Soak the glue in water till it is soft; then heat on a water bath till melted. Add glycerin and continue heat till a firm glossy skin begins to form on the surface of the mixture, in the intervals of stirring. Add the carbolic acid and mix intimately. Keep in well closed glass jars. When wanted for use, heat in water bath till just melted, and apply with a soft, flat brush over the burn or scald, where it will form a firm, yet flexible artificial skin.

For small burns, an aqueous solution of tincture of cantharides, 1-40, applied on lint, relieves pain and facilitates healing; but it is not to be used if the burn is extensiv, on account of the danger of absorption of poisonous amounts. A saturated solution of the common washing soda is a good dressing for small burns, promptly relieving the pain. Another valuable liquid dressing for superficial and limited burns is prepared as follows:

Remove dirt and charred clothing; saturate steril gauze in the solution and apply to part. Over gauze place absorbent cotton and hold in place with a light bandage. The dressing dries rapidly, and need not be renewed for several days. It is then moistened and removed and another similar dressing applied and allowed to remain a week. It relieves pain, prevents pus formation, and leaves a smooth scar.

The internal treatment must not be neglected in severe burns and scalds. Shock is usually present to a considerable degree in extensiv lesions, and should be met by stimulants hypodermically, external heat, and hot water and whiskey by the mouth. If the circulation does not respond to these measures, strychnin and digitalis are called for. The pain should be relieved by a hypodermic of morphin 4 to 1/2 grain, with 1 grain of atropin. The body should be well covered, after the burns are drest, to conserve all the body heat possible.

The burned area acts precisely like a large blister, and the powerful effect of this is well known. Hence the effects on the internal organs, such as the kidneys and intestins, must be remembered. The extra work thrown on the kidneys because of the destruction of the skin often causes a complete abolishment of their function and consequent death. Citrate of potash and sweet spirits of nitre should be given in large doses whenever there are extensiv burns, and the depressant effect of the citrate combated with free stimulation.

In infantil convulsions there is nothing acts so nicely as a half dram each of chloral and of bromid of potassium in two ounces of peppermint water, of which a teaspoonful is given every two or three hours.

ORIGINAL COMMUNICATIONS

Short articles of practical help to the profession are solicited for this department.

Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors. Copy must be received on or before the twelfth of the month. for publication in the issue for the next month. We decline responsibility for the safety of unused manuscript. It can usually be returned if request and postage for return are received with manuscript; but we cannot agree to always do so. Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than anything else.-RUSKIN. REFLECT COMPARE RECORD

READ

A Plagiarist.

We are sorry to say, that the article on Pilocarpin, on pages 396 and 397, September WORLD, is the most flagrant piece of plagiarism that has ever come to our notice. Nearly all of this article, word for word, appears in the Therapeutic Digest (of Cincinnati) for May, 1903, page 83. The Digest took it from the Eclectic Medical Journal (of Cincinnati), and proper credit is given. The original source of

most of this matter is an article in the Eclectic Medical Journal, for June, 1896, where an excellent article on this subject appears on pages 260 to 264, from the pen of J. F. Hines, M.D., of San Antonio, Tex. Another article on the same subject appears in the same journal, October issue, 1902, pages 541 to 544, by W. E. Kinnett, M.D., of Yorkville, Ill., who gives some experience of his own (a part of which is copied in the plagiarized article), and then quotes parts of Dr. Hines' article. It is probable that the plagiarist got all the matter that he copied from Dr. Kinnett's article in the Eclectic Medical Journal for October, 1902, or from a partial copy of this article (with due credit) in the May, 1903, issue of the Thrapeutic Digest.

As soon as we discovered these facts we wrote a very sharp letter to the plagiarist, Dr. E. B. Ellis, of Birdston, Tex., and tho more than fifteen days have elapst, no reply has been received. He is probably hiding his head in shame. We want only honest correspondents. Dishonest correspondents need not expect to escape detection, for THE MEDICAL WORLD is thoroly read in every part of this great country, so whatever should escape our "eagle eye" will be sure to be detected by some one else, and we will carefully trace up any such matters and expose the plagiarist without reserve.

