believe if the operation by the injection method is properly done it will sterilize nine out of ten. One advantage, it is comparativly harmless, and can be repeated. R. L. FORD, M.D.

Beda, Ky.

Calcium Sulfid. -"Cuban Itch." Bad

Breath.-Medical Guesses.

Editor MEDICAL WORLD:-I must dissent from the editorial on calcium sulfid. Even if Dr. Munson has failed to find it useful for boils, that is in itself nothing against the drug. In fact, so universal is the testimony in its favor that the gentle man's failure is self condemnatory. Calcium sulfid is no specific, as I have found. I once gave it to a lady affected with a succession of boils. It stopt them while she took it, but as soon as she quit, the boils reappeared. Constipation and autoConstipation and autotoxemia were the true causes, and these relieved, the boils ceast. In a similar case diabetes accounted for the obstinate recurrence, while in a third the boils were an incident in the course of an affection I diagnosed as Addison's disease, tho the symptoms were strung out along ten years instead of two. Calcium sulfid is one of the most difficult drugs to obtain in chemical purity. It decomposes from the moment air touches it, and very little of that dispensed is at all activ. Moreover, Dr. Munson may have been dominated by the Ringer idea of dosage-gr. 1. I rarely order less than a grain at a dose, or seven grains daily.

The discussion on Cuban itch interests me greatly. From the reports you can form some estimate of the reporters. There are two ways of studying such a question. The usual way is to make up one's mind what the malady is, and then accept as gospel truth everything that confirms this view, ignoring, denying, or explaining away all that goes against it. A better way, but one rarely used, is to observe and note all the facts presented, and from them deduce your opinion.

Now it will be seen that several observers note the absence of umbilication, others see it sometimes. One says no whites have the malady, but adds a postscript to say one case is reported in a white, and that case alone pustulated. Had this case not appeared he would have been positiv that only negroes were affected, and that no pustules occurred.

The questions to be settled are: (1) Is

is

there one malady, or are there two, now prevailing? Beyond a doubt small pox widely prevalent at present. It does not follow that no other eruptiv fever is possible. (2) What is its behavior toward persons who have had small pox and those who have been recently successfully vaccinated? The questions of umbilication, of shot-like feeling, of secondary fever, of scarring, of uniformity of size in the vesicles, are none of them crucial, as we may easily conceive of epidemics of small pox differing from the classic type in any of these respects. But we cannot conceive of small pox again occurring in those who have had it, or those properly vaccinated. The only uncertainty about the latter is as to the production of true vaccinia. To illustrate: I once vaccinated a child, first vaccination. In one week I called and was told it had taken well, but was then about over. I at once told the parents it was a spurious vaccination, and revaccinated, this time with perfect success.

By the way, let me say that there seems to be some uncertainty as to the name of the malady under discussion. It is smallpox; not small pox, nor small-pox.

And here is a chance to test the latest claims for calcium sulfid. For if this drug has the control over micro-organisms attributed to it, this control should be shown especially during the incubativ period, when there are few micro organisms in the body. isms in the body. Whenever you have a case of small pox or any other infectious malady, and persons liable to that disease are exposed to it, bring them at once under the influence of calcium sulfid, giving enuf to saturate the body so that the breath and perspiration smell of it, and keep this up till the day has past when the outbreak is to be expected. In small pox this is twelve days; but as we cannot tell what day infection has occurred. as a rule, it is best to give the sulfid for eighteen days.

Now by this two vitally important questions may be settled. (1) Does calcium sulfid thus given abort the attacks? (2) If so, are such persons thereafter immune against the disease?

I have no opinion to offer on the question. The idea is strictly in accord with the germ theory, and the claims made for the sulfids as systemic germicides. It is no argument in medical matters to scoff or sneer. Nothing has ever been gained in our science as important as the absurdities

that were scouted at first, and the promoters hooted, jeered, persecuted and driven out of the congregation. I will only instance vaccination, anesthetics, the ligature, antiseptics, and oophorectomy.

The letters on bad breath are models. Each one reported what he himself saw, and no more; and from the sum one could write a very pretty paper. Not that the list is by any means complete, for many affections not mentioned may cause bad breath, such as fetid bronchitis, pulmonary gangrene, obstruction of the bowels, ulcers and diphtheria of the mouth or its neighbors, autotoxemias of various kinds. Uricemia is usually attended by bad breath from gastric catarrh. Saliva tion is another cause; decayed teeth and smoking.

