case. affinity for the positiv pole; therefore, the negativ should be the activ one in this The iodin is carried into the tumor on the electric current, seeking its affinity in the anode, and by this means saturating the whole tumor with the iodin. When we thoroly understand the electrical affinity of substances, we will be able to do a great deal more than now in the local treatment of disease. We will be able to send remedies in a nascent condition to the diseased spot upon a current of electricity. D. M. CURRIER, M.D. Newport, N. H. For Obstinate Epistaxis. Editor MEDICAL WORLD:-I think the following plan an improvement upon Dr. McCampbell's glove finger for epistaxis (March WORLD): Pass a soft catheter (clean) thru the nostril, attach a string, pull it thru the nose. Put a small wad of absorbent cotton into the end of a condom," attach it to the string, pull thra the nostril until the wad of cotton presses closely against the posterior nares. Then fill the condom with air, cotton or cold water (any one of them will do); tie the end and you will have no more bleeding. This plan is not original, and is no doubt known to many of your readers, but a good thing cannot be too well known. I am glad to see that you take a more reasonable view than formerly about the value of diphtheria antitoxin. THOS. J. TURPIN, M.D. Monterey, Mexico. [I am not aware of having changed my view concerning diphtheria antitoxin. -ED.] Lemon Juice in Epistaxis. Editor MEDICAL WORLD:-In your summary of remedies for epistaxis in the February WORLD, page 43, one very valuable remedy is not mentioned. I refer to lemon juice. It is generally easy to obtain a lemon, and the juice is a clean and effective remedy for epistaxis. One part of lemon juice to three or four "of water, snuffed up after clearing the nostrils by "blowing," will promptly check bleeding. In emergencies I have used the lemon juice clear, but should not advise it in ordinary cases. I claim no credit for this suggestion, as it is one of the good things that I pickt up many years ago, and I do not know who is entitled to the credit of first using it. Under this head I wish to relate a case that is both "singular and true." Some months ago I was called to treat a lad about 12 years of age for persistent and oft repeated epistaxis. This occurred by day and by night--frequently half a dozen times in twenty-four hours. There was no history of injury. Examination of the nasal cavity revealed nothing. I treated him according to my best light, but I failed to relieve him. As he had some visual disturbance-persistent winking, floating specks before the eyes, inability to use his eyes in close study for any considerable time, I advised him to consult an oculist. I had barely a suspicion that the visual disability and the epistaxis had any close relation to each other. When awake he could predict the oncoming of the nose-bleed by a number of seconds. He described it as a 66 something" (an aura, congestion or feeling) beginning on either side of the head near the top of the ears, proceeding slowly forward to the eyes, and a few seconds later the nose-bleed began. This disturbance was habitual and well-verified. I cautioned him to make no mention of the epistaxis to the oculist. In due time he was fitted with glasses which not only corrected his defective vision, but at once and effectually cured the epistaxis. From the day of putting on the glasses to this now about three months he has not had a single attack of nose-bleed. Afterward the oculist was informed of his double cure, but he had no philosophy: or science by which to explain the singular relationship, or the cure of epistaxis, by correcting the vision. Treatment of Varicocele. Editor MEDICAL WORLD:-I am a general practitioner, and have been a reader of THE MEDICAL WORLD for five years. Of all my medical journals I consider THE WORLD one of the most valuable to me because it is filled with the practical, every day experience of many physicians in the same line of work with myself; and the most humble may know, and tell us, something you and I do not know. That makes it valuable and helpful to its many readers, to say nothing of the valuable editorials and monthly talks by the editors. Dr. M. H. Wheeler, on page 72, February WORLD, asks for a bloodless operation for varicocele. The following plan I have employed successfully: Make aseptic the scrotum and hands. Take scrotum and vein in left hand, allow the vas deferens to slip to posterior part of scrotum, nick the true skin inch opposit the vein on both sides of scrotum one inch below ring. Now pass a good sized needle, threaded with medium