many of this size a patient would bear. I have 1-30 and 1-20 grain tablets in stock all the time. I frequently give 1-20 grain before meals for months at a time in cases of pulmonary tuberculosis, and in one instance I gave with good results, 1-15 grain doses, or two 1-30 grain tablets, for many weeks. But every patient cannot bear so large a dose, and few but what can bear an initial dose of 1-30 grain. It is advisable to commence with a small dose and gradually increase it to the point of tolerance. If the dose is excessiv, you will generally find it out by the patient complaining of pains and muscular stiffness in calves of the legs and back of the neck. The above paragraph develops the following thought: Many physicians fail to get good results from certain remedies because of insufficient doses. One will give 1.20 grain agaricin or 1 300 grain to 1-200 grain atropia for night sweats; 1-120 grain to 1-160 grain strychnia for functional paralysis; 2 or 3 grains quinin for a malarial paroxysm in its protean forms; and wonder why his results are negativ and become a pessimist in the efficiency of remedies; while another doctor gives the same remedies for the same ailments, and secures perfect therapeutic results, simply because he pushes the doses of his remedies until he gets their physiological effects. DR. CHAS. W. MURPHY.

Salem, Ind.

Ulcer of Leg. Editor MEDICAL WORLD:-I will give O. C., of Ohio, my treatment for chronic ulcer, especially on lower third of the leg, with no constitutional symptoms. Cause absorption of the obstructing bank of lymph. This is accomplisht by heat, moisture and pressure. Soak the ulcer for two hours at night in warm 2 per cent. boric acid solution followed by a thick poultice of boric acid solution and ground flax seed, the surface being coated with boric ointment. Protect with oiled silk or waxt paper, so that the poultice may not cake before being removed. In the morning, substitute for the poultice strips of lint wet in boric lotion. Cover these strips with waxt paper, and apply very carefully over the whole a roller bandage, taking in the foot and going as high as the knee. At night remove the dressing and soak again. Continue this treatment for three or four days, or until the bank of induration is softened, then stop. Use

adhesiv plasters one inch wide, and long enuf to extend nearly around the limb. After elevating the leg and allowing the blood to drain out, begin the dressing by applying the first strip two inches below the lower border of the ulcer, making firm pressure as it is carried around the leg or foot; the next strip is applied nearer the ulcer, overlapping the first for twothirds its width, so continue till the ulcer is reacht, where the strips must overlap as before, but in applying them first fasten one end, then press the edges of the ulcer together, diminish its size as much as possible, and secure it in this position by continuing the strip firmly across it and around the limb. The strips must entirely cover the ulcer and two inches above and below. Over the strips apply a layer of lint, and cover the whole by a closely fitting roller bandage. The dressing is removed and reapplied as required by the amount of discharge.

If this method cannot be carried out, apply a Martin's rubber bandage directly to the skin, removing it at night; wash the leg night and morning in borie lotion.

A blister applied to the entire ulcer and surrounding skin may cause the induration to disappear. Incisions or shaving off of the induration may be required.

The former has proven very satisfactory to me in numerous cases. I have never failed to heal one in from five to six weeks. J. J. EZELL, M.D.,M.E.

Lafayette, Ky.

1. Wash ulcer in warm water before dressing.

2. Remove sluggishness of ulcer by nitrate of silver pencil over entire ulcer; scarify edges of ulcer slightly with sharp knife, enuf to cause gentle bleeding. This may be repeated two or more times, until you get a good, healthy, granulating surface.

3. Sprinkle thus cleaned ulcer slightly, not heavily, with powdered boracic acid.

4. Apply borated gauze, under surface smeared with carbolated vaseline, in four or five thicknesses. Outside of this over ulcer place some absorbent cotton.

5. Bandage moderately tight, beginning at the toes, while limb is elevated.

6. Change and repeat this dressing only every third day.

17. Bid patient to have limb elevated as much as possible while under treatment.

8. At time of dressing use massage,

gentle at first, then moderately hard, strokes upward. Best done while washing with warm water.

9. Continue until ulcer is healed. Internal treatment not necessary, unless ulcer is due to syphilis.

If you follow directions closely you will be crowned with success.

N. G. J. DAHLSTEDT, M.D.,

Elliott, Ill.

Gelsemium for Grip.-Vital Force and Immu= nity.-Scraped Potato for Chronic Ulcer.

Electricity for Chills.

