treatment of inflammation under certain circumstances.

I am sorry to say that we do not practice venesection as often as we should. It is as far in the extreme of not being resorted to often enough, now, as it was fifty years ago when it was resorted to for all diseases. And the cause of this is our timidity, which induces us to surrender to the fashions of the times, and not that blood-letting is any less valuable as a remedy than it was fifty years ago. When we use it judiciously, in cases where depletion is proven by experience to be a valuable factor in the treatment, our mortality will not be so great by ten or twenty per cent as it is when we use the arterial sedatives and equalizers of the circulation (aconite, veratrum, gelsemium, etc.).

Dr. Goss has peculiar notions, and is not satisfied unless he has something to abuse; and, after saying that calomel is useless as a drug and not suitable for anything except to kill rats, he comes out and says that venesection should not be practiced in pneumonia or any other disease. Doctor, do not be so sanguine; do not try to implant something in the minds of the young generation of physicians that has found its way into your head through the prejudice you have against calomel and blood-letting-two of the most valuable agents the physician has at his command.

And Dr. Standlee, one of Dr. Goss' disciples, comes boldly to the front (on p. 377) and advances the idea that medicine to-day is so deeply involved in scientific principles that blood-letting should only be recognized as one of the relics of barbarism, and contends that the pathological condition caused from the congestion in inflammation can be best allayed by such remedies as will have a tendency to equalize the circulation, as aconite, veratrum, gelsemium, digitalis. Now, I do not propose to condemn these drugs, as he does venesection, because they are excellent remedies, administered at the proper time and place, nor do I pretend to say that venesection is admissible in all cases of inflammation; it might have an admirable effect upon one case of pneumonia, and in another do great mischief; so it depends altogether upon the condition of our patient, whether we bleed or

not. Plethora is the general indication, but we should not act upon this alone, but should take the other indications into consideration before we decide to bleed our patients.

Now, if Dr. Standlee will take a patient with pneumonia, in the first stage, plethoric, with full, frequent, hard or incompressible pulse, distended jugulars and flushed face, and rapid and painful respiration, etc., he can very well dispense with his gelsemium and veratrum, and resort to blood-letting, with the effect of relieving the labored and painful respiration, tranquilizing the circulation, and, in a great degree, modifying the inflammation going on in the lung; and some go so far as to say that we abort the pneumonia. Dr. Standlee claims that there is no scientific reason for the abstraction of blood in such cases.

Now, I think there is just as much reason in taking a little blood away from a system that contains too much as there is to let it remain. Blood being a natural stimulus, and the lung being engorged in pneumonia, it is reasonable to suppose that removal of part of it would diminish the force of the heart's action, and would be a right step in the direction of relieving the engorged lung. The results of inflammation depend upon the amount of effusion from the blood vessels, and it is evident that this effusion would diminish by lessening the amount of blood in the system. The blood is the pabulum for the whole process of inflammation.

Dr. Lawrence says: "If we may be allowed to use figurative language, the obvious increase of heat in the part is analogous to that of fire, and blood is the fuel by which the flame is kept up; in fact, if we could completely take away its blood from the part, we could be able entirely to control or arrest the increased action."

Now, I hope our brother physicians(Drs. Goss and Standlee) will not attempt to cause the lost art (blood-letting) to be any more neglected by the mass of the profession to-day than it is. Any physician who has realized the appreciation of its real value would attempt to revive it rather than try to cast it out of the hands of the profession.

Homer, Ky. W. A. PROCTER, M. D.

SEND 50 cents for a Binder.

Typho-Malarial Fever.

I was rather amused in reading the article on this fever in August BRIEF by Dr. Swearingen, especially the treatment employ ed.

There is no question that we have typho-malarial fever. But the typho part means, not a part of typhoid fever, but a low state of the nervous system, or the system generally, and now loaded down with sufficient malarial poison to produce the typho-malarial fever. I have treated this fever for the last fifteen years, and more or less cases every year; so I write here not from books but from experience.

This fever has no limited course to run like typhoid fever, but in many cases, if permitted, will run from thirty to forty days, or even longer. But I hold that if we understand the cause and the pathological condition, with proper remedies we can cure it in from two to eight days. But if we prescribe improper remedies, especially those that will set up irritation, then the case will be prolonged and perhaps have a slow, protracted case.

My friend prescribes mercury, colocynth and podophyllin. These are more or less irritant to the bowels, and as there is a strong tendency in this fever to a diarrhea anyway, hence it is improper to prescribe such a remedy, as it will prolong the disease.

Now, if the physician is called say the second or third day of a typical case, adult age, the temperature 104, pulse 100, headache, bowels rather costive, with a tenderness over them; tongue usually coated white, or yellowish white, urine scanty, high colored, burning fever, and perhaps nausea and vomiting; now we want to, and can, promise the patient we will break up this fever in a few days. My remedy is this:

R. Phosphate Sodæ..

Ext. Aconiti fl

Ext. Gelsemii fl.

8pts. Nit. Dulc...

....

2 drachms. 10 drops. drachm.