sized catgut, thru the cut back of vein and out on opposit side; reenter where needle came out, without cutting thread, and pass in front of vein and out where needle first entered. Tie firmly and cut off ligature close to scrotum. The small cut in scrotum needs no suture. Ligate in same manner the same vein one inch below first ligature. Dress scrotum with dry bichlorid gauze. Put a few turns of a bandage around the body above the hips for a girth. Pin to this an end of a soft towel, bring forward between legs and pin to girth in front to keep parts elevated. This bandage can be unpinned and pinned again by the patient as occasion requires for the moving of the bowels. This bandage is worn for two weeks; then use the ordinary suspensory. This plan, tho not preferred by most surgeons, commends itself to many on account of it being bloodless, causing very little pain, not requiring an anesthetic, no loss of time from employment, and is without danger if done with proper antiseptic precautions. I I wish to say here for the benefit of those I see inquiring for something that has already appeared in other numbers of the same journal, that I keep an indext blank book in which I record alfabetically any valuable article or information. have my best journals bound for my library, and preserve some numbers of the others. By turning to this book I know where to find special articles when wanted for reference. This plan has proven valuDR. W. H. ROB. able to me. Williamsport, Pa. Cocain for Earache. Editor MEDICAL WORLD:-Seeing Dr. J. S. Wheeler's note on earache in February WORLD (page 68) reminds me of a little experience I had a few nights ago. Was called out to see a boy of about 13 years, supposed to have tonsilitis, did in fact have some 66 but the sore throat; main trouble was earache. After fumbling thru what medicins I had with me, I ran onto my cocain bottle and thought I would try that. I made a solution, 1-20 gr. to half a teaspoonful of water, dropt a few drops into his ear, and to my relief he said his ear felt all right and throat did not hurt so badly. I have tried it once or twice since and it workt like magic. Braddyville, Iowa. J. B. CRAIN, M.D. Cause and Treatment of Rheumatism.-Dose of Strychnin.-Rattlesnake Bite. Editor MEDICAL WORLD:-The relations between rheumatism and several other affections have been recently attracting much attention. Long since a connection was made out between rheumatism and endo- and peri-carditis. Chorea was then shown to be especially common in rheumatics, or at least the two coexist in a large percentage of cases. Purpura hemorrhagica is now attributed to the same cause. That a relation exists between rheumatism and tonsillar disease is well known, but just what that relation is seem uncertain. Quinsy is not specially a rheumatic malady. tonsillitis, the tonsils and pharynx reddening and becoming somewhat swollen, the hyperemia extending at times to the posterior nares of the larynx. He also tends to excessiv meat-eating at times, and this is followed by bad breath and muscular pains. At other times he eats largely of fruit; in fact, he is a large eater, his bowels usually easily and frequently acting. If we accept the most recent pathology of rheumatism, this case is quite intelligible. Rheumatism is a microbic malady. The chronic disease of the tonsils lessens their power of resisting attack; they constitute the open door thru which disease enters the patient's body. Located as they are, it is not to be wondered at that very often pathogenic microbes alight on them, finding in the crypts and in the masses of pathologic tissue of low vitality favorable nests for development, hence the recurrent attacks of tonsillar catarrh or erythema. Penetrating to the blood, the intruders give rise to constant irritation of choreic form, and if aided by exposure to cold and wet an acute inflammatory attack would be the consequence. That this has not occurred may be attributed to his free intestinal action-a safety valve-and to the promptness with which symptoms are dissipated-jugulated-by a dose of calomel, gr. t, followed by veratrin and aconitin. It is in just such cases that endocarditis frequently develops in young subjects without being preceded by articular rheumatism. Frequent examinations of the heart should be made in children subject to "growing pains," aches in bones or muscles, nervousness, fidgets or irritability of temper. The following case possibly illustrates the connection of some of these affections: A boy of nine, robust, in blooming health, with no rectal, intestinal or genital sources of reflex irritation to be found on careful