Editor MEDICAL WORLD: -Some time since you requested me to state my method of treating the grip. I will say that poisonous doses (only) of gelsemium will abort and cure it, and do it every time. The story of my own case would be too lengthy to repeat in THE WORLD. But it was thru actual personal experience that I discovered it to be a veritable specific in grip, for myself, and I am led to believe too, that almost any dose may be safely given at the onset of the disease, provided it is true grip. In my desperation from head pain I once took twenty drops of fluid extract of gelsemium (P. D. & Co.). In the short space of one hour I had completely recovered. I had not one single symptom or pain remaining. Thereafter I got down to ten, then to five drop doses, always fluid extract. One or at most three doses have always cured.

There have been no sequelae, no complications. I have advised some of my friends to prescribe it. One, a homeopath, actually gave a teaspoonful of mother tincture. It cured. No symptoms other than slight somnolence and inability to keep eyelids open, and this only in one case and for only a few minutes. I cannot too strongly urge, however, utmost care and closest attention for a time after any such dose, in any case.

In grip pains, colocinthis given homeopathically, ten drops in a half glass of water, teaspoonful every fifteen minutes, will give quick and permanent relief. Tell all our folks.

Immunity is immunity. And one is immune only while his or her vitality is of a higher order than that of any microbe that may be floating about in the fluids of the body. The very instant we drain to deterioration our individual vitality, we throw open wide the door to every form of bacilli within us, and that

form then present in highest vital force, aided by special momentary environment, will grapple with our very life forces for supremacy. Keep up your vital force and be "immune."

If O. C., of Ohio, had given his address on page 71, February WORLD, I would have written directly to him to say that in his case of chronic ulcer if he will take a nice, clean, sound, Irish potato, peel it, scrape the clean tuber into fine pulp, and bind directly to the ulcer, changing about four times each day, in about two to four weeks he will be able to report a clean and complete cure.

If malarial chills and fever are the product of a microbe, why then may any such chill or fever be almost instantly broken up and completely cured in three days by a proper and simple application of a good faradic current of electricity?

DR. J. H. McCARTNY.

Avon Park, Fla.

It is not "Cuban Itch,” but Small Pox. Editor MEDICAL WORLD:-" In a multitude of counsel there is wisdom." This is why I consider THE MEDICAL WORLD & great medical journal. In it we have counsel from all over the United States, of the most practical kind. In the January number we find an article headed "Cuban Itch," and under this a query if there be any such disease.

There is an eruptiv, highly contagious disease prevailing in our state variously called "Cuban itch," "Elyhout itch," chicken pox, etc., which is nothing more nor less than small pox in a mild form.

I wish to state in the beginning that I am no small pox expert, neither do I think it requires an expert to properly diagnose the disease after having observed it in all its stages. There is some excuse for a physician mistaking the disease in its early development, but he is criminally and inexcusably unpardonable for doing so after having watcht the whole course of the disease.

I have this to say as to "Cuban" and "Elyhout" itch. Search where you will outside the cogitations of the brains of the laity and the mental dwarfs in the profession and you will fail to find anything said of Cuban and Elyhout itch. It is nowhere to be found in medical literature.

But some say it is a new disease brought to our country by our late and intimate relations with foreign countries, and we

would as well call it Cuban itch as any thing else, as it has to have a name.

I claim emphatically that the disease under question is small pox. Can I prove Can I prove it? I think I can, to any unbiased mind. As far as I have been able to learn, those who say the disease is not small pox use the following arguments for their reasons for so saying:

1st. That the disease is too mild for small pox. 2d. That it leaves no marks. 3d. That vaccination affords no protection.

It is an easy matter to refute each and every one of these assertions. Everyone will admit that any contagious disease is milder some seasons than others. Some cases may be mild and some severe. It is so in any disease. Typhoid fever may run a long and severe course, or prove fatal; another member of the same family may have it in so light a form as not to confine him to bed at all. Yet from that fact we would not say that the disease was not typhoid. So it is with small pox. We may have it in mild form. The American Text-book of Practice (Pepper, 1898-good authority) says: "We seldom or never see the disease in its former self." Are we to deny the existence of small pox because it is not so fatal as it once was? I think not.

2d. As to the disease not leaving any marks, we will quote William Osler: "Whether pitting occurs or not depends on the severity of the case." In a majority of cases Sydenham's statements hold good, "that it is very rarely the case that the distinct small pox leaves a scar." That is what Osler says about it. Will we take him for authority, or be guided by our own narrow preconceived ideas?

3d. If it were a fact that vaccination afforded no immunity against this prevailing epidemic disease I would not have written this article; or if I had I would have taken a different view.

