become "authorities" by distinguisht services in the art of healing the sick.ED.]

Calomel.

Editor MEDICAL WORLD:-The use of this valuable and powerful drug has been a much discust subject, and discussion assists in bringing out the truth. Its physiological actions are:

Cathartic: Almost equal to a search warrant in legal affairs, it seems to scour the intestins. I have known it to cause a little blood to appear in children's stools. It is best to follow it with salts or something to carry it all out of the intestin.

Cholagog: It carries off worn out bile, and produces good yellow stools.

Antiphlogistic: It tends to break up forming inflammation.

As an antiseptic of the alimentary tract, it is of very certain action.

As an anthelmintic, it is better used in combination with others of that class.

As an antipyretic, it seems to come nearer making a continued fever jump the track than any that I know of. Have seen a few doses in first week of typhoid reduce fever, produce sweating, clean the tongue and almost induce convalescence.

As an alterativ it has great power; in many incipient diseases it just makes the patient get out of bed and go about his business.

As a diuretic as well as alterativ to mucous membranes, it is good in combination with squills or digitalis; it acts well in hematuria; increases amount of urin and clears it up.

Calomel used to be my remedy for croup. The best combination I ever used for croup is calomel, gr. 1; ipecac, gr. o; soda, gr. j, with potass. bichromate, gr. 7, and nuclein W-A. one tablet. One of each every half to two hours, according to urgency. Try it brothers, and report results.

Calomel in small doses is antiemetic. I had a case of gallstones with vomiting and debility. Gave patient calomel, gr. each hour, hot water to drink, tablets nuclein each two hours, and strych. arsen. gr. every four hours. This put him on his feet and at work.

I have had two cases of meningitis in young men, with temperature of 105° F., when I was doing my best to reduce it. Gave 20 gr. calomel, and that aborted both cases. No salivation resulted; only debility resulted, which was soon remedied.

The thought of calomel gives a homeopath the horrors; but the judicious use of it cures many diseases.

I have used a good deal of calomel, but never salivated any one. Small doses are generally very efficient, and are better every way in this day of scientific advancement when we have so many good remedies.

In the first days of tonsillitis calomel given to a good purgativ effect, together with dosimetric trinity and nuclein, will cause the disease to disappear like frost before the sun.

In the treatment of diphtheria, calomel used freely does much good, evacuates bowels thoroly, draws blood from throat, gets a valuable alterativ action on the glands, helps to correct a tendency to septicemia. It wants to be given boldly to effect (of course this is only a small part of the scientific treatment of diphtheria).

The great antiphlogistic trinity in my experience is calomel to free purgation, morphin to relief of pain, and about 30 gr. of quinin sulfate daily. The inflammation that this does not relieve will generally take much time and often the surgeon's knife to relieve.

An experienced physician told me that you couldn't salivate a child with calomel, because a child's liver is so large. I have never seen one salivated.

Calomel has the advantage of a small and tasteless dose; which is worth much in practise.

Calomel is a powerful and very useful remedy in the practise of medicin; but it demands judgment, caution and knowledge to use it properly. It will repay any physician to study the use of this agent very thoroly. M. C. MARTIN, M.D.

Our

Heartwell, Neb. [Does the above represent the experience and views of the "average doctor" of the "regular" school? Doubtless our eclectic friends will demur, and homeopathic friends will say that the old school is just what it used to be, except that small doses, very small compared to the old style, are usually given, tho the old ten and twenty grain dose is still occasionally given. What we want to get at is the actual daily practise, at the present time, of the average physician in general practise. See further remarks under a pneumonia article in this issue. -ED]

Pneumonia.

Editor MEDICAL WORLD:- Pneumonia season will soon be here. In the cold season we have more pneumonia from the fact that the action of the skin is deficient and the lungs are called upon to do a larger part of the work of elimination. This increase of the activity of the lungs is partially responsible for the tendency to congestion. Now, it has been my experience that strong men having large and powerful lungs are most apt to be stricken with pneumonia; and those with delicate lungs are more apt to have pulmonary edema.

