uvula and tonsil, firmly hugging the mucous membrane of the posterior nares, and probably penetrating the membrane of nares, as it required quite a little traction to remove it with forceps, altho it was readily done.

Now, the unique and singular thing to me was, how that child could have gotten the pin in the posterior nares, and retain it there instead of swallowing it.

Case 2 was that of a young man, a railroader, who left his train to call at my office in a peculiarly distrest condition of both mind and body. Two days previous to calling, while eating canned peaches at his boarding-house, he thought he had swallowed two pins that had in some mysterious way gotten mixt up with the peaches. One hour previous to calling he had an evacuation of the bowels, and simultaneous with evacuation a jagging, piercing pain was felt high in the rectum. On examination per rectum, and at extreme limit of fingers' length, the two pins were detected protruding thru the rectum posteriorly towards the coccyx, about one-half of their length being in the cavity of the rectum. A rectal speculum was introduced, rectal cavity illuminated, and with a pair of placenta forceps the pins were easily graspt and removed. The placenta forceps were used on account of their being the only instrument I possest that was long enuf to reach so high in the rectum. Why these pins should pass the tortuous, labyrinthian course of the bowels, to become stranded in the rectum, is beyond my comprehension.

I regret that so many physicians are so antagonistic to the use of antitoxin in the treatment of diphtheria. I shall not attempt to argue the great merit that antitoxin possesses, simply contenting myself with the hope that the little bit of advice I here offer may, at least, be the means of prompting the skeptical to employ the remedy as herein prescribed. Never use more than 1,000 units as an initial injection, and before injecting, immerse the antitoxin bulb in a vessel of warm water, of a temperature of 110° to 115°. The difference in the effect of antitoxin injected warm and of that injected cold is truly marvelous-so much so that I believe 1,000 units injected at above temperature will give better results than 1,500 units injected cold, besides the mechanical assistance rendered in forcing the thin heated fluid, instead of the cold thick fluid, thru the needle of the syringe. The increast efficiency is also quite a financial consideration among the poor, as only too frequently

this disease seeks its victims amongst the poorer classes. The syringe, of course, is expected to be heated to about the above temperature. I have obtained remarkable results from 500 units injected in this manner. Try it, gentlemen, and watch results. GEORGE G. IRWIN, M.D. Mt. Holly Springs, Pa. [There are not so many physicians "so " who oppose antitoxin. The opposers are confined almost entirely to a few who have had no experience with antitoxin, but who have, in some way, contracted a violent prejudice against antitoxin.-ED.]

Experience with Diphtheria Antitoxin.

Editor MEDICAL WORLD:-I thought the subject of diphtheria so trite and the antitoxin treatment so firmly establisht that hardly anything more could be said about it; but since you have opened your columns for its discussion, and since there are still members of our profession who fail to recognize the value of antitoxin, I send you my short experience, and if you think it sufficiently interesting, you may give it to the WORLD family.

When I graduated I felt rather skeptical in regard to the antitoxin treatment, having been influenced to a certain extent by the teachings of Dr. Winters, of New York, one of the strongest opponents of the antitoxin treatment. However, while I was practising in the city where the laity seemed to know all about antitoxin, I did not dare to treat diphtheria without it, as a fatal result without the administration of antitoxin might prove fatal to my practise. But I never relied upon antitoxin alone, always having used local applications of Löffler's solution and hydrogen dioxid sprays in connection with it. This treatment I always found satisfactory, having lost but one case of diphtheria so far, and that one case was moribund when I first saw him, and he died half an hour after the administration of antitoxin.

The following cases made me an ardent believer in antitoxin. Early in April, this year, A. K. came to my office and askt for something for his boy for hoarseness. I gave him some calcium sulfid tablets. On the 22d I was called to his house. I found five of his children suffering with diphtheria; in three of them the tonsils and fauces were covered with membrane, while in two the trouble was in the larnyx. The remaining two children were apparently well. Not having any antitoxin on hand, I had to wait

till the next day before I could get it from another town. The next day as I drove to see these patients, I met A. K. on the road. He told me that one of the patients, his eldest daughter, was in a dying condition. I hurried to his place and found all the patients much worse. In the eldest daughter the diphtheritic process had apparently

spread to the trachea and bronchi. Her face was cyanosed; her breathing rapid and shallow. She got an injection of 2,000 units and the rest of the patients received from 1,000 to 2,000 units each. Examining again the remaining two children, I found that one of them had already developt a diphtheritic membrane over his fauces. Not having any more antitoxin on hand, I applied the Löffler solution, ordered the dioxid spray and all the rest of the treatment the same as with the other patients. On the following day I found all the patients who received the antitoxin considerably improved, while the one who failed to get it was decidedly worse. The latter then got an injection of 1,500 units, and the next day he, too, shared in the general improvement of all the patients in the family. They all made an uneventful recovery.

