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predisposition to diarrhea. Should this measure fail, soak the feet in hot mustard water, and lastly give potassium bromid.

If the bowels are moderately loose it is well to not meddle with the condition, but if the purging is frequent enuf to be weakening, chalk mixture, or for an exaggerated condition, zinc oxid in doses of one-quarter to one-half grain every three or four hours, are both excellent remedies.

The condition of hyperpyrexia that marks the acute stage does not call for special treatment unless it continues longer than twelve hours. When baths are given a temperature of 98° should be first used, and if this fail to reduce the temperature, tepid and finally cold spongings should be resorted to. Of the antipyretic drugs, phenacetin is the safest and most reliable. This may be administered in an initial dose of one grain for any age between two and six years. If the temperature falls If the temperature falls afterward, watch the extent of the depression; if not, gradually increase the dose to two or three grains. The dose may be repeated as often as necessary to keep the temperature below 103°, the condition of the heart being carefully watcht.

The treatment of convulsions, bronchopneumonia or other complications in nowise differs from that employed when these occur idiopathically, and therefore need not be considered here.

A subscriber in China writes as follows: "Could not THE MEDICAL WORLD take up the subject of drunkenness among physicians? A year ago I was home on a furlough, and was grieved at the amount of drunkenness I observed among country physicians. They were good, skilful men when sober, but if a new physician would locate in their town they would keep sober and hold their practice until the new and sober man was starved out. Then they would go in for a good old drunken spree.' Should not physicians who are intemperate have their diplomas revoked? This could be done by the college granting the same, or by the State. It is a sin

against humanity to allow them to endanger human life by practising while they are drunk."

This will be a very interesting subject for discussion by our readers. A frank, free and bold expression is desired.

An "Advertising Dodge."

In January WORLD, page 31, appears an apparently candid and innocent article, from Harvey M. Mathews, M. D., of Corsicana, Texas. It is made to appear that the object in reporting the case is the large amount of morphin and cocain taken by the patient. The treatment of the case was not given, but we publisht the article in good faith, supposing that of course the treatment would be given if askt for. We have since written twice for the treatment, but have received no reply. A subscriber who wrote directly to the author of the article for the treatment received the following reply: "I cannot furnish you my method of treatment, as I do not desire same to be used outside my home. If you have any cases you wish cured and will send them," etc. A subscriber in sending his renewal, writes: "I like your WORLD, but think if I was editor I would eliminate such an advertising dodge as is found on page 31." The editor wishes now to confess that he was caught on this "advertising dodge," and he also wishes to beg the pardon of his readers for the same." considers that he usually has a pretty good nose to smell out such things, but he is not infallible. It is surprising how many apparently innocent communications, but with a secret self-interest behind them, seek admission to the reading pages of medical magazines. To the writers or instigators of all such we wish to suggest that there is an honest way to advertise.

Drug Prices Here and Elsewhere.

He

THE MEDICAL WORLD feels it to be its duty to serve the interests of the medical profession in a financial as well as a scientific way. For this reason we have been giving persistent publicity to the wide discrepancy of the price of phenacetin and some other patented preparations in this

country and in other countries; the price being several times greater in this country than in other countries, while the duty is only 25 per cent. I appealed to the importers of phenacetin, the Farbenfabriken of Elberfield Co., of 40 Stone street, New York, for their reason for this state of affairs, earnestly suggesting that they ought to sell their products to consumers in this country at the same rate as in other countries plus the duty. They referred to the great difference in the selling price of many other drugs, not patented, in this country and in Germany. I then askt them for some definite and detailed information on this subject. They have very kindly sent me the following list:

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The prices are taken from Merck & Co.'s list for the United States, and from R. Schering's list of German pharmaceuticals; both lists are intended for the retail drug trade. In each case preparations of corresponding degrees of purity or of equal specific gravity were selected according to the United States or German Pharmacopeia. None of these preparations are patented, or covered by trade-mark, so that the manufacture in the United States is just as unrestricted as in Germany.

By this list it seems that the importing of drugs into the United States must be a very profitable business. Are the Americans so rich that they do not care what prices they pay? Or what is the reason for this wide discrepancy?

ORIGINAL COMMUNICATIONS

Short stories on the treatment of diseases and experience with new remedies are solicited from the profession for this department; also difficult cases for diagnosis and treat

ment.

Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors.

Copy must be received on or before the twelfth of the month for publication in the next month. Unused manuscript cannot be returned.

