Editor MEDICAL WORLD:-During the last few years I have had such good results in the treatment of this painful affection that I feel it my duty to tell the younger members of the profession how I cure this trouble without the knife, cautery, or ofttimes dangerous carbolic acid. If the toe is very much inflamed and very sensitiv, I apply a small pledget of cotton wet with a 4 per cent solution of cocain. In a few minutes remove the cocain and apply Monsel's powder or sulfate of iron to the unhealthy granulations. Be sure and see that the powder is fine, and make a free application. In from twelve to twenty-four hours wash the parts, remove the crusts, use the powder again, and apply a moist compress. In severe cases in which there is great swelling and ulceration of the tissues, we may have to make four or five applications before a cure is effec ed. Monsel's salt is one of the most powerful styptics that we possess, and its action upon the inflamed, slufing, and ulcerated tissues is marvelous. The tissues quickly shrink to a normal size, all tenderness and pain being removed. Now, trim the nail right, avoid undue pressure, and no further trouble will occur. Sometimes I use two or three narrow strips of adhesiv plaster to draw the tissues away from the nail, so that the powder can reach all ulcerated parts. I now cure all severe cases of ingrowing toe-nail in from three to five days. Try this treatment, and you will never remove nails nor cauterize again.

GEO. A. MITCHELL, M. D.

Richland Center, Wis.

Acid Tooth Wash.-Healing Ointment. Editor MEDICAL WORLD:-It is said that the following formula will remove tartar from the teeth and preserve them until extreme old age: Soft water, one pint; lemon juice, one ounce; burnt alum, four grains; table salt, four grains. Mix and boil one minute, then strain. Wash the teeth with this two or three times a week.

A good ointment that will remove proud flesh in twenty-four hours, clean any ulcer or old sore, and that is excellent for healing purposes is made as follows: Boil one-half pound of bittersweet in one and one-half pints of water for an hour or longer, then strain and add one ounce of lard; then boil until the remainder of the water is evaporated. Sullivan, Ark. J. A. BURNETT, M.D.

The Dilutionists.

Editor MEDICAL WORLD:-For some time the question of dilutions has been discust. I have been pondering in my mind just where to place the man of dilutions. What species of homo is he? He seems perfectly capable of making "mountains of molehills." The man who can see grave diseases knockt into "kingdom come by thirtieth triturations of common salt can certainly see stars thru the blackest clouds. His vision is intensely acute. Such a man, it seems to me, could stand on the hill and speak and hear the "dry bones of the valley shake," or stamp his foot and feel the earth quiver. If he were lying sick, I'd dislike to walk around his premises for fear of shaking him from his bed. Such a man could easily see the sun stop in its course "for the space of three hours" in obedience to an order from a lilliputian man on a stump "in the wilderness." He could easily discern that the "fiery furnace" would not roast human flesh. His is that phase of mind that could look thru a choked telescope and see elephants and armies waging war on the moon's surface. As an agriculturist he could be a howling success by planting potatoes, laying fence rows, and chopping trees by the phases of the moon. The thirtieth dilutionist could see potent evils result from the number thirteen. He can see the "plans of mice and men gang astray "because they were begun on Friday. He could see the giant oak swaying under pressure of the gnat's heel. His faith would surely remove mountains. He could see cancers dispelled by violet sun-rays; could even see death come from sleeping in the moonbeams. Such minds could even grasp infinity itself. They can think the thoughts that are unthinkable. They have so far passed the confines of the material world that they revel only in the unseen beyond. Their imaginations are frenzied beyond control. They can see snakes where there are no snakes; see light where only darkness prevails; even see the sun when the earth intervenes. They are those who dote on their experience. They think "I've tried it" to be the end of the law. They have passed beyond the guide of a sound judgment. Their thoughts are thinned down to vaporous imaginings. They are whirling in ethereal space clear beyond material entities. Don't check them; they will sooner or later land in "Abraham's bosom " or in the asylum. "Selah!' P. A. SPAIN, M.D.

course, be fair enuf to read the same carefully and attentivly. We do not endorse the claims of the dilutionists, but we feel that a body of about 10,000 respectable and intelligent medical men deserve at least a hearing in response to an article like the above. But we ask the 10,000 to kindly not send a deluge of replies upon the devoted head of " ye Editor." Write to Dr. Spain, and he will send us such articles as may have influenced his understanding or opinion.-ED.]

Bile Obstruction.

