full bath in broncho-pneumonia in infants. I do not think it advisable to use the bath at 90° F. or higher, with cold douching of the head and shoulders, to obtain reaction in infants. The procedure rouses the patient only momentarily and the subsequent depression is greater. The cold packs over the whole body are also heroic remedies, but are advocated by some authors.

The heart is supported by means of digitalis, camphor, musk, strychnin, caffein, and ammonium carbonate. Of these agents the most useful are digitalis, strychnin, and musk. Digitalis is administered in the form of the tincture. A drop is given for every six months of the age of the patient. It should not be used unless the pulse is high, and should then be given every three hours. It is discontinued after being administered for two or three days. The effects of stronger preparations, such as the fluid extract, cannot be gauged so carefully as those of the tincture, and they are therefore less useful. The cases in which digitalis is of the greatest value are those in which there is cyanosis to a mild degree, or excessiv pallor denoting great cardiac weakness. Strychnin is one of the most useful in the treatment of the heart. An infant six months old will bear a too of a grain very well. Older infants and children bear of a grain quite well. Strychnin should not be used in cases where there is excitability of the nervous system. I do not use poultices; some authors use them as a routine measure.

Inhalations of benzoin and turpentine are of very little efficacy. They do not affect the local lesion in the lung, nor do they act on the mucous membrane as they do in catarrhal processes of the nose and throat. In some cases I have seen harm result from over-loading the atmosphere with balsams.

The patient should be isolated from the healthy children of the family, and the room kept at a temperature of 68°. F. to 70° F. and well ventilated. An open wood fire is the most satisfactory method of ventilating the sick room.

Whiskey is so universally used that the mode of administering it should receive special mention. Alcohol should not be used as a routine remedy. In some of the milder cases its use is superfluous. There are other cases in which its use must be suspended because of the constant vomiting. In the severer types of broncho-pneumonia, in which the temperature is persistently high, the effects of the toxemia may be counteracted by administering whiskey. Infants receive from twenty to thirty minims, older children a dram every three hours. The whiskey should be well diluted and should be given after the nursings. The feeding of infants who take a substitute for the breast should be carefully watcht, especially in bronchopneumonia, a disease in which diarrhea is apt to supervene. If diarrhea is present, the milk should be discontinued and a cathartic given.

In threatened edema of the lungs, I have found, as in lobar pneumonia, that the right ventricle is best relieved by nitroglycerin, zoo to ho grain being given at a dose, and by the constant administration of oxygen containing 20 per cent of nitrous oxid.

The cough is sometimes very harassing, and then only should be relieved. The camphorated tincture of opium may be given in moderate doses. Codein is useful in older children; morphin should not be used. In the many hundreds of cases I have treated, I have not found it necessary to use it. Strapping the chest to relieve pain is harmful in infants and children. The

chest in these subjects is resilient, and any limitation of the action reacts unfavorably in preventing a full expansion of the affected lung.

The eclectic practise is set forth by Mundy, in Diseases of Children, publisht by The Scudder Bros. Company, Cincinnati, Ohio, as follows:

A child suffering from broncho-pneumonia should be kept in a well ventilated room of even temperature, in which the air is kept moist, by vapor if necessary. Locally, a mush jacket, covered by oiled silk or glazed paper, should be applied during the acute stage.

After the urgent symptoms have passed, this should be replaced by a cotton or oiled silk jacket until convalescence is assured. Some prefer the greased cloth dusted with the compound emetic powder.

