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 treatment.

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.

Editor MEDICAL WORLD:-It is proper to take a glance at medical ethics before proceeding to the discussion of errors and abuses. Happily, the straight-laced majesterialism of the ethical past of medicine is fast disappearing. Still there are many who are too free with the use of the word quack. If there were a scientific and inflexible therapeutics, then this system, by the force of its evident rightness, would be the legitimate one. Any deviation from this would constitute doubtless quackery. But there is no such system, so that it is difficult to make charlatanism depend upon therapeutic methods. The difficulty is increast by the fact that the mortuary lists of differing schools do not help us out in the matter. Let us be fair about it; we may call Christian Science a humbug (which I believe it is as a system), but can we call it quackery? Unless they lose a greater proportion of patients than do drug doctors, we cannot call them quacks. Realizing how much malmedication there necessarily is, and remembering that the patients of Christian Scientists escape all this, is it not probable that they can show as creditable totals as we? This, which may be true now, won't be true in the future, because the legitimate physician will add to all the psychologic benefits of christian science, doubtless drug benefits, instead of subtracting from them, as is now done in a majority of cases by over or wrong drugging. It is a little humiliating to concede the fairness of the foregoing argument, but I believe that every unprejudiced and hard thinker will do it.

Quackery, in my judgment, depends almost wholly upon business methods. The doctor who spreads himself showily thru the lay press, and who handles secret

preparations, is a mountebank and a beast of prey. He well deserves the ostracism of all decent people, medical or not. Fourfifths of our worst quacks have hanging in their offices diplomas from reputable medical colleges. Their turpitude depends upon vulgar gall, not upon method of medication. They sin more against the dignity of a learned profession than against the laity, excepting that they are practised robbers almost to a man. Let us not denounce the adherents of one-ideaistic systems as quacks, but as visionaries, sciolists, etc.

No

A criticism of the college methods of the regular school will seem a brazen thing in so obscure a personage as myself, but it is certain that such criticism is justified. The fault I shall call attention to is coming to be recognized by many of the more thoughtful of the dominant school, as it has been so recognized by the membership of protestant schools for a long time. What I refer to, is the comparatively small amount of attention the teachers in the regular school give to therapeutics. end of time and labor are given to etiology, pathology and diagnosis, while the study of drug action-the heart of medicine-is made next to incidental. The clinical value of all the rest of medicine is as one to ten compared with that of a knowledge of drug spheres, with their associated symptom-schemes. To cure a patient, we must give the right drug, and whether we do this or not must always depend upon our knowledge of two things: symtomatology and drug action. We may affect a "proper" scorn for the empiric, but it is an implacable fact that he bears to us the relation of master to slave. Rational empiricism constitutes nearly the whole of the healing art, whatever may be its relation to medical institutionalism. We laugh at the symptomic elaborateness of homeopathy, but are forced to acknowledge that if they are excessive in this, that is better than negligence in it. It seems a pity, but it is notable that the development of no trustworthy drug has resulted from scientific suggestion. The regular school is battling bravely and enthusiastically with bacteriologic relationships, but unless natural analogies stultify themselves, the ultimate result will be a splendid structure of ornamental knowledge-only this. The veil between time and eternity is not more impenetrable than is that between scientific prevision and the specific electivity of an untried drug. There is

but one way to establish remedial virtue in any agent, and that is by countless provings.

In this connection, there is a self-suggested rule which some may not have noticed. It is this: Generally, the efficacy of a drug in a particular condition is not establisht as long as it does well for some doctors but not for others; it must behave the same for all. For instance, the proper use of a reliable preparation of phytolacca in threatened mammary abscess always prevents the trouble. It will do this for any doctor on earth whose symp. tomotologic acuteness is equal to the discriminative strain (!) in the case. The niche for phytolacca in the therapeutic temple has, therefore, been hewn out. It is curative in all glandular troubles, and a specific for "gathered breasts," if given before pus has developt.

I have discust, far from exhaustively, the abuse: hypermedication. I propose, now, to call attention to a very comprehensive error, which holds a prominent place in the therapeutics of all systems which employ drugs. This error is that fallacy out of which has been evolved the idea of tissue-feeding. The theory is so plausible and fascinating upon the surface that only the most wary have not, to a greater or lesser extent, been entrapt by it. It is classical and blue-blooded to the very uttermost degree, so that you might, under its ægis, girdle the earth with funerals, and still maintain the smugness of "eminent respectability." It is astounding that this ankle-deep philosophy should have controlled the medical world for ages, and that it still does so to a great extent. That its necessarily negative or harmful results did not work its extinction centuries ago constitutes a scathing satire upon the obduracy of preterism, and the servility of orthodoxy. This half-baked philosophy, so far from losing vitality, has at last crystallized into a new medical sys. tem, but this will be discust later.