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than anything else.—RUSKIN. COMPARE. RECORD,

READ.

REFLECT.

Notes and Comments.

Editor MEDICAL WORLD:-What a fine object lesson is that on smallpox in the March editorials. What a pity our antivaccinators cannot see such things like ordinary people. Of all the numerous members of the class which tries to distort facts to make them support their theories, none compare in fanaticism with the opponents of vaccination. A certain official statistician of Austro-Hungary once endeavored to show that his official records proved the worthlessness of vaccination; and his report gave great comfort and encouragement to his fellows and trouble to the cause of truth. I have among my books a report made by my friend Korosi, his official successor, showing how the records had been garbled, distorted and even deliberately falsified to make them support the anti-vaccinator's contention. Have any of our friends tried calcium sulfid in smallpox? This salt is so powerful an antagonist of suppuration-producers in general that it ought to prove effective here. If it restrains the secondary fever, which is due to the absorption of pus from the suppurating pustules, it should ameliorate the symptoms of the latter stages and prevent the disfigurement to a great extent. But it should be given in full doses, a grain four to six times a day, and not in Ringer's 1-10 of a grain.

There is one small objection to the use of jaborandi as a sudorific in scarlet fever, and that is that it occasionally dries up the sweat instead of increasing it. In fact, the question of which action will be obtained from this drug depends altogether on whether pilocarpin or jaborin happens to predominate in the sample the druggist dispenses. Generally, the pilocarpin in it is in excess, but I got caught once with a specimen that worked just the wrong way, and it came near costing a life, before I

found what was the matter. Since that experience I have stuck to the alkaloid pilocarpin and have never had reason to regret it.

I think the WORLD family will be glad my remarks on Dr. Benedict's letter were made, since they elicited the reply in the March issue. I object to the term "alterative," because it has no tangible meaning behind it. "Relaxing vasomotor spasm has a meaning we can comprehend, even if we cannot explain how that action is accomplisht. In the second stage of pneumonia, even if aconitin and strychnin had no effect beyond the area of consolidation, they would still be effective in limiting the spread of the process from lobe to lobe. We need not have lobe after lobe involved, as in Kipling's case, while we sit idly and watch the process. But I am sure that these agents, especially strychnin, act on old tissue that is not already lifeless, and that this action can be demonstrated. I once saw a child with pneumonia to whom an overdose of strychnin and digitalis had been given by mistake. Every evidence of consolidation disappeared, as well as the rales. My confidence grows firmer with experience, that in strychnin we have a remedy that is capable of increasing the vitality of pneumonic tissues so far that they will recover and throw off the disease, where otherwise they would have undergone molecular death.

Now as to the mortality to be expected in pneumonia. If you look over Juergensen's article in Ziemssen's Cyclopedia you will find that he cured all his cases except those in which the "6 pneumonia " was simply the termination of chronic incurable disease, such as diabetes or cancer, in which no one could expect a cure; or hemorrhagic and "old age" cases, in which his treatment was not successful. We do a little better with the alkaloids, but not so much as to render our claims incredible. Some cases are necessarily are necessarily fatal, such as I have mentioned, and those in which the vitality is so nearly exhausted that attack of almost any complicating disease may kill. Leaving these out of the question I would not expect any case of croupous pneumonia to die, under the treatment I have suggested; and that not under the management of one of the great masters of our profession, but in the hands of any average country doctor. These claims are not for superior skill in the physician, but for vital superiority in the

methods employed. claim deliberately.

And I make this

Let me say a word in reference to Dr. Stearnes' brief but misleading note on the same subject, on page 114. Probably ninetenths of the cases would get well quite as nicely without the antimony, opium, niter, calomel, digitalis, blistering and counterirritation he mentions; but it is the other tenth we want to save. Has he lookt in a work on therapeutics publisht since 1858?

Several writers have recently asked about a remedy for diabetes mellitus. A lady now under treatment has taken strontium lactate, 10 grains six times a day for three weeks, and there is no trace of sugar in her urine to-day. This is not my first trial of this remedy in diabetes, and thus far it has succeeded every time.

The case described by "Reader," may be colic due to constipation, but is most likely to be gall-stones. They do not necessarily show in the stools, as they may slip back into the gall-bladder, Test the urine for bile immediately after an attack. Put her on sodium succinate, 5 grains four times a day, and continue for a year.

