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For pneumonia I usually prescribe carbonate of ammonia, and alternately with the ammonia I give small doses of the tincture of belladonna, combined with

sulfate of strychnin. There is very little said in medical literature about the use of belladonna in the treatment of pneumonia, but I find it very useful. Small doses (3 to 5 drops of the tincture), combined with strychnin, and given every three hours, acts well as a respiratory stimulant, and at the same time dilates the capillaries of the lungs. Perhaps the sulfate of atropin would be better, but the tincture is more convenient for me.

Cedar Creek, N. C. K. G. AVERITT, M.D.

Shall We Jump at Conclusions? Editor MEDICAL WORLD:-"Jump at conclusions," "bad guesses," and "I don't know" are all reminders of uncertainty. Men of nervous temperaments jump at conclusions, men of lymphatic temperament creep at conclusions, while men of mixt temperaments and too busy to guess or think, may belong to the "I dont know" class.

Experience and observation cause men to guess, think or suppose when they have no positiv knowledge of a fact, neither the way nor means of ever finding it out.

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"I don't know" may signify that nobody ever will know, and nobody should make a guess about it. But where is the man who can restrain himself from guessing or supposing, be those guesses ever so bad? We have read of and heard of guesses equally bad concerning the cause of male and female offspring; yet a bad guess shows a little more life, thought and pluck than an "I don't know." Hence I will continue to guess when I "don't know."

Does a fetus float in the amniotic sac? Can an object float when it is much larger and heavier than the fluid in which it floats? How much amniotic fluid is generally in the amniotic sac a month or two before childbirth, or at birth? I never had an idea that the amniotic sac was a swimming and floating pool, wherein the child

birth.

There is no effect without a cause, yet different causes may produce similar effects, as easily as different effects are produced by the same cause. It may have been a "bad guess" to suppose that the spina bifida in the first case was caused by the mother's fall down the stairway, striking her back against the steps; and in the second case, the spina bifida caused

by the mother pressing her abdomen the child to the front; yet it is no unusual against the washboard with the back of occurrence for a shoe or boot to rub a

person's foot in walking, even if a stocking is between the foot and shoe.

direct and indirect causes. Our experience teaches us to believe in Whether both the spina bifidæ were produced by the same direct or indirect cause is not clear. "I do not know" is an expression that I have made hundreds of times to my

patients, without any guesses, but when one professional brother speaks to another brother he has a right to guess, and should guess, even if it is a vague or almost improbable guess. As long as we do not know, let us guess.

To day I visited one of my patients, and when I arrived at his house he was in charge of the undertaker. I saw him for the first time four weeks ago at my office. He was jaundiced, had good appetite, no pain, clean tongue, and an intolerable itching. He had been under treatment four weeks before he consulted me. I told him the trouble was with his gall-ducts, due, perhaps, to catarrh of the duct and liver.

I concluded, or guessed, that he had no cancer nor gall stones from the fact that he had no pain. Two weeks before his death he told me that he had “a small lump" on his back, which bled occasionally. I told his family that it looked suspicious. On my way home I "guessed" he was suffering from melanotic cancer of his liver. During the past week he had considerable pain. A week ago I guessed that he might live a month or two. On my arrival to day I was surprised to find him dead. I askt the son for a post. I found his liver black and enlarged, the gall bladder more than twice its normal size, stretcht full of bile, and a closing up of the cystic duct at the neck of the gall bladder, which was hard, but easily gave way upon pressure with my thumb and finger. There was no trace of biliary cal

Treatment for Obstinate Neuralgia. Editor MEDICAL WORLD:-I notice in the November WORLD, page 431, that Dr. H. Rosahusky wishes help in an obstinate case of facial neuralgia. I had a case some time ago in an old gentleman eighty seven years of age, who had been suffering from the above over twenty years. He had consulted eminent neurologists, and had the nerve cut and cauterized with the galvanic cautery, but received only temporary relief. He was troubled with neuralgia of the superior maxillary, and also the orbital, and received permanent relief from my applying the following treatment:

Wash parts afflicted with bichlorid solution 1, and inject the following into the inferior maxillary nerve, at base, and into

ah

of potash until action of the kidneys was restored, then quinin. Elimination and quinin are what you want and must keep up. I had a patient whose urin past only once in four days, and recovered. I wish some of our delta brethren would write more about malaria.

Montpelier, Miss. W. V. SAUL, M.D.

Sulfuric Ether for Stings of Insects.

