only precautions are to cleanse with a two or three per cent. watery solution of antinosine and dust freely with nosophen, coapting the wound as nearly as conditions will admit of.

Also, in chronic varicose ulcers, where in former years we relied upon rest and position of limb as important factors in their successful treatment, since commencing the use of antinosine and nosophen in their treatment I place no restriction of that kind upon my patients, even in cases of street-car conductors, men who have to be active upon their feet. I find the healing process to go on steadily and certainly by the use of these remedies and the support of a fannel bandage. The causes of delay in the healing process in these cases mostly are two-activity of micro-organisms and defect in apposition.

The chief and essential causes which we recognize as the disturbing element in the repair of these lesions are micro-organisms and their ptomaines, and their action upon living tissue, which constitutes sepsis.

The ideal treatment in these cases of chronic varicose ulcers is that which overcomes this septic condition and preserves it for the greatest length of time. This is only accomplished by the destruction of these germs and their ptomaines, and the prevention of their further development where their exclusion has been impossible. To accomplish this very desirable object the antinosine and nosophen are the only remedies I have yet found that have proved satisfactory in all such cases, and I have used them many times in the last 3 1-2 years.

The antinosine in a two or three per cent. watery solution deodorizes and sterilizes these ulcers readily; dusting the powder into the deeper ulcers, it will gradually become dissolved by coming in contact with the exudation from the hyperemic capillaries. As a preventive from further invasion of germs, dust the surface of both superficial and deep ulcers with nosophen powder. This makes a permanent dressing which lasts from one to three days. It deodorizes and sterilizes; it protects and gives tone to the newly formed healthy tissue without any toxic or irritating effect, either

general or local, and induces the reparative process more speedily, and gives greater relief to the patient from soreness and pain than any remedy or class of remedies I have yet found.

Also, in all cases where a moist antiseptic dressing is desired, the antinosine being soluble in water or alcohol, makes it an ideal dressing, as it certainly has some anodyne properties, or at least gives relief from pain.

In case of severe turns covering large areas, involving both superficial and deep structure, the dry dressing with nosophen gives the most ready relief from pain for a remedy which is absolutely safe as regards after-effects, and is also the most permanent dressing I have any knowledge of. Its exclusion of outer germs reduces the tendency to inflammation to a minimum, and a sure preventive of suppuration. The researches of Pasteur, Tyndall and others have clearly and definitely settled the scientific truth that no decomposition or fermentative change will take place in organic matter except after the introduction into it from without of living microbes, which find pabulum for their subsistence. The nosophen not only disinfects and sterilizes devitalized tissue, but excludes from without the introduction of all living organisms.

Among the number of burns I have treated in former years by the use of other remedies, but of late years with nosophen, I select this one, owing to its extent and severity, as it was the most serious burn I ever saw, and the patient

recover:

In November, 1896, Captain M., of the steamer Pilot, whilst in the engine room with the engineer, met with an accident in the way of a gasoline explosion, which resulted in the death of the latter and injuries to the Captain so serious that his life was in jeopardy for a number of days, on account of shock. In this accident the burns extended over the entire face, ears and nearly over the entire head; also over both hands and forearms. The scalp was nearly all involved, and at least one-fourth was destroyed with the areolar and deeper tissues; over the frontal eminence, both right and left, the burn was so deep that the periosteum was

destroyed in patches. The external ears suffered seriously, the entire integument being destroyed and portions of cartilage of helix were burned away. The integument of face was destroyed, and over the most prominent portions all the areolar and some of the deeper structure was destroyed. Both hands were completely denuded of integument, superficial fascia, and in many places muscular tissue was destroyed with every nail, which came off of both hands. The forearms were in a similar condition in spots.

The first regular dressing applied in this case was nosophen powder covered with sterilized cotton. This dressing proved so satisfactory in its relief of pain, deodorizing and aiding in the reparative process, that it was continued until a complete recovery was established. This remedy and method reduced the pain and labor of dressing to a minimum. After this dressing had been on from one to three days the exudation from the hyperemic capillaries would combine with the powder, forming a crust, and when suffi ciently loose and free could be removed with necrotic and devitalized tissue. odorless and without one particle of pus. This process was followed by a similar dressing and repeated until the work or reparation was completed, which required nearly three months, but without any pus, odorless and with but very little pain.