Internally we give such remedies as are indicated. The fever is treated by the special sedativs. Aconite, when the pulse is feeble and rapid. Veratrum when it is full and bounding. These remedies have not only an influence on the temperature, but, when used in small frequent doses, have a controling influence upon the heart and capillary circulation as well. Should there be any pleuritic complication, it would be shown by the catchy, jerky respiration, every respiration being accompanied by a moan, we would combine with either of the above bryonia. If the skin be hot, dry, and pungent, asclepias. For the cough, use lobelia when the dyspnea is markt, the rales are dry, the heart's action labored, and the pulse small and feeble. It can be combined with any of the above, or used in alternation. We would not use it for its emetic action, as we believe it to be dangerous to do so in the graver cases; tho when given to nausea, relief is often obtained. Should the cough show abundant secretion, and the rales be moist, and there is weakness or prostration, use ipecac. Pilocarpus has been recommended when there is elevation of temperature, a sharp, hard pulse, dry skin and mucous membranes, and dark colored urin. The nervous system will call for gelsemium when the patient has a flusht face, bright eyes, and contracted pupils, and is restless and nervous, or if there is convulsiv action. If, on the other hand, there be dulness and stupor, we give belladonna, which will also have a good effect upon the congestion of the lungs. It might be rhus. tox., when there is sharp, shrill cry, sharp, quick pulse and red, glazed tongue. Expectorants are not called for, and especially those containing opiates. The remedies enumerated above will do all we could look for from expector ants. Occasionally stimulants are needed. If so, it will be noted by the weak, rapid, irregular heart action, and weak, compressible pulse. We then use either the alcoholic stimulants or strychnin; possibly both. The hot mustard bath will be of advantage in such cases. [What temperature, brother eclectic?ED.] In protracted cases, cod liver oil, the hypophosphites, iron, or arsenic, will be needed, in connection with a carefully regulated diet; giving only that which is most nourishing and easily digested.

This is the exact statement of the latest policy of two eminent men. We feel that the presentation of this subject in this authoritativ manner is appropriate at this time.

A True Mirror.

THE MEDICAL WORLD seeks to mirror the medical profession just as it is; and also, at the same time, to unflinchingly point out error wherever found, and advocate the highest truth as we see it. While we have opinions, very decided opinions, and express them without fear or favor, we believe that the broad toleration shown in these columns the best

plan to bring about a mutual understanding among all.

We venture the statement that THE MEDICAL WORLD has more "regular" subscribers than any other "regular" medical publication, more homeopathic subscribers than any homeopathic publication, and more eclectic subscribers than any eclectic publication. Occasionally intolerance shows its ugly head by: Stop my subscription; I don't want any ." But that doesn't affect our policy. We would rather be alone with truth

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than to be with the crowd in error. Also, we would rather be with the multitude, even tho somewhat heterogeneous, than to be among a bigoted few. If you have a truth to tell, tell it like a man. If have a conviction to record, lay it before your brothers in all sincerity. But don't imagin that the truth that you know is the only truth; don't think that your conviction is the only sincere conviction in the world. Don't allow the truths that you entertain and the convictions that you cherish to blind you to what others may have to present. Have opinions, but don't let them blind and bind you. The contests in the arena of thought are the grandest in history; the gladiators in this arena are the real heroes of the world; the contests decided here have enduring results, while the bloody battles of the Roman gladiators decided nothing.

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When he is first engaged, a Russian surgeon starts upon the salary of $400 a year. On this pay he remains four years, when he is advanced to $500 yearly for four years. Four years later this is increast to $650; then to $750; the final renumeration, the highest which he can obtain, being $2,750 a year. When compared with the salaries of American army surgeons, it will be noted that Russia pays less than half the amount received by United States military surgeons.

At the Trousseau Hospital, France, from 1885 to 1889, there were 470 cases of socalled peritonitis. After appendicitis had been recognized and differentiated there were, from 1895 to 1899, in the same hospital 443 cases of appendicitis. Thus we see that appendicitis is not a "new disease," as the laity seems to think, but it is as old as any other ill that flesh is heir to. The only thing new is our knowledge of it and its treatment.

In rheumatism, kidney and bladder troubles, and in typhoid fever, ascertain exactly how much water your patients are taking, and make sure that sufficient is being ingested.

ORIGINAL COMMUNICATIONS

Short articles on the treatment of disease and experience with new remedies are solicited from the profession 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 next month. Unused manuscript cannot be returned.

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 RECORD

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Herpes Progenitalis.

Editor MEDICAL WORLD:-Herpes progenitalis is one of the most annoying of the

minor affections that come under the observation of the genito-urinary surgeon. Altho it can hardly be called a severe affection, it is nevertheless of extreme importance, for the following reasons:

1. Its liability to be mistaken for disease of a distinctly venereal type.

2. The fact that an infection of any kind may produce primarily herpetic vesicles, as a result simply of irritation of infectious secretion. A diagnosis of herpes being made without due caution, both physician and patient are disappointed, and ofttimes disgusted, by the appearance of syphilis or chancroid later on at the site of the herpetic lesions.