It is impossible to fairly treat this subject without, not in a mean sense however, stepping upon somebody's toes. This is because it cannot be so treated without seeming to disparage preparations which honest and conscientious men make to sell. But-think over it-must we suppress free discussion because it might hurt the sale of Hood's Sarsaparilla, for instance? Don't you know there are scores of "legitimate "drug preparations which are no better than it? On the other hand,

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can an editor afford to publish an article which adversely criticises, however justly, any preparation, the advertisement of which he carries? Happily, I don't think THE WORLD advertises a single preparation which I cannot more or less endorse.

To bring into startling relief the tissuefeeding fallacy, I will consider the subject of anemia. Now, doctor, does not the mere term, "anemia," start in you a ferruginous trend of thought? Certainly it does, unless you have a very independent and exacting method of logic. Anemia, iron-what ruthless iconoclast shall attempt to sever this twain, which have clung together thru all the historic past! Well, the investigating spirit of the age is going to do it. Within a year I have read two or three articles upon this subject, written by prominent regular physicians, in which iron was very considerably given the go-by. They did not make war upon this time-honored agent, but such allusions as they made to it were not caressive. They were a little gingerly about it, but they did go so far as to express a doubt as to whether the good qualities imputed to it were equal to the bad ones which actually do belong to it. Altho the tip of the white feather fluttered thru their dare-deviltry, the motif and bent of their utterances showed which way the wind medical is setting.

But anemia. The word is a misnomer, for anemia is not a disease-it is the effect of disease. I will not waste space in a description of the various varieties of anemia, included among which are oligemia, oligocythemia, or aglobulism, hypalbuminosis, etc. The causes of the different anemias are numerous and complex. I shall consider, principally, the commoner variety which, under a strained pathologic courtesy, is called idiopathic anemia. This is the form of anemia which has been ironed thru all the dim ages since Hippocrates, and which has ever transmuted the process into the sinister echoirony. You will infer from this that I do not advocate iron in anemia. I do not. I will present my objections as plainly and clearly as I can.

There is a family consisting of seven or eight persons. They all sit at the same table and eat the same food. One of them falls into the condition known as anemia. What is the cause of this? We know it is not a lack of iron in the food, else they would all become anemic. But can we give the patient iron under any other theory

than that he does not get enuf of it in his food? And in giving it, don't we assume to be better histogenetic caterers than Nature is? And if the monstrous conceit could be realized, and we could thus artificially feed the blood, why should the system ever again become reconciled to Nature's preparation of iron?

Having excluded iron-lack in the food as a cause of anemia, a class of physicians will, under the irresistible stress of common sense, admit that a form of malassimilation is at the bottom of the trouble; but, under pressure of orthodox impulses, they give iron just the same. Altho they will not admit it to themselves, they actually reason as follows, if they reason at all: "The ultimate condition of the assimilating apparatus is such that it can not appropriate iron, therefore I shall give the patient-iron!""

We have all of us read the scholarly papers of medical doctrinaires in which successive laboratory examinations of the blood were made during the adminis tration of some favorite iron preparation. There would be a steady increase in the number of red globules until the normal proportion was reacht. It is certain that most of these reports are perfectly accurate and trustworthy. But if these experimenters will surround the patient with the same hygienic improvements, the same psychologic influences, and give him, say the tincture of the muriate of ironconceded to be the best of all iron preparations-giving this minus the iron, they will note a much more rapid improvement. It is not the iron that does the work, but the elements associated with it. Hydrochloric acid is a positive remedy in several forms of defective assimilation. The iron can do nothing but harm unless it is a remedy for malassimilation. But we know that it damages the stomach and bowels and ultimately, therefore, the assimilative process. No one claims that iron directly improves the assimilative function. What kind of physical logic, then, would inhere in a fact which should depend upon the easy assimilation of the enemy of assimilation? It is understood, of course, that the iron of our food is assimilable, and is only barred out by a pathologic condition. It is not an enemy of ferric election.

If a lack of hemoglobin, or what-not, constitutes a disease, and to directly supply that lack (as by tissue-feeding, so-called) is to eure that disease, what a soft snap we can have of it, anyhow. What is the

use of spending months in curing anemia thru the round-about and tedious route of the prima via when we can do it in a few minutes by hypodermic injections? We obtain a drop of the anemic's blood, and by examining it, we ascertain just what element is lacking. All that is left to do then is to inject a proper amount of the "shy" elements, and presto, the patient is cured! I submit that this idiocy is rigorous and unshakable logic, with reference to the tissue-feeding idea.

