or transference shall be had. In filling the bottles a a funnel should always be used, to keep the necks clean, and the fluid should be a full inch below the neck. The bottles should be plugged with cotton, extending well down into the neck, any impurities which this may contain, in the form of moulds or bacteria, being destroyed by the same process which sterilizes the

food. The bottles are now placed in the cold receiving vessel (to prevent breakage) and heat is applied by means of gas, or a kerosene or coal stove. To insure a complete sterilization, heat should be maintained altogether for one and aquarter hours.

Food thus prepared can be kept at ordinary temperatures for an indefinite period, doing away entirely with the use of an ice-pail or refrigerator for keeping the milk sweet.

When the food is to be given, the bottle is to be well shaken to mix in the cream, the cotton plug is removed, and the nipple applied to the bottle at once. In cases where it may be necessary to administer food at a higher temperature, the bottle is stood in warm water, as is customary. In regard to the nipples, it is not practical to sterilize them, as heat destroys the rubber, but they can be thoroughly cleansed by the ordinary methods.-Med. Record.

[Physicians wishing to use or commend to patients the use of the "Arnold Steam Sterilizer," can obtain information as to sizes and prices by addressing Wilmot Castle & Co., the manufacturers, at Rochester, N. Y.-ED.]

Chronic Sore Legs.

In the July BRIEF, I notice an article under the above heading, by W. W. Matthews, M. D., of Louisiana. While I heartily endorse his plan of treatment, which I think is good, mine is somewhat different as to the external treatment; and as the subject is one which deeply interests every practicing physician, I think a little discussion upon the subject will assist the younger members of the profession.

While in the U. S. Navy, during the late civil war, I sent many a sailor to the hospital to be treated for sore legs,while, with my present experience, I would not send one.

In cases of indolent ulcers, non-specific in character, I have poulticed for about twenty-four hours, to clean up the debris, after which I apply, in powder, the following:

If patient can remain in bed, no bandage is applied; if patient must be on duty, apply bandage, and let it remain for two days at a time. When cleaned, I only have removed with plain cold water any matter that may present itself; after drying the parts, have them powdered, and repeat the cleansing every two days. I usually succeed in healing the ulcers in about ten days or two weeks. If they are a little tardy in healing, I add one drachm subnit. bismuth.

I never allow my bandages to be washed in soda water of any form.

It is a well-known fact that napkins washed in soda water will keep the buts of little infants forever red and sore, and the same applies to sores of any kind, with soda-washed bandages. All bandages should stand from ten to twenty hours in a solution of bichloride of mercury, or sulphate of copper, and then be washed out with pure soap and water.

If I find I have very indolent ulcers, instead of using the poultices or powders, I use, for the first three or four days, the ⚫ following:

Morbid Anatomy, Cause, Symptoms, Diagnosis, Prognosis, and Treatment of Valvular Diseases of the Heart.

In valvular lesions, the left side of the heart is more frequently affected than the right, owing to the more stimulating character of blood which comes in contact with the valves of that side, and greater strain which is placed upon them in order to accomplish the systemic circulation. Seems as if the greater amount of fibrous tissue which is around the aortic and mitral valves renders them susceptible to inflammation, so these predispositions to inflammation account for the more frequency of occurrence of valvular disease of the left side than the right.

Dr. Hope says "the affections of the left valve are in proportion to those of the right as twenty to one." When the valves become altered in form or shape, it is evident that they do not open and close as they did when they were in a normal condition; they either produce obstruction to the circulation by contraction, or allow regurgitation by insufficient closure, which, of course, compels the heart to do an extra amount of work to combat either one of these defects, and, laboring under this undue amount of work for some time, produces hypertrophy and dilatation, which are the most prominent factors in the pathological anatomy of chronic valvular lesions. Other changes are also brought about in this trouble, such as tuberculous formstions upon the surface of the valves, cartilaginous degeneration may take place, producing what is known as ossification of the valves. Bronchitis, pneumonia, etc., may be caused from congestion of the lungs.

The cause of valvular diseases in a great majority of cases is endocarditis, either acute or chronic, most frequently of rheumatic origin. Ossification of the valves may take place in old persons, independent of inflammation. Calcareous depositions sometimes take place in the valves in persons of a gouty diathesis. An impoverished condition of the blood may cause enlargement of the valves. Excessive and continued action of the heart, from any cause, may produce an altered condition of the valves.

Symptoms.—In order to understand the physical signs in valvular diseases, there are certain points connected with the heart which are absolutely necessary for us to remember. The first to look for is, what is the condition of the sounds? Are they normal or abnormal? And, in order to distinguish the normal from the abnormal sound, it is necessary for us to know the normal sound when we hear it.

When you listen over the apex of the heart, which is about one inch below and a little to the right of the nipple, you will hear a low-pitched, booming sound, which is the first heart-sound, and is caused by the contraction of the ventricles, closing of the auricular-ventricular valves, and striking of the apex against the chest walls.