Hot

Editor MEDICAL WORLD:-A man, 78 years of age, of full habit, living an inactive life, was suddenly taken with what appeared to be colic with intense diffused abdominal pain. A mixture of powdered carb. magnesia, sub-nit. bismuth, and Hoffman's anodyne in camphor water was given at short intervals, which caused free eructations of gas, but gave only temporary relief; so limited that I had to give a hypodermic of -gr. morphin and a fractional gr. of atropin, which in a few minutes gave relief and a good night's sleep. The next day the patient was to all appearances as well as usual. The bowels not having been moved, I gave early a full dose of calomel with a small portion of ipecac, and followed this at two-hour intervals with a dessertspoonful of effervescing phos. of soda until bowels were freely moved. Sparse diet was enjoined, and at each eating elix. lacto-peptin was given. The third day at same hour he had a re-attack of the same intensity. applications were reapplied, and another hypodermic given, with the same prompt relief. After the second attack he was extremely jaundiced and exceedingly nervous; not sleeping. He was given fld. ext. cannabis ind. and taraxacum, which not only quieted him but caused a free flow of highly colored urin. Supposing that there was some malaria back of this trouble, I gave bi-sulfate of quinin at short intervals until its specific signs were induced, still keeping the patient on a careful diet, giving fasting each early morning doses of the effervescing phosfate. The bowels were so torpid that low enemas would produce no effect, only high enemas acting. Four days. after the second attack a recurrence took place, which was subdued as before. An extra careful examination with much kneeding finally showed a tenderness along the region of the ductus communis choledochus. This proved to me that the attacks were largely hepatic, and that I had either in

spissated bile or gall stones to combat, or both. I gave alternately every three hours an 0 capsule of powdered sulfate of soda, and the same size capsule of salicylate of soda. After forty-eight hours of this treatment we obtained a quantity, not only of bile, but small stones. After this occurred there was a relaxt condition of the bowels, followed by paralysis of the sphincter ani, which, after three days' free use of local electricity, was entirely cured. The hints to use the above medicaments were given me on a previous occasion of obstructed bile by Professor Jacobi, of New York City. After the lapse of four months the patient is, as he puts it, as well as he ever was.' He continued the use of the phosfate once daily for some time.

Rahway, N. J. ELIHU B. SILVERS, M.D.

A "Love" Fit.

Editor MEDICAL WORLD:-I was called to a woman in a mill boarding house in convulsions. The only one present was a man. He said: "She has been drinking and has a rum or alcohol fit." I gave her a hypodermic of pilocarpin. When she came to herself in about two minutes she said, "What is the matter?" I told her that her partner said she had a drunk fit. fit. "No," she said, "I have had only one glass of whiskey tonight; it was no rum fit, but I will tell you: You see, I love that man, and I am a fool, but I love him bad. When he neglects me I get to thinking and thinking, and That is no rum fit, I tell

then I have a fit. you, but a love fit." Danielson, Conn.

W. H. JUDSON, M.D.

Elongated Prepuce.-Early Training.-A Sad Case of Early Venery.

Editor MEDICAL WORLD:-A great factor causing so many boys and men to become lost in self-abuse or venereal excess is an elongated prepuce. Every boy, in my opinion, should be circumcised, as we all know that an elongated prepuce is one of the many causes of nervous diseases in children. Common sense teaches us that anything that creates an irritation of the glans penis causes erection, and may lead

to masturbation. Take a man who is a masturbator and circumcise him, and I'll bet he'll stop it for a while, at least. With that rest, and a nerve tonic to build up a broken down system, and the removal of the covering which creates heat to the glans penis, you will find that the great majority of cases go on to complete recovery. I am no veteran if I have been in practise fifteen years, but I speak from facts that I have seen.

If we indulge in excesses and allow the

animal passions to run riot, what can we expect but a tendency in that direction in our own offspring? Like begets like. On the other hand, if the child is taught to go to Sunday school and church by going with it yourself until it is able to go of its own accord, and that influence is continued until it reaches the age of sixteen, there is little to fear as to his future life. I heard a Catholic priest say several years ago, "give me a child until he is twelve and you can have him after that. What has been planted in the young mind will never be erased, do what you may.”

Some three weeks ago two boys came to my office to consult me about one's condition; they were nine and eleven years of age. The older boy said he had hurt himself some way, he thought by falling from a horse. On examination I found a well developt bubo in the right groin. Upon drawing back a swollen prepuce three very pretty chancroidal blisters appeared around the corona glandis. It was a pitiable sight. I made his younger brother look at it, and I think he got a lesson that he will not forget very soon; and by the time I was thru scalding out the prepuce with peroxid of hydrogen, etc., I think the older boy had sufficient to last him for a reminder that "the way of the transgressor is hard." These children were less to blame themselves than most children, because they are orphans, and their associates are an ignorant, illiterate class of people, in many respects not much better than brutes. The reason I cited this case was for illustration to show what association will do for children, and what depraved condition humanity can reach. The girls who gave this boy the disease are less than eighteen, and yet the parents of these girls thought their girls were all right until very recently. The girls have been called in check by the community, and the boys have been sent away to an orphans' home where they can receive the right training. Warsaw, Mo. J. R. SMITH.