I am going to give my own observations in regard to this matter as I have witnest it. There were eight cases of this eruptiv disease in our little village last spring. Two families were affected by it. There were four occupants in one house and six in the other. Six and four are ten, and only eight cases of the disease; what does that mean? It means that one member in each family had been previous ly vaccinated, and the other members had not. And what does that signify? It

signifies that vaccination protected the two that escaped, and that signifies that the disease was small pox-irresistible conclusion.

Some say the disease is chicken pox. That is essentially a disease of children, so we dismiss that.

In conclusion I will give some of the symptoms of these eight cases mentioned above: A chill ushered in some of the cases, and in the ones so taken the eruption followed on the third day. This is significant. There were headache, backache, slight fever. The eruptions first occurred, in every instance, about the head and face. A. F. AYER, M.D.

Glenville, Ky.

The

Small Pox or Cuban Itch: Which? Editor MEDICAL WORLD:-It is a well known fact that for the past two years small pox has been epidemic in many states. Its mildness has paved the way for its rapid introduction thruout the entire country. The people and the physicians have alike shown little disposition to take even the ordinary precautions against infection. Doctors, like the laity, seem to think that unless the death rate is forty or fifty per cent., it cannot by any possibility be small pox. Hence we are continually having the foolish diagnosis of chicken pox, Cuban itch, impetigo contagiosa and so on ad infinitum. query of J. R. Vaughan in January WORLD, was my first encounter with this new disease, but I had barely finisht reading the article when I was called to see a young man just returned from the Texas plains. On arriving at the house he informed me that he had the Cuban itch. I found him covered from head to heel with an eruption in the pustular stage. The pustules were somewhat elevated and about one-fourth inch in diameter, many of them presenting a central depression, with a dark spot also in the center as if a small thorn occupied the spot. The adjacent skin was very red and considerably swollen. The pustules were in greatest number on face, scalp and extremities, while the abdomen was singularly freenot more than a half dozen pustules from the free border of the ribs to the pubes. It was the eighth day of the eruption.

He gave the following history: Some twelve or thirteen days before he left the plains he was exposed to what was generally called Cuban itch; but he admitted

that some of the doctors called it small pox and some chicken pox. The first day out he felt bad; the next he had fever which continued until the third day, when he noticed the eruption on his forehead and it soon covered his face, scalp and extremities. He suffered terribly with his back, but that fever and pain subsided when the eruption was well out. Itching was intense, and his body and extremities bore the marks of his nails.

I pronounced it small pox and askt that the health officer of the county be sent to see the case. Dr. W. E. Brown, of Gatesville, Texas, was promptly sent and the case pronounced small pox. The patient was isolated and all those exposed, eight in number, were quarantined and vaccinated. The reaction was prompt and in four days the characteristic vesicle made. its appearance. On the eleventh day after vaccination one of the number was taken ill, and after two days fever the eruption made its appearance on his face and scalp, and then on the back and extremities. It is now the ninth day of the eruption and the pustules are very much in evidence, tho this case is very much milder than the first case.

None of the others have shown any symptoms of the disease, tho they have practically past the usual incubativ period. Did vaccination prevent it? Six of them past two whole nights and part of two days in the same room with the first patient when he was in the seventh and eighth day of the eruption, sat at the fire together, and ate at the same table. Only two had been previously vaccinated, and that many years before.

The foregoing proves to me that it is genuin small pox, and that the name "Cuban itch" was doubtless given by some returning soldier of the Cuban war, to hoodwink some empty-headed M.D. and escape quarantine.

There are at present in this county four infected places, all under observation, each brought from different localities, and the patients present the characteristic eruption of small pox. No, sir, we have no new disease to deal with, but a very old one seen thru the "specs" of incompetents. In a recent letter from the plains shown the writer it is stated that

66

very few have died from it, but that many are disfigured from the pitting." The West is the home of this so called "Cuban itch," and I am told that no

attempt is made to isolate the infected, and that persons suffering from the itch (?) in its milder form are allowed to go when and where they choose, thus spreading it broadcast thru the thickly settled counties further east, for at this season of the year there is a constant and steady stream of emigrants to that section.. A great many return for various reasons, and bring with them the "new" disease.

In the southern part of the state one county reports a thousand cases, and it is stated in the daily press that state aid has been askt. Where will it end?

J. D. MOORHEAD, M.D. Levita, Tex., Jan 29, 1901.

Small Pox, Sure.

Editor MEDICAL WORLD:-After having read the several articles in this and other journals referring to small pox and what many seem to think is only Cuban itch, I will add my mite in positiv proof of the former disease, i. e., small pox.