Dr. Brunner (page 67) is a pretty good guesser; and he is not the only one of us who has to do some pretty tall guessing occasionally. But I don't like guesses when certainty is in reach. I may give some chloral on the guess that it will put my patient to sleep, but it kills him in stead. I may guess my patient's kidneys are all right, but they're not, and he dies of the ether. Guesses grow into beliefs; beliefs into creeds, and creeds breed persecution. There is no room in modern medicin for hypotheses (guesses) that have no support, direct nor concurrent. WILLIAM F. WAUGH, M.D.

Chicago, Ill.

Calcium Sulfid.

Editor MEDICAL WORLD:-In response to your request in February WORLD, page 46, will say that I have long protested against the wide range and indiscriminate use of calcium sulfid, contending that sooner or later such use must bring this valuable drug into disrepute. That it is valueless in boils (furuncle) and many of the ailments for which it has been recommended must be apparent to every close observer who has made extensiv use of it. But that it is a specific for carbuncle if promptly and properly used can scarcely be questioned. Whatever the bacteriological difference between this disease and other forms of suppurativ inflammation, need not here be considered. Suffice it to say that to the experienced physician, the carbuncle is familiar, and he regards it as a serious trouble, quite distinct from all other forms of suppurativ inflammation, occasionally

proving fatal in spite of the best directed efforts under the old plan of treatment. It is in this disease, and this only, so far as my experience goes, that calcium sulfid is invaluable, a God send in many cases.

It is beneficial in all stages of the disease, but it is in the formativ stage that the greatest good may be accomplisht. Called to a case in its formativ stage, no matter how extensiv the inflammation or how great the pain and fever, prompt and proper means will abort it. First give a saline cathartic followed by one grain doses of a chemically pure calcium sulfid every hour until pain and inflammation subside. The relief is usually prompt, and no lancing is required. Also in advanced cases where there has been no re-absorption thru an incised wound in the barbarous practise of lancing, the sulfid if pusht and maintained to the point of saturation, will arrest the further progress of the disease. Do not lance a carbuncle. It never did cure one, and it never will; it aggravates the disease and endangers the patient's life. J. C. S. COHN.

St. Louis, Mo.

Editor MEDICAL WORLD: - Munson is not the first medical man to declare calcium sulfid valueless in the treatment of boils. Senn says in his second edition, Principles of Surgery, page 247, that "Sulfid of calcium, which has been recommended in such strong terms, has no influence either in the prevention or cure of furuncles." Notwithstanding these declarations, I shall continue to use the drug, having secured many happy results in the past eight years from a constant and persistent use of it. It is true that failures

can be recorded against it, and it may be askt of what drug cannot this be said? I have used it in boils, carbuncles, enlarged and suppurating glands, eczema, etc. I think I may say that I get as uniform results from this drug in indicated conditions as any remedy I use. I do not remember ever prescribing it in larger doses than grain. F. S. DUNHAM, M.D. Cozad, Neb.

Calcium Sulfid.-Jugulation of Pneumonia. Croup.-Spina Bifeda.

Editor MEDICAL WORLD:—Your editorial on the failure of calcium sulfid to maintain its position as a potent medicinal agent in all indicated cases, and asking experiences, prompts this reply. Out here, the drug is constantly claiming new laurels, and is coming into popular favor; but that may be because we can get an activ preparation of this drug, and thus get results. Of the many on the market the only one giving invariably good results in my hands is that of the Abbott Alkaloidal Co., Chicago. I have prescribed it for years and it has yet to fail when given for effect. In pseudo-membranous (non-diphtheritic) and suppurativ tonsillitis, diphtheria, scarlet fever, measles and its sequelae, it has proved of great service, its effects being almost magical. In gonorrhea, male and female, it lessens discharge and checks attack. In gonorrheal rheumatism and all sequelae caused by the gonococcus, saturating the system with this activ drug ends the trouble. In pustular acne and furuncles it has been a sure and certain remedy. In all infectious and contagious diseases it holds a place hard to dispute, and its beneficial effect is pronounced. Calcium sulfid, when a good preparation is used, will continue to be without an equal in its line, and will constantly increase its usefulness, as it is more earnestly tried.

Dr. W. M. Beck, page 69, inveighs against the jugulation of pneumonia, and the specific effect of calcium iodized in membranous croup. There are too many and constant reports from unimpeachable and responsible sources to doubt that acute diseases can be jugulated, and are; but the only way to prove this fact to oneself issimply go and do likewise. Not with r gr. aconitin hourly, but defervescent in sthenic and dosimetric trinity in asthenic cases, given for effect: if need be, every

ten to thirty minutes, until pulse and temperature fall. Attention to the primae viae is essential as a first procedure. If the good Doctor will try honestly, and be willing to learn, he will conclude definitly that he has indeed not known all the felicities of modern felicities of modern scientific practise. Get in line, Doctor.