In obstinate gingival neuralgia and in toothache where no cavity exists or where insufficient cavity is present to retain any application, paint the gums around the aching area with pure tincture of iodin every five minutes till three applications are made.

Lupus vulgaris has been cured by painting with formaldehyde and glycerin, equal parts. Loosen the crusts as they form. If the application be found too caustic, dilute and lengthen the intervals of applica

tion.

Treatment of Surgical and Accidental Wounds Editor MEDICAL WORLD:-It is very gratifying to observe and consider the progress made by the medical, and especially the surgical, profession during the past few years in its departure from the untenable ground occupied by so large a number of its members for so long a time on the proper, or improper, manner of treating wounds and surgical patients, and to note the alacrity with which it is now dropping the cumbersome and ridiculous paraphernalia and details with which it was trying to prevent suppuration in wounds, and after operations.

There is more or less danger now that the pendulum may swing too far in the opposit direction in the efforts made by some individuals to discover, or at least to advocate, something different from the customary methods of procedure, in too many cases apparently more concerned in the effort to attract attention to themselves than benefit to their patients.

It was very strange that it took so long a time to convince so many of the profession that a fluid strong enuf to destroy the vitality of germs was often also strong enuf to destroy the vitality of the cells which constitute the human organism, and that if there were onehalf the dangers from septic contamination from the atmosphere that so many of them supposed there was, that the human family would have been swept off the face of the earth many generations ago; finally, they discovered that the danger from air infection was very slight, and now the fear runs with so many that the great danger from infection is in the liquids used, and for this reason are discontinuing the use of anything and everything but dry wiping or sponging, evidently overlooking the fact that the danger is certainly as great from infection from any cloths or dressings as it is from any clean liquid, as it is certainly as difficult to purify the cloth dressings as it is to purify the liquids; in fact, the way to purify the cloths, gauze, sponges, etc., which they use, and the way they recommend for their purification, is to boil them in water, and if boiling them in water purifies them, then it certainly also at the same time and in the same manner must purify the water in which they are boiled, as it is the heat which purifies each of them, and it is as easy to keep the water pure as it is to maintain purity in the cloth dressings. The late Dr. Chas. T. Parkes, of Chicago, who was credited with conducting the largest surgical clinic in the world the last few years of his life, as early as 1888 in a conversation with the writer, ridiculed the then very prevalent idea that all the wonderful and tedious details were necessary for the prevention of suppuration, and said, what has taken years for so many to learn, that all that was required was strict

cleanliness and that this could be obtained just as well without the use of chemicals that were liable to do direct injury themselves, as with them, and that he used nothing but thoroly sterilized water, and plenty of it, as that removed the uncleanness, the sources of infection, and then by having his hands and instruments clean, he had no trouble in, or with, suppurating wounds made in operations.

While not intending to censure in the slightest degree the sincere efforts on the part of any one to find an improved method of conducting surgical cases, the writer wishes to caution against the all too prevalent customs and practises of so large a number to go to extremes in any one method without due consideration and reflection, and the use of common sense in connection therewith.

Good results will attend any form of practise that provides for and maintains cleanliness, altho at times, despite the utmost caution, there will be some fault in the technique, and the result will be that that there will be some suppuration, and therefore that form of technique that is the simplest, and therefore the least likely to have some of its important elements omitted, should be used if it is a reliable method when properly made use of, as in this manner the results will be more uniformly good and satisfactory. The simplest method I have ever used, or seen used, that produces uniformly satisfactory results if properly used, is so very simple that it will no doubt require the proof of demonstration with many before there will be any confidence in it, but as it is easy to try, it should not need much time to assure one's self of its merits. It simply consists in the use of diluted alcohol, one part of the spirits with three parts water, and the wound after operation kept covered with a gauze dressing saturated with the mixture, and if the wound has been kept clean during the operation there will be no suppuration, swelling, inflammation nor pain, and the healing will be complete in surprisingly short time. Where, for any reason, there is any doubt as to the wound having been made entirely clean or aseptic before the operation is completed, and when the nature of the case permits it, it is well to wash the part with a stronger preparation of alcohol. I often use

it pure for that purpose just before closing up the wound, and then keep it wet afterward with the weaker preparation as above mentioned. The results are absence of swelling, tenderness, pain and throbbing; there is no sticking of the dressings to the wound and disturbance of the healing process when they are removed, and of course no suppuration. The effect of the dressing with this mixture is a repression of the otherwise excessiv influx of blood with its distention of the parts and the attendant pain.