When you listen over the base of the heart, which is behind and a little to the left of the sternum, between second and third rib, you will hear a sharp, clicking sound, which is the second heart-sound, and is caused wholly by the closure of the semilunar valves; these two sounds may be compared to the words lub-dub, whispered. After we learn the normal sounds, it is then necessary for us to know what is taking place during these sounds, the course and direction the blood is going, etc., so we can understand how the abnormal sounds are produced. All the abnormal sounds are known as murmurs, and these murmurs may be caused from two conditions of the valves, viz.: insufficient closure, causing the regurgitant murmur, and contraction, causing the obstructive or direct murmur.

The aortic and mitral valves are most frequently the cause of these murmurs. The valves of the right side of the heart are very rarely affected, and if they are, the murmurs they produce are similar to those of the left side, only being a little louder, because they are nearer the surface of the chest, and, for the sake of brevity, we will just notice the valves of the left side. If the murmur is heard loudest at the base of the heart, the aortic valves are affected; if heard loudest at the apex, the mitral valves are affected. The aortic obstructive or direct murmur is heard during the first heartsound, and is heard loudest over the base, with the sound ranging upward into the

carotids. This sound may be compared to the whispered letter I. The aortic regurgitant murmur is heard during the second heart-sound, over the base, with the sound ranging downward. This sound may be compared to the word awe, whispered during inspiration. The mitral regurgitant murmur accompanies the first heart-sound, and is heard loudest over the apex, with the sound ranging around the chest towards the left. This sound may be compared to the word who, whispered.

The mitral obstructive or direct murmur accompanies the second heartsound, and is heard over the apex, with the sound ranging downward and a little to the right. This sound is of a lower tone than the mitral regurgitant murmur. In addition to the abnormal sounds, we have other prominent symptoms in valvular lesions, such as irregular pulse, a feeling of compression or constriction in the chest, sometimes acute pain in region of the heart, shortness of breath upon exertion, cough, dyspnoea, hæmoptysis, etc., all of which are caused from pulmonary congestion, owing to the impediment in the circulation through the heart.

Diagnosis. We sometimes have cardiac murmurs, dependent upon functional derangements of the heart, caused from a hydræmic condition of the blood, as found in chlorosis and anæmia; but these murmurs are not of a rough, grating character, as the organic, and are only heard under excitement of the circulation, while the organic murmurs are heard under all conditions of the circulation. As regards the diagnosis of each particular murmur, a few words may be said. The aortic direct murmur is heard during the first heart-sound, and is heard loudest at the base, with the sound ranging upward into the carotids, while the mitral regurgitant is heard during the same sound, but is heard loudest at the apex, with the sound ranging around the chest towards the left, and is of a lower key than the aortic murmur. The aortic regurgitant and the mitral direct murmurs are heard during the second heartsound, but the aortic murmur is heard loudest over the base, while the mitral murmur is heard loudest over the apex of the heart, and is of a lower tone than

the aortic murmur. The aortic direct murmur is carried upward into the carotids, while the aortic regurgitant is carried downward into the ventricle. The mitral regurgitant murmur is carried around the chest toward the left, while the mitral direct is carried downward and a little toward the right.

Prognosis. We can not mend the old valves, nor give new ones, but by proper remedies and careful treatment, life can sometimes be prolonged, so prognosis is always unfavorable as regards effecting a cure of the valves.

Treatment.-The indications are best met with such remedies as will have a tendency to tranquilize the action of the heart, by giving it strength to perform its undue amount of work, and we can best accomplish this by the cardiac stimulants, such as cactus grand., digitalis, strophanthus, etc., and a tonic of iron, quinine and strychnine, to keep the blood in a good condition. Should guard our patients in the amount of exercise to be taken, and prevent, as far as possible, any undue excitement of the action of the heart. W. A. PROCTER, M. D. Homer, Ky.

"Worms in the Nose."

The Best Method of Applying a
Tampon.

As I am always in the habit of making little suggestions, rather through a medical journal, that may prove of some value to other members of the medical world, than to answer each and every colleague privately, as to how and when a particular mode of treatment is to be carried out, I trust that Dr. F. S. Peck, Nashville, Kan., will be pleased to read about the "tampon" in the BRIEF, and will excuse me for sticking strictly to my principles.

Many practitioners do not care to apply a tampon, for the reason that they consider it to be a part of surgical proceedings. Some dread to make it, saying that their patients complain of it as being very painful. Again, some never practice it, as they have not had good results from it. But all these objections

are mainly due to the fact that few of them, if I may say so, properly understand how to apply a tampon, especially

in cases of abortion. I will endeavor to describe, as plainly as possible, the easiest and most reliable mode of applying it.