Now all this is not to say that some ferric preparations are not more or less good, but they are good in spite of the iron they contain. More next month. Cleves, O.

W. C. COOPER, M. D.

[These rather bold expressions by Dr. Cooper inspires me to make a personal confession-let us always be willing to confess for the good of the profession and for the sake of truth. The lawyers have this saying: "A lawyer who pleads his own case has a fool for a client." So it might be said that the physician who treats his own case has a fool for a patient -or shall we say, has a fool for a physician? Last fall I occasionally had those symptoms of malaria best described as "a feeling of general cussedness." I took anti-malarial treatment, and felt well again. In a few weeks the symptoms returned, and I again took treatment and was well. After this comedy was repeated several times I began to resolve to watch for the septennial return and ward it off; but in time I found that the return was at irregular intervals. Then I tried regular and daily dosings with antiperiodics, but the depression came anyway. By this time spring was approaching, and while I had all along been "making a hand," my state of health was not satisfactory. I began to doubt my diagnosis. I then went to my scientific friend, Dr. Judson Daland, to see if he could find any malarial "jiggers" in my blood. I was surprised and somewhat disappointed to learn that none were present. To be a patient of Dr. Daland means business. I immediately gave up all further attempts at self treatment, and devoted my efforts to being a good and obedient patient (and that always pays). He made further blood examinations and found the percentage of hemoglobin much too low. Then he made a thoro physical examination, then close questioning as to diet, hours of work, rest, etc. I inadvertently mentioned a baked apple-dumpling with cream (of which I am

very fond), for dessert the day before, and all pastries were at once forbidden. And as for cream : "Yes, I take a great deal of cream; I drink my coffee half hot cream; cream has always agreed with me; it builds me up and sustains me." "But, Doctor, you are not digesting it. Let me see your tongue. I notice, also, that your breath is heavy. Avoid all fats for the present, and take milk instead of cream with your oat meal, coffee, etc." When we discust hours of rest, he said: "Now I am going to hit you hard. Nine continuous hours in bed! and one hour of complete rest and relaxation, with massage, in the middle of the day." My urine was analyzed, and every inquiry made in the direction of: "What is your system doing, and how is it doing it?" I was ordered to drink more water, and directed concerning physical exercise. Medicine? Yes. First a bitter tonic, and later a digestant was added. I had taken ferruginous hematics during the winter, but to little or no purpose. Calling to mind the diminisht percentage of hemoglobin in my blood, one day I ventured to suggest iron. (And this is the reason I am telling this story.) The Doctor said, "No, Doctor, I not only think it would do you no good, but in your present condition, I think it would do you harm." Thus, among the masters in medicine, cold scientific analysis, with a view to discover the abnormal in order to reestablish the normal, is superseding the easy and routine prescribing of iron, iron, iron. I rapidly recovered my usual health.ED.]

Notes and Comments.-Summer Diseases of Children.

Editor MEDICAL WORLD:-Dr. Cottew (page 191, May WORLD) certainly had nerve to give gr. 1-30 of atropin to a child six months old; and in spite of the favorable results, I would not care to repeat his experience. But I have given pretty nearly a relative dose of strychnin. Except in emergencies it is better to give the small doses very frequently until effect, as all danger of over-dosing is thereby prevented.

In Dr. Hill's case (page 192) the patient had disease of the arteries far beyond the affected limb. Assuredly the operation was justifiable, and the patient was given the only chance for his life.

"A Doctor's Wife," on page 193, asks if conception can occur doing menstruation. Not only so, but it is more likely to occur

then than at any other time. I have on several occasions advised childless couples to cohabit at this time, and pregnancy resulted. What effect does intercourse during menstruation have on the female? Sometimes a headache follows, but as this is a common thing at the wind-up of menstruation, it is doubtful if it is caused by the intercourse. Women are more amorous during menstruation, and some have the sexual orgasm then and at no other time. The menstrual flow may be increast by anything that arouses sexual feeling, such as toying with the genitals or the breast, by the free use of rich foods and stimulants, hot baths or hot tea of sassafras, tho that comes under the category of drugs. The most effective emmenagogues are potassium permanganate and other preparations of manganese, sanguinarin in frigidity, iron in amenia, colchicin in plethora, gold and platinum in obesity.

I cannot agree with Dr. Landes (page 194) when he blames the medical profession for the spread of morphinism. The cause lies deeper in the conditions of our modern civilization. As long as men will wreck their health in the mad race for riches that they cannot enjoy when they have won them, there will be the tendency to look to such drugs for temporary stimulation, for holding physical ailments in abeyance, or for a solace to their disappointment. Among the hundreds of cases I have treated in the last ten years there are scarcely any that could justly charge their habit to the doctor, tho some were ready enuf to saddle him with the wrong they had done themselves.