examination, has developt a habit of grimacing, sighing, twisting his features, opening his mouth to the widest extent, with imsomnia, disturbed sleep, occasional nightmares in which he becomes almost frantic if anyone touches him, incessantly active. In school he is going ahead of his comrades, but shows no abnormal disposition to study. Out of school he is out of doors most of the time, engaging in boyish sports with the most boisterous abandon. He is large, strong, awkward, overbearing, strongly The indication is the cure of the tonsils. masculine in type, strong willed and per- There has just been a most lamentable sistent, mastering his lesson by concen- death from anesthesia in Chicago, a child trated effort and retaining what he learns. on whom a slight operation for removal of He has hypertrophied tonsils; the project- pharyngeal or nasal adenoid growths was ing portions were removed some time ago, in contemplation. This is an unusual but were largely reproduced. His eyes occurrence. Death may occur from blood and nasal passages have been examined flowing into the glottis while under anesby a thoroly competent specialist and pro- thesia. Nevertheless, the best way to nounced normal. Now while not choreic deal with a chronically diseased tonsil is he is near it, his nervous state and grima- to take it out entirely, cutting thru the ces strongly recalling victims of this affec- loose cellular tissue behind it, as there is tion. He complains recently of aches, less hemorrhage than when the diseased especially in the legs, with weakness; has gland-tissue is cut thru. Besides, the tonattacks of fever running up to 104°, last- sil completely removed will not be reproing one or two days, and subsiding. He duced. If the objections to operation on has also frequent attacks of superficial the part of the frightened child are in superable, and the necessary patience and persistence are at command, the frequent application of pure water-free glycerin, or of strong iodin, may in time reduce the enlarged glands to normal size. If this be done daily there is benefit due to preventing the attacks of microbic swarms. The throat should be rinst with an antiseptic gargle after each meal and sprayed with an antiseptic oil, one of the popular combinations of eucalyptol, menthol, thymol, etc., in fluid petrolatum. If fresh attacks are thus prevented, the disease subsides under proper treatment. As with erysipelas, it seems probable that several, perhaps many, varieties of micro-organisms may give rise to rheumatism, and not one specific form. We may some day learn to distinguish various forms or grades of the malady, as occasioned by one coccus or another. Possibly several distinct organisms may unite in an attack; as in pulmonary affections, where it is impossible to find sputa containing but one micro-organism. Of the classic anti-rheumatic remedies, alkalies probably act simply by neutralizing the acid products of bacteria, and by interfering with their reproduction. All other drugs effectiv against rheumatism are simply intestinal antiseptics and germicides. The salicylates, salol and resorcin are both. All purgatives relieve rheumatism by washing out the alimentary canal and stopping autotoxemia, and these agents are far more effectiv than diuretics or diaphoretics, which shows that their virtues are not simply based on elimination. Whatever remedy is used, it will be found that the very frequent administration of small doses will do more than rare large ones; the former method providing a constant influx of the remedy into the stomach or blood, the big-dose method waiting till the enemy has revived and then "swatting" him. As one dose never kills all the microbes, those that escape at once begin to reproduce; and after a time the body has had all the salicylate it can bear, ears ringing, digestion all knocked out, and yet the disease is renewing its forces. Clear out the alimentary canal with a good dose of calomel, followed by a "sweeper" of salts; then give salicylic acid, gr. one sixth to one-half every five, ten or thirty minutes, and keep right at it. You will be surprised to find how little you have required to subdue this big blustering Goliath. But don't quit too soon. As the patient improves let the doses be increast in size and decreast in frequency, but keep them up. And keep the alimentary canal clear and aseptic. A sick stomach or fetid stool is good evidence of your lack of skill as a physician, or of the nurse's disobedience. Is an excess of nitrogenous and saccharin food injurious by lowering the patient's resistance directly, or by furnishing materials for microbic