strict attention to the dietary of the patient, together with such tonic and stimulating medicinal agents as will whip up an appetite and improve digestion. An excellent systemic tonic in extreme weakness is the following: Fowler's solution, one drachm; the elixir of glycero-phosphate of lime and soda, six ounces; a small tablespoonful after meals in a wineglassful of water. If the tongue shows a leaden hue, or if it presents a dark-red color, the acid solution of iron in two or three drop doses after meals, taken in a little water, will act kindly, as will patent doses of iodide of potassium three times a day taken in solution with tincture of gentian. In this form of the disease, as well as in the other varieties, the emunctories of the system must be kept in a normal condition. The local treatment will not differ from that followed in other forces of the morbid state.

Tubercular arthritis so frequently met with among the poorly nourished usually improves under a hygienic and tonic course of treatment. Peptics, tonics, and stimulants whip up an appetite and improve digestion. The food should consist of well-cooked meats, pickled pigs' feet, eggs, custards, olive oil on salads, and other suitable food, rich cream and fresh milk, graham and whole wheat bread.

Topical applications, such as equal parts of turpentine and camphorated oil, clove oil one part to alcohol three parts, chloroform liniment, and hot salt bags and hot water bags, will be comforting by assuaging pain in most cases. In marked inflammatory states a rubber bag filled with cracked ice and applied to the joint with a layer or two of flannel adjusted between the skin and the bag to prevent too profound effect, will prove highly beneficial.

Traction and fixation will benefit some cases of tubercular arthritis by overcoming spasm of muscles, thereby relieving pressure pain. The course seems best suited to sub-acute cases. It is the writer's experience that suitable traction benefits more cases than that of fixation by splints or the plaster cast. There is not much likelihood of ankylosis resulting from enforced rest by fixation; if it occurs it will likely be due to continual inflammatory action. As long as there is evidence of irritation about the joint, which will be indicated by tenderness and spasm of muscle, the cast of the extreme apparatus should be worn, if the time be three months or six months.

In grave cases giving evidence of great quantities of tubercular deposit, in and about the joints especially, should there be a de

struction of the tissue resulting in abscesses, much benefit has resulted from the injection into the joint tissues of a 10-per cent emulsion of iodoform in glycerine. If no benefit is derived from the injection of the emulsion within a reasonable time, resort will be necessary to operative measures, such as laying open the tissues about the joints, curetting away all necrotic tissue, making extension, and treating the injured joint as we would a fresh wound. Abscess formations must be evacuated through a small incision, the cavity thoroughly cleansed with a one to three thousand bichloride solution, followed by the iodoform emulsion, an ounce or more being used, being governed, of course, by the extent of the cavity to be treated.

In place of the iodoform emulsion bismuth paste is preferred by surgeons who have given it an extended trial. The mixture is prepared by thoroughly mixing three drachms of subnitrate of bismuth in two ounces of liquid petrolatum or melted vaseline.

In grave cases where the above treatment proves ineffectual, excision of the joint will be the next step, which will be followed, of course, by ankylosis, or amputation of the limb, where all forms of treatment fail to stay the progress of the disease and the patient's life is endangered.-California Eclectic Medical Journal.

COLLINSONIA.

BY H. T. WEBSTER, M. D., OAKLAND, CAL.

Every fellow sees a remedy in an individual light. Even our oldest agents possess new features, if every practitioner would record his experience with them and describe the ground they cover in his hands. Some of our best observers of drug action are prone to keep their light hidden, not because they wish to conceal anything, but innate modesty keeps them in the background. Some of the best things we have learned in therapeutics have been given us by modest and obscure country practitioners who never attempt to write for publication. They were oral lessons. Collinsonia is an old remedy, but one that does not receive enough attention from the average practitioner. Hemorrhoids, chronic laryngitis, and atonic heart are leading indications for it, and here it receives attention from the average practitioner. Many neglect to remember it in rectal pain unless due to obvious hemor

rhoids. Its action here is sometimes instantaneous. The writer has more than once had occasion to bless the action of this remedy

in his own case. A country practice in the long-ago enabled him. to accumulate a combination of rectal pockets and hemorrhoids, which where finally properly treated and cured, but a rectal neurosis has remained, which is aroused by sitting on a cold, damp seat; and when such exposure is committed, the following night is liable to afford a disagreeable surprise in the way of sudden excruciating pain which wakes the sleeper out of a sound slumber and may be likened to the piercing of the rectum with a sharp knife.

We have been schooled, and sleep with a bottle of collinsonia on the dresser at the head of the bed, and one or two applications of the full strength of the specific medicine to the tongue, made by turning the bottle upside down on the dorsum, banishes every unpleasant feature, and within ten minutes sweet oblivion is again on, and no more trouble for a month or two until another indiscretion provokes another attack.