Now, as to the question of treatment, we most all differ. Complications are prevented, and rapid and complete convalescence is assured by the use of the indicated remedies, there is no doubt. I think the principal object in the successful treatment of pneumonia is how to promote the process called resolution. "When resolution occurs, the contents of the alveoli become fatty and granular and are absorbed and the pulmonary epithelium is restored." The treatment is to be varied with every case, as no two ever run exactly the same course. In all cases I use calomel to open the secretions and to eliminate waste matter. When the fever is high and pulse bounding, I give veratrum, often in small doses. Veratrum must be used early in the stage of excitement, and pusht to effect, exerting its influence upon the nervous and circulatory system. The danger of heart failure from veratrum is less than has been supposed, if given cautiously in small doses. If the pulse is weak I use strychnin to sustain the heart's action. Strychnin is my sovereign remedy in pneumonia, but never in the beginning of a violent attack with high fever. We should watch carefully and know when strychnin is indicated. In the treatment of pneumonia I give all the hot water the patient will drink. Free drinking of hot water is useful in the cough, and stimulates the secretions and excites free elimination. Hot water tends to control the congestion.

I never use poultices and blisters any more. Instead I use cloths wrung from hot water and alcohol over the chest as dry as I can get them, removing quite often so as to have plenty of moisture for evaporation to carry off the heat. Warmth and moisture over the diseased lungs is necessary to life. Belladonna (tincture) is one of

my favorit remedies in pneumonia. Now, to make my patient rest, I use codein. For a stimulating expectorant, muriate of ammonia is my favorit. Strychnin is a most admirable remedy in pneumonia, a powerful agent, and depends for its therapeutic effects upon the intelligence with which it is given. Patients vary much in the amount of strychnin required to produce the desired effect, hence we must be perfectly familiar with the drug or we will do more harm than good. Pneumonia, like typhoid fever, requires close nursing. W. S. ROBINSON, M D.

Frostville, Ark.

[Any profession is made up most largely of its average members. Bright lights and leaders, as well as laggards, are in the minority. In these pages the average doctor finds an opportunity to tell his "average" co-workers in all parts of this great country what he is doing, and how he is doing it. This is of the greatest importance, for by far the greater part of the work of the profession is done by the average men-the "rank and file "—the backbone of the profession. The question is, Is the above a fair example of the treatment of pneumonia by the average doctor? We are inclined to think that it is. We have purposely refrained from any "polishing" of the article, in order to submit the above question. Possibly this may not be a prudent question for us to ask, for about three out of every four doctors may consider themselves " way above the average." Young men, in their first ten years of practise, are particularly apt to think so; but if they don't keep their thoughts on themselves too much, they get over it. The average man is peculiarly fitted to fellowship with and help his fellow average man. We do not wish to intimate that every "average doctor" treats pneumonia just as given in the above article; but that the article fairly represents the average treatment. Don't you think so? In what way does your treatment differ? No one will claim that the above treatment is perfect. Perfection can never be attained; but it can be approacht by contributions from various sources, combining the best features from many. Let us try to collect these best features and combine them. Let us try the same thing in the treatment of other diseases, also, say for common colds, coughs, bronchitis, both tubular and capillary, etc.-ED.]

Chloral Hydrate for Strychnin Poisoning. Editor MEDICAL WORLD:-Was called hurriedly to Mr. L., a young married man who, on account of some family unpleasantness, decided on self-destruction by taking strychnin. He purchased fifteen grains from a druggist, stating that he wanted to kill some dogs that were annoying him at night. After procuring the drug he went into a saloon and purchased a half pint of whisky; after dissolving the strychnin in it, he drank a little over half the contents of the flask and left for home, about three hundred yards distant. Immediately upon his arrival he was seized with convulsions, which continued in rapid succession. Upon reaching the patient I found that he had all the symptoms of strychnin poisoning: Opisthotonos, forcible extension of the lower limbs, tetanic spasms in rapid succession, dilation of pupils, rapid breathing; cardiac pulsations slow and the breathing very labored and difficult. The time had passed for the introduction of the stomach pump as the teeth were tightly clencht; so much so that I could get nothing into the stomach. I would have given him apomorphin hypodermically, but unfortunately I had none. The drug had evidently been absorbed into the circulation, dealing its deadly effect upon his vitality. As soon as I could remove the multitude of people who had assembled around him, in order to obtain fresh air and quietude, I thought of chloral hydrate being antagonistic to strychnin, and after taking into consideration the amount of strychnin the patient had taken, which was fully eight grains, I dissolved two drams of chloral in an ounce of warm water, and proceeded to inject this amount in different parts of the arms and lower limbs till all of it was injected. Immediately after doing that I forced him to inhale chloroform till the effects of the chloral were manifest. This was accomplisht within fifteen minutes. Chloroform being removed, patient was well under the influence of the chloral; all rigidity ceast and patient slept soundly for nine hours and awoke of his own accord; no complaint, only feeling of weakness and slight nausea. He then took a light breakfast. Now as to the amount of chloral that was administered, I confess it was rather heroic; but considering the amount of strychnin the patient had consumed, I am confident the amount of chloral was demanded to antagonize the strychnin.