The following is the experience I had with antitoxin as an immunizing agent: January 18, 1900, I was called to see W. H., a boy of 15 years; found him suffering with diphtheria and injected 1,500 units of antitoxin. I injected also four of his brothers and one sister with 500 units each, for immunization. January 23 I discharged patient, cured. February 15 I was called again. Found that one of those "immunized" had diphtheria. Again I injected 1,500 units to the patient and 500 units to each of the four remaining children. February 19 I discharged second patient, cured. March 3 was called again; found that two of those twice "immunized" had diphtheria. I injected antitoxin into those two, and stopt immunizing this time. March 6 I discharged the last two patients, cured. There was no more diphtheria in that family.

As the peroid of incubation for diphtheria is from 2 to 6 days, it was not likely that they got infected from each other, unless we should suppose the diphtheria bacilli to have stayed with the patients weeks after they were cured. On the other hand, it showed that if antitoxin had any value at all as a preventiv, its effects last only a very short time. I must add that I always boil syringe and needle before administering antitoxin, and that I always inject the healthy

for immunization before injecting the patient, so that I was reasonably certain that no infection could come from that source. Ashton, Neb. LOUIS I. BOGEN.

The Wanderings of a Hypodermic Wire.
Editor MEDICAL WORLD:-I would like to

report the following case thru your valuable journal, for the purpose of eliciting comment, and calling out from their secret hiding place in the brains of the country doctors, reports of any similar cases that may may have occurred. Early in the spring of this year a man placed a hypodermic needle wire in his mouth to hold it a while. It passed back in his mouth, and the more he tried to get it out, the farther back it went, until it finally went down his throat. In a few days he began having slight pain and tenderness in the region of the appendix vermiformis; he also had diarrhea. The pain and tenderness grew worse. On the seventh of August the tenderness was so great that he could not bear the pain produced by the jar in walking. He was put to bed and given morphin hypodermically, and in two or three days was better. He got out of bed and walkt around about the house until the twenty-fourth of August, when he was seized with severe pain which seemed to radiate over the abdomen, producing severe shock. In fact, he went into collapse. Morphin and strychnin soon relieved the pain and brought about reaction. He suffered only a very little pain after that. After keeping quiet a while, he was able to go where he pleased. The diarrhea stopt, and he began to grow strong and take on flesh.

About the middle of September he discovered the end of the wire protruding thru the skin on the outer aspect of the thigh, about three or four inches below the great trochanter. When the wire had passed half inch thru the skin, I took it between my finger and thumb and pulled with all my might, but the wire would not come out. In a few days the clothing, rubbing against the wire, broke it off under the skin, leaving the loop end of the wire in the thigh. Did the wire pass thru the bowels? If so, at what point? Why did not peritonitis follow? Why were the shock and other constitutional disturbance so slight? I saw the patient every day from the time the wire passed into his stomach till the present time, and know whereof I speak. Is this not an unusual Occurrence with an unusual ending?

Martin, Ga.

T. H. LYON.

[We do not think that we violate confidence in stating that the Doctor, in an accompanying letter, says that he, himself, was the patient. He was, perhaps, too modest to say so in the article. It was an unusual case, with an

unusual ending. It is impossible to discover just where the wire left the bowel tube, and penetrated into the tissues. The reason that there was not more profound disturbance was because the wire was so small.-ED.]

This

A Needle in the Gluteus Maximus. Editor MEDICAL WORLD:-Patient a nervous lady, aged 28 years. Had no symptoms other than her usual nervousness. Slight bruising, one and a half inches in diameter, with slight induration in the center, was found over the right gluteus maximus. Pressure over the induration discovered a point at its center; on deep pressure around it, a needle point extruded thru the skin. With forceps a bright, golden-eyed "Sharp" was extracted. needle was small but unbroken, and neither its presence, nor my pressure over the point, nor the extraction of the needle gave her the least inconvenience or pain. The induration probably indicates that the needle had been encysted, and this, in turn, may account for the absence of pain. The patient thinks she did not swallow the needle, and is sure she did not sit on it. The point was outward, and the needle at a right angle to the surface. Query: How did the patient surround this needle?

Toronto, Canada. ALBERT D. WATSON.

Malario-Grip.

Editor MEDICAL WORLD:-As we are right in the midst of an epidemic of influenza, I think it well for us to exchange views with our fellow-practicians on this subject. Observation will demonstrate the fact that different localities give different pathologic phases to the same disease. This being the case, an exchange of ideas might be of practical value to all following our calling, and to those who look to us for relief from suffering. Here, where the malarial impress is made on a large percentage of our people, the grip element gives a different set of symptoms to the malarial trouble. If the malarial disease be intermittent fever, instead of having the regular chill the patient usually has a succession of rigors and a severe pain at the atloido-occipital junction. You will usually find that when the patient turns his head he can hear a popping noise in that region. There are usually more myalgic pains than either pathologic condition above gives rise to. I am sure there must be some disturbance to the physiological adjusting of the cerebro-spinal fluid. Another point of interest to be observed in those malario-grip cases is a supra-orbital pain, usually on the left side, which so affects the eye of that side as to cause diplopia when the other eye is closed. Also, those affected with both diseases are more

likely to be troubled with renal difficulties; and ascites often develops. Also, I have never seen an infant which was not cross-eyed whose maternal parent suffered with malaria and grip during the pregnancy. Now, I have seen children borne by malarial mothers straight-eyed; also those borne by those who have had the grip pure and simple during pregnancy.

