means failing to stop the hemorrhage, was to have packt the uterus with anything at hand. In such an emergency you would have been justified in using even the handkerchief from your pocket. Any rag should have been used in preference to allowing the hapless patient to die of hemorrhage. If you are ever again confronted with postpartum hemorrhage which does not at once yield to ordinary measures, pack the uterus with any cloth at hand; and if vinegar can be secured, saturate the cloth with it if you have no perchlorid of iron at hand. Every country practician should carry a bottle of Monsell's solution for just such cases. Words always fail us when we are confronted with such a tale of butchery as that you send us regarding this "midwife" (?). Is there no law in Michigan by which you can bring her to speedy and merciless justice? Go to the district attorney of your county and acquaint him with the facts in the two cases and get his opinion. What would not such a woman do? Is there any limit to her fiendish, brutal, cruelty? We know there is no limit to her ignorance. Did you ask yourself the cause of the temperature in this case? Women do not have a temperature of 101° F. in a labor lasting twelve hours. Rupture of the uterus is very rare in so short a time. Is it not likely that your patient had been in labor nearer thirtysix or forty-eight hours than twelve, do you not think? If the uterus had ruptured before your arrival the pulse, temperature, and respiration could all be accounted for. But, doctor, had such accident occurred, you should have been able to diagnose it (such diagnosis is easily made in the majority of cases). All in all, it is one of the most deplorable cases we have ever had to record.-ED.] Method of Making Simple Syrup. Editor MEDICAL WORLD:-I notice a few notes on how to make simple syrup that will not sour or settle (go to sugar). I can tell you the best way that I have ever found: Make your syrup with water and sugar as thick or thin as desired (I prefer it thick) by boiling it in a vessel, add a little alum when boiling, say half or a teaspoonful of alum to a gallon of syrup. When the alum melts it will appear as foam on top. This should be skimmed off well while boiling, and when it gets cool you will have a fine syrup that will stay just like it is made. This is a handy and quick method. JOHN ALBERT BURNETT. Dean Spring, Ark. Ellingwood states that when calendula is used in dressing wounds, the scar tissue forms without contraction, and that healing by first intention is encouraged. In-as-much as the dressing is specially commended in burns, such a claim, if well founded, should make the remedy a valuable one in this connection. It is an antiseptic, and is used in all varieties of recent wounds. Editor MEDICAL WORLD, Philadelphia, Pa. DEAR SIR: -Our Client, the "Success" Auto. Mfg. Co., have complained to us of a libelous article in your October issue, and they have instructed us to begin both criminal and civil actions against you unless you publish a satisfactory retraction. We have written Dr. Van Noppen and also told him he is liable in same way, and have asked him to sign a letter in accordance with the facts. Herewith we hand you a letter from our Client, and we expect you to promptly give it the same publicity that you did the Van Noppen letter. We await your reply. Yours truly, Dict. J.C.H.-R. HIGDON & LONGAN. This is the letter from "our Client": The "Success" Auto-Buggy. Editor MEDICAL WORLD:-Your publication in the last MEDICAL WORLD of Dr. Van Noppen's erroneous statement that the "Success" Automobile is only a "plaything" and that he compelled us to refund his money by legal proceedings for "fraud," etc., etc., does us a great injustice, as it does not state that the Doctor's "legal" proceedings never came to trial. Dr. Van Noppen also failed to state that the Auto-buggy did actually run fast, and did climb the steepest hill in his town, even according to his own experts. His suit we settled before trial, he paying all costs and charges for freight both ways. The real fact is that the "Success" is what its name implies; been running over a year and over 100 sold this season. And the best part of it all is that there are 99 satisfied customers to one not satisfied, as evidenced by many letters we have received from time to time like those of W. L. Bristoll, of Mt. Blanchard, Ohio, and J. W. Westlake, of Marysville, Ohio, copies of which we have sent you. Why, the Auto-buggy is such good value for its small price of $250 that a number of doctors have actually thanked us for sending them so much better Auto than they expected. "SUCCESS" AUTOMOBILE MFG. COMPANY. Following are the two letters inclosed : MARYSVILLE, OHIO, Sept. 4th, 1906. "SUCCESS" AUTOMOBILE MFG. CO., St. Louis, Mo. GENTLEMEN-There was a man in our town from Findlay, Ohio, who was on his way to the Ohio State Fair, and was driving one of your make of Automobiles which I admired very much for a number of He stopt a short time to replenish his gaso reasons. line tank, and his Automobile attracted the attention of a great many people besides myself. This rig consisted of a common rubber-tired Buggy, propelled by a gasoline engine. I had a short conversation with the gentleman and he informed me