Any doubter of the efficacy of this treatment can easily satisfy and convince himself of its merits by a trial of it, and to be fully assured of it let him some time, when he has a case of injury to two or more fingers on the same patient, make use of this method for some of the injured members, and the ordinary dry dressings for the others, and note the difference; and if this is not sufficient, or if he has no such case as above mentioned, let him provide for keeping a portion of one injured part thus wet, and dress the rest of the same wound dry, and the same difference in favor of the wet alchohol dressing will be observed.

A favorit practise with me is to sponge, or irrigate, the field of injury and operation with a solution of sulfate of zinc, about a dram to the quart of water, and after the operation is completed, for sake of security, douche the whole surface with pure alcohol, then put up the part with the weaker preparation as described. In this manner I have frequently had complete healing of finger stumps on trainmen on whom the operations had been performed in filthy cabooses without any other means of cleanliness at hand, in a week's time without any suppuration or pain.

Alcohol in the strength mentioned appears to have no ill effects on the cells of the body, and promotes healing, or at least prevents any obstacles to prompt healing from taking place, and is strictly antiseptic, and has no bad results either on the hands of the attendants, or on the instruments used by them.

As a dry dressing, fine ashes in appropriate cases are unexcelled. It would be manifestly improper to use them upon the raw surface of wounds, but where wounds have been put in good condition and the edges of the skin brought into accurate apposition, for the purposes of asepsis a coating of ashes over the whole surface about the line of approximation and then covered with dry dressings will require no further attention and will heal rapidly Some years since, on a very hot Sunday afternoon, I was called to an Italian camp of railway laborers six miles from the city, and found a young man who, in jumping off a moving freight, had fallen on the ends of the ties and cut the left side of his face from the nose to the ear, a ragged wound, which gaped to a width of from half an inch to two inches, and filled with sand, gravel, cinders, bristles, straw, chaff and all imaginable filth, and a big quid of tobacco bound over it all. My arrival was some four hours after the occurrence of the accident, and the condition is more easily imagined than described. It took several hours' effort to clean the wound so as to justify closing it, but it was accomplisht eventually; the stitches were then inserted and the

edges approximated; after the usual brandy bath in such cases, the edges carefully approximated, another brandy douche, then a good coating of cigar ashes over the whole surface, and a wet dressing of brandy and water applied, and to make a long story short, the healing was complete in less than a week without a drop of suppuration and with a very slight linear scar.

For an infected wound due to neglect as so often occurs among many people, and for a cellulitis and dermatitis, I have found nothing that produces better results than the liberal use of a mixture composed of alcohol and spirits of turpentine of each one half ounce, olive oil three ounces, well shaken together and the part kept constantly covered with a gauze dressing saturated with the mixture. It will please those who try it.

In my medicin case I carry an ounce or so of brandy, and in the absence of alcohol I make use of the brandy, and the results are just as good, the only difference being in the expense; that is what is meant by the statement above of "the usual brandy bath in such cases."

South Bend, Ind. S. L. KILMER, M.D.

Novel Splint for Fractured Femur in Infant. Editor MEDICAL WORLD:-I had a case of congenital (?) fracture of the femur to attend to a short time ago. When the nurse called my attention to the leg which she said had something wrong with it, I obtained a shingle and made three small splints, padded them, and placed one on each side and one anteriorly, bound them up and left, saying, I would call next day with proper appliances and fix the baby's leg as it should be done.