Always have a separate bag ready, on hand, which should contain as follows: Ferguson's speculums, three sizes; one pair of placental forceps; a bottle of

ren, but being only a 'Country Doctor' I stand aside for some of the bigger guns." Now, doctor, the "bigger guns" would prove themselves but little louder in report than fire crackers, the first time they are called to treat a case of in the nose."

worms

That terrible pest to stock, and occasionally to man, during our wet summers -the "screw worm "-(cauliphora anthropophiga) will be more than ordinarily abundant this year, owing to excessive and continued rains; and although I have treated, very successfully, cases with them in nose and rectum by the local use of iodoform, calomel, sulphur, etc., as the case required, I would still like to hear the doctor's plan of treatment; and I am sure many of the "bigger "would be equally interested in the guns report. T. N. CLARK, M. D. Reagan, Tex.

plenty of carbolized cotton; a spool of silk thread; a vial of vaseline; and a Davidson syringe, with a bottle of carbolic acid. Such a bag I keep always ready on my desk, and call it plainly my "abortion bag." I never use Sims' speculum, for the reason that I like to apply tampons by having the woman lying on her back, and because it requires an assistant, while, with the simple tube speculum, I can either hold it in position with one hand myself, or ask my patient to hold it there when necessary. Further, the reader will notice that I use a placental forceps for grasping the cotton. I like it because it is very handy; it is long enough to work, not soiling your hands, and it enables you to keep the speculum with one hand, while grasping the cotton and introducing with the other.

Now, as to the method in detail. Being called to a case of abortion, do not enter

into prolonged conversations with the patient or friends, as to her general health, etc., but, having ascertained the trouble and whether or not something has been discharged, proceed at once to make a digital examination. Finding the os not being fully dilated and the bleeding being profuse, begin with your tampon at once. Bear in mind that the bladder and rectum may interfere with your process, and, therefore, they should be tested, and, if necessary, emptied. Place the woman on her back, with her legs flexed, her feet resting upon the edge of the bed, while you are to sit on a chair right opposite her. Previous to that of placing the patient in the said position, you have to prepare your cotton. The carbolized cotton is to be torn into small pieces, each one is to be rolled up into a ball and tied with thread silk, in this manner: double the thread and place the ball of cotton on it, near the open loop, then pull the free ends of the thread around the ball through the open loop and tighten it firmly. In this way, I am able to make from fifteen to twenty balls within five minutes.

Having satisfied yourself that you have got enough cotton to fill up the vagina, put

it on a chair

at your right hand, pour some of your glycerine in a saucer placed alongside of the cotton, introduce your speculum. The speculum is to be held in position with the left hand, while the work is done with the right one, by means of the placental forceps. First of all, pass very gently the small sponge, which was previously tightened with a string as well as the cotton, pressing it firmly against the cervix, then proceed with cotton. Each ball is grasped with the forceps, dipped in the glycerine, and gently introduced-first around the cervix, and then continually inserting them until the vagina is packed. The speculum is to be gently pulled, little by little, outwards, as you introduce more cotton, at the same time repeatedly pressing the cotton inwardly, so that it should come closely in contact with the vaginal walls. The vagina being completely packed, withdraw

your speculum, place a few pieces of cotton at the vulva, and make a T bandage. Applying a tampon in this way, no blood can possibly escape from the womb, and good results are undoubtedly obtained. Before leaving, instruct your patient that she is to keep her bed, and should not be much disturbed by visitors. At last, do not fail to tell her that she might have severe pains, and that this operation, being a harmless one to her health, might be necessary to be repeated accordingly.

Never use a glass speculum; you may meet an occasion where you will be obliged to remove your tampon with broken fragments of glass.

M. J. BURSTEIN, A.M., M.D. 182 Henry St., New York.

Case of Ruptured Bladder-Patient Insensible to Pain.

Townsend, aged sixty-two, short and thick set, an English soldier, illiterate, one of those patients who seem to be almost devoid of feeling, sent for me to open a bunch on his back.

I called on him, and found he had a very large carbuncle on his back—one of the largest I have ever seen. Promising to see him the next morning, I took an aged man (his intimate friend) to see the operation. I told the patient that I should be obliged to make some large incisions, and advised ether. He objected, saying "Cut her open; I don't want none of yer pizen!" I had known the man, and knew he was of a slow, stupid, phlegmatic nature, so, to pacify all concerned, I gave him some camphor on a cloth to inhale, while his aged friend and myself stood ready to operate. After he had taken a few whiffs, I made a slight incision, and, as he showed no sensitiveness, I incised the carbuncle nearly the whole length of my scalpel, each way. On taking the cloth away from him, he accused me of not opening it, saying he did not feel the stuff, and he would not be satisfied until his friend had brought his fingers around so that he could run them through the cuts, while his aged and ignorant friend was astonished at the marvelous effects of the medicine I had given him.

Some six months after this, he was shaving hoop-poles at his branch, when