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Isn't it strange how things come in bunches? When you have a breach presentation, for example, one or more are likely to follow soon after. Perhaps every doctor has noticed this more or less. It is so generally understood among doctors that an article sent to us receives no attention unless signed by the full name or accompanied by professional card of the writer (not necessarily for publication), that we very seldom receive a communication signed only by the initials or by an assumed name. However, a "streak "of this sort of thing is upon us. Please see standing notice at head of Quiz Column. Is it necessary to put the same notice at head of Original Communications also? No man should be unwilling to give his name with what he writes. It is necessary as a guarantee of good faith.

Therapeutic Philosophy.
No. 5.

Editor MEDICAL WORLD:-I have devoted considerable attention to iron, because it may be taken as typical of the various so-called tissue-feeders. There are numbers of others with which the general profession is familiar, and they have been uniformly employed under the tissuefeeding theory. Very prominent among them is some form of phosphorus. As civilization (artificiality) has advanced, and nerve-tension has increast, the imaginary demand for phosphoric preparations has grown. In this country, brain fag and neurasthenia have enormously increast within the last fifty years. The prime cause of these ailments, like that of all diseases, is extra-corporeal; but in this class of cases almost no secondary, or intrasystemic cause, develops, which is amenable to drug treatment. Why should the treatment of brain-strain, or nerve

strain, be different from that for eye-strain, muscle strain, etc.? We all know that there is but one remedy for a strain of any kind, and that is rest. If this strain has been merely severe enuf, or lasted long enuf, to only depress the patient's vital energy, enuf of rest will effect a complete Cure; but if its severity and duration has been such as to partly exhaust the patient's vital sum, he will not completely recover. In the latter case, he will be left in an etiolated condition which nothing will correct, unless it is a fact that one's vital sum may be increast, and this is not a fact. The vital principle cannot be considered as something distinct from the organism, but rather as the outcome of physical endowment. It is a remarkable fact that volume of life essence furnishes no basis of

calculation referential to longevity. A person whose vitality is 50, stands just as good a chance for long life as he does whose vitality is 100. It is all a question of economy against wastefulness-prudence vs. imprudence. An individual's life-fund is the peculiar complement of a particular heredity, and it is as inveterate as is the color of his skin. He, therefore, who attempts to medicate vitality into his patient, is wasting a vain dreamer's time.

The man who is suffering from brain fag -what has he been doing? He has been using up gray matter faster than his neuritic machine could grind it out; that's what he has been doing. He has tried to translate an emergency possibility into a perpetual certainty. He has been doing the fatuous role of the inexterminable perpetual-motion crank. Of a piece with this folly, he expects you to cure him with medicine. Why not? There is only a lack of phosphorus in his nerve tissue and phosphorus is plentiful. He could cure himself if he only knew what preparation of phosphorus to take. He has been taking a dash of acid phosphate in his ices, but for some inexplicable reason it doesn't reacheven a little bit. Don't scorn him too irrisively, Doctor, for he is only a layman. He has not ransacked the sub-cellar of pathology; he has not wound thru the labyrinthic mazes of the etiologic temple; he has not followed vital expression back to the arcana of primal activities-how could he know that this phosphoric lack is not the disease, but is merely its effect? How could he know that his neural factory is daily offered ample quantities of perfectly assimilable phosphorus, but turns much of it away because its capacity is limited, not

unlimited? How could he know that these marvelous little hoppers have lessened in capacity, as a result of over-work; and that to strain, has been added a crippled condition which may be irreparable? Think what a bright layman he would be to know these things, when such a tremendous majority of the doctors don't know them, or at least don't seem to know them. Now I cannot believe that more than a few physicians take the superficial view of neurasthenia I have imparted to this layman. Many have nearly no views about it, but give phosphorus in these conditions because other doctors do, or because authorities tell them to do it. Simply, they have not stopped to think about the matter. Many others know that chemical phosphorus is not a brain food, nor a nerve food, but they give the hypophosphites for two reasons. First: the simplicity and specious plausibility of the tissue-feeding fallacy instantly commends it to the wide-open confidence of the patient, and a psychologic triumph is scored. There is no doubt about the moral value of phosphorus, when the patient knows what a prominent element it is of nerve tissue. Second: Most phosphoric preparations contain other ingredients which are more or less indicated in the cases which are supposed to need phosphorus. I suggest these as probable reasons why many doctors give the hypophosphites, but I do not say they are good reasons. I believe all the WORLD readers will agree with me when I say that to knowingly give an unindicated drug is to do a wholly inexcusable thing.

