fession, I would like to add that there is a traditional remedy which among the populace is regarded as not only speciîc, but infallible; that is the wonderful madstone, of which I suppose every boy and girl on the American continent have heard.

I have known several who, after having been bitten, have visited the madstone, and had it applied to wounds inflicted by dogs, and who claim to have been benefited by the application, but I have never seen or heard anything about it that had any tendency to increase my faith in any such superstition.

About three weeks ago my hired hand was bitten by my dog on attempting to chain him, and about two or three days after he received the wound he was influenced by his friends to visit the madstone, after I had cauterized the wound, and, as usual, he claimed to have derived all the benefit from the wonderful madstone.

Always having my conscience susceptible to conviction, though as yet not having been converted to the madstone theory, I would like to call the attention of the BRIEF readers, and the profession generally, to search for all the facts that may throw some light upon the efficacy of the venerable madstone, if there is any known, and by so doing might convert some one, and save a soul from death.

[Written for the MEDICAL BRIEF.] Abnormal Eyesight-Responsibility for Its Correction.

BY WILMOT P. BRUSHI, OPH. D., Fredonia, Pa.

Being a regular reader of the MEDICAL BRIEF with other periodicals pertaining to ophthalmology, and especially the branch known as optometry, the position of the glasses as shown in the frontispiece in the July issue of the BRIEF, Doctors Carmalt and Waldo, is, I think, of sufficient importance for some practical observations on eyesight work. All modern optometrists recognize the necessity of properly placing the lenses before the eye that comfortable, or easy vision, may be secured. The visual axes of the two eyes,

the optical center of the lenses, and the angle at which the lens sets before the eye should be considered carefully, and if possible, adapted to the needs of the user. The optical center, when the glasses are used exclusively for either distance or near work, can be quite easily set, so as to avoid prismatic effects, but when the single lens is used for both far and near work, if set for distant objects, and then the eyes directed to an object at the usual working distance, say fourteen inches, the eyes turn down and in, the visual axis, instead of passing through the optical center of the lens passes in from the center horizontally,and down from the center vertically. If the lens used is a plus or converging one, it is thickest in the center, hence when the visual axis is turned in from the center it is affected as though passing through a prism base out, and if it passes down from the center it results in a prismatic effect base up. In case that the lens used is a minus or diverging one, then the prismatic conditions are reversed, because this form of a lens is thinnest in the middle or center. A prism bends or refracts rays towards its base, which in this case horizontally deflects the rays that enters the eye from the object to temporal or outer side of the macula, thereby compelling the brain to turn the eyeball outwards in order to bring the macula within the area of the displaced focus to avoid double vision or diplopia. In case that the lenses are set so as to center for near vision, and the eyes directed to some distant object, it results in the optical centers of the lenses being within the inter-pupiliary distance, too close, which results in the rays from the object looked at passing through prisms base in, and deflecting the rays from the object towards the nasal side of the fundus, or macula, thereby compelling the brain to turn the eyeball inwards in order that the focused rays from the object may fall on the macula and distinct and easy vision be secured, though at the expense of an extra amount of nerve force to the extra ocular muscles concerned, and some disassociation of accommodation and convergence. It is true, however, that where a lens is properly set for either near or distance vision the eye is directed ob

liquely, producing prismatic effects, but it returns and looks through the optical center of the lens, thus relieving the brain in its extra supply of nerve force used in overcoming the prismatic effects. Then, in case that one pair of lenses are to be used for both far and near, we divide the distance of the pupils apart when in the near vision, and the distant positions, using a focal point distant about twentyfour inches from the eyes of the patient. Now, the point that I wish to make, if point it is, is that however exact the refraction found and the lenses conform thereto, in order to have easy and comfortable vision the lenses should be properly set before the eyes.