... 2 drachms.

M. Sig.: Teaspoonful every one or two hours. This will reduce pulse, temperature, and induce diaphoresis.

Also give one drachm sulphate of quinine, two drachms salicylate soda, mix, make powders or into ten doses. Give one powder every four hours, regardless of fever.

Have the patient sponged in warm water, with soda in it, every night.

This treatment, in a few days, will break up the fever; now give some mild, non-irritating cathartic, if indicated, but in a majority of cases the 'bowels will move regularly without cathartics.

We want to build up our patient. Here I want to remind young doctors and old doctors as well, that in all cases or diseases where there is high temperature, much of the red corpuscles of the blood are burned up, or consumed, and must be replaced. For this I always give the citrate of iron. I usually give:

Pin Worms-When to Use the Forceps-A Grandmother at TwentySeven.

In reply to Dr. A. J. McIntyre, Corinth, Ill., I would say, you might do as did a Mr. P., of Central Indiana, along in the seventies. Having been troubled with pin worms until forbearance ceased to be a virtue, he saturated some cotton with ol. terebinth and introduced it into the rectum; and in speaking afterwards about it, he said: "Doc., I never had anything to hurt so d-d bad in my life. Why, I just got down and sledded like a d- -d dog." But it was effectual. But, laying all jokes aside, I would say, I have had good success with the following:

by the influence it has upon the patient. One case may be in labor only a very few hours, when symptoms of exhaustion supervene, while other cases may be prolonged for from twenty-four to thirty-six hours, and still the lady maintain her strength wonderfully. We should be guided in the use of forceps entirely by circumstances, and not by the time elapsing.

No, I think you would not have been justified in using them in the case you gave, for you say the bag of water was absent, consequently, no doubt, the delay was caused by the slowness of dilatation of the os, and forceps would not have helped that.

While I am on this subject, I would say, I have been engaged in practice fourteen years, and had my share of obstetrics. I have not had a rupture of perineum. It is true, in primiparous labors, the fourchette has been torn, but I have not had a rent that required clos

I wish to relate the peculiarities of a case which caused, at the time, a wonderment in my mind, as to its cause and nature.

It was in the fall of 1867. In either the latter part of September or the fore part of October. I had had a very busy day and at 10:30 had retired for the night, and my good lady was preparing to follow. Owing to frequent calls at night I had accustomed myself to keep my lamp burning low all night. On this occasion my wife turned the light clear out by mistake, and on relighting it, she threw the lighted match on the carpet. She stooped to pick it up and when her hand was within about six inches of the burning match, she screamed with pain, and grasping the index finger of the right hand with the left she went prancing around the room in perfect agony. I sprang out of bed, and as soon as I could catch her, her finger had swollen to at least four times its natural size. Taking

a small bistoury from my pocket case, I cut from about four lines from the first joint to the end clear to the bone. No blood followed the operation, but, in its stead a substance similar in every particular to the germ of an egg fell off of the bone. From the moment the knife entered the flesh she was as free from pain as ever she was, and in less than ten minutes the swelling had left the finger, and in a week's time the wound had entirely healed up.

Will some of our brother doctors please say, through the columns of the BRIEF, what they diagnose this case and if they ever had a case like it, or similar?

I have related this to a goodly number of physicians, among whom was Prof. A. B. Spinney of Detroit, Mich., none of which attempted to hazzard an opinion, except Professor Spinney, who thought it was a bone felon.

For my part, I do not think it had the first symptom of a felon, for she said she felt no inconvenience till she stooped to pick up the match.

Salina, Kan.

CHAS. W. STOWE, M. D.

Precocious Fecundity.

Dr. S. I. Fox (August BRIEF) wishes to know if there is any younger mother on record than the one he reported (not quite twelve years).

In Sims' Uterine Surgery, page 29, we find a case reported by Dr. Curtis, of Boston, that occurred in the poorhouse in that city, as follows: "The girl, Elizabeth Drayton, became pregnant twenty-four days before she was ten years old, and was delivered of a fine, full grown male child, weighing fully eight pounds, when she was ten years, eight months and seven days old. The reputed father of the child is said to be about fifteen years of age. The mother menstruated once or twice before conception, was healthy during gestation, and had rather a lingering, but quite natural, labor."

I had a case that went full time, and child was born, before the mother was twelve years of age, and another that miscarried in her twelfth year.

L. NORTHRUP, M. D.

Valley Falls, Kan.

The Verdict.

In order to test the claims of Sozone, the new remedy for asthma, the BRIEF instituted a clinical inquiry among the profession. About one hundred reports on the remedial action of Sozone have come to hand.

We find they nearly all agree in one particular or peculiarity of the remedy, viz., its affinity for the pneumogastric nerve. Some report Sozone a specific for asthma, others only where there are no organic lesions, and others as a powerful sedative and antispasmodic in all forms of bronchial irritation originating either in the afferent, efferent or

peripheral nervous system.

We can not but congratulate the proprietors, Dr. J. D. Stoneroad & Co., Meadville, Pa., on the verdict thus rendered by the profession.