Formaldehyd.

Read before a meeting of the Association of Surgeons to the Pennsylvania System of Railroads, held in Pittsburg, Pa., September 12, 1902.

By ANDREW LYLE RUSSELL, M.D., Midway, Pa. As a profession we over-use, misuse, or abuse every new medicinal agent. We employ them excessivly in the dawn of their popularity, and consequently misuse them by exhibiting them when not indicated; then, as the pendulum of enthusiasm swings backward, we abuse them by neglecting to employ them to the limit of their power. The arraignment is severe, but just, as the whole history of medicin proves.

Formaldehyd, like many others, has suffered at the hands of its riends, tho it is one of the most valuable agents ever discovered. Its

popularity is waning because it has not been sufficiently appreciated. May we hope to recall some forgotten facts?

Formaldehyd (CH,O) is an alcohol of the marsh-gas (CH) series, deprived of its hydrogen by oxidation. It is a gas readily soluble in water and alcohol to about 35 or 40 per cent by weight. It is produced by the slow and incomplete combustion of methyl alcohol (CHO) in the presence of atmospheric air. The proper name of the 40 per cent saturated aqueous solution found on the market is formalin, but custom leads it to be referred to as "formaldehyd." It is our most powerful and most easily manipulated disinfectant, deodorizer, and germicide; it is inexpensiv and innocuous. It kills all germs and spores with which it comes in contact for a sufficient length of time, when supplied in a nascent state in sufficient quantity. The gas is generated by slowly heating methyl alcohol or polymerized formaldehyd tablets over an open flame; it may be liberated as produced, or as in the autoclave, confined under pressure and liberated by a valve at the proper time. Commercialism, the matter of economy, and the question of definit results, have led to the introduction of much apparatus for producing the gas, and a multitude of names for its saturated solution. The methods mentioned now have the sanction of the best authorities.

The recognized difficulties attending the cleansing of cars and depots, the perplexing problems of heating and ventilation, the carelessness and unsanitary condition of the passengers, render deodorization and disinfection highly desirable, if not imperativ. Formaldehyd is the only agent which seems to meet the conditions, and its use in emigrant cars, smokers, day coaches, sleepers, and closets cannot be too strongly urged upon the Company.

As a deodorizer it may be liberated as slowly as desired, and "it has the advantage of forming odorless and harmless compounds with such products as sulphuretted hydrogen, ammonia, mercaptan and other offensiv products of decomposition" (Abbott). Its own fumes are quickly destroyed by a slight spray

of ammonia.

As a disinfectant, its intense penetrating power and great diffusibility make it an ideal agent where inaccessible places, such as small corners of wood and metal work, high cornices and ornaments, curtains and hangings, blankets, inattings, bedding, etc., are to be reacht, and these are the nesting places of germs, altho they commonly receive but scant attention in the way of cleansing. It is readily obtainable and may be used by unskilled employees after slight instruction. Under good pressure it works thoroly and quickly, and complete

66

disinfection of cars by its aid is quite feasible. Abbott declares that "80 per cent of all exposed infected objects in a room could be disinfected when 500 cc. of a formalin solution to which 10 per cent of glycerin had been added were vaporized to each 1,000 feet of air space and the room kept closed for three or four hours;" thus it is seen that a coach or room may be quickly and satisfactorily fumigated, deodorized, and disinfected, and at the cost of a few cents.

The four per cent aqueous solution is the ideal antiseptic for the disinfection of instruments and sutures used in the trying emergencies of minor railroad surgery. Only a few moments' immersion is required for absolute disinfection; no heat is required; it has no injurious action on instruments, and the solution may be repeatedly used. One may thus sterilize his instruments en route to the scene of accident and reach the spot ready for work.