that his outfit was manufactured by the "Success" Automobile Co., of St. Louis, Mo. It strikes me that this kind of a rig is just what I need in my business. I remain, yours truly, (Signed) J. W. WESTLAKE. ELEVATOR AND COAL YARD "SUCCESS" AUTOMOBILE MT. BLANCHARD, OHIO, Sept. 8, 1906. "SUCCESS" AUTOMOBILE MFG. CO., St. Louis, Mo. GENTLEMEN-I thought I would drop you a few lines and let you know that I made a trip to Columbus, Ohio, with my Success Automobile, and went thru in good shape. It took me nine hours to go down, and I came back in less than eight hours; the distance is between ninety and ninety-five miles. That was my first long trip, and I climbed all the hills I came to, and went up some bad ones. I went up one hill at the edge of Columbus; as I started up, there was some grease on my Clutch Pulley, and it slipt so that I had to stop. Then a number of people came to see the machine and said to me, 'Can't you climb the hill?" I answered that I hadn't found one that I haven't gone up. So I put some dust on the pulley and went up the hill with two of us in the Auto. They told me that the hill gave lots of the larger machines all they wanted to do to climb it. Well, you may get a number of letters, for I was doing some advertising as I went along, and there was a number in Columbus wanted your address. This is Fair Week at Columbus, which is the Capital of this State, and I met people there from all over the State, and they askt me for my card and said they wanted something like the Auto. They said that is just what they had been looking for. I wish you would put me up a few catalogs, when you ship the other two machines. Very truly yours, (Signed) W. L. BRISTOLL. There is the entire business, and it ought to be satisfactory to the "Success" people, as it presents their own showing, and fulfills their every demand. All we want is truth, and we want it from every side. There may be there are-cranky doctors, hard to suit; and there are doctors not exactly cranky, but not being naturally of a mechanical turn of mind, do not know how to manage and run machinery. They may be well intentioned, but hard to suit with a machine on account largely of their own short-comings. But these two classes are only a small portion of the medical profession. Sellers of machinery should take these classes into consideration, The two letters above are not very strong testimonials. One man saw the machine go thru his town, and the other man is a selling agent for the machine. If these are the best among their "many letters," it cannot be a very flattering lot of letters. If these people are doing a straight and honorable business, they should be protected in it. We certainly have no wish to injure a straight business that is a service to the medical profession. But if these people are defrauding the medical profession with comparativly useless machinery, they must stop it, and we will see that they do so. If they are honorable, they will applaud this stand; for it applies not only to them, but to all other firms that are seeking to deal with our patrons. At the same time, doctors should realize that an automobile is frequently "a bunch of trouble," even the ones that cost thousands of dollars. Don't expect too much of them. Even if you get a new horse you expect to get acquainted with him and any peculiarities he may have before you feel entirely assured concerning him. When you get a strange and complicated piece of machinery you must, likewise, expect to get acquainted with it before you know what you can do with it. It seems to us that detailed and very careful instructions should be sent or given with each machine, with privilege of trial, say, for a week before purchase. Removal of Live or Dead Insects from Ear. Editor MEDICAL WORLD:-To remove insect from ear, seat patient on chair, assistant to support head. Then grasp in right fingers a little pine probe six inches long. Have sheet of tangle-foot fly paper lying near. With left thumb and finger grasp lobe of ear; with right hand use pine probe, touching end very lightly in tangle-foot. Carry this into the canal. Stop, look, and see. Touch the insect, dead or alive: insect comes. Common · sense. Have removed many in this way in 30 odd years of practise; often after they had been fumbled with for an hour. Canton, Pa. W. S. LEWIS. DR. C. F. TAYLOR:-Here is one dollar for THE MEDICAL WORLD for next year. Long may your journal live, you and Dr. Russell, too. I like the independent medical journal, run by independent medical men, like THE MEDICAL WORLD. The J. A. M. A is, no doubt, all right, but there I stop. Success to you. Mt. Pleasant, Texas, Oct. 9, 1906. W. H. BLYTHE. NOVEMBER, 1906] Injury to Hands or Feet as a Possible Cause of Heart Disease Injury to Hands or Feet as a Possible Cause of Heart Disease. Editor MEDICAL WORLD:-Permit me thru the columns of your journal to ask my professional brethren if ever they knew of a case of organic heart disease to follow an injury of the hands or feet. My reason for asking the question is that we had a young man that had his left hand badly sawed on a small circular saw, and it was necessary to amputate the greater part of his hand. Chloroform was used at time of the operation. I examined his heart and did not find