The position of the eye-glasses shown in the photographic picture of Dr. Carmalt, shows him to be engaged in reading or near work, and undoubtedly looking more than half way between the optical center of the lens and its lower peripheral border, resulting in the effect of a prism base, up or down, as the case may be. In either case an undue effort of muscular action, or nerve impulse, is required. Thus far we have only referred to or supposed to be using spherical lenses, but when compound lenses are to be used the question becomes more complicated and requires even more care in the proper setting and the results to be attained. If strong and vigorous, which the Doctor looks to be, but little or no nervous trouble may be aroused, but in the case of one more susceptible or less vigorous, every modern optometrist knows the inevitable and sure result. On turning over a page in the BRIEF we note the position of the lenses before the eyes of Doctor Waldo. The right eye is looking about two-fifths of the distance outward from the optical center of the lens, whilst the left lens seems to droop downward, causing the visual axis of the left eye to be about two-fifths of the distance upwards from the optical center of the lens. The lenses may be, it is true, simple sphericals and of low power, and the wearer physically able, which he looks to be, to overcome the displacement of the focus of the two eyes without noticeable muscular trouble, or resultant eye-strain. On the other hand, the condition of the eyes may have been that they required the ap

parent decentration of the optical centers of these lenses, but every up-to-date eye man at once recognizes that if that were the case that such decentration could and should have been made before the lens was cut and edge ground, if for no other reason than that of having the frame set right for a better appearance. The main point that I desire to make is that the wearer of a correction should always be instructed how his glasses are intended to be adjusted, and it seems to me that all those engaged in the fitting of glasses should take pride in knowing not only how to refract, to diagnose disease, gain a thorough knowledge of the anatomy, and reflex nervous troubles, but be competent to measure for a frame, and see that it properly sets the lenses before the eye of the wearer. If the reader will but take the time and note the number of misht frames that he may chance to see in a single day, he will, doubtless, if he have an ambition to do unto his fellow as he would be done by, resolve to become proficient in correctly fitting his patients with a frame affording the best possible vision within the purview of modern optometry. One has but to note the rapid advance made within the past few years in the art of correcting abnormal vision with lenses, and no single observation contributes more towards the conformation of this fact than does a perusal of the questions used by the California State Board at its last meeting, held in May, where but seven of the seventeen candidates successfully passed the examination.

[Written for the MEDICAL BRIEF.] Blood Conditions in Rheumatism.

BY IRA B. BARTLE, M. D., Carmen, Okla.

There is a wide difference of opinion in regard to the exact blood condition encountered in rheumatism. In fact, almost as many different opinions as there are different observers. As to what condition these blood changes can be ascribed, is still a matter of doubt, as many of the blood conditions noted in both acute and chronic rheumatism, are nearly identical to those encountered in other acute and

chronic conditions; consequently, to base the diagnosis upon biood conditions alone, would be impossible. However, a close study of the blood in several cases of both acute and chronic articular rheumatism, convinces me that the causative factor of these diseases may be traced to conditions existing in the blood itself, and not, primarily, to deposits in the affected joints or muscles.

The average condition found in my blood observations were alkalinity, always present, gradually diminishing as the disease progresscs, until, in a few instances, almost a neutral reaction was obtained. Increased fibrine, the time limit of coagulation is about normal. A diminution of erythrocytes, especially in the chronic cases; this diminution may amount even to a mild enema. Almost invariably there is an increase of leucocytes, especially in the earlier stages of the disease. The hemoglobin estimate is slightly higher than would be expected from the red blood count. Consequently, there is a disproportion between the hemoglobin estimate and the red cell count. The average count is four million two hundred thousand erythrocytes, with a maximum of four million five hundred and eighty thousand, and a minimum of two million eight hundred thousand.

The average hemoglobin per cent is sixty-five, with a maximum of eightyfour and a minimum of fifty-six. Some writers record much lower per cents and red cell counts, but these are the average in my experience, and it includes some very severe and protracted cases. Rheumatism, as a rule, attacks the full-blooded, gouty patient; consequently, prior to the attack, the blood count would naturally be at its maximum limit, and without having had opportunity to make a count prior to the attack, it would be impossible to know the exact amount of cellular destruction. There is a tendency, always, in these cases, to resume their original high-blood standard very shortly after recovery.