Combined with the use of aseptic soap, it is an ideal agent for disinfecting wounds; with such a combination grime and grease need have few terrors for the surgeon. A I to 2 per cent solution of formalin is amply strong for cleansing purposes, and a weaker solution still is our best agent for irrigation of foul ulcers, suppurating wounds, sinuses, and lesions which refuse to granulate kindly. "Such strengths are not irritant" (Gould). An ounce to a quart of water disinfects feces. Catheters are never safer than when treated by formaldehyd vapor. A 21⁄2 per cent solution is valuable in lupus, psoriasis, and parasitic skin diseases, and stronger solutions or the pure formalin may be used as caustics. It hardens tissues and toughens the skin, and properly diluted is valuable in bromidrosis and hyperidrosis.

As a continuous moist dressing it will produce granulations when other agents fail. We should not allow its brilliant disinfectant power to overshadow its many other virtues, and the more it is used by the surgeon, the better he will like its action.

Editor MEDICAL WORLD; Dear Doctor:-Permit me to express my admiration for you as Editor, writer, professional friend and creditor. I inclose subscription price for our medical mother, and I admit that it was mean to stand you off so long. I have no excuse to offer, because there can't be any; but promise to be better in the future. I would rather miss all other papers than THE MEDICAL WORLD, which brings always seasonable, sound medical as well as social, financial and political advice. Sincerely and gratefully yours, F. DUTTLINGER, M.D.

2730 Euclid avenue, St. Louis, Mo.

I read the articles upon investments with much interest. It has been a matter of surprise to me that doctors are so often such easy marks for adventurers and swindlers. The articles in question were very timely. I have on general principles abstained from paying any attention to the countless circulars sent me by promoters, believing that if the certain gains which they promise were really in sight, there would be enuf smarter and richer men than 1 eager to grasp such opportunities, and not leave it for poor me to reap the harvest.-F. A. CAVANAUGH, Chatopa, Kan.

QUIZ

New books as they appear, are sent to our Assistant Editor, Dr. A. L. Russell, of Midway, Washington Co., Pa., for review As the Doctor thus has all the late books for reference, and is made familiar with them by reviewing each one carefully as it reaches him, he is unusually equipt for answering queries. Therefore it has been our custom for a long time to send queries to him for reply. In fact, the Doctor made a special request that this be done, as he enjoys this work. It now occurs to us that time will be saved if you will send directly to Dr. Russell matter intended for the Quiz Department, which has grown so much under his vigorous treatment" Please notice that our query department is not used to "boost" proprietary remedies, almanac fashion. THE MEDICAL WORLD has no interests other than to give to the medical profession the greatest amount of honest service possible. It has absolutely no interests in any proprietary preparation nor any medical supply house. Other medical editors have become, and are becoming, wealthy, by using their pages to increase the sale of preparations that they are interested in; but we prefer to render service to our subscribers that is above suspicion of personal pecuniary interest. How can a man interested in the sale of certain preparations render the best service? He is always trying to push one of his preparations in. That is commercial journalism. We prefer ethical journalism-and so does the profession, for THE MEDICAL WORLD is growing in popularity faster than ever before-and our subscribers are paying ones. They must be, for we have no medicins to "boost," nothing to sell, nothing to depend on but pure journalism; but doctors that want honest, straight journalism are willing to pay for it-they are glad of the opportunity.

Only such queries will be publisht as are likely to interest and instruct many others as well as the one asking help. No charge has ever been made, nor will any charge be made, for this service to our subscribers. However, those who wish an immediate and personal reply by mail may obtain the same by inclosing two dollars to Dr. Russell. This is really a consultation in the interest of the patient, and should be charged to the patient-two dollars being a very moderate consultation fee. The Doctor agrees to give full, careful and immediate attention to such consultations. We reserve the right to publish in this department any such consultations that may be interesting and helpful to our readers. Name and address will be withheld if requested. Come freely for help, but read up as fully as you can before coming to us.

[The specific contagium of small-pox has not yet been isolated, and the latest authorities have nothing more to offer than their predecessors of many years ago. The only advance, if advance it be, is to place it in the list of airborne diseases. What the air "bears," we know not. We may hazard our own guess as to whether it be germ, scale of epidermis, noxious odor or exhalation. Some think it is carried by the scales of epidermis; if so it may carry "as far as the wind goes." We know it is transmitted by personal contact, and is conveyed upon clothing, and is probably carried by the air; but to what distances, and for what length of time, we do not know. We know of many instances where the doors, opening directly upon the street where thousands pass daily, the doors being closed, and no contagion results. We know personally of doors being kept open thru an epidemic attacking a whole family, one after another, with the public sidewalk but a few feet distant from the open door, and no contagion resulted. We know that after an epidemic the disease may remain quiescent for a time and break out again with

renewed fury. It is easier to tell what we do not know, than to set ourselves up as authority. You are just as good authority on the point you raise as any other practician. It is needless to add that the popular fear of entering a town where small-pox is prevalent is unfounded in reason. Vaccinate everybody, and fumigate with due diligence after each case, and you will soon stamp the disease out of your community. The authorities place more reliance on vaccination latterly than on fumigation, but both are practised; the one to prevent, and the other to stamp out.-ED.]