any organic disease of the heart, and he took it nicely and rallied promptly and made a nice recovery. The accident occurred August 17, 1901. The following June a physician was called to see him as he was suffering from an acute attack of rheumatism. The physician discovered that he had organic heart disease. His regular family physician saw him shortly after, and he, also, claimed that he had.heart disease and treated him for several months. The patient never had rheumatism before the above-stated attack, and in fact was always considered to be in good health. He died June, 1906. Now his parents are trying to establish the fact that his heart disease that caused his death was due to the injury of the hand he received some five years ago. Now if that is the fact and can be proven by the profession, it would throw a different light on the case and a great many others of a similar nature. I would like to have your opinion as well as many others. [It is not our opinion that organic heart disease could result from an injury to hand or foot, however severe; but organic heart disease could easily follow, without having connection with the accident, as it evidently did in this case. It is probable, tho not certain, that the heart was damaged by the rheumatic attack. Such a result can happen in a few hours of rheumatism. We are not aware of any diagnostic method that will establish the duration of an organic lesion of the heart. In this case the rheumatic disease may have caused the heart lesion, and yet, if only a few hours had elapst, the examining physician might have found evidence of the lesion at his first examination. If there was no discovery of the lesion for a matter of ten or eleven months following the accident, the parents cannot hope to establish any connection between injury and heart lesion. Have you read the new book, doctor, "Perjury for Pay," just off the press of The Burton Company, Kansas City, Mo., by Dr. Willis P. King? It has 312 pages, and sells at $2. It casts many side lights on all manner of questionable claims and assertions following accidents, fatal and otherwise. 443 Another very interesting work, just off the press of D. Appleton & Company, New York, N. Y., entitled "Diseases of the Nervous System Resulting from Accident and Injury," by Dr. Pierce Bailey, deals with a different but closely connected phase of the subject. The latter book contains 602 pages, but we regret that we cannot inform you of the price, the publishers having omitted naming it to us. If you have any considerable number of such cases, of if you do much emergency surgery, it will be profitable for you to own both of these works; perhaps this case, alone, would justify the investment. Do you read our columns of book reviews regularly, doctor? It will be time well spent to do so.-ED.] A Good Tonic Rheumatic Mixture. The following letter, forwarded to us by its recipient, explains itself and seems worth publishing: CAMBRIDGE CITY, IND., Sept. 6, '06. J. A. BURNETT, M.D., Dean Spring, Ark.: DEAR DOCTOR: -I see yours in July WORLD in regard to salicylate of iron. I want to mention to you a nice preparation of this nature that I accidentally ran onto. I add 2 drams of salicylate of soda to 3 oz. elix. calisaya, iron and strych. It answers all the indications you mention. It is fine in rheumatism, doesn't taste bad, and agrees with stomach much better than ordinary rheumatic mixtures, and you get a good tonic effect as well as the salicylate effect. Try it, doctor, and if you find it as good as I have, write it up. Yours, W. R. LITTell. Typhoid Fever. Editor MEDICAL WORLD:-I cannot agree with Dr. Finley Ellingwood in his statement that "a most notable error is the inauguration of the treatment of typhoid with the administration of an activ dose of physic and the continuation of laxativ remedies during the course of treatment." Since autotoxemia is guilty of about 90 percent of the symptoms usually seen in an attack of typhoid fever, it would seem that the initial activ dose of physic is certainly rational treatment, and to follow this up with sufficient to keep the gastroenteron empty as possible, stopping short of free catharsis, would seem a priori to be proper treatment. Even in diarrhea of the first stages of typhoid, a tablespoonful of castor oil removes the source of irritation or a good part of it, soothes the irritated tract, and places the patient in a much better condition, as evidenced by reduction in the fever. large high enema is often indicated and should be used often during the course of the disease. It alone removes a large amount of fermenting material, a few millions of the Eberth germ, and leaves the large bowel in The a fairly clean state. Add to the enema, peroxid of hydrogen, as suggested by. Dr. Ellingwood, or better, perhaps, the sulfocarbolate of zinc if diarrhea is present, in the proportion of one teaspoonful of the c. p. salt to a quart of warm steril water. Large doses of calomel are not indicated, and seldom is it necessary to use the small divided doses other than in the beginning, and then only in constipated cases. If the bowel is kept clean and empty there is never any extremely high temperature to fight. With a low temperature, there is obviously less wear and tear on the