The theory of crystal infiltration or deposits in the myolema or muscular inter-spaces or the joints, is, I think, to be discredited, only as the secondary condition and not as a primary factor. Neither do I think rheumatism due to any specific,

single micro-organism or plasmodia. When the biood seems to be in a certain condition, there is a predisposition toward these crystalline deposits, and any disturbance of the normal equilibrium may precipitate an attack of rheumatism. I believe that there are several micro-organisms which can bring about these blood conditions favorable to crystalline depositз, namely: Kleb's-Loeffler bacillus, streptococcic, gonococcic, staphylococcic (to a limited exten:), pneumococcic, bacillus associatus, influenza bacillus, etc.

The analogy between the disease caused by this micro-organism and a post-rheumatic affliction, has been observed for a great number of years. We expect rheu matism to follow diphtheria, and are not surprised to find it after scarlatina, and it has been observed that following a grippal epidemic, we will have an unusual high number of cases of rheumatism. My observation in 1901, was that about twelve per cent of the cases of la grippe were followed within two months with a mild attack of rheumatism. The epidemic of 1903 showed a still larger percentage, while the recent epidemic of 1905 has not, up-to-date, shown so marked a tendency toward this rheumatic condition. However, the blood picture in the attack of la grippe this year has been different to that in the years before mentioned, the impoverishment being much more profound than heretofore, and our la grippe cases were of a much more acute type.

It is my belief that, in the disease caused by these germs there is an antitoxine elaborated, which is curative to the acute infection, although it brings about blood conditions which favor rheumatism. I am strengthened in this belief on account of my experience in the administrating of the various anti-toxines. In my use of anti-streptococcic serum in mixed tubercular conditions, I have always had attacks of acute articular rheumatism following in from nine to twenty days from the beginning of the administration of the serum, and the severity of the attack does not seem to be affected greatly by the amount of serum used. In writing to other physicians for their experience along these lines, I find that they have encountered the same complication, with the exception of Dr. J. T. Walles, of Portland,

Ore., who reports to me one case in which he used four hundred and seventy cubic centimeters of serum with no rheumatic reaction whatever. We invariably look for some rheumatic symptoms following the administration of anti-diphtheric serum, and I think that the same is true of the use of all of our serums. I therefore believe that the anti-toxine, whether elaborated in the system of the patient himself, or whether introduced thereto by artificial means, seems to bring on that peculiar blood condition which is favorable to rheumatic attacks.

In our post-mortem work we often find heart changes in diphtheria, scarlatina, septicemia, pneumonia and la grippe cases that are identical to those found in rheumatism cases. Whether those heart changes are due purely to toxines, elaborated by the causative organisms, or to antitoxines elaborated by the system, or to lowered vitality, is a question which would be hard to answer. Even under the old theory of uric acid deposits, the heart changes encountered were poorly explained, and the fact that they followed rheumatism was more of a clinical observation than a scientiac deduction.

That

these same heart conditions are encountered after acute infectious diseases, caused by the germs before mentioned, would indicate, to my mind, that they play an important role in these heart changes.

This year's grippal epidemic seemed to be secretive in its attack upon the heart muscle. Not only, in our experience in this locality, but in talking with physicians from over the entire middle South, they have encountered the same experience. The attack of la grippe was often heralded in by an attack of pericarditis, accompanied by great irregularity; especially was this true of the aged. In a good many cases death occurred from heart failure within the first three to five days, with apparently little trouble elsewhere, and yet they were distinctive cases of la grippe, the influenza bacillus being found in the sputum in every case, and sometimes in the circulating media, just before death, at least such was found in two of our cases. We were not permitted to make a post-mortem examination in either of these cases, consequently, we do

not know the exact condition of the heart. One, however, had a previous mitral regurgitation, but within a few days from the beginning of the attack, murmurs were distinctly heard over the entire cardiac area.

Mitral regurgitation very commonly develops in even mild cases of pneumonia, where the tissue waste and the severity of the attack would scarcely warrant an anemia murmur. Both diphtheria and scarlatina have a very selective tendency toward the mitral valve, and in this case it must certainly come from direct influence through the circulating media of the micro-organism itself. Consequently, it seems to me more feasible to accredit many of the muscular and valvular changes, heretofore ascribed to rheumatism, to an attack of some germ disease.