Editor MEDICAL WORLD:-Inclosed find money order for $1.00 for WORLD for 1903. While you are telling us how to cure disease and keep well, don't fail to devote in each issue a liberal space for the "Business Side," as that is just as important to the doctor and his dependent ones as are the " cures "to his patients. Physicians are generally too busy thinking about the welfare of others, and think too little about their own affairs; so don't fail to give them a good dose in each WORLD, and I assure you it will be appreciated. J. A. RICHMOND, M.D.

Black Hawk, Colo.

Editor MEDICAL WORLD:-Will you please give me a little help? as I am a new man at this place and would like to please my patients. Miss A., age 18, with a sallow complexion and who has been the rounds of a number of physicians without relief, presented herself to me complaining of supprest menses for the last eight months. Was regular from fourteen up to eight months ago. She complains of pains in hips and lower part of back once every month; bowels regular; tongue has many furrows running crosswise and lengthwise; clean; she has a constant cough. Have given her iron, quinin and manganese; also, permanganate of potassium. Please give me a treatment, as she shows no sign of appearance of menstrual period.

Young man, 20 years old, has been troubled with constipation for the last three years; has to take physic; a great deal of mucus passes with stool; masturbated for at least two years previous to my seeing him. Had an attack of typho-malarial fever three months ago, which left him in a very emaciated condition. His mind is very weak; he talks of dying, and the least little thing annoys him, as his nurse going on a different side of bed he thinks is a token or omen. His pulse is from 55 to 65. Temperature 97 degrees; very near always below normal. Complains of pain in stomach; at times stomach bloats regardless of what he eats. Heart palpitates; this frightens him very much. His liver feels soft and doughy; spleen somewhat enlarged. He describes pain in stomach as a drawing feeling. Am feeding him on milk, beef soup, beef tea and a very soft diet; nothing seems to agree with him. Have been giving him heart tonics, Fowler's solution, nux, peptonate of iron and manganese, and asafetida pills. A young married lady complains at times with pain in knees, but more often a severe pain in the third

and fourth toes of left foot; toes will draw very

crooked, downward; pain is almost unbearable at times. There are no outward manifestations. Seems

[Your first case is probably complicated by gastro-intestinal catarrh; the furrowed and fissured tongue would indicate that. Put her on silver nitrate in distilled water twenty minutes before meals; begin with one-eighth grain to a dram of water, and gradually increase dose to two drams. Tell her to take it directly without adding to water, and not to take a drink of any fluid till meal time. Give her digestants at meal time, and your tonics between meals. Never mind about her "bowels being regular"; give her enuf rochelle salt every night to loosen stool thoroly and yet not to act as a cathartic. Tell her she has been taking too much good medicin, and that you must clean her system out; tell her as you get her system in better condition her complexion will improve. After you have tried that regime a few weeks, go back to your iron, quinin, and manganese and you will get different results. If she will submit to a vaginal examination and there is no danger of rupturing a hymen, you may find a chronic endometritis which will be benefited by a course of depletion by glycerin tampons with a strong probability of a return of the menstrual flow.

Case 2. You probably have a catarrhal condition of the rectum from repeated drastic purgativs and as a sequence of the typho-malarial fever. Tell him he must give up his childish, superstitious notions, for you will help him twice as rapidly if he does. Tell him he has no complaint that is liable to cause death. Doubtless his cardiac palpitation comes almost entirely from his stomach, and when you get his bowels on duty the palpitation will be better. He is better with a "soft and doughy liver" than a hard one. Don't give him the iron and manganese just now. Try chloroform water in 2-ounce doses for the pain in stomach; give a dose every fifteen minutes till he is relieved, or three doses are taken. Keep up the arsenic and strychnin, but give no further heart tonics unless there is really something the matter with his heart. Too many physicians give heart tonics when they ought to be devoting their attention to the stomach. Get his bowels moving nicely every day in the following way: Place a pint of sweet oil in a cup beside the bed and about a foot above the level of his anus; have a few feet of rubber tubing with a long rectal tube attacht, and fill with oil from tip to tip; keep tube and tubing filled by tying string around tubing and inverting it until tube has been passed as far up the bowel as possible, then untie the string and place end of tubing in cup of oil and tell him to lie quiet for an hour and retain all the oil.