reproduction and support? Anyhow, the injury is undoubted; and the diet should exclude such excess. Beyond this, and the injunction to select the diet suited to the patient's needs, I will say nothing, always dreading the close limitation of food to a few articles whereby so much harm is done-more, in the aggregate, than by the absence of all restrictions. The predigested foods, freshly pressed fruit juices, vegetable soups, jelly of Irish moss, junket, light farinas, all starchy foods having a generous allowance of disastase to insure digestion, will be found acceptable and harmless. I cannot enter the field of "chronic rheumatism." It is too vast, covering as it does myalgia, neuralgia, uricemia, indigestion, spinal ails, uterin disease, hemorrhoids, and a host of other things commonly called rheumatic, for no other reason but that, like it, they "hurt." In many of these painful maladies I have found a disproportion between the albuminous food consumed and the physical exercise taken; so that the use of colchicin for immediate relief and the injunction of hard work or vegetarianism, become more and more frequent with me. And with this the necessity of prescribing strychnin to "take up the slack," or macrotin to soothe irritated, spastic nerve fibrils, becomes almost habitual; the injunction to clear out the bowels, render them aseptic and keep them so is altogether habitual. There may be persons who keep their "inner skin" clean as conscientiously as they do the outer skin, but they are surely rare. May I be pardoned for rather a broad smile at the efforts to fix the dose of strychnin? There's only one dose; that is, just dose enuf. Do not give this powerful, highly specialized remedy unless you have a distinct idea of what you desire it to do, and of what evidence will show this object to have been attained; then give enuf to do it. In the aged especially, doses are required that would have scared me twenty years ago. In treating alcoholics I have given a grain a day; but find some cases that cannot bear gr. 1-67 at a dose. Trousseau gave over a grain daily to epileptics, rising of course to this dose by degrees. When the head begins to ache or the muscles to twitch, you have reacht the limit. 66 Reminds me of a story that I have related before: A doctor told me the only remedy for his wife's rheumatism was 'athlophorus"; that salicylates were useless. I turned to Oleson's "Secret Nostrums" and showed him that athlophorus was simply salicylic acid, but in four times the dose he had given. I must differ from Dr. Haigh as to whisky being a specific for rattlesnake bite. Whisky is only specific for the fright, and actually increases the depression due to the poison. It is well known that persons who only thought they had been bitten by a snake, took huge doses of whisky without its affecting them; but the moment they found they had not been bitten they became very drunk. This is strictly analogous to the difficulty of anesthetizing patients who are in extreme terror of the operation. The remedy for rattlesnake bite is strychnin. Chicago, Ill. W. F. WAUGH, M.D. Dose of Strychnin. Editor MEDICAL WORLD:- -I can think of no medicin the size of whose dose is susceptible of greater variation than strychnin. I had a patient carried to the city hospital, Nashville, Tenn., girl, 11 years, whose foot was shot off. She had lost much blood; shock was great. We gave her 1-10 gr. strych. sulfate hypodermically. It acted well. I have on hand at present a patient who drank a little too much Xmas and afterwards; was taken with catarrhal pneumonia. Much deprest from his debauch. In a few days he developt symptoms of gall stones; pulse weak. I began with 1-15 gr. of strych. nitrate every three hours in day time, and any time at night when awake. Next day used 1-10 gr. every three hours and next day gave 1-10 gr. every two hours in day time, and three hours at night, and continued thus for twelve days save two nights when he was given 1-10 gr. every two hours all night missing only one dose on account of his sleeping. I have on a few occasions used 1-30 gr. doses hypodermically every hour for three doses in continued fever where the patient is so very weak. The above case did not develop symptoms of strychnin effect save the pulse, which was strong and regular. He is still living, too, and better. In most cases it is wise, I think, to begin with the sixtieth grain dose repeated every one, two or three hours according to effect desired. If a case needs 1-10 grain doses of strychnin, it seems to me that he should be seen twice or more daily, at least until the dose is regulated to suit the |