Umbilical hemorrhage in many, if not all, cases is due to syphilis. I have checkt the hemorrhage temporarily by transfixing the tissues with long pins and applying a ligature, preferably of rubber. Brady's second case (page 123) reminds me of a newspaper story:

Dr.

"What I don't understand is why she-"·

"There is no known reason."

"But why don't you wait till I've finisht what I had to say?"

"You did finish it. I tell you there is no known reason.'

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The last case will develop into angina pectoris. Give him strychnin arseniate 1-30 grain, four times a day for a month, and follow with arsenic iodid 1-67 grain for three months more, to improve cardiac nutrition and innervation.

Dr. Franks (page 123) asks for a remedy for eczema. If the patient is plethoric give her colchicin, about three granules, 1-134 grain each, every day. Regulate the bowels, give calcium sulfocarbolate, 40 grains a day, to render the bowels aseptic and give the tissues a little more solidity. Relieve the general itching by mild mustard baths, or by pilocarpin in doses enuf to cause sweating. If the eczema is confined to limited areas apply the official ointment of red oxid of mercury.

But

eczema is a pretty big proposition to prescribe for in a lump, all sorts and phases at one shot. For instance, if there is induration of the tissues, or thickening, you will do no good until you have reduced the engorgement by applying pure, water-free glycerin long enuf to shrivel the skin like a washerwoman's hands.

Dr. Harwood, of Texas, writes me that I unintentionally did him an injustice in my January letter, as the treatment to which I objected was not his, but that of another physician, who had preceded him in the case. I am glad to make this ex

planation.

One of the most troublesome affections we have to deal with is cystitis. In many instances it resists all medicinal treatment, and the old and new remedies are tried in succession and fail. I have generally found that when a case resisted good management by a good doctor, there was something else back of it. One such case was sent to me recently, in which diabetes mellitus was detected. I made an opening from the vagina to the bladder for drainage, to give the inflamed bladder some rest, and cleared away the sugar by strontium lactate, giving xanthium spinosum as a specific, the symptoms corresponding to those for which this agent is recommended. She improved, but the xanthium did not answer my expectations. But, as she had contracted the morphin habit, it was not to be expected that any remedy would have a markt effect.

WILLIAM F. WAUGH, M. D. Ravenswood, Chicago.

Therapeutic Philosophy and Hypermedication. Editor MEDICAL WORLD: If I had twenty or thirty thousand hands, with arms long enuf to reach half-way round the globe, I should shake hands with every one of THE WORLD family. That is my feeling, and I believe it is the feeling of almost all THE WORLD readers. The generous breadth and catholicity of THE WORLD'S editor have been contagious, and the result is a unanimity of honest purpose on the part of his subscribers. This fact is full of progressive promise.

In the spirit of helpful brotherhood, I want to submit some of the results of my studies, experiments and observations. I ask you to waive all schoolish bias and every partisan trammel, if you can, as we wade thru a little medical philosophy together.

I wish to call your most particular and serious attention to certain errors and abuses which inhere in all systems of medicine. If these could be weeded out, it would leave therapeutics on a plane not infinitely distant from scientific possibility.

There are a number of axioms underlying therapeutics which are as inflexibly true as are those fundamental to mathematics.

Thus, 1. No morbid effect can be dissipated except by a removal of its cause.

2. What will make, or tend to make, a well man sick will make a sick man sicker.

3. Medicine is medicine, and food is food. 4. Each drug has a specific affinity (kindly or not) for a particular nerve center.

5. A drug, to be remedial, must not, at least in the long run, oppose natural reparative effort. 6. A drug's capacity for doing good, when indicated, is invariably less than its capacity for doing harm when not indicated.

7. A drug is double-edged, so that, however much it may cut in the right direction, it will cut some in the wrong direction.

8. There is no such thing as a drug tonicdrugs are heterogeneous to the animal organism. 9. Hygiene is the big brother of drugs, psychology being included in this branch.

Examine these propositions thoughtfully and fairly, doctor, and see if you do not conclude that they are basic truths. I am sure they will stand the severest of analytical tests. It would follow that if we square our clinical methods with their essential principles, we shall not go far wrong. How many of us do it?