Phosphorus is an excellent remedy when indicated. In fact, in certain conditions no other known drug can take its place. The best of all phosphoric preparations is the simple tincture. In most forms of hoarseness it is doubtlessly the best remedy known. In spasmodic, paroxysmal, laryngeal cough, especially in children, it is the most trustworthy remedy I have ever tried. Even the hypophosphites have merit in these cases, but the straight tincture is vastly better. The tincture is a good remedy in certain forms of cystic, prostatic, and testicular irritation. You can depend on phosphorus in any form to do no good in cerebral fatigue, nervous prostration, impotency, etc. I know whereof I speak, for I have had much experience with this remedy. I have not only prescribed enormous quantities of the hypophosphites, but have taken many bottles of it myself.

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Enuf of it will produce an ephemeral mental exaltation and an erotic conflagration. This is simply intoxication. Its action is purely catalytic, like that of cantharides or any other agent which is heterogeneous to the organism.

Even as you cannot directly feed nerve tissue, you cannot directly feed bone tissue. And yet, how few doctors can think of rachitis without thinking of phosphate of lime. Of course, if the doctor will pause, and think down one little half inch below the surface of things, he will realize that his patient is not rickety because its food is lacking in the calcium element. He knows its lime-electing cells are offered as much of this salt as are those of its brothers and sisters who are not rachitic. The cause of this trouble, he knows, is not lime-lack in the child's food. He knows that limelack in the bones is not the disease, but is the result of the disease. He knows that the ultimate lesion is a specific form of malassimilation, and he knows that a cure will necessarily depend upon a correction of this assimilative fault. He knows that the physician who ignores the cause and attempts to dissipate its effect is trying to circumvent the impossible. He knows that in such an instance the medical ministrant has his therapeutic pry under the wrong end of the malady. He knows that, altho one may take a water snake by the tail and by a peculiar flick, snap its head off, he cannot do that with disease. Above all, he knows-if he is a careful observer and has had experience that no form of lime is, in any possible sense, a remedy for rickets. He has never seen a case helpt in the faintest degree by it. He knows that it is philosophically and practically impossible for it to do any good in such cases. Now what will this doctor-who knows all these things-do with his rachitic cases? Unless he happens to be the one out of a hundred who thinks for himself, he will (very sensibly) improve the child's hygienic relationships, and then (very conscientiously) put it on-phosphate of lime!

If I have sought to bring this phase of human nature out in a strong light, it is because I so strongly feel the need of doing it. The nature of the subject is such that it is about impossible to comprehensively discuss it without seeming to assume a sort of superior isolation. The thoughtful reader will readily see this, and generously acquit me of excessive self-containment. I hope it is needless for me to say that I despise anything which even savors of autola

try. Any insular feature which may pertain to my method depends upon my heresy, and the fact that I have given special study to the questions I am trying to discuss.

Nothing less than a logical earthquake will shake orthodox conservatism. It is so easy to warm over old thoughts, and do over old deeds, and so hard to grapple new problems, and to actualize new philosophies. But it is the hardest of all to pi that solid stick of prejudice which you have been all your life in setting up. I have several times had my patience knocked into total depravity by the unconscious persistence of conservatism in some of my intimate medical friends. After having syllogized them clean out of classical error and back-age traditionism, I have seen them recommend in print for such as leukemia, for instance, the same ancient ferruginous misfits. In one case in particular, my amiability was strained to the snapping point. In this instance I knew that, philosophically at least, my friend was all right. He had conceded the invulnerability of my arguments against tissue feeding, etc., and had announced his intention to teach conformably to this divarication, for he is a college professor. But in an article of his upon "Palludal Poisoning"-written soon after our last interview-he said: "Of course, in broken down conditions characterized by cachexia and emaciation, you must give iron and cod-liver oil." My surprise was great, and when I called his attention to it, his astonishment was equally great. "Do you know," said he "that I did that unconsciously-automatically?" This was true, for he is an honest and a candid man. all goes to illustrate the fixedness and force of habit, whether of thought or act. But the daring, searching spirit of the age is rapidly disintegrating those ancient fabrics whose mortar is error, and whose brickwork is prejudice. This is destroying that automatism whose father is Servility and whose mother is Laziness when it is not Indifference.