Calcium iodized is a specific in true membranous croup, but useless in diphtheritic croup. It is not given in infinitesimal doses at all: one-third to one grain every ten minutes is fairly finit. It is never too late to adopt a good thing.

Dr. Frank R. Brunner, in December WORLD, gives the apparent causes of two cases spina bifida. In one, the patient fell during the sixth month striking her back; in the second, the intermittent pressure of a washboard. Spina bifida is a fetal lack of development of the vertebral arches, and to be produced, the cause must act at least from the time of the

closure of the vertebral arches. This is complete in cartilage in the fourth month, and the uterus at this period is just rising It is difficult from the brim of the pelvis. to understand how such a cause as the

fall at the sixth month or the very intermittent and probably only occasional pressure of a washboard, could produce any effect on the spine of a child in the uterus. 50 per cent. of all cases of cleft spine are met with in the lumbo-sacral region as this is the last to close in fetal development of the arches.

The amniotic fluid up to the middle of pregnancy is greater in weight and amount than the fetus; at the end, the fetus is four or five times heavier, still it may be said to float. Notice the ease of "turning" the child in utero with fluid present, the difficulty when fluid is absent.

THE MEDICAL WORLD is a practical journal and one hard to do without. The efforts of its Editor to make it the best, and to give the greatest aid to the greatest number, ought to be and no doubt are appreciated. For one, I find not a leaf from cover to cover that I can afford to R. J. SMITH, M.D.

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Indianapolis, Ind.

Editor MEDICAL WORLD:-I thank you for the kind reminder of the "dollar due," and beg pardon for the seeming neglect. It is certainly a small outlay for the very large return we get. It is now almost twenty years since I became a subscriber and yet each number is as fresh and interesting as the first. It keeps one in touch with the entire medical fraternity, and its elevating tendency (independent of clans and creeds) must be apparent to every reader of THE WORLD. May success ever attend it. DR. J. C. SPOHN

St. Louis, Mo.

Calcium Sulfid.—Strychnin in Grip. Editor MEDICAL WORLD:-I for one want to say that calcium sulfid has given me negativ results invariably, whether used in large doses to promote suppuration, or small doses to prevent. My remedies par excellence in boils are liquor pot. arsenitis, and pot. et sodium tartras; the latter I use dissolved in port wine to keep bowels quite loose.

I want to answer Dr. Gore in regard to his article on dosage of strychnin. I give one-twentieth grain doses of strychnin during grip and have never seen anything but very gratifying results. I continue it every four hours until I leave the case; then, after meals, with other tonics. If I can support the system (one-twentieth grain strychnin every four hours does), grip loses half its terrors. I prescribe that dose where vitality is low and no contraindications. I believe we should use fewer drugs and give them for more definit effects. Wattsburg, Pa. W. J. Cook, M.D.

Typhoid.–Strychnin.

Editor MEDICAL WORLD:-I suppose that in order to have a vote in your family conflabs, I must be a member, and I therefore inclose my initiation fee, to cover the subscription for the current year of your official organ. I like journals like yours, where the articles do not run off into the most impossible scientific jargon, which we have forgotten years ago, but are practical terse statements by and for practical and busy physicians. The reason why I ask for the floor, lies in the question of Dr. L. C. Hurd (Feb. WORLD) in regard to castor oil in typhoid. I have been using it for two years, simply because it seemed to me common sense treatment, and have fared well with it. I have never had to resort to Dover's powder to check diarrhea. The castor oil and intestinal

antiseptics do that. Given a case of typhoid; that means a small bowel studded with ulcers. These must of necessity discharge their broken down tissue, and this must be removed. Again, the ulcers must be treated to antiseptic lotions, in order to heal kindly, ergo: Give sulfocarbolates (the W-A intestinal antiseptic tablet made by the Abbott Alkaloidal Co., Chicago, is the best preparation of sulfocarbolates which I have yet found) for antisepsis; then plenty of water to wash out the bowels; thirdly, castor oil, to remove the debris, and there you are. Of course

you must give stimulants (strychnin is my standby) and regulate the food; but that is another part of the story. As to food, do not-as you want your patients to get well-give milk. It is a very breeding ground for bacteria, and the casein cannot be taken care of, acts as an irritant and causes relapses. I give cream, broths, fruit and meat jellies, baked apples and all the water that is askt for. Once the fever has gone down and recovery is well under way, I like grape nuts (Postum Cereal Co., Battle Creek, Mich.) well softened. It is tasty, nourishing and easily digested. The castor oil is kept up during the entire period of recovery sometimes alternating with saline laxativ (Abbott's) or, later on, with some aloin strychnia and belladonna pills to which may be added podophyllin. The principal point of the treatment is: Keep up the nourishment, and keep the bowels going.