3. The frequent recurrence of herpetic lesions, and the psychic disturbance produced thereby, the patient believing, as a rule, that he has venereal infection, or a recurrence of chancre or chancroid, which he has experienced some time in the past.

4. The fact that herpes progenitalis is very likely to occur from time to time, as a postsyphilitic phenomenon, and be mistaken for genuin syphilitic lesions.

5. The danger of direct infection of the herpetic lesions in case of exposure after their development.

Etiology: There is hardly any question that a special predisposition to herpes is a prime factor in the etiology in many cases. The same kind and degree of local irritation which will produce a crop of typic herpetic vesicles in one individual, in the majority of cases produces either simple irritation or no result whatever.

There is also no question in my own mind that once a crop of herpes appears on the genitals, an acquired tendency often exists thereafter for a prolonged period. Recurrences are usual, altho they may vary in frequency and severity.

The neuropathic element is perhaps the most important one in the etiology of herpes. We frequently find neuralgia or hyperesthesia of the affected part associated with the herpetic eruption.

Conditions of debility, fevers, malarial poisoning, rheumatism and lithemia are undoubtedly predisposing causes to herpes progenitalis. Given the favorable neuropathic foundation, and almost any source of irritation is sufficient to develop the vesicles.

Phimosis is a predisposing cause which deserves serious consideration, by reason of the fact that in many instances successiv crops of vesicles will develop, until circumcision has been performed. The explanation of the etiologic influence of phimosis in the production of herpes progenitalis is very simple, the redundant prepuce favoring the sensitivness of the mucous and quasimucous surfaces, and promoting uncleanliness. Decomposing secretions are a very important etiologic factor.

There would seem to be a special tend ency to herpes progenitalis in syphilitics. Herpes does not develop, as a rule, before the lapse of six months or a year after the primary infection. Once it does develop, however, it usually recurs from time to time, in some instances for many years. I am of opinion that a general and local neuropathic tendency is developt, firstly, by the syphilis; secondly, by vigorous treatment. That the irritation produced by the primary sore, whether it be typic or mixt, has something to do with the subsequent tendency to the development of herpes progenitalis at or near the site of the primary lesion is probable.

Herpes progenitalis in women is often of a distinctly neuropathic character. I have seen a number of instances in which it developt coincidentally with menstruation. In other instances I have observed that the crop of herpetic vesicles heralded the occurrence of pregnancy.

Treatment: The first duty of the physician is to remove all possible sources of local irritation. Cleanliness and, in cases in which it is indicated, circumcision are prime indications. Care should be taken to avoid irritating local applications. The patient is sometimes so uneasy lest venereal infection of some kind exist that the physician is likely to be tempted to apply caustics, with dire results. Bland dusting powders, such as the stearate or oxid of zinc, bismuth, calomel, and suboxid of bis

muth are among the best of these. The parts should be kept as dry as possible.

The internal treatment should consist of measures to improve the general health and check debility. The special feature of internal treatment should be the administration of nervine tonics, such as strychnin, the mineral acids, iron and arsenic. remedy which has acted well in my hands is bromid of arsenic, in doses 2% grain, three or four times a day.

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Caustics and greasy applications should be avoided in all cases. Local astringent applications tend to prevent herpes by lessening the sensitivness of the mucous membrane.

In cases in which lead poisoning and malaria are possible or probable factors in the etiology, the treatment required is sufficiently obvious. In a large proportion of cases remedies which counteract debility are indicated.

In many instances the disease is very resistant to treatment, and returns from time to time with great pertinacity. Ergot may sometimes be of service, especially if combined with the bromids.

Chicago, Ill.

G. FRANK LYDSTON. [Professor of Genito-Urinary Surgery and Syphilology, State University of Illinois.]

Fatal Swallowing of a Tack.