What Constitutes Tedious LaborWhen to Use Forceps.

I should like to answer Dr. B. W. Summy's questions: "What constitutes tedious labor-how soon forceps should be used?" MEDICAL BRIEF, Aug. '89.

The question, when to use forceps, is of great practical importance, because much harm can be done by using the forceps too soon or withholding its application too long. Though no cast-iron rules can be given in this regard there are two guiding principles which are of great use, and upon which all good obstetricians are agreed.

I. Never to use the forceps before the orifice is completely dilated, except there is immediate danger to the mother or child; because extraction before complete dilation of the orifice is very difficult and dangerous to the mother and child.

II. Not to delay the application of the forceps too long after complete dilation of the 08, because the mother

becomes exhausted and is liable to suffer in child-birth; too long a delay endangers also the life of the child. Many of the best obstetricians do not wait longer than two or three hours after the dilation of the os, even when there is no other indication for applying the forceps.

These two rules are as useful to the physician as the compass to the sailor; they are not everything, but still great helps.

Labor is tedious when it lasts longer than the average time-ten to fifteen hours in primiparæ and four to six hours in multiparæ. Labor may be tedious before or after the complete dilation of the os, or may be tedious from the beginning to the end. Any interference to accelerate the first stage of labor is, as a rule, far more injurious than beneficial.

When to apply the forceps: We can not go so much by the time from the beginning of labor as by the time when the orifice has become dilated and by the condition of the mother and child. Therefore we can not say whether Dr. Summy was right to wait so long with the application of the forceps. To decide this we must know when the orifice became dilated and what was the condition of mother and child. But he deserves credit for acting according to his best judgment and not according to the suggestions of incompetent outsiders. Jos. KUCHER, M. D.

New York City.

M. ft. pil. No. 3). Sig.: One pill three times a day. Many thanks to Drs. I. J. M. Goss, of Ga., and J. C. Fear of Kansas for diagnosis of the case I reported in July BRIEF page 320. I pronounced the case cerebrospinal meningitis, but every one else pronounced it strychnine poisoning. I know it was not strychnine that killed her.

Brethren of the BRIEF, please give your opinion on this: I called Dr. W.B. B., in consultation and after we had consulted and agreed as to diagnosis and treatment, he asked for a private talk with the head of the family and staid at the residence after I left. Does this look entirely suspicious less. He came back the next day, he says at the solicitation of the patient's mother. I had to leave before he returned the next day and he got mad at me and did me lots of "dirt." So I think his conduct the first day was malicious and expressly for the purpose of raising himself and lowering me, and on these grounds I will not consult with him again. Am I right?

The BRIEF is a great help to me, long may its "banner wave above the breezes." A. B. BISHOP. M. D.

Mineral Springs, Ark.

"Bear Ye One Anothers' Burdens." Fellow-Doctors of the BRIEF Family: This contribution may amuse you, but, as "an honest confession is good for the soul," let me hope that relief may follow the confession I make to you:

I am a young married man; graduated in March, 1888, but being of poor parentage I necessarily became involved in debt in order to get my education. My notes are now due, and I have fallen on the plan to ask you to help me pay out. This indebtedness and a poor community have kept me considerably in the background since I commenced practice. But if every one of you will respond to my request, I can be lifted out of the mire, and equip myself with the books and instruments I need to enable me in the practice of my profession. I have no

claims on any of you, but ask you for a personal favor. The amount I ask you for is so small it can't hurt you, yet if all the readers of the BRIEF will respond, just see how it will help me! You have put hundreds of dollars into physicians' pockets by your intelligent contributions, so help me to Ten cents direct, and by enabling me to get my books and instruments, indirectly, too. Just while the matter is fresh in your minds, please put Ten cents in an envelope, with your name on a slip of paper, and address and mail to me. I promise you I shall not only feel grateful, but will give you an account of the success or failure of the plan. JOHN H. MOORE, M. D. Cripple Creek, Va.

What Is It, and What Shall I Do?

I have a patient that I am at a loss to know how to treat. I know of no better way to get counsel than through the BRIEF. So I come, and hope that at least eight or ten will respond with a successful treatment.

My patient is a German lady, about fifty-five years old, the mother of seven children. Has enjoyed good health up to about four years back, when she was taken with a very severe pain in her right ankle; from that, an eruption appeared on her foot and leg, with an intolerable itching and burning. It has extended now above her knee, and a clear fluid is discharged excessively.

The foot and leg are swollen to an enormous size, and about once in twenty-four hours the whole epidermis peels off. She does not suffer from it now, except the itching and burning sensation.

My patient has tried several physicians without any benefit. Finally, she came under my treatment, and, so far, the result has been the same as my predecessors. I will state, in conclusion, that after one of her confinements she had phlegmasia dolens.

The treatment that I derived the most benefit from was bismuth subnit. and glycerine, applied locally, with a tight bandage, with Fowler's solution internally.

Now, gentlemen, help a young practitioner. J. A. RYAN, M. D. Central, Ark.