Editor MEDICAL WORLD:-In 1893 I was called to see a boy six years old, in Wright County, Mo., who while eating peaches was stung by a yellow jacket (he said). I found a sting left inside the under lip. I found him struggling for breath; his lip as thick as my finger, and from edge of hair to sternum purple and greatly swollen. I applied sulfuric ether to the sting, and in five minutes he was breathing easier, and in twenty minutes was completely cured. I have used it many times, and always with good results.

Have any of the brethren tried it in poisonous bites and stings? Mosher, Ark.

JESSE R. ROBERTS.

Horsemint as a Diffusible Stimulant.

Editor MEDICAL WORLD:-I see in December WORLD an article on 66 Frozen Patients." I agree with it perfectly until you come to the brandy or other alcoholic stimulants. Here I would add or substitute three to five drops of the ess. of monardo punctata, or horsemint, put upon the tongue every five or ten minutes until warmth and vitality are restored. I have used this remedy for more than thirty

years, and succeeded when other things failed. Also, one or two drops on sugar, or in hot water, is a most excellent stimulant where you do not wish to use alcoholic stimulation; or where there is a prejudice against such stimulants-in fact, in all cases where you want a prompt, quick, diffusive stimulant. It will not induce a habit. It is invaluable to the country M.D. on account of the small dose, quick action and pleasant results. New York City. A. B. WHITNEY, M.D.

Editor MEDICAL WORLD:-It strikes me that I have made a terrible "hash" of

your journal to send me the reports of their cases as follows:

I. The condition of the heart and pulse and pulse rate.

II. The effect on the heart and pulse and pulse rate within ten minutes after the suprarenal powder, three grains, is chewed and swallowed without water, by the patient. SAMUEL FLOERSHEIM, M.D. 218 E. 46th St., N. Y. City.

A Careful Record of One Hundred Obstetric Cases.

Editor MEDICAL WORLD:-Being deeply interested in obstetrics I will give a record of one hundred obstetric cases, carefully

about some fellow who has treated two to sixteen hundred pneumonias without a death, seventy to a hundred membranous croups with some infinitesimal drug in one winter and no deaths, lobar pneumonia jugulated "while you wait" with Y gr. aconitin hourly. Hanley Falls, Minn.

W. M. BECK, M.D.

An Unusual Obstetric Operation. Editor MEDICAL WORLD:-I will report the following case and would be glad to know if there has been a similar case. It is of three and one-half years' standing, caused by atresia of the os uteri. At term she expected to be delivered; was as large as other women; milk was secreted and ran out. Still she went on until all the water was absorbed, leaving nothing but a mass of bones and corruption. A few weeks ago I was called to see the lady. Found her as above stated. I advised an operation as the only hope of relief. So about four weeks ago I chloroformed her and made an incision where I supposed the original os had been, dilated it and removed the bones with long forceps; also a considerable amount of very offensiv matter. Notwithstanding she was very weak and feeble from much suffering, she survived the operation, which lasted about three hours, all right. I think she will entirely recover. As this is such a brief statement, I will be glad to answer any questions.

Bakersville, N. C. M. F. PENLAND, M.D.

Editor MEDICAL WORLD:-I intend to publish a second paper on the use of the suprarenal capsule in organic heart disease (for first paper see N. Y. Med. Jour. Oct. 6, 1900, pp. 581-585). Will you kindly ask the readers of

47 males. Two still-born, one caused from diabetes and one from albumin. There were two cases of placenta previa, one case of adherent placenta, three cases of puerperal eclampsia (used instruments in two of these cases), two cases of breech presentation (used instruments in one case), two cases of post partum hemorrhage, one case of face presentation (turned) and ten cases requiring the use of instruments. There were two more cases in which I would have used them but for the objections of some member of the family.

The shortest period that any one patient was in labor was twenty minutes, the longest period was forty-two hours.

Ten babies were born before my arrival, but I had to remove the placenta in six of them after my arrival. One case of placenta previa in particular, the placenta was situated wholly over the internal os uteri. Sent for me about three days before the termination of labor. Found the woman bleeding profusely with very little dilatation of os. Had consultation. We

took a large sponge and shoved it up against the os uteri and thoroly packed the vagina with cotton tampons, which effectually stopt the hemorrhage for a few hours; but the cotton became soakt with blood, and getting loose, hemorrhage would break out afresh, so I had to renew the plugging twice a day, also on account of the septic condition of the cotton if it remained too long. After the third day the pains became stronger, os dilated, we tore a hole through the placenta and delivered with forceps, as there was profuse hemorrhage. Mother and child made a good recovery in spite of the gossip mongers, who said if they did not change physicians the woman would bleed to death.