To-day the non-professional, casual observer will see nothing abnormal in the general appearance of the Captain, so complete has been the reparative process.

In all cases of scalds and burns of children at any age it is the ideal dressing, owing to its soothing effect and safety from absorption and after-effects. Open the blebs, if any, apply the powder liberally and cover with cotton, and in most cases a single dressing is all that is required.

WH

ANTITOXIN.

BY FRANK R BRUNNER, M. D.

PHAT is diphtheria antitoxin? Some say "it is almost a specific-an infallible remedy for the cure of diphtheria, if administered in the beginning of the disease;" others say "it is a failure," "a nasty stuff," "a tainted horse serum," and the physician who injects it into the system of a child is more guilty .of malpractice than the one who does not inject it.

These arguments and assertions remind me of a court of justice, where the witnesses for the plaintiff swear to one story and the witnesses for the defence swear to the contrary. The judge defines the law to the jury of 12 men, honest, good and true, and adds, "If you believe the evidence for the plaintiff you must find a verdict for him, but if you believe the evidence for the defendant you must bring a verdict for the defendant."

I appear before the readers of the SUMMARY as a witness for antitoxin, yet on cross-examination I may not prove very strong in its favor.

In a recent epidemic of diphtheria I treated 52 cases. Five were treated with antitoxin and one died; 47 were treated without antitoxin and two died. This would prove a poor showing for antitoxin, but when I state that the five cases treated with antitoxin were among the unfavorable cases, it would not seem very discouraging after all. In the favorable cases treated by antitoxin I did not inject until the fourth and fifth days; in the unfavorable case I injected the second day. into the favorable cases I injected from 4000 to 6000 units each, and into the unfavorable patient 6500 units. The unfavorable case was four years and four months old; the favorable cases were from six to 13 years of age. The unfavorable case died on the sixth day from heart failure. The exudation in the throat continued to spread in spite of the antitoxin, and swelling also appeared after the injection, but had again gone down at the time of death. The exudation had also diminished, but upon its peeling off it always left or showed a

dirty, unhealthy base, proving that the patient was in danger. The two patients who died without antitoxin remained swollen and the exudation remained intact at the time of death.

The patient who was treated with antitoxin and died had the greatest fever. On the third and fourth days he took two to four drops of Norwood's tincture of veratrum viride every four hours. His tongue remained dry to the end, in spite of calomel to excite the glandular secretions. His nasal passages were affected, but not closed, as they were in some of the other patients who recovered and those who died.

The reason that I injected antitoxin in the four cases who recovered was because I was afraid they might die without its use and I could not clear my conscience, even if I would not be paid for it. The reason I used it on the second day in the case that died was because he was my own grandson, an exceedingly bright and interesting boy, and I did not even desire to lose the first opportunity to save him.

The first case in which I used the antitoxin was my own granddaughter; on the fourth day, when she had developed into a serious case, I injected in all 4500 units, and I felt certain it helped and perhaps saved her. Those who recovered under the antitoxin treatment suffered more and longer from the after results of diphtheria, such as post pharyngeal, paralysis, difficulty in swallowing food. and fluids, impaired articulation, troublesome cough and general partial paralysis, not due to the antitoxin, from the fact that I have experienced the same difficulty years ago in severe cases. I have also had cases formerly that died from heart failure after the swelling and exudation had nearly or all disappeared, but not until the end of the second week.

I used the Mulford Company antitoxin, but I was not thoroughly posted with regard to frequency and number of units. I also remembered the warnings against its use, which made me more or less timid. I am, nevertheless, satisfied that it is not that "ugly," "nasty" and "dangerous stuff" attributed to it by some of the professional brethren, and I would

now

use it more frequently and more heroically were it not for the high price it costs. Poor people cannot pay for it, and doctors cannot afford to pay for it in cases where they know they will not be remunerated for it. It is true, it costs less than a coffin, but the coffin and antitoxin is still more expensive than the coffin alone.