Editor MEDICAL WORLD:-I was much interested in Dr. Brown's article, page 519, December WORLD. I presume that nearly every physician at some time or other has similar experiences. Many times frightened mothers have come to me saying that their babies had swallowed this, that or the other thing, and it has invariably been my habit to relieve the worried minds of these distrest mothers, telling them that Nature would take care of the case, and at the same time offering such advice as I thought the case might require. Babies swallow all sorts of things, and yet Nature, ninety-nine times out of a hundred, comes to the rescue and provides a way of escape. Once in a lifetime, perhaps, we have a case which does not end as fortunately. Such an experience was mine, and I desire to describe the case.

July 9, 1899, Mr. M. brought his little son, almost two years old, to my residence (I was laid up at the time, with a badly sprained ankle, having been thrown from my buggy a few nights before), saying that he had swallowed a furniture tack, the large kind which is sometimes used in upholstering. The head of the tack was almost half

inch in diameter, and the point was exceedingly sharp. Upon examination of the child it was difficult to say whether the tack was lodged in the esophagus or not, but that was what I feared from the actions of the child. I suggested that Dr. G., a specialist in a neighboring city, be called, which was done. He was of the same opinion as myself, that the tack was lodged low down in the esophagus. The Doctor therefore inThe Doctor therefore inserted (I was not present) an esophagus throat forceps. He thought he could feel the tack, but after continued efforts to grasp it, in which he did not succeed, he withdrew the forceps, fearing that further effort might result in lacerating the esophagus. The following day the tack was found in the stool of the little patient, having passed thru the entire alimentary canal in about 40 hours. But alas! The suffering of the child was only aggravated. The esophagus was severely lacerated, either by the tack or the instrument, or both, inflammation and complications followed, and after several days of great suffering the little fellow died. Had the case been left to Nature, the result might have been different. But who can tell? O. L. THOMPSON.

Buckley, Ill.

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Another Safety Pin Swallowed. Editor MEDICAL WORLD :-Inclosed find check for three dollars, for which you will please credit me with four years' subscription as per offer. THE WORLD is always welcome at my office, not only for the direct and "to the point" manner of handling medical subjects, but none the less for your "Monthly Talks" on public affairs. have practically held your views on these subjects for some years-long before my name appeared on your subscription list. Let the government take, at a fair valuation fixt by an impartial commission, all public utilities, and you will have little more of the vext question of trusts. Railroad discrimination is their chief bulwark; remove that and they will totter and fall. Make railroad rates under government control like postage stamps, the same price to all, large and small.

I was interested to read in last issue an account of a child swallowing and passing in stool a safety pin (open). The second call to which I responded in private practise, six years ago, was of the same nature. Male child, nine months old, had swallowed an open safety pin about one inch long. Mother and grandmother were nearly frantic

with grief at the supposed impending death of the "only baby." I gravely assured them that all would be well, altho I was a little doubtful, having never heard of a similar case at that time. Laxativs were forbidden, placebo prescribed, mother ordered to advise me at once if baby should at any time appear ill. Three weeks passed, during which the child appeared perfectly well, when the happy mother brought a corroded open safety pin to my office, saying it had passed in baby's stool a half hour before. R.

Mass.

Slippery Elm Bark Will Assist the Passage of Articles Accidentally Swallowed.

Editor MEDICAL WORLD:-In the December number I notice an article from Dr. Thad. J. Brown, of Novelty, Mo., about a child swallowing a safety pin, open, that passed thru the alimentary canal in two months. The Doctor doesn't claim anything for treatment, nor does it appear that his advice had anything to do with the pin passing. As he says, two long months" is a long time for such a thing to remain in the alimentary canal; and many things might have happened to the patient within that time. I want to give some experiences of my own that I think will be of great benefit to the medical profession; and if the Doctor has any more such cases, he will not have to wait two long months for the pin to pass.

Several years ago I had this case: A boy four years old had swallowed one of the glasses out of a very large pair of spectacles. The glass soon passed thru the stomach, but finally lodged in the bowels, causing lots of pain and tenderness. For four or five days I tried various means to remove it, but all failed. About that time I met an old doctor eighty-five years old. He told me to have the boy chew and swallow the inner bark from the slippery elm tree; to chew it into a pulp before swallowing, and to eat all he could in two or three hours' time. The fresh bark is the best. had the boy chew and swallow the bark until he got tired chewing. The next day the glass passed wrapt up in the slimy bark so that some of it had to be removed before we could see the glass. All bad symptoms subsided at once.