Of the three cases of puerperal eclampsia, I will mention this one in particular: A strong, robust young woman of 24 years; first child; sent for me in great haste, the messenger saying Mrs. T. was having fits; to come at once. Found the woman having convulsions about every five minutes. Made a digital examination and found no dilatation. Very rigid os. I administered chloroform and gave her Norwood's tincture of veratum viride in five drop doses every eight to ten minutes. Dilated the os the best I could with my fingers. Under this treatment the convulsions gradually grew less in severity, and in three hours delivered her of a fine baby with instruments, convulsions continuing with less severity for about one and one half hours after delivery. Mother made a good recovery and the child did well.

I could give the treatment of all of my cases more in detail, but as space is limited, have condenst it, but would like to say that I am heartily in favor of the intelligent use of instruments and chloroform when needed. How can we, as physicians, sit idly by (or go to bed and go to sleep) and hear the agonizing cries of a woman when in the throes of childbirth, and hear her pleading for help, when we have such useful remedies at our command (when properly used). We can save our patient hours of untold suffering and misery (not counting the after effect of such a nervous strain kept up for hours) by the skillful use of chloroform and in struments. But you may say, all are not skillful in the use of instruments. Then they would better not use them, or better not practise obstetrics. Now, understand, I am far from advocating the indiscriminate use of the forceps or interference with a normal healthy labor. I wish merely to insist that nature is incompetent to meet the requirements of all cases, and when competent, nature would frequently require hours of exhaustiv effort and untold suffering on the part of the patient. The judicious use of chloroform and the instruments should be our stronghold. I have never in my experience had any bad after effect from the use of the instruments. In a country practise where a physician has to include obstetrics, he can soon make or lose a reputation. If it were not for obstetrics and diseases of women and children, our practise would be very much curtailed. As a rule, if a

physician attends a woman in confinement and all is well, he will thereafter have the practise of that family, attending the baby in its sickness, cut its tongue-tie, treat, it for measles, whooping cough, croup, scarlet fever, mumps, chicken pox, and a host of other diseases; not counting sickness caused by the administration of catnip teas, paregoric and soothing syrup, castor oil, molasses and whiskey, by some kind old woman for supposed colic, because it is so bound up and wrapt up and covered up that it can hardly breath. Pins prick it and it kicks and squalls with pain. Result, physician is called; baby gets well. But the path of the obstetrician is not strewn with flowers, for when he is in the happy land of dreamland and rest he is aroused from his slumbers by a bang at his door or a ring of his bell. Inquiring what is wanted, he is told that Mrs. H. is in labor and that he is wanted at once. Mr. H. was never known to pay his medical attendant, but if he refuses, all of her relativs, rich and poor, will give him the cold shoulder, the neighbors will call him inhuman, hard hearted, and say that he should not be allowed to practise medicin; that they will never employ him again. He never has a day that he can call his own, for an obstetric practise of twenty-five a year will keep him engaged all of his time, looking every stormy night to be called. He can not go a gunning, altho game be plenty; everybody else is bagging the game and catching the fish and he is in need of the recreation. But somebody's wife is going to have a baby before long, and if he be off fishing or hunting when wanted, he will catch fits on his return. Vevay, Ind. L. H. BEAR, M.D.

Editor MEDICAL WORLD:-I know of no way in which one gets more from his money than subscribing for THE MEDICAL WORLD. I feel that the editorials are safe guides, and the "Monthly Talks" something not found in so plain and condenst form in any other publication. Will you please give us an article on "Cuban itch" and Manila fever"? Will some one give ol. ricini a trial in typhoid fever? giving daily in moderate doses, and if necessary to check the bowels, use Dover's powder, and report results. One remedy not mentioned for hiccup is tr. cannabis Indica. Durango, Col. L. C. HURD, M.D.

[We appreciate your liking for our ef forts. Cuban itch was toucht upon on page 24 of the January WORLD and also in this issue. This disease is not known in the eastern states, and is regarded by most writers as a mild form of small pox. We will refer your communication to an army surgeon now in the Philippine Islands for information on Manila fever. Malta fever is well known, but "Manila fever" has not yet won a place on authoritativ lists of diseases. Manson, Tropical Diseases, sold by Leary, Stuart & Co. New York, at $3.50 net., is the latest and best work on tropical diseases. Will someone try the Doctor's suggestion in typhoid? Doctor, have you used this yourself, with success? ED.]

Chronic Ulcer.

Editor MEDICAL WORLD:-Mr, S., aged sixty-three years, suffered with lumbago in 1864 while in the army, and recovered nicely. But one limb was affected slightly, and in 1868 it became swollen from hip to knee; it measured forty inches at knee. Finally it located in right foot, then improved slowly, and in 1875 the inner side of calf of left limb became swollen and broke out in the nature of eczema, full of small furuncles, gradually increasing in size, until in 1892 it broke open and