I think in some cases of rheumatism, you can, by delving thoroughly into the family and personal history, find where the original rheumatic nidus was located. The reason that some persons are predisposed to rheumatism is very readily explained, because when these peculiar blood conditions once exist, there seems to be never an entire return to normal. The same as in an attack of small-pox, there is an immunity found, though we have never been able to find any differcnce in the blood examination before or after the attack. Yet this peculiar immunity remains, and in nearly every disease of germ origin there is left after the acute attack, either an immunity, or a predisposition, consequently, the same rule will hold good in these cases of recurrent rheumatism. Therefore, discover the secret of immunity and predisposition, find what an anti-toxine truly is, and you will undoubtedly discover the cause of rheumatism. Find a remedy that will put the circulating media in exactly the same condition that it was prior to the attack of an infectious disease, and you will have discovered the cure for rheumatism.

[Written for the MEDICAL BRIEF.]

Commonplace Remedies-Tur

pentine.

BY W. T. MARRS, M. D., Jewett, Ill.

It would be well for every physician to familiarize himself with the therapeutic possibilities of the remedies usually found in homes. One frequently finds himself in an isolated place without the very thing he most needs, when some homely remedy or appliance must be called into requisition. Again, many poor people, not able to pay the doctor's fee, to say nothing of a druggist's bill, may often obtain good and serviceable treatment from remedies regarded as valueless, simply by reason of their cheapness.

In this short article I wish to call attention to a drug which is cheap, valuable and nearly always at hand.

Turpentine, divested of its homely name, frequently comes under our notice in some form of derivative or analogue. Among these are the oils of succini and thuja, terebene, terepine, sanitas, etc. All of which are good remedies for their separate indications.

The dose of turpentine is from five to fifteen drops in pearls, capsules, or emulsion. Given as an emulsion with glycerine, the taste is, in a measure, disguised. The dose as an anthelmintic is from a teaspoonful to a tablespoonful. When thus given in large doses it should be combined with castor oil, in order to hasten its elimination from the system. Large doses irritate the kidneys and irreparable damage may, possibly, ensue. In Bright's disease, or any abnormal state of the urinary tract, turpentine should never be given in doses beyond the minimum. Strangury, hematuria and other untoward symptoms may be produced. The normal urinary tract, however, usually tolerates large doses of this drug. One girl under my observation stated at she drank a half pint of turpentine with abortive intent, not to get the desired result, nor any unpleasant symptoms.

The vapors produce in susceptible persons a nasal and renal irritation. The writer always observes his urine to have the characteristic odor after having only

poured turpentine from one bottle to another. From this and other facts I look upon it as being a two-edged sword.

Turpentine, in goodly-sized doses, is a stimulant to the vaso-motor system, causing for a time increased arterial tension. Years ago the old backwoods doctor, on finding his patient nearly moribund, gave a teaspoonful of turpentine. Being a diffusible stimulant and quick in action, the results were often gratifying.

In typhoid fever, after eliminants, turpentine holds a conspicuous place, and is likely to come in good play locally or internally, or both, during some stage of the disease. It possesses greater antiseptic properties than many agents used for that purpose. It controls meteorism and stays intestinal hemorrhage. It relieves chest symptoms and acts upon the secretions in a way not easy to explain. A dry, cracked, brown tongue is a "turpentine tongue," as our homeopath friends would say. In such a condition it is usually indicated, both locally and internally.

Pneumonia, with symptoms simulating typhoid, also suggests turpentine. Likewise many other fevers or low states.

In puerperal fever turpentine is a valu. able remedy used internally and, also, as stupes. A septic uterus, when swabbed out with turpentine and glycerine, equal parts, loses much of its bad odor, with microbic action correspondingly lessened. A tampon of this mixture will control post-partum hemorrhage.

Dr. Bevill, in the Medical Summary. states that turpentine will remove nasty odors from the hands, such as result from handling decayed placentæ, uterine cancer, etc.

Turpentine when taken into the mouth, causes heat, burning and a flow of saliva. From this fact one would think it contraindicated in mercurial ptyalism-simply adding fire to the flame, but among the laity, where it is used for this purpose, I find that it very materially cuts short this troublesome condition.

Turpentine when exposed to the air becomes somewhat ozonized by absorbing oxygen, which it retains tenaciously, thus increasing its efficiency in the treatment of wounds. Nail thrusts and other punc ture wounds, when cleaned and treated