Dr. Stearns' letter (page 196) is most suggestive, but it opens the door to fruitless discussion. Do but suggest the prevention of venereal diseases by state regulation of prostitution, the only possible way, and Theology steps in to say to Hygiene, "Thou shalt not." And as Theology has not as yet devised a practical means of protecting the inexperience of youth, the perpetrator of a sexual sin is ruined, body and soul, and allowed to go abroad in the community, a standing danger to everyone he approaches, for the very insufficient reason that he ought not to have done it. This is not much consolation to the innocent victim, but such considerations have little weight with the people who construct their ideals of what men ought to be, and then send them to Gehenna because the clothes don't fit

But I must quit, or the small remains of my hair that the ladies left when I tackled the child-avoidance question will be in danger.

On page 200 "Central California" asks advice. The salient points in his case are, the evidences of abdominal decomposition, gas-formation, etc., and auto toxemia, as shown by the pains at points not affected simultaneously in any affection unless it be multiple neuritis. Pruritus is frequently an indication of uricemia. This is as far as one can go safely without a physical examination, but the location of the pains in the back and their persistence under good treatment, would arouse in my mind the suspicion of cancer somewhere in the abdominal cavity. Meanwhile the only treatment indicated by the symptoms given is: Empty the intestinal canal by repeated doses of some mild saline laxative and hot colonic flushings; keep him on an exclusive diet of milk and fruit juices, and give enuf sulfocarbolates to keep his alimentary canal aseptic; also a dose of pilocarpin enuf to make him sweat freely, repeated whenever the itching is noticed. My only case in which pilocarpin failed to relieve itching was that of poor Imgard, which turned out to be cancer of the liver. Mustard baths give complete relief when the pruritus is due to urticaria or prickly heat, and in other forms of cutaneous disease. In cancer of the liver there is the same tendency to find ease in lying on stomach as in cancer of the stomach, but not so generally.

A gentleman came to me recently for the morphin habit. He had contracted this terrible disease in seeking relief from the pangs of spasm of the gall bladder. He had had the gall bladder opened, over 100 calculi removed and the viscus stitched to his side. Since then he had been having frightful spasms in the gall bladder, the last requiring twenty-four hours' suffering, six grains of morphin and six ounces of chloroform to relieve. Evidently this was a case demanding something stronger than morphin to meet the indication; but when I suggested this he denied the existence of any such agent. He was not familiar with the resources of modern medicine. The morphin was taken off, the process requiring three days, without any special suffering; then the spasm appeared in all its vehemence. The pain was so intense that the man could not speak and he was as gritty as they make

them a Tennesseean-the pulse almost imperceptible, the extremities cold. I at once gave him a hypodermic injection of hyoscyamin, gr. 1-50, glonoin gr. 1-50, and cocain gr. 1-8. In a very short time he showed the physiologic effects of the mydriatic, when I gave him a whiff of chloroform, about five to ten drops. This settled the paroxysm.

But my next case was a caution! A woman who had taken morphin for renal colic, and was decidedly of the opinion that the drug was harmless, or at least that its use was unobjectionable. She had had better health than before she used it, had gained flesh," etc., etc. To those of us who are familiar with the drug-habits, such talk is evidence of an advanced stage of the malady, when the mentality of the victim is affected by the drug. However, she was put upon the usual treatment, the morphin withdrawn in two days, with very little suffering, when she suddenly began to writhe and groan, declaring that she had her renal colic! There were none of the symptoms usual in such attacks, but she averred that this was the way they always commenced with her. I therefore gave her the same combination as the preceding case.

The most markt effect manifested was dryness of the mouth, with delirium of active type. She claimed that the pain was still intense, but smelling the cork of the chloroform bottle sent her off, and she displayed the greatest energy in endeavoring to secure the chloroform bottle, a condition totally impossible to a person in the agonies of renal colic. In eight hours the delirium subsided, and after a moderate hypodermic of pilocarpin she slept about six hours, and awaked sane and cured of her desire for the drug.

My object in describing these cases is to call attention to the vast superiority of the new remedies for the relief of pain. Too many physicians associate the idea of pain with that of morphin, so that the one follows the other as a matter of course. And yet for the severer forms of pain morphin in any dose is inefficient. It cannot compare with spirits of chloroform for colics, cramps and other gastro-intestinal pains, while for the agonies of renal and hepatic calculi, and the major neuralgias, the potent combination above named is far and away more effectual. And who that has attempted with morphin to suppress the pain of confined pus, or of a testicle swelling under adhesive strapping, does not redden with shame as he recalls the experience!