I can only speak of about thirty cases in the last two years, but of these thirty some were "pizen mean" ones, and I have not lost one. Ergo, let Brother Hurd use castor oil, or any other common sense remedy with confidence. He will never get left.

To Dr. A. C. Gore (dose of strychnin) I would suggest that no physician, whether in city or country, is justified in leaving a patient to whom he has given heroic doses of heroic drugs (and the alkaloids are all heroics) until he has observed the first effect, from which he can draw his conclusions as to further doses. Strychnin is a two-edged sword, but a most benevolent one, which we may use confidently after having tested each case as to his or her susceptibility to it. I have spoken.

Roselle, Ill. H. J. ACHARD, M.D.

Editor MEDICAL WORLD:-In reply to Dr. A. C. Gore, Hohenlinden, Miss., will say I have given strychnin nitrate in to gr. doses morning and evening, and 2 gr. at noon hypodermically for several days' duration, without any discernible bad results. sults. The patient absolutely refused to partake of the best Kentucky sour mash in any quantity after four days' treatment. Small doses had no effect whatever in destroying his appetite for drink. On another occasion I gave a pneumonia patient, four years old, who was in a collapse, two drop doses of specific nux in whisky every hour for two days and nights, with satisfactory results. These

are the largest doses I have ever prescribed. Strychnin in large doses has no doubt saved many a life.

If Dr. J. A. Elliot does not relieve his case of dizziness after following the Editor's valuable suggestions, February WORLD, page 75, kali phos., 3x, will in my opinion relieve him, if there are no lesions present. This remedy is almost a specific for the dizziness so common in old, feeble men and women who claim they are not sicknor can you detect anything abnormal with them-but are simply dizzy.

For the benefit of Dr E. M. Downs will say the following is said to be a good shampoo mixture: B. Potassium carbonate, 1 oz., rain water, 1 quart. Mix, color and perfume to suit taste. Beardstown, Ill.

C. C. PATCHEN.

A RECORD TO BE PROUD OF. Editor MEDICAL WORLD:-Inclosed find one dollar for THE MEDICAL WORLD for the year 1901. I commenced the practise of medicin in connection with my father January 1, 1813, and have been in the harness ever since that time, until the 4th day of October last, when after a hard two days' drive I took cold, which resulted in a severe nervous prostration, with rheumatism, which I am now recovering from. I think very few of your readers have a record like this; and I have taken THE WORLD ever since it was printed-at any rate, have taken it since the first copy was sent me. Yours very truly,

Proctorsville, Vt.

D. R. STORY, M.D.

Rattle Snake Poison Cured by Large Doses of Strychnin.

Editor MEDICAL WORLD:-In the February WORLD, page 72, Dr. A. C. Gore wants to know something about large doses of strychnin. In reply I will say that during the month of June, 1900, I was called to see a man, about thirty, who had been bitten by a diamond rattlesnake. His condition was most alarming. I gave this patient one-tenth grain strychnin every four hours. This was kept up for forty eight hours, without any untoward effect from the strychnin. Will say that patient made a complete recovery. I think anyone who gives less than a onethirtieth grain strychnin will get but little if any results; especially is this true in desperate cases. J. J. HARDY, M.D. Sutter, Ind. Ter.

This remedy has cured several cases in my hands, but failed to do any good in this instance. An aristol salve (3j to 3j) was used next, with like results. The enormous size of her leg, and its funnel shape from knee to ankle, rendered efficient bandaging almost out of the question: so I put her to bed, elevated the limb, and tried mentholy ptine ointment. All swelling left the limb, but still the ulcer refused to take on 'reparativ action. next tried vitogen, an ochre colored powder put up by the G. F. Harvey Co., and in the course of three or four weeks, with satisfaction to physician and patient alike, the ulcer of large size was entirely healed. "One swallow does not make a summer," but this remedy is certainly worthy of further trial.

Dr. Gore, in same issue of The World, seems doubly cautious in the use of strychnin in 1-20 grain doses, and wonders how