From the statistics of the Philadelphia death reports, it seems the death rate averages one out of every five to six cases of diphtheria per week. If it is true what the Mulford Company claim, that the early antitoxin treatment brings 100% cures, then the City Board of Health would be justifiable in supplying antitoxin for all poor families and save their children as well as those of the rich, who can afford to pay for the treatment.

I am not convinced that antitoxin is a true specific in the early stages of diphtheria, because it has not proved that fact in one of my cases, but I do believe that it is the best treatment I have used in

severe cases.

Owing to its price I cannot use it until the patient's condition becomes threatening, unless the patient or family desire it and is able to pay for it, but when the patient's condition becomes serious I will use it, pay or no pay, cure or no cure. Eshbach, Pa.

A CURIOUS CASE.-A PLEA FOR A LITTLE

A

ENTHUSIASM.

BY BEN H. BRODNAX, M. D.

YOUNG lady, 19 years old, of good health, eats and sleeps well, awoke on Thursday morning, December 7, 1899. with an ulcer on left side of tonsil. There had been no previous discomfort and no pain prior to getting up. The inflammation extended all over the back of month and esophagus during the morning, with considerable fever. No special medication, except gargles, were used during the day, but at night I cauterized the entire irritable surface with 80 grains nit. of silver to a half ounce of water, as also the next morning, Friday. She complained of some itching on Friday evening, and an examination showed a rash similar to roseola, which gradually diffus

ed over the abdomen and legs, and extending up the back.

On Saturday the rash had become of a deep scarlet, very tender and itching very severely, and thickened the skin.

On Sunday the rash showed in patches on palm of left hand and fingers, on the neck and inside of mouth and on] tongue, all of which were thickened and stiff. There were some small patches on the feet and legs about the size of a silver dollar and thickened, the skin turning white when pressed and returning to its deep scarlet color when pressure was removed. The inside of the eyelids, gums and cheeks were pimpled.

By the above time, Sunday evening, the throat was much easier and the fever nearly gone, but skin still tender, itching and very red.

The point with me is, did the eruption (or rather the cause of the eruption) produce the first symptom, sore throat? It looked to me very much like a case of erythema scarlatiniform, but I do not see in my book on skin diseases (Duhring) that sore throat accompanies the disease. The treatment was to open the bowels and keep them open. Calomel, with Tarrent's seltzer aperient, once daily. The following solution was occasionally applied to the eruption:

Chloral hydrate, five to 10 grains, as required, diluted, was given to ease pain and produce sleep. She was given any kind of food that she could swallow-eggnog, soup, Horlick's Malted Milk, milk and wine spiced, crackers soaked in hot milk, soft-boiled eggs, baked apples, stewed dried apples and prunes. The thickening of the skin and eruption spread to the arms and neck on Sunday night.

She seemed to think that a pinch of common salt acted better as a cautery of the throat than the nitrate of silver. This caused the discontinuance of the calomel, and the seltzer aperient alone was used afterward.

After trying nitrate of silver, chlorate of potassium and salt with very little amelioration, I went back to my old

friend, subsulphate of iron, 50%. This relieved the pain and soreness and gave her more satisfaction. She has about recovered, the throat still being a little sore, but is healing nicely under the iron. This is the 15th day.

Two cases (children) similar to the above have occurred in Merrouqe, eight miles distant, but they had never been near the above case; also, no other cases have occurred in the house or neighborhood.

A PLEA FOR A LITTLE ENTHUSIASM.—“As I said before, I believe we should all be teachers in the fullest sense of the word, and that we should hold our professional knowledge entirely within our profession; that is, keep it out of the hands of the scheming individuals, whose only interest is to make money, even if by so doing he sells the people."

The above was written by one doctor to another on account of the recommendation of a proprietary, non-secret remedy; also to the effect that the profession should make all of its remedies and not contribute to the proprietary chemical company's by buying their output, more particularly in recommending the elegantly prepared and useful articles made by

these houses.