First, as to my direct knowledge and experience with this dread disease: In 1885, while attending the St. Louis College of Pharmacy, I was taken down with it myself, and was said by several eminent physicians of the city to have a typical case of it. Suffice it to say that, if it was not small pox, I do not want any nearer relationship to the malady, as I was a solid mass of pustules from head to foot, and itching does not half express the feeling I underwent. It was in the dead of winter, and I felt as tho I would give a thousand dollars to get my hands unmuffled and get one good long rake at those pustules. But in due time I recovered, and have always had very vividly imprest on my mind that peculiar odor.

While practising medicin in St. Louis, in 1892-3-4 and 5, I had occasion to see several other cases; but the ones direct in mind were as follows: Last July 20th, two gentleman walkt into my office to consult me as to the danger of infection of one of them, who had just come from an Iowa town (overland route) where there was what was claimed to be Cuban itch. I advised this one man to isolate himself for a few days at least, by living in a tent, to be on the safe side. Three days later I was called to see him and found him in his tent out in an eighty acre corn field. While yet within twenty steps of him I saw him sitting in the opening of the tent, and the thought came to my mind, "small

pox, by Jove." On closer examination, and getting the complete history of the case, I was convinced beyond a doubt in my mind that it was really small pox, from the way he exprest his feelings, the appearance of the eruption, the shot like feel of the surface of the skin, and now and then an umbilicated papule, and later as they developt into pustules nearly all became deprest in the crest. There was nothing extraordinary in this case. While profusely broken out all over his body, the symptoms were all of a mild character; temperature never exceeded 101.5° F.

On August 2, I was to see Mr. K., the gentlemen whom this man had spent one night with, and found him with a temperature of 104.6°, having had a hard chill first and suffering intense pain in head and back. As he exprest it, it seemed as tho every bone in his body would break. I prescribed for him the regular course for all small pox cases, and by order of the city authorities, I put a nurse and guards to see that strict quarantine law was enforced. Three days later the typical rash appeared; and so on thru his family of nine, only one escaping. All were of a modified form from early vaccination except the wife, who was nearly at full term of pregnancy at time of attack. Twelve days after Mr. K. was taken Mrs. K. followed, and at the sixth day of eruption, when pustulation was being completed, she was confined. If any of the readers of this journal ever had a similar case, they will realize what a glorious job I had on hand; but there was go getting out of it, or shirking on some one else, as the other physicians of the city wouldn't go for love nor money. So I went and did my duty. In thirty-five minutes after arrival, everything was all over and all doing well. The mother clung to the child (a nine pound boy) and would not allow it to be taken away from her presence during her disease. She even compelled it to nurse her own disease.

She was the worst case of small pox I ever saw, of the confluent form, and on the eighth day of eruption she had three convulsions from absorption of pus from the great amount of suppuration, as she was a mass of pustules, even the tongue and soft palate being thickly studded with the For forty-eight hours I hardly knew whether she would live or die; but with the best of care she finally began to convalesce, and in due time made a good

same.

recovery. The confinement was natural as-with any healthy patient to the end. The child, to my surprise, lived, had eight or ten pustules developt on his body, and is as fine a specimen of humanity to day as one often sees.

The proof of genuin small pox in her case is seeing her as she is to day, deeply pitted from head to foot, even very markt on the tongue and soft palate with the white scar tissue and indentation. With this patient the temperature ranged at the beginning 104° to as high as 106.2° ten days later. The odor was almost unbearable, even with every antiseptic precaution and in the open air.

Thousands of cases have been very mild and hardly noticeable, but still the germ was there, and reproduced in the proper field for its growth may cause the typical case. We cannot guard too carefully the lion that to-day may be tame, but to morrow may appear in all his fury. I would rather make a mistake in protecting the safety of my people than be found fault with and derided because of undue precaution.

One question I wish to ask: Have any of the readers of this or any other journal ever met with ptyalism from intra-uterin irrigation after removal of long retained placental tissue from abortion, mercury bichlorid 1-3000 solution, at second irrigation, thirty-six hours after operation? If so, will you kindly give your experience, and oblige J. R. SMITH, M.D.

Warsaw, Mo.

Thoughts Suggested by the Cuban Itch Discussion.

Editor MEDICAL WORLD: Inclosed please find $1.00, for renewal for WORLD. Of all the journals that I take, I like THE WORLD best; because it is the experience of the practising physician. Much of it of real value, some of it amusing, all of it useful, giving a correct estimate of our fellow practitioners. The plan is correct. I often see something that I think of replying to, but neglect. The articles on small pox and the so-called Cuban itch produce thought. I have not had any experience with either as yet, but does it not excite wonder at so widespread an epidemic and so light a mortality? While the description is so uniform, the climatic conditions are so varied, treatment different, and recovery so universal. And good men differ as to its real nature. What is it?