bodily tissues, less emaciation, greater desire for nourishment. Where elimination is neglected, there is always high fever, always delirium, tympanites, inappetence, and often hemorrhage and perforation. I do not mean to infer that diarrhea is a good thing, but would lay emphasis on the fact that typhoid being an autotoxemic fever, the production of four movements in the twenty-four hours by castor oil or a saline laxativ, aided by enemas if necessary, aids in the shortened attack usually following an empty antiseptic canal. Apropos of the sulfocarbolates in typhoid, I have found that in those cases where they cause irritation of the gastric mucosa, or are refused because of some idiosyncrasy of taste, the following combination is usually agreeable: Menthol Bismuth salicylate gr. gr. v Sulfocarbolates of zinc or soda, and lime. gr. v-xv Dispense in powder, to be followed by a full glass of pure water. In several of the cases treated lately, I have noticed that while the bowels moved freely, at least four times daily, the temperature remained low and decreased in height by a daily drop of one half to one and a half degrees; and if thru carelessness on the part of the nurse the bowels were permitted to become sluggish, moving once daily by enema, the temperature immediately started its upward climb, to come under control again as soon as the free movements again obtained. This has happened too often to be anything but cause and effect. For fifteen years I have treated this disease on the autotoxemic theory, using elimination and anti-epsis, and have yet to see any reason why this treatment should be substituted in general by any other. R. J. SMITH, M.D. Smithfield, Utah. The hypodermic injection of grain of strychnin and grain of atropin is declared by Girard to be a specific for prevention of sea-sickness In those persons who show a resistance to atropin, it may be necessary to repeat the dose at hourly intervals for one or two doses: but usually one dose is suffici nt for the voyage. The method was first publisht in 1888 but it is now fortified by commendations from army officers and surgeons, and by extended experiments among all classes of voyagers. Privy Vaults and Other Things. Editor MEDICAL WORLD:-Dr. Halliburton, of Sabinal, Texas, asks for advice regarding privy vaults. The best thing to do with a privy vault is to abolish it altogether. Instead, prepare an ordinance as follows: Each householder is required to provide a water-tight pail or convenient receptacle of some kind for each seat in the privy; he is required to keep slakt lime, sifted coal ashes, or road dust, and to apply this liberally after each stool. The village authorities must employ a scavenger who shall empty these receptacles at least once a week, and carry the contents in a water-tight tank to some suitable place where it will endanger no one's health. I have seen the above ordinance tried and it workt well. The householder and scavenger are a check to each other. The scavenger is sure to complain if the privy pails are not water tight and plenty of dust used. The householder will complain if the scavenger is not prompt in emptying the pails. Of course, the efficiency of any ordinance depends largely upon the authorities and upon the sentiment of the town. But the above is the best plan of disposing of night soil in an unsewered town that has come to my notice. It is, if well enforced, much safer and less costly than the always dangerous vaults. In the editor's reply to Dr. Stein regarding "sick headache," he does not refer to defectiv eyes and misfit glasses as a cause of this trouble. I am sure that carefully fitted glasses will cure more of these cases than any other one measure, and perhaps more than all other measures. But see to it that your patient has his eyes examined and glasses fitted by an efficient ophthalmologist and not by the ever present incompetent "optician." Our city library contains "The Story of New Zealand." Some time ago I took it out to read. The book did not look as if it had ever been read, altho it had been on the shelves a long time. After returning it I called public attention to the book and stated that it could be found in the library. Since then the librarian has told me the book is in constant demand. Brother doctors, is this book in your city library? If so, is it being used? If not, call attention to it. And call attention to other books in the public libraries which ought to be read in your community. You can easily do much good by a little use of your home paper in this way. Boulder, Col. L. P. BARBOUR, M.D. The internal administration of 15 grains of calcium chlorid on the day of and for two days subsequent to the injection of diphtheria antitoxin, is declared by Arnold Netter, in Le Bulletin Medicale, to be a harmless and almost certain preventativ of urticarial eruptions The use of the calcium chlorid has no effect on the results of the antitoxin, and in 252 cases there were only six cases of eruption, whereas in 258 other cases, without the calcium chlorid, 15.53 percent showed urticarial eruptions. The Doctor and His Medicins. Editor MEDICAL WORLD:-I have been a reader of THE WORLD for a good many years, and I find myself turning to it with increasing interest each year. It