haps, first and last, we have had two hundred cases. On the other hand, very few unprotected properly exposed persons have escaped.

We have many negroes who live crowded together in cabins containing seldom more than one sleeping room for the whole family. The negro dreads vaccination and will lie to escape it, asserting that he has been vaccinated and almost lost his arm. He has little or no dread, however, of "Cuban itch," as they invariably call it, especially if he has prospects of being fed by the municipality during the attack and dismist with a suit of new clothes. Those of them who have been recently successfully vaccinated have in every instance escaped.

At the risk of becoming tedious, I will, with your permission, relate a case in point:

On January 14, 1901, H. B., colored, called me to see his girl of fifteen years, who had been ill two days. Two weeks before she had visited a family in which her mother said there was a case of "dis 'ere Cuba itch." After examining her and finding the usual symptoms, I told the mother that the girl would break out to-morrow with small pox. With considerable difficulty I induced the mother to submit to vaccination, and to bring in for the operation the three little negroes who had fled to and hid in the cotton patch at the first mention of vaccination. These with the sick girl were all the family that were at home, the father and grown son being absent. On returning to town I met the son, and advised him to be vaccinated. He positivly refused, and was told to stay at home. The father sent word he had been vaccinated when a boy. Some three weeks later I was called to see the son. He had confluent small pox in the pustular (maturating) stage, with violent secondary fever. He died next day. The father had an ordinarily severe discrete attack. The mother and three little children, upon whom the vaccination "took," have escaped unscathed, tho they have occupied the same room with the patients thru all stages of the disease. If this be "Cuban itch," God pity Cuba!

Let me say, while on the subject, that tho we have used none but the best lymph obtainable, and have taken all necessary precautions in rendering the site aseptic, we have still had many badly ulcerated arms, requiring from four to ten weeks to heal. One arm of this kind gives excuse to every person in the community who is averse to the operation, and several such make the doctor's path anything but a strewn one. How can this be invariably prevented-can it? H. T. BYARS, M.D.

Caruthersville, Mo.

rose

Editor MEDICAL WORLD:-The discussion on Cuban itch and small pox in the last two numbers was most interesting. I believe that it is small pox. Those not thinking so seem to base their belief chiefly on their observation that vaccination does not prevent it. Thus the old question seemingly will not down. What is the opinion to-day, based on personal experience of the general practitioner on the value of vaccination as a preventiv or modifier of small pox?

In Denver we are having the order of the health officers to exclude from the public schools children not successfully vaccinated, or not having made a recent attempt to have it "take," resisted by mandamus and other suits. Denver having been nearly free of small pox for many years, very few practitioners have personal experience to advance as to the use of vaccination, and don't wish to rely on tradition only.

The opposition claim that modern methods of sanitation and isolation prevent the appearance or spread of the disease, as is undoubtedly the case with other zymotic diseases, and that the effects of vaccination are imaginary save where they are evil. What do the doctors think? Denver, Col. PERSIFOR M. COOKE, M.D.

If It's Small Pox, It's a New Kind. Editor MEDICAL WORLD-I have been

practising medicin for about thirty years. I have seen and treated small pox. Now, if this contagious, eruptiv disease is small pox, it's a new kind, different from what I have ever treated or seen. There are about fifteen hundred inhabitants in this town. During the last year we have had about three hundred cases, without a single death from this disease. Í have visited patients in all the different stages of the disease, and been careful to note all the different symptoms. The patient first is a little indisposed; he takes on a fever which, in some cases, is as high as 1050 or 1050; headache, backache, coated tongue and constipation, which are symptoms resembling old small pox. About the third or fourth day the patient breaks out with small, red spots, which soon raise and become round or oval bumps, which in about two or three days form small, watery blisters. In about from the sixth to the eighth day the papules begins to dry up and scale off. Instead

of penetrating the true skin and leaving pits, it leaves oval shaped red bumps, and in a short time the bumps sink down on a level with the other skin, and assume the natural color, leaving no signs of having had the disease. There is no shot-like feeling under the skin before the eruption appears. I have never yet, in a single case, been able to get that peculiar smell that belongs to old small pox. I have never met with a patient that ever had the secondary fever that belongs to the old small pox. My observation has been, that as soon as the patient breaks out the fever leaves, and he expresses himself as feeling perfectly well, and has a good appetite.

I was called to see Mrs. A. She had all the symptoms. She had four children. I vaccinated three out of the four. All three that I vaccinated successfully had the "small pox," and the fourth one escaped. I have made several such experiments with the same results. Several families of six or eight would have this "small pox," and one or two would escape. I had two lady patients that were four and a half and five months in pregnancy. They were the worst broken out of any cases I have had to treat, and neither of the ladies miscarried.