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and in two days (not two months) the pin passed, wrapt completely in the slimy, stringy bark.

Another girl, three years old, swallowed a badge pin; a boy, two years old, swallowed a one cent piece; another swallowed a silver quarter (twenty-five cents). I had them all use the slippery elm bark, and within two days each article passed, wrapt in the pulp of the bark. It is a very simple remedy, easily applied; and within the reach of everybody where the tree grows, and the dried bark will answer the purpose, but not so readily as the fresh bark. I believe it will give relief in every case it is used; besides, if any thing is swallowed that is poisonous or liable to cut or tear the delicate membrane of stomach or bowels, it wraps itself around the article and protects the surrounding parts from injury. The old doctor helpt me out of several very serious difficulties by his timely advice, and I hope this will help others as it has me. G. W. FARVER, M. D. Montezuma, Indiana.

A Broken Glass Syringe in the Rectum. Editor MEDICAL WORLD:-The safety pin incident, related in December WORLD, beginning on page 519, reminds me of the following, which may be of interest: I was hastily called about five miles from my country home to see a boy babe, eight or ten months old. His mother told me that on account of costiv habit she had for weeks moved his bowels with one or more fulls of a one-half ounce glass syringe. This time the babe had moved so violently that the syringe was broken about the middle of the barrel, and the distal end was in his rectum. Examination revealed a little blood oozing from anus. The jagged end could easily be felt with my finger. That was about thirty years ago, and besides being a young doctor I was a comparativ stranger in that neighborhood; and to make matters more embarrassing, the kinsfolk on both sides were there to see what I would do. Fortunately, for me at Heast, the babe's bowels had not moved, so after careful examination I decided to give an ounce of castor oil and wait for developments. Within less than two hours I saw evidence indicating a movement, and prepared myself by cleansing my hands and oiling my finger and inserting it into the rectum. I had to wait only a few moments for sufficient pressure to dilate the rectum and press the glass edges over the end of

my finger so that, as it passed the sphincter ani the jagged glass followed without harm-very much to my relief and to the gratification of the assembly. As the child was not injured there was nothing more to do. J. W. MILLER.

Shannon, Miss.

More Pin Swallowing.-Antitoxin Should be Warmed Before Injecting It.

Editor MEDICAL WORLD:-After reading the case of a child swallowing a safety pin, reported by Dr. Brown, of Missouri (page 519, December WORLD), I am prompted to report two cases that have occurred in my practise which to me seem unique.

Case I was that of a little girl four years of age, whose distrest father came to me, stating that his child had swallowed a pin, and he was convinced that the pin was sticking in her throat. I could hardly think the pin had lodged anywhere, but at the father's earnest request I accompanied him, to his home. Upon my arrival I found the little patient very nervous and crying incessantly. As her expression and general appearance suggested suffering, I felt that perhaps I had been too hopeful and confident in the assurance I had given the father. I at once proceeded to examin the child, both by direct and indirect illumination, which, of course, was very imperfectly done, as all are aware it would be, with a child in her condition and at her age. nevertheless, it was complete enuf to satisfy my mind that there was no pin to be seen in the throat; and as the child immediately ceast crying after the examination, I was encouraged to inform the parents that the pin had passed safely, no doubt, into stomach. After advising them as to her diet, and impressing upon them the importance of not physicking the child, I departed, and the case was dismist from my mind and received no further attention.

Yet,

A week later the father and little patient called at my office, the father remarking as he entered the door, "Doctor, my wife saw that pin in her throat." Seating her in the office chair in a favorable position, the mouth was opened and inspected, along with throat, with negativ results. She then began to cry, and before getting my illuminating apparatus ready, I again opened her mouth, and as the crying elevated and contracted the soft palate and uvula, about onehalf of the pin's length (an inch and an eighth) was seen pointing downward in the middle of the arch of the palate, between