At this time I was thinking of a long splint from the axilla to the ankle, in the orthodox fashion, but on the way home I began to reflect that a baby is a quadruped, not a biped (see the best authorities on evolution), and I reasoned that in fixing the leg in a straight line with the spinal column I would be unduly stretching the anterior muscles of the leg and foreleg, and putting the limb in a position Nature did not intend it to take for at least another year. And the question arose, how should I be able to keep the broken pieces together during the healing process? When I reacht home I consulted all the surgical authorities in my possession, but all were silent on baby fractures. I could not recall any instructions I had at three different colleges dealing with such cases, and I began to think hard. Then I went to the tin shop, got a piece of heavy tin, cut it the length of the baby's leg, and shaped it like an eave-trof. About half way between the ends I cut each edge about half an inch towards each other, then bent the tin at this place like the letter V, tho a more obtuse

OCTOBER, 1903]

angle and towards the convex side; padded the concavity and placed at the back of the thigh and calf of the leg, with short anterior and side splints, and bound all together. This allowed the leg to flex on the body and the foreleg to flex on thigh, and as a healthy baby sleeps most of its time and does not kick, I concluded I had made a scientific job. At the present time it appears to be all right. What says the Editor? ONTARIO.

[The job was all right.-ED.]

A Few Suggestions on the Treatment of Lobar Pneumonia.

Editor MEDICAL WORLD:-We are taught, and know from experience, that pneumonia is a self limited disease, running a regular course. Therefore symptomatic treatment is the only recourse. The most prominent symptoms are as follows, which demand more or less treatment: pain, pyrexia, cough, dyspnea, rapid pulse, and sometimes delirium, great prostration and nervousness. Pain, as a rule, is one of the initial symptoms and continues thruout the disease. A hypodermic injection of 4 gr. morphin and 10 gr. of atropin upon arriving affords the patient comfort and is very satisfactory to the doctor; it quiets the patient and relieves the stitch in the side, relaxes the intercostal muscles, thereby assisting respiration. The effect dies out in from eight to ten hours, and as a rule on opiate is indicated again, and I most strongly recommend the use of codein sulfate in 4 and 2 gr. doses, given as necessary to control pain. The codein quiets the patient, makes respiration easy, delays the restlessness and makes the patient comfortable and does not constipate the patient, does not dry up the secretions, and does not produce any distressing or depressing effect; it also quiets the cough, which is very necessary. It has a decided advantage over the coal tar products in as much as it doesn't weaken the heart nor disturb the mental faculties.

Strapping the sides with adhesiv straps I consider an excellent way of relieving pain; it also supports the patient during a paroxysm of coughing. This acts in a mechanical way by placing the intercostal muscles at rest.

Turpentine stupes are very valuable. I frequently use equal parts of lard and turpentine spread on a flannel cloth that has been wrung out of hot water and apply it over the affected side.

Blistering does good in some cases, and I occasionally use it. I might mention in this connection the use of an ice bag placed over the affected area, which controls pain very admirably, reduces temperature in a small degree, and lessens the congestion.

Ice caps

445

to the head frequently relieve a severe headache which is often present, and quiets delirium. Cold water being the best antipyretic, it is the only one that should be used, in the form of an ice bag, cold pack or baths, if restlessness and high temperature demand.

When the temperature has been lowered in this way the patient does not pass into a deep comatose condition being bathed in a profuse perspiration, as is sometimes the case when drugs have been used for the purpose of controling those alarming symptoms; but instead, the patient feels refresht and falls into a natural sleep, which always gives him more strength.

Cough remedies and expectorants are as a rule useless and very often harmful. Codein given when necessary to control the cough, is the best remedy; 5-gr. doses of the cabonate or muriate of ammonia is also excellent. Iodid of potass. in tardy resolution is of some value, given in 10-gr. doses four times daily.

Aconite, veratrum, or any drug depressing to the heart I think should never be used, the main effect being to support the patient. Strychnin sulfate given in or gr. doses every three or four hours, as patient needs, I think should always be given. Whiskey or brandy in proper doses are necessary to a lagging heart.

A normal salt solution is often very beneficial to the patient, and I think can be used with advantage in every case if the symptoms demand.

Delirium is best treated by cold water, and if necessary the cold plunge bath should be used.

To summarize: the patient's bowels should be kept open thruout the attack, the patient should be kept in a well ventilated room, a light but nourishing diet, a supporting treatment consisting of strychnin, alcohol, caffein, and other stimulants if necessary, codein sulfate for pain, cough and restlessness, cold water in the form indicated for high temperature. Carbonate of creasote in 5-drop doses with 5 or 7 grs. of salicylate of ammonia is highly recommended by some and is worthy of trial. Let us always bear in mind that nature saves our patients, and not our drugs; therefore don't drug your patients too much. Z. B. CHAMBLEE, M.D. (City Physician.)