While this may be a new kind of small pox, I

believe we all agree that it is a horrible, infectious and contagious, loathsome and nasty disease, and should be crusht out if possible. But with all our quarantine, it seems to continue to spread. Some of the M.D.'s seem to think, and even go so far as to say, "if all the doctors would call this the old small pox, we would have crusht it out long ago." Now, I would ask, what is the difference, so long as all agree that it is contagious and infections?

Malad, Idaho.

J. D. MCATEE, M.D.

Editor MEDICAL WORLD:-This strange eruption has been prevalent all over this coast for two years. It was scattered over the country for months, not causing any excitement, hurt nobody, and finally crept into town when it was at once given the soubriquet of small pox. I objected, and still object, to calling such a frivolous eruption by such a horrid name, as it carries with it to the laity an idea of all the horrors of that dread disease, and ruins the business of the town in which it may be prevalent. With us it is a self-limited eruption, requiring no treatment other than a clean alimentary tract. I have noticed that those in the prodromal stage, if saturated, as Prof. Waugh says, with calcium sulfid, either have it very light or not at all. We are full of it out here, and no attention is paid to it any more, people have learned not to dread it, and scout at the idea of its being small pox. We call it "nigger itch" for short.

I dry up successive crops of boils out here, every time, with from five to ten grains of calcium sulfid a day. Cleanse bowels with a teaspoonful or more of the following (a favorit of mine), as required, in a glass of hot water before breakfast:

Editor MEDICAL WORLD:--I have been very much interested in the discussion going on anent "Cuban itch," impetigo contagiosa, small pox, etc., and find that even in far off Canada they are wrestling with the problem even to the clashing of physicians and the dignitaries of the health boards. Now, Mr. Editor, I will advance an idea not yet toucht upon in the discussion, even tho, to use an ordinary expression, I should "put my foot in it." If so, I hope you will let me down as easy as possible. I believe the present epidemic to be modified small pox--modified and rendered less dangerous by the immunizing protection of one generation on another by vaccination. You can put this assertion in italics if you wish: Up to the year 1800, before vaccination became general, no family in Germany, France, etc., ever escaped without one or more members of the family having small pox and being pockmarkt thereby. That is not the case now. Why? Immunization! Then, too, look at the number of people imperfectly vaccinated. If this idea be tenable, then the phenomena discust in your journal may be expected to be repeated as

Editor MEDICAL WORLD:-To read the articles in THE WORLD for February and March, on "Cuban itch," gives me a pain for which I find no remedy so effectiv as expressing myself.

During the winter of 1899 and spring of 1900 we experienced an epidemic of the "what is it." It appeared in very mild form among the negroes of our little city, from whence it was soon spread thruout the place. After being bothered with this unknown monster for two months (for the profession were as much disagreed as the laity), the board of health called before it every physician in the city, and the result of the meeting was disagreement; and even abuse and slander were thrown on those few who knew it as small pox. But later on, when some of our best citizens died of this loathsome disease, a new board of health was appointed, which, I am glad to say, did nobly and did well.

We establisht a quarantine, isolated all patients in small pox hospital, vaccinated those who had been exposed, fumigated all houses in which the disease had been, burned those which would not hold the fumes, and what was our reward? We started the crusade with two hundred cases of small pox, one thousand infected houses to fumigate and twenty to burn, and in sixty days we had accomplisht our desire-no small pox, no "Cuban itch."

In our battle with this disease, not one of our physicians nor assistants who had been successfully vaccinated within the past five years was ever affected. I will state further, that during my work I did not find nor hear of a small pox immune having this so-called "Cuban itch." Now, what shall be our conclusion?

1. We know of no such disease as "Cuban itch," nor have we authority that such ever existed.

2. We have seen from the infection of very mild cases of "Cuban itch" (so called) developt in the one exposed typical malignant and hemorrhagic small pox.

3. We recall a family of seven which had been exposed to "Cuban itch"; vaccinated day after exposure; six vaccinations were successful; the other had small pox.

Now it is a fact (the courts hold) that a horse may be fed on hay and corn (which is personal property), yet his fecal discharges are termed real estate. But I can't see how any physician who gets his knowledge from a medical library can sow the seed and germ of "Cuban itch " and reap small pox in an abundance.

Jonesboro, Ark. L. W. COPELAND, M.D.

WORLD four years for $3.