Perhaps it may be the ethical and the right thing, and it may be wrong, to recommend these "new fangled" remedies, but I cannot think that one is very far amiss in stating his experience with a remedy that has done him good service in a pressing time of need.

While reading the remonstrance I could not help glancing back over the 60 odd years during which I have taken medicine of some kind, more or less every year, and compare the home-made doses of those early times of my life with the present. A capsule had never been thought of, and the nearest thing to it was a slippery mass of slippery elm exudate wrapped around the aloes, podophyllum, scammony and gamboge pill and swallowed at a gulp. Instead of quinine in a gelatine coated pill, a tablespoonful of the sawdust of Peruvian bark was wet up and washed down with warm water; instead of the effervescing tablet dropped into a

little water or a teaspoonful of seltzer aperient or of Crawford's effervescing Epsom salts in half a glass of water, it was a teaspoonful of Epsom or Glauber's dissolved in hot water and washed down with a cupful of senna tea. Calomel, jalap, gamboge and tartar emetic by the teaspoonful, and red pepper tea to clean it down. A corn salve was not thought of, and soaking and paring with a sharp knife the last resort.

Compare these primitive methods with the alkaloidal granules, the encapsuled pills, the salicylated corn salves that remove the trick without pain entire; the concentrated tinctures of plants unknown 30 or 40 years ago that are so potent for good, and the capsule to take them in; the process of depriving nauseating, bitter drugs of taste and leaving them equally effective. How many of these were discovered by strictly professional medical doctors? Were they not put forward by the energy and money of those who were not doctors? How much is the doctor of to-day indebted to the chemist for the thousand and one elegancies of the present time? and a doctor who cannot, nor never could, make these is to be scolded because he would rather use a nice palatable remedy or the same crude drugs encased in gelatin capsules than he would the crude, nasty messes of years past. Also, because he finds a thing that is a pleasant, complete remedy, he is to hush up and keep the trick to himself for fear some one will misuse the remedy or make some money out of it. Why should not the workman be paid for his labor. It would be almost a curse on the doctor of to-day if monied men would not expend their means, time and brains to bring the good things to the very doors of the doctor, and by skill and care to make a more perfect article. For my part I think the two should work together and each should profit by the labor of the other.

I have spent years in learning the apothecary's trade, and have since then spent days at work on pills and tinctures of native plants. The pills I can buy with half the cost in time, and the tinctures were no better than the tinctures we buy of any good pharmacal manufacturer. It is a matter of economy for a

doctor to make tinctures of the plants native to his neighborhood, but otherwise there is little inducement.

Taking the average graduate, and the knowledge he has of the compounding, of incompatibles, and the order of mixing is very small. Some of the mishaps would bring a smile to the face of the sphinx.

One of a very precise, self-opinioned medical doctor, of three or four years' practice, had asked me how the acid tonic (nitro-muriate of iron) was made, and on learning made some up when he wanted it. corked the vial and handed to the boy who was waiting for it. He got half way home when it exploded, saturating his clothing. A more tearful face I never saw, as the boy came running into my office for relief. The doctor had forgotten to let it stand 24 hours to digest. Numerous instances of these mishaps makes the average doctor lean toward the pharmacist with a paternal feeling.

It strikes one that the doctor who is so quick to read his brother a lecture on such matters has never had the experience of making up his remedies, therefore cannot compare the bolus of the past with the alkaloidal granules of to-day. About the same comparison holds in the present fast electric trains that take you along at the rate of 60 miles an hour and the stage coach or horseback journey of 50 to 75 years ago. Brodnax, La.

ANTISEPSIS.

BY WM. HOOKER VAIL, M. D.

HE value of rendering antiseptic the field of operation has been run to death, and the subject has given way to many other valuable reports, but in spite of all this there are many deaths, and necessarily our attention is called to the fact that there are other fields where a septic condition may be more pernicious and do more harm to life than the menacing effects of septic wounds, either primary or secondary.

I have learned that a general septic condition resulting from a protracted pollution of the tnbe from the mouth to the anus, is more often the cause of septic