The bane of the city man in such instances is the cold car seat. Early mornings in winter find the seats in the street cars chilled. through and through, and unless the car has been warmed they are bad for those afflicted with sensitive rectums. We long ago learned that a happy precaution was to carry a newspaper in the pocket for such emergencies and spread it on the seat before sitting. When this has been forgotten it is good practice to stand until some sitter leaves the car and sit on exactly the same spot. A robust, fat passenger makes a good seat-warmer if seated for a reasonably protracted time.

The country practitioner should see to it that his auto, carriage cushion or saddle has been warmed on cold winter days before undertaking long rides. Many cases of rectal disease among country practitioners are due to warming ice-cold seats with body heat. Sensitive parts become chilled and congested, until finally chronic disease is established.

Pelvic pain of any character suggests collinsonia. It may not always succeed, but it promises something in every case. Recently we were telephoned to in the evening from a case of perineorrhaphy by the nurse, stating that the patient was suffering excruciating rectal pain. A call made during the previous day had demonstrated that the patient was more comfortable than could ordi

narily be expected, yet sudden and severe pain had come on at night. Collinsonia, five drops of the specific medicine, every hour until better, was ordered, and the report the following morning was that the pain subsided within a short time.

Hypogastric pain is frequently due to congestive conditions of the rectum, and here collinsonia will promptly meet the demand for relief, whether it be chronic or acute. A country contemporary told me, when a young practitioner, that a specific indication for collinsonia was hypogastric pain. He did not associate the idea with that of rectal congestion, but he had dug the fact out from observation that hypograstric pain called for collinsonia. This was in the early days of specific medication; before we had learned as much philosophy about specific indications as we now apply. There is always a reason for specific action of remedies if we can unravel it. There are yet many things to learn.

We do not care who teaches us this philosophy or the facts, whether it be a Physio-Med., a Homeopath, an Allopath, a Chiroprac, a nurse, or a good old grandmother. We are out to learn all the practical medicine we can. No matter where we get it if we only get it and it proves good.

Rectal pain may not always be relieved by collinsonia, but when it comes from vascular disturbance engorgement-it is surely appropriate and almost positive in its favorable effort. Rectal neurosis is liable to be due to pressure from such condition, and we are not sure but that collinsonia is a remedy for the condition, whether vascular in cause or not.

In our days of country practice we were in the habit of gathering our own collinsonia herb and tincturing it for the season by filling a quart fruit jar with the fresh herb-leaves, tops and blossoms and covering with alcohol, thus allowing it to stand until poured off for use. If it were the glad summer-time and we were in the old neighborhood, we believe we could go promptly to the same old fence-corner now.

Professor Lloyd several years ago put a preparation of that kind on the market under the name "aromatic collinsonia," but we have never been able to find it in this market. However, the preparation from the root-the specific medicine-fills the bill excellently, and is possibly as good as a preparation from the tops, but those who have never observed the finer action of the remedy should try the aromatic tincture.-Eclectic Medical Journal.

NOTES AND COMMENTS.

Pain in the Back. If one goes over the history of patients suffering from Bright's disease, from stone in the kidney, or from septic infection of the kidney, it is surprising to note how few cases, if any, have pain in the back; that is to say, pain referred to the vertebral column. In most of these cases the pain is a dull ache or soreness referred to the lumbar region, and in the case of colic it is usually referred along a definite path. So, also, the number of cases of pain in the back, popularly referred to some displacement of the pelvic viscera, is far too great to have any definite scientific reason for localizing the cause in that region, and the proof of this lies in the fact that so many of the leading gynecologists of the day are very conservative in their operating on this class of cases.-W. G. TURNER, in the Montreal Medical Journal.

House Fly Pest. In a crusade against the house-fly pest in Washington, D. C., where children under sixteen were given substantial prizes for bringing in the greatest number, millions were secured and counted by measures. The destruction of flies, which may have some merit, does not impress us as the best way to get rid of them, or rather to "prevent" them from spreading disease, as they are known to do. As mentioned in a paper in our October issue, the best way is to prevent their appearance. This is comparatively easy and would be accomplished in a great measure promptly by concerted action. This dangerous pest is unknown, except where filth accumulates and furnishes a home for their larvæ. In frontier portions of our country they are not seen till civilization makes its appearance. One good word can be said for the fly, however, and that is that it serves as a warning to us of the neglect that we have shown in the disposal of offal and filth about our homes. That it is a faithful messenger of evil all can vouch for, and that it torments us till we can not help but hear the message that it brings to us, to clean up and keep clean and be sanitary.-Editorial in Wisconsin Medical Recorder.