Since then I learn that the patient has had, no further trouble, has reformed, and he and his wife are living happily together and doing well.

M. B. POLLARD, M.D.

Winnsboro, Tex.

Skin Grafting.

Editor MEDICAL WORLD:-Congratulations to Dr. Hurd on his successful case of skin grafting, page 429 October WORLD, This is such an interesting subject, and success gives so much satisfaction, that I am going to describe a method of covering the entire raw surface with grafts. This method I have many a time used, and find that it gives quicker healing, a better and softer scar, and less contraction than the method of planting islands of skin here and there.

A sharp razor and a willing friend are essential. When the wound to be covered is free from slufs, dress with mild antiseptics for a few days, and scrub surrounding skin thoroly with soap and water and 1 to 1,000 bichlorid. To cut the grafts, stretch the skin crosswise with the left hand, and without further fixing of the skin shave off with a sawing movement a piece of epidermis as broad and long as possible. Pieces 1 inches long by an inch wide can easily be cut with practise. These float on the razor, which is moistened with warm boiled water. Now lay the razor on the raw surface and coax the graft on to the wound with a needle and glide it into position. Fit the other pieces edge to edge so that the red surface is entirely covered; overlapping does not matter. If the grafts are refractory and curl up the deep surface should be inwards, invariably. If the raw surface is too large to cover at one sitting, do one section first and the other later.

If in a position where prevention of contraction is very important, scrape off the surface of the wound very lightly with a sharp spoon or curet; for this an anesthetic is necessary, and the grafts can at the same time be taken from the patient. After scraping see that all oozing has stopt before applying grafts. Dress with plain sterilized gauze (easily made at home), wrung out of warm boracic acid solution. This would stick to grafts and perhaps pull them off if directly applied, so they must be separated from it by t inch strips of oiled silk, laid in a parallel

fashion inch apart, and crost at right angles by another layer similarly arranged, but not quite so close to each other; the intervals allow for oozing. Do your first dressing on the third day. The surface from which the grafts have been taken is dotted with oozing points; dress this with boracic ointment; it will heal quickly. The above method is known as Thiersch's. Philadelphia. DR. SENIOR.

Concerning a Case for Circumcision. Editor MEDICAL WORLD:-Some years ago the term quack was applied to certain classes of medical charlatans and pretenders. The word was one of reproach, sanctioned by usage, and had a definit meaning. In these days it is less frequently used, and chiefly in a vague and indefinit way. But the quack-salvers are still with us, more or less prosperous, and under a multitude of titles and guises. So long as they sail under their true colors the community is free to patronize or to ignore them, as they choose; but when they steal the livery of heaven to serve the devil in," when the socalled regular physicians stoop to practise the methods and arts of quacks then, indeed, the community is assailed in the very citadel of its friends.

These reflections are called forth by a recent experience somewhat out of the common: G. W., a youth of 19 (at whose birth I had the honor of officiating), was recently matriculated at a southern university. It chanced that he had as a room mate a young medical student. In the confidence of chumming the medical student thought he discovered something unnatural in the genital organs of G. W. So he advised G. W. to seek medical advice; to consult the doctor-professor connected with the university. He did so, and was gravely informed that the opening in his prepuce was gradually closing up, and that the only remedy was prompt circumcision. This was news, as well as a surprise to the young man, who could not well gainsay the conclusions of the learned professor.

He left the university and came home to this city, as was said, on account of his health. He appeared really ill, and for some time it was uncertain whether he was suffering from malaria or was developing typhoid fever. His mind was worried and anxious, constantly dwelling

upon the dreaded operation. Finally he made a clean breast of the matter, and told me of his university experience, which was the starting point of his illness. On examination I found no difficulty in retracting the foreskin behind the head of the penis-in short, there was nothing the matter with him; his organs were essentially normal. With this assurance he promptly rallied, and malaria and typhoid were banisht to the winds.

He said that this same professor-doctor had found in the class some fifteen or eighteen other students that in his opinion needed circumcising. This would afford sufficient material for an interesting if not a profitable genito-urinary clinic.

Now, what is the natural conclusion? Either that this was a rare and "measly lot of young men, or that the doctor has a "bee in his bonnet."