North Birmingham, Ala.

A Case of Melena Neonatorum. Editor MEDICAL WORLD:-Having had a case of the above disease come under my care, and noting the rarity of the disease and its grave prognosis, I thought it worth the time to write you about the case. On July 29, the seventh day after labor, I was called by Mrs. C., to see her baby. The baby then lookt as if it would not live twenty-four hours. Its features were pincht and drawn, its little abdomen flat and lookt as if it rested upon its spinal column. The child at times cried as if in great pain; at other times it slept as if in a stupor, and was very hard to awaken. The mother told me that on the fifth day after labor the baby had vomited bright red blood, and had vomited blood once since, and that it had lost very much flesh since birth. She also told me that from the second day after the birth of child its stools had been black in color; also that she had noticed blood from its vagina; also said that she could not get the baby to nurse much. I found that the mother had very little milk, and the child now seemed too feeble to suckle. I saw the stools that night and the next day, and they were very dark colored, almost black.

I diagnosed the case as one of melena, aggravated by an insufficient amount of milk on the part of the mother. I decided on the following course of treatment: 1. To feed the baby in part upon a modified milk, alternating with breast feeding. I gave this formula:

To be divided into five feedings and alternated with breast feeding. I also ordered the baby to be bathed with cod-liver oil and wrapt in flannels. I gave by the mouth sulfate of iron, grain, every four hours. I ordered twice per day a high rectal injection of 38 percent silver nitrate solution, followed by a normal salt enema.

On first day of treatment baby vomited once after feeding from bottle, and vomited the medicin twice. After first day it held every thing down. On the third day baby was very much constipated, and a bright red rash came out upon the face, neck and arms. The color of the stools from day to day became less dark, and on the fifth day after treatment were normal in color. Only once since have they shown any sign of digested blood, and that was on the eighth day after treatment. On the fourteenth day I stopt all treatment except the cod-liver oil inunction and the modified milk diet. The baby is now six weeks old and quite well to all appearances and gaining slowly.

State Farm, Mass. H. O. JOHNSON, M.D.

The Treatment of Diarrhea Associated with Pulmonary Consumption.

Editor MEDICAL WORLD:-Diarrhea occurring in the course of phthisis is of more than usual interest. This class of patients, already reduced in strength, show little resistance to the debilitating process.

Occurring as an acute disorder in the earliest stage, the reserve fund of strength and vitality is usually sufficient to allow the employment of tentativ measures. Any expectant plan of dealing with the diarrhea supervening in the later stages of phthisis will allow the patient to become deprest to a degree from which he will rally with great difficulty, if able to do so at all.

Leaving out of consideration the comparativly infrequent cases of tubercular lesions of the intestins and the obstruction of the absorbent vessels by infection and enlargement of the lymphatic glands in the mesentery, we come to the treatment of this malady when of a nonspecific character.

The first manifestation of this disorder is looseness of the bowels. Almost without exception it has come on as a consequence of over exertion. The appetite for a single meal has been increast without increasing correspondingly the digestiv ability, which results in overcrowding the stomach at a time when the portion of food should have been less than usual.

If the patient is being otherwise properly fed at this time, there need be no change made in the diet. No medicin is required. Absolute rest in the recumbent position will prove sufficient for its arrest.

With patients in whom the phthisical process is more advanced, the greater number of causativ agencies and the vigor with which they operate, as well as the coincident debility, demand a more activ plan of treatment. Each stool should be inspected, and unless such examination is satisfactory it should be examined under the microscope. It will often be found that food of whatever kind taken, some is passed imperfectly digested. This defect is often relieved or greatly improved by lavage.

As most of the mucous membranes, and especially of the respiratory tract, are passivly congested in this stage of consumption, the mucus secretion is more abundant than in health. In persons who expectorate freely there is also found much matter of a muco-purulent character, brought up and swallowed during sleep. A capricious appetite and the consequent improper diet and often improper and harmful medication have, altogether, produced varying degrees of congestion of the gastric mucosa. As a result the stomach is found to contain a con