Editor MEDICAL WORLD:-The discussion on Cuban itch" in the last two numbers of THE WORLD interested me greatly. But the arguments (?) and proofs (?) submitted by some of the self-claimed mental giants seem far from conclusiv to me. Epithets such as "Mental Dwarfs," "Empty-headed M.D.'s," "Incompetents," etc., are mighty thin arguments. The effervescence of our Kentucky friend is a particularly lame proposition. If all cases of fever, accompanied by a vesicular or pustular rash, that are contagious, are to be called small pox, we may as well call every case of abdominal pain appendicitis; and every case of pyrexia, typhoid fever. If our text-books are of less consequence than the mere opinions of imperfectly informed practitioners thruout the country, we may as well do without them and save our money. But the text-books must be taken for authority until proven in error. Permit me, therefore, to make some quotations from them, and relate a little personal experience bearing on this subject:

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Anders' Practice of Medicin, article Variola: "The onset is sudden and accompanied by characteristic signs. These are, a severe rigor, high fever, headache, and intense lumbar pains. [Italics not mine]. Each pock passes thru the various stages noted in the pathologic description, viz. papule, vesicle, pustule, and scab; and when the stage of pustulation has been reacht, a secondary fever develops. Eruption appears as slightly elevated macules; at end of forty-eight hours they have developt into papules, accompanied by itching and burning of skin surface. They feel like shot under the skin. At the end of third day (sixth of disease) the conical apices contain liquid (vesicles). In three days the vesicles become pustules. The scab forms about the ninth day.

"There are varieties of small pox that pursue an abnormally mild course. Of these, varioloid deserves first place. The initial symptoms of varioloid do not differ, either in character or severity from those of true variola. But when the regular eruption appears, the fever falls to normal and remains there. Pustulation rarely takes place for the reason that resolution takes place, as a rule, before the latter stage is reacht.

"An abortive form is characterized by the great intensity of the invasion symptoms, but these promptly subside, and the patient enters at once upon a stage of speedy recovery.

"An exceedingly mild type may arise during an epidemic, either with or without a scanty eruption."

Óther authorities, such as Gould's Cyclopedia, DaCosta's Medical Diagnosis, etc., agree in all essentials with this description.

The case described by Dr. Moorhead was, no doubt, a case of small pox; but that does not prove all cases of so-called "Cuban itch" to be the same. I now have under observation two cases one of small pox, or rather, varioloid, which, as Anders says, is a mild or modified form of small pox. I saw him on the second day after he had had a severe chill. He then had a temperature of 104°, and complained almost constantly of the "awful" pain in his back. The eruption appeared the following day

and was distinctly papular, hard and shot like. These later changed to vesicles which became slightly pustular, then quickly dried up with very little crusting. No secondary fever. Itching and burning of surface was much complained of.

In the other case, while the eruption was much more extensiv, and went on to profuse crust formation, the character of the disease was entirely different. There was first a slight chill followed by moderate fever which disappeared on second day. He felt entirely well thruout the remaining stages of the affection. Second day after chill, the rash appeared on lower half of face in the form of vesicles and gradually extended over face, body and extremities. The vesicles changed to vesico-pustules and then formed crusts; some were yellowish in color and others were brown. Scarcely any itching and burning of surface was noticed, and there was no secondary fever. This is the so-called Cuban itch-in realty, impetigo contagiosa. I first saw the affection three or four months ago. My three-year-old boy brought it with him from Illinois; it later developt in the three other children. My wife informed me that the doctors in Illinois called it Cuban itch. An antiseptic ointment was used and they all recovered in about two weeks. It did not spread further, altho no attempt at quarantine was made. These cases, as well as the one described by Dr. Hall (in February WORLD, pages 52 and 53), are accurately described in Shoemaker's work on Diseases of the Skin, from which I quote, that comparison may be made with Dr. Hall's article:

"Impetigo contagiosa is an acute, inflammatory, contagious affection, characterized by the development of isolated vesicles, blebs, or vesico-pustules, which dry into slightly adherent crusts.

"Symptoms: The disease is generally ushered in with mild febril symptoms. The eruption appears as small isolated vesicles, or blebs, which soon increase in size and become transformed into vesico-pustules or pustules. They may appear simultaneously or in successiv crops. In the course of a few days they dry into yellowish and slightly adherent crusts beneath which some slight excoriation exists. The crusts soon fall off, leaving an erythematous surface, which also in time disappears. Subjectiv symptoms are generally absent, but there may be at times slight itching. The affection, in the majority of instances, attacks the face, head, arms and hands, but it may appear on other parts."