Perhaps the very most devastating evil pertaining to therapeutics is hypermedication. It was the accumulated results of this drug barbarism which led that grand medical scholar, John Mason Good, M. D., F. R. S., to say: "The language of the science of medicine is a barbarous jargon." It led Sir John Forbes, M. D., F. R. S., of London, to say: "Some patients get well with the aid of medicine, more without it, and still more in spite of it." Doctor Frank, an eminent English practitioner and author, said: "Thousands are nually slaughtered in the quiet sickroom." Professor Jameson, of Edinburg, said: "Nine times out of ten our miscalled remedies are absolutely injurious to our patients." The great Dr. Baillie, of London, said: "I have no faith whatever in medicine." I could quote utterances of the same tenor from many of the great lights, including Dr. Evans, Fellow of the Royal College of London, Dr. Bos

tock, author of the "History of Medicine," Sir James Johnson, M. D., F. R. S., editor of the London Medico-Chirurgical Review, our own Dr. Oliver Wendell Holmes, and others. It merely proves that these men were conscientious, independent thinkers, and that they accepted therapeutics as taught by the dominant school. More; it proves that their disgust was so general and massive that they were unfair in ignoring the two or three therapeutic certitudes their school had evolved, such as quinin in morbid periodicity, mercury and iodid of potassium in syphilis, etc.

The general status of therapeutics has been finely illustrated by the numerous articles on pneumonia which have appeared in THE WORLD within the last few months. Suppose an intelligent Martian should visit the earth, and study all those articles (each of which was written by a sincere believer in his own method) with the purpose of learning the correct treatment of pneumonia; what would be the effect upon him? If it should not set him crazy, it would drive him to the conclusion that "any old" treatment will do for pneumonia, or that the main thing is to keep the patient full of some kind of medicine. Now, honest to God," doctor, have I exaggerated? You do know that I have not done so. We are all in it together, for one of those articles is mine.

Now if it is a fact that light medication is as successful as heavy dosing in pneumonia, is it not the urgent suggestion of wisdom that we adopt the former? I need not name them, but the reasons are numerous and rational, why we should adopt light medication if it is as effective. Included among them is a clinical culture and refinement which shall be in esthetic harmony with our high civilization. We can step as far away from the coarse methods of the present as we have already stept away from the use of the bolus, the moxa, etc.

It is certain that a much greater proportion of patients recover under light than under heavy medication. This is as certain as it is certain that we almost never know which is exactly the right drug at the right time. Hence we violate axioms 1st, 2d, 4th, 5th and 6th. Besides, it is Besides, it is conceded by all intelligent, unpartisan and honest observers, whatever their school of medicine. You see it has to be true, unless those axioms are false. The overdrugging eclectic or physio-med is just as

unsuccessful as the hypermedicating "regular," unless it should happen that their drugs are less toxic.

Please note that I do not insist that light medicators know any better which is the right drug, in a given condition, than do heavy medicators. It is the superiority of temperate drugging that I insist upon. What I mean is well illustrated in Dr. Spurgeon's treatment, Feb. WORLD, p. 61. It is physio-medical treatment, not eclectic, as Dr. Taylor supposed. The combination-lobelia and capsicum-evolves a drug expression which is very little opposed to the vis medicatrix naturae, if it is not positively helpful to it. The philosophy underlying their use is false, for the idea of simultaneously relaxing (depressing), and stimulating the organism, is selfcontradictory. The primary expression of the drugs are reciprocally nullifying. The medicinal output of the combination is neither depressive nor stimulating, unless the bulk equation is not identical with the drug expression. Dr. Spurgeon will forgive this little critical dash when I say that I know his method of treatment is highly successful. I know of but one method of treatment which I think is a little better, and it may be only negatively better, its superiority being dependent upon its greater friendliness to the lining of the stomach. When he claims to have lost only five per cent. of his cases, I can eagerly believe him. So do I believe Dr. Berry Bowen, (Feb. WORLD, p. 63) when he says he has lost only two cases in nine years when he has been called in within fortyeight hours. I believe him just as truly as I believe Dr. Spurgeon, altho he is an ex

cessive medicator. I believe him because there is an aura about his method of statement which is possible to a sincere and earnest man only. I am sure of this, tho, that his comparative success has not depended upon his hypermedication. I am sure, too, that his strong common sense will soon constrain him to use less medicine.

It was my purpose at the outset to discuss several errors or abuses, but the first one, hypermedication, has absorbed all the space I can decently ask for, and it is not half exhausted. If the editor should think it will be of sufficient interest to his readers, he may permit me to continue thru future numbers. I would say, finally: Since there are only five or six so-called drug certitudes between the wisdom of expectancy and the universality of m

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