is, in truth, a medical world, for it gives a better idea of the views and practises of the rank and file as well as the leaders of the medical profession, at least in America, than any other journal with which I am acquainted. In most of these we get the views of the leaders only. But experience-and some of it is recent experience, too-has convinced me that while for purposes of diagnosis it is well to call in the college professor and the leading specialist, yet when it comes to the matter of treating a case of pneumonia, or typhoid or malarial fever, or diarrhea or influenza, or indeed any of the common diseases, I would rather trust myself or my patient in the hands of the average country doctor than in those of the eminent specialist or the distinguisht consultant. I want to say a few words in relation to Dr. Parker's plan of putting up ready-made formulas and selling them to his patients and other people who can be induced to buy them, as described in the last three issues of THE WORLD. I believe in Dr. Parker's right to please himself in this matter, and that without being called hard names; but it seems to me that he is not putting forth a very high ideal of the physician's work. I think Dr. Sherman (page 389) has about the right idea in the matter, tho I might put it a little differently. I do not think it is any part of the medical profession for a doctor to be a nostrum vender, or even a drug-seller— tho I am willing to admit that a man may be both a doctor and a druggist. But, on the other hand, I have found vastly more satisfaction in carrying my own drugs and dispensing them to my patients than I have in writing prescriptions and sending them to the drug store. By this means you always have your remedy at hand when you need it, thus saving valuable time. It also saves expense for your patient, and puts money in your pocket at that; for you can always furnish drugs cheaper than the druggist does; and then by this means you insure that your patient will come to you for further examination and medicin, instead of taking an empty bottle to the drug store to be refilled. By this means, also, you do not give the opportunity for Tom, Dick, and Harry to go behind the druggist's counter and look over your prescriptions, to find out just what you are giving to each of your patients. There is another advantage, at least I have found it so in my own experience, namely, that you become more familiar with your drugs and their actions when you handle them yourself and have a chance to watch their effects on your patient, than you do when you simply write out an order for some one else to fill, and the patient has to wait until the hired man has time to go to the drug store to get it filled. In this way you will become a better therapist, and do better work. Moreover, there can be no possible objection to this method as unprofessional, as it is simply a return to the original idea of the doctor's duty to provide the remedies which he orders for his patients. Of course a doctor cannot carry everything with him, and for some rare and seldom-used things he will always have to send to the druggist. But the doctor who uses the activ principles will have no trouble in carrying with him on his daily rounds the material for the treatment of nineteen-twentieths of all the conditions he will meet in his practise. This point is well made by Dr. Robert Gray in the New England Alkaloidist, when he says: "I carry 156 activ principles, weighing less than five pounds with case, the equivalent of which in Galenic forms would load two mules. I am never ambusht by the enemy when suddenly confronted by some desperate emergency, no matter what the disease or the complication may be. I have the antidote while time for medication yet remains, and do not have to send prescriptions to a distant drug store for uncertain remedies, a makeshift often fatal to an imperiled life.' J. M. FRENCH, M.D. Milford, Mass. An Obstetric Case by Dr. Parker. Editor MEDICAL WORLD:-Having recently and in your columns criticised the management of a case of obstetrics, I desire to report one which very much reminded me of it. Night before last at 8 o'clock I was called to a case nine miles distant, and reached the scene at about 9 o'clock. Primapara, age 24, rather stout build. I soon discovered that I was early. Pains were moderate and regular, but, while the head of the child was pressing well down, the os uteri lay away back on the rectum and was entirely closed. I explained and lay down on sofa for a rest, leaving the patient to worry along a few hours unmolested and with privilege to assume any position she might choose, in or out of bed. I ordered warm water injected into the rectum occasionally. At the end of six hours I found the os still rigid, but could insert one finger into it, which I did and pulled forward against it for a time. The membranes had ruptured now (too early) and I used the dilator gently for a few minutes and with some little benefit. At end of next six hours I found little change, and I explained that I would perhaps have to assist the patient with forceps; but that I could not do so until the os was sufficiently dilated. The patient was feeling well excepting her regular pains, which made her a little nervous, |