To quarantine families for this affection, subjecting them to financial loss and other inconveniences, is nothing less than an outrage, altho it may be proper to isolate persons who have the disease.

University Place, Neb. O. C. MASTIN, M.D.

Editor MEDICAL WORLD:-Last November a young man who had been visiting in Colorado was taken sick at a hotel here. In a few days an eruption appeared, which soon became pustular, and was distributed over the entire body. His temperature, which for several days imme

diately preceding the eruption had continued about 1040, suddenly dropt to normal. Within fifteen days scabs were formed, and the patient was on the street. He went from here to his home in a neighboring village, where he was quarantined and a state expert sent for, who, after a very thoro examination, pronounced it a genuine case of small pox. Within ninety days following his departure quite a number of similar cases appeared here, one of which I shall briefly describe:

The patient, a bright little girl, ten years old, who had not been vaccinated, was taken on the evening of February 16. I saw her first on the following day, and found her suffering from slight headache, severe aching of limbs, occasional vomiting and a temperature of 104°. The symptoms continued with more or less severity, the temperature at times reaching 1050, until the morning of February 19, when the eruption began to make its appearance. The first appeared immediately under the right eye, and was soon followed by others over the face, and then other parts of the body, so that by the evening of the 21st the eruption was complete, and all parts of the body affected. The pustule, when fully developt, is conoidal in shape, with a slightly inflamed base, while the surrounding skin has a healthy appearance. On February 25, scabs began to form, and by March 1 pus had entirely disappeared. Temperature dropt to 1020 on the appearance of the eruption, and when this was fully developt her appetite was fairly good and temperature very little above normal. After the appearance of the eruption there was no suffering of any kind except from itching, which at times was very annoying.

With this very short and incomplete history of a typical case, I submit the question, what is it and hope some of your numerous readers will be able to answer, at least satisfactorily to themselves. For myself, I can only say that it is not a dangerous disease, will, finally, leave no scars, and, experts to the contrary notwithstanding, is not small pox. S. SCRUGGS, M.D. Clay Center, Neb.

Editor MEDICAL WORLD:-During a two years sojourn in Cuba, Central and South America, I never encountered any such thing as "Cuban itch ;" and I am convinced it does not exist. It is utter folly to term the present small pox epidemic "Cuban itch" or any other itch. The present epidemic of small pox is identical with that existing among the natives in the Philippines. I have seen infants in arms and men and women in the public markets in Manila with the precise rash and train of symptoms as in cases I treated here this summer. When the American soldier became infected with the Philippine virus it assumed a most malignant phase and was terribly fatal. Four out of five boys in my own company who went to the "pest house" never returned. This is genuine small pox here minus the malignant symptoms. The treatment in the Philippines was expectant and supportiv. I saw it very successfully treated in the De Lesseps Hospital in Panama, South

America, with Donovan's solution internally and baths of permanganate of potassium.

To Dr. Hurd (page 71): There is no Manila fever unless it is the malarial type as found in all tropical countries. Twenty to thirty grains of quinin every four hours night and day during whole course of fever was the routine treatment. Any less of quinin was useless, and the large doses did not "jar" there any more than five or six grains here. Tropical dysentery treated with calomic lavage of nitrate of silver and sixty to one hundred and twenty grain doses bis. subnit. four to six times daily. Large doses? Certainly, but the patient recovers and that is the result you are after.

I am convinced the position of the MEDICAL WORLD on the Philippine question is absolutely wrong. I was in the Philippines over a year and helped dress down the Spaniards at the battle of Manila, and fought the insurgents for months afterwards. I also scrapped against the same breed of alleged patriots (patriots for revenue always) in Central and South America, and I know the stripe mighty well. The Administration has erred in one way only. We have injected too much Christianity and too little lead into those fellows. I could write a volume to sustain my contentions, but will state just one fact, and I want every "anti" to set his "nut cracker" to working over it. In every SpanishAmerican country there is a vocation little understood here, that of professional revolutionist. It is highly remunerativ—the stakes always big and loss nothing. I was a professional revolutionist in Central America and know what I am talking about, Aguinaldo and his ilk belong to that class. We will never pacify the Philippines until we put the professional revolutionists out of business for good. General Weyler (Governor General of Philippines for four years) understood his business when he lined up the "patriots for revenue" and made good Indians of them. The Administration does not understand its business when we give the insurgent thirty dollars for his rifle and pat him on the back and tell him to be a good boy and go back to his farm. He goes-straight back to the insurgent lines as fast as his legs will carry him. But the Administration is slowly getting "wise," and I have hopes for the future.