The straight treatment for malaria (that is, the quinin treatment) will aggravate all the symptoms, and possibly give rise to serious nervous complications. I find that salicin, combined with caffein cit. and strychnin, a very efficient treatment, with proper attention to the alimentary canal. Gelsemium is a fine drug, combined with bromid of potash or soda. However, the populus monilifera is the most prompt therapeutic agent I have ever used in these combined diseases. But in the absence of that we have other useful things, which I will mention. Sodium salicylate ranks first after populus monilifera. As an all-round routine remedy give grs. v every three hours till ears ring. I usually give a formula something like this:

Tuberculosis in Rural Missouri. Editor MEDICAL WORLD:-This past summer I was called four miles into the hill country to see Miss C. S., and I found about as follows: A little squatty two-roomed log shanty, which was supposed to be home for an old man, his son, one single daughter, one married daughter and her husband. The interior was filth and squalor, a condition which I would not allow my hogpen to get into. Still, out in the beautiful forests where the wild flowers bloom and the blue jay sings, with crystal waters and air so pure, we find this little hovel, and I'll venture to say, thousands more their equal in the rural parts of every state (if the truth were only known). I found a young woman who they said had taken cold and her menses had stopt; her appetite had left entirely (and, God knows, mine would, too, if I had been compelled to stay there long). Her temperature was 103° F., chills every day, night-sweats, no appetite, coughing paroxysmal, and expectoration of profuse, thick, yellowish, offensiv material. She was thin, pale and anemic, with hectic flush. Dulness over large area of right lung and upper portion of left lung. I did what I

could (palliativ), with rigid orders for a thoro cleansing of the house and more sunshine.

Before leaving I was told that the married daughter, Mrs. F., wisht to see me in the other room, as she had been troubled some with bowel complaint. Upon inspection I found conditions and symptoms similar to the other case, except in place of the lungs being involved, the entire alimentary canal was infected with tubercles, buccal membrane of mouth and throat showing a tubercular inflammatory condition. When I told them I could only help to relieve their suffering, they thought I did not know much; and upon leaving, the old

man

came out to the fence and askt my opinion of the cases. I told him frankly that they would not live longer than early fall. He said nothing, but a few days later I heard that they had employed an old "doctor" from a little settlement nine miles from them, and he had said that I did not know my business, and that he could cure them sound and well. When told this I simply remarkt "he may."

The intestinal tubercular case (he said there was no such case on record) died in September, and the case of pulmonary consumption followed in October, altho the day prior to her death he (the doctor) was there, and said she was "just doing fine; that the right lung was all healed up sound and well, and if they could just keep her alive one week longer he could pull her thru." How is that for quackery or malicious ignorance? and that by one representing himself to be a licensed physician. JOHN RUSSELL SMITH, M.D.

Warsaw, Mo.

Obstetrics in India; an Echo Half Around the World.-Quinin in India,

Editor MEDICAL WORLD:-I have just read the letter of Dr. Romig, of Alaska, in your October WORLD, page 417. In his letter he states: "It appears to me that much of the female troubles of civilized people can be traced to meddlesome midwifery, unclean hands, and instruments." Perhaps some of your readers would like to hear from the other side of the world on this subject. In India, where I have been practising medicin during the past ten years, I have frequently been called to the bedside of Hindoo women to extricate their unskilled midwives from a dilemma. As the patients prefer to have the midwife remove the placenta, I always remain passiv. At my first case I was surprised to see the midwife plunge her unwasht, dirty hand into the womb immediately the child was born, and in about ten seconds she had delivered the placenta intact, without the slightest mishap to the mother. This is the oriental way of removing the placenta in India. I do not think it would

answer for Alaska, or for our American women. Different countries seem to have their own peculiar ways of assisting Nature, and I think if you in America were to follow our Alaskan friend's manner in delivering the women of the United States, or the Hindoo way of delivering the placenta, which is successful here, you would not practise midwifery long.

I believe in meddling when it is necessary, and if done at the proper time and in the right manner, I think humanity would have greater cause for rejoicing on account of the labors of her physicians.

A few words as to the cause of "malarial hematuria." I cannot agree with Dr. Wilson that quinin causes this trouble. India is a malarial country. Every man, woman, and child residing here comes down under its power. I have treated over 10,000 malarial patients, and in every instance quinin in large doses was one of my remedies, and in not a single instance has it ever brought on malarial hematuria. We frequently meet with it in malarial patients, but after they have taken a few doses of quinin the condition nearly always improves. I do not like to see such a grave charge brought against quinin. It is our best earthly friend here-it is our staff of life. Europeans could not live in this country without it. Moreover we take it as a preventiv. We take it in the morning, we take it during the day, we take it in the evening, and we take it during the night. We keep our systems saturated with quinin, and yet we are practically free from malarial hematuria.

Trusting these rambling remarks will find space in your valuable journal, and that this drug will eventually be cleared of the stigma that has been placed upon it, I will close for this time, and if you consider my letter worthy of printing, I will try again. Rutlam, India. C. R. WOODS.