The latter is probably the true explanation of the matter. Specialists are liable to go daft in their specialty. Some years ago a really able and skilful surgeon of this city gradually imbibed the notion that almost every young man should have his meatus urinarius slit. Eventually he became a monomaniac on this subject, and did incise right and left as scores of young men now living can testify to their sorrow. When there was no more material available, he migrated to Manhattan, where he found "fresh fields and pastures new."

In charity, I assume that this doctorprofessor of the Blank University is afflicted with the circumcision bacillus, developing a monomania for removing the foreskin of every young man so unfortunate as to venture within his reach. But what will be the fate of the young men placed under his fostering care? Some fathers and mothers would be horrified if they but knew the actual influence under which they have unwittingly placed their sons. There are cases in infants and children-but rarely in adultsin which circumcision is called for; but in the great majority of cases of phimosis and contracted prepuce, simple dilation with forceps will remedy whatever trouble there may be. Of course this simple maneuver does not warrant the fee nor secure the eclat that the operation for circumcision does; but I consider the result more satisfactory, for in my humble opinion the Creator knew what he was about when he ordained the foreskin to be the

natural and proper covering for the sensitiv corona glandis.

Brooklyn, N. Y. BENJ. EDSON, M.D. [A good hygienic habit is daily retraction of the foreskin and thro cleansing. ED.]

Treatment of Acute Gonorrhea. Editor MEDICAL WORLD:- Pursuant to your request for treatment and data on the curability of syphilis and gonorrhea, I send the following, trusting it may be of service to the many WORLD readers:

The therapeutics of gonorrhea is in a transitional stage. Not a few physicians still cling to the old method of treatment in vogue at the time when the causativ organism of this widespread malady was unknown. Viewed in the light of modern research, all authorities agree that gonorrhea is due to a specific organism, the gonococcus of Neisser; hence the old method of treatment, that is, dosing with balsams and the oil of santal, with an astringent injection to be administered by the patient, is rapidly yielding to the modern method, the chief aim of which is the destruction of the gonococci. It is this recent method of treatment that I wish to briefly outline.

Personally I have treated and cured over two hundred cases in private practise during the last five years by the irrigation method, introduced in this country by Dr. Ferd. C. Valentine, of New York. He has devised an instrument especially for this work, which bears his name, but an inexpensiv and fully as effectiv an apparatus can be improvised by using the ordinary fountain syringe with a suitable blunt pointed glass nozzle. The bag should be elevated to a height of eight to ten feet, according to the pressure desired. The patient can either recline in a sitting posture or stand, the latter of which I personally prefer, holding a vessel under the penis to catch the solution. The technic of performing the irrigation is as follows: Grasp the penis with the left hand, holding the left corpus cavernosum by the third, fourth and fifth fingers in such a manner that their tips rest lightly on the urethra, the left thenar eminence pressing against the right corpus cavernosum. The index finger and thumb are thus left free to manipulate the foreskin and glans, by compressing which the meatus will open for the introduction of the nozzle. Gently introduce the nozzle and release the re

tainer on tube of the syringe, the air, of course, having been previously expelled. If the anterior urethra only is to be irrigated, the fifth finger is firmly prest against the urethra, thus preventing the solution from passing beyond the point of compression. The anterior urethra should always be thoroly irrigated first, to prevent pus being washt back into the posterior urethra or bladder. I find it almost impossible to irrigate the posterior urethra without allowing the solution to pass into the bladder, but always assure the patient it will in no wise injure his bladder.

The solution I find from experience to be best suited for irrigation is potassium permanganate, freshly made, and in strength from 1-6,000 to 1-1,000. For an acute case I proceed as follows:

The hours will of course vary somewhat, the only point to observe is that irrigations given twice daily should be twelve hours apart.

If the above treatment is religiously followed, it will cure 90 per cent of acute cases in ten days and the remaining 10 per cent in three or four weeks. There is no doubt in the writer's mind that gonorrhea can be cured by the method given. I have followed the vast majority of my cases from one to five years and find there is no history of a relapse; in many instances the patients have married and have become the fathers of happy families, the wives showing no infection whatever. closing, will say I give no medication internally except alkalin diuretics where there is ardor urinae in acute cases. I do, however, absolutely forbid sexual intercourse, or what is as bad, sexual excitement, during treatment. As to diet, interdict all alcoholic and spirituous liquors; also fats and greasy dishes. Little salt allowed, but no pepper or highly seasoned

In