Hanley Falls, Minn. W. M. BECK, M.D. [We welcome all information and news based on observation and experience.-ED.]

Editor MEDICAL WORLD:-Utah has its share of small pox, and is having it yet. The writer has observed and treated about 130 cases since last August. In 1889 an epidemic in New York resembled this, except that that epidemic was more fatal. Umbilication, when it exists, is not always observed, and those of the writers to THE WORLD who state that the umbilication was not present would probably have said the same in any epidemic. There is a primary and a secondary umbilication, and between times the pustule is rounded. The text books state this clearly. It is folly to question the fact of this epidemic being anything but small pox. In times past, small pox has not

always been the awful disease that those unfamiliar with it have supposed. Still there is no questioning the fact that the variola of the last year has been mild. It has been quite fatal among the Indians of Utah, and pitting is not at all uncommon. In every epidemic of small pox and other diseases there are always some doctors that question the diagnosis. How about yellow fever? Then again, haven't we all seen mild epidemics of typhoid, and then those more prolonged and fatal? Without the microscope is it not pretty difficult to say what is and what is not diphtheria? Why then should not small pox bave its variations? Utah is becoming famous because her fool" Legislature passed an antivaccination bill which her good common sense Mormou Governor vetoed. C. E. BOYNTON. Sandy, Utah.

He

The Dose of Strychnin.-A Skin Disease. Editor MEDICAL WORLD:-In answer to A. C. Garr, M.D., Hohenlinden, Miss., will say that I have given 1-64 of a grain of strychnin every three hours for weeks. I had a patient come from Cincinnati, Ohio, to whom I gave three grains of strychnin in a sixteen-ounce mixture, of which he took a teaspoonful every three hours until the whole of the sixteen ounces were gone, and he did not die, but gained in weight and strength. weighed 115 pounds when I first began to treat him; had a letter from him four months after first beginning to treat him, stating that he weighed 153 pounds. Also have a patient who was brought to me on a mattress from the interior of Canada, who could not be taken from the baggage car to the ambulance in a wheel chair, but had to be taken on a stretcher. Was sup. posed to have a floating kidney, etc., but had her kidneys in the proper place. She took strychnin sulfate, grain 1-40, at least 300 such tablets, one every three hours, with an occasional let up for a week, with the result that she is well and happy today. Her condition was one of debility, complicated with stomach trouble. Also was wearing a pair of glasses that did not fit her. She had a great deal of trouble with the muscles of the eyes, and an astignatism, and was quite hysterical and extremely nervous, but is well to-day and doing her own work in a farmhouse. Most doctors are too much afraid of strychnin. I would rather have it than any other drug in many debilitated

troubles.

I do not believe that the disease called Cuban itch is small pox or modified small pox. I have had some ten cases of it during the past year, and all the cases I

have had have only affected the face, neck and head. A barber shop in my immediate neighborhood is turning out the most of my cases. I had one patient who gets shaved at this shop who infected his son of eighteen years and his wife. The rest of the household escaped, some four in number. I also got a slight dose of it in this same shop. A small scab on my chin was the first that I discovered. It was very small, and was so tight that I could scarcely pick it off. There was no discomfort before removing the scab, but the moment it was removed it began to burn and itch, enuf to keep one busy, and there was a sticky, mucilagenous discharge that burned and excoriated the cuticle. This discharge, when brought into contact with any other part of the face, would produce the same kind of a scab, which, when again removed, would cause the same symptoms all over; so it spreads until the whole face and neck is covered. I have not seen any of these scabs on any part of the body, only on the face, neck and head.

One writer says: "Those who have had small pox do not have the Cuban itch.' This is not so. I have had two cases that have had small pox; they also have had the Cuban itch.

My treatment is: Hyd. ox. flava., gr. xl; glycerin gtt., xx; vaseline, oz. 2. Sig. Use morning and night. Keep water and soap away from the face and keep the finger nails away from the scabs. Also be careful not to rub the face, as the serum will cause the whole face to be infected if brought into contact. I confined my own to two spots. Most of my cases were quite bad. None of them were sick in bed, and none of them had any headache, backache or fever; the only thing they complained about was the itching and burning.

Probably some of these cases which some of the writers describe as Cuban itch is actually small pox, as I see by their writings that they have all the symptoms one would have in small pox. Apparently the cases are modified cases of the disease; but what we in Detroit here designate as Cuban itch is entirely a different thing from what some of the writers are describing

Keep up the just what it is.

discussion until we know W. J. BRAND, M.D.

Detroit, Mich. [This is evidently a skin disease, not a