In relation to phosphate of lime: It must not be inferred that, because I have condemned it in rickets, and do condemn it in delayed dentitions, broken bones, etc., I do not consider it a medicine. On the contrary, I am sure that in a few conditions it can hardly be replaced. I have used successfully in the diarrhea of teething children, in crusta lactea, in strumous conditions and in bronchial irritations.

There are at least a hundred conditions for which it is commended by various writers. In my next I will discuss Schuesslerism. Cleves, O. W. C. COOPER, M. D.

Replies.

Editor MEDICAL WORLD:-I shall try Dr. Priestley's remedies for membranous enteritis (page 275) in my next case. So far, I have had better results from enemas of silver nitrate, to 1 grain to the ounce of water, than from anything else.

Apropos of Dr. Bickford's letter (page 277) on cancer pastes have any of you ever tried a suggestion I once made in regard to mixing the chlorids of zine and of cocain? Cocain and fuming nitric acid, mixt together, form a creamy substance that has all the caustic effect of the acid but is quite painless. In using thiosinamin to destroy cicatrices, etc., I have found that by taking up the solution into the syringe, and then drawing in a few drops of a weak cocain solution, the injection is practically painless. In both cases the cocain seems to exert its anesthetic action instantaneously.

Dr. Wilson's case (page 277) was one of septicemia in the first place, and it is not unheard of for the temporary congestion occurring in that malady to fix on the brain for one of its manifestations. If the attack left absolutely no trace of paralysis it could not have been either apoplexy, thrombus, or anything that would permanently interfere with the cerebral circulation. Was there not a little, unconsidered wound of the hand, on the affected side?

One of your readers (page 294) asks for directions for ligating the dorsal vein of the penis. The first direction is-don't do it. When the penile veins have become so dilated that they empty the blood out faster than the arteries bring it in, erections become feeble or impossible. This is the condition present in many cases of impotence. There will then be found veins along the side of the penis much larger than usual, and these may with advantage be ligated. The dorsal vein is controlled by the compressor, and as a rule it is the lateral veins, not controlled by the compressor, that should be ligated. The operation is simple: Pass a threaded needle under the vein, and then back thru the same skin-holes, but above the vein, so that the latter is included in the ligature, which may then be tied, making a subcutaneous ligation. Done under antiseptic

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precautions no reaction follows, and the patient need not be confined to the house. The ligature should be placed as near the body as possible. The results are good, Dilatation is the result of over congestion, and this may in time lead to the enlargement of other veins, so that the patient should be warned that the restored function is to be used but not abused.

THE MEDICAL WORLD.

Inquiry is made (page 294) for something to keep away insects. At Columbus I picked up a cake of menthol soap, 10 per cent. I made a lather of it and applied thickly to all exposed skin. This kept the mosquitoes off for an hour or two.

Dr. Garrison (page 294) has an interesting case of gastric catarrh, with autotoxemia. Regulate his bowels with aloetic laxatives, put him on a diet of hot milk and fruit juices exclusively, and give him calcium sulfocarbolate five grains every two hours, up to forty grains a day. Keep him hungry.

sotect fin

315

one named. I have so often spoken of the
management of heart diseases that I do
not like to repeat. But the editor is so
thoroly right, in his advice to treat the
patient, that I must emphasize the im-
portance of his words. In all cardiac
affections the indication is present, of re-
lieving the organ of its work in proportion
to the degree in which it is incompetent to
accomplish its task.
If the leaky organ
needs help, don't rush off to your drugs,
but lessen the quantity of the blood it has
to propel thru the vessels. This can be
easily done by enforcing the dry diet, until
the influx of fluid is below the excretion.
This, with regulation of the exercise,
temper, bowels, etc., will enable the pa-
tient to live out his full expectancy, with-
out digitalis or any other heart-tonics.
But if such remedies are needed at first,
while the hygienic method is being put in
operation, give the true digitalin, gr. a' to
r's twice a day for a week, and follow with
cactus. If the dropsy really requires relief,
give magnesia sulfate, a tablespoonful of a
saturated solution every two hours till the
effused serum has been reabsorbed; mean-
while keeping up the strength with iron,
strychnin and good diet.

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

Dr. Shirk has met a difficulty (page 295) in finding as acceptable a remedy as the

317 Atten

Dr. Allard (page 295) can perhaps prevent an attack of asthma by taking a full dose of quinin at bedtime, or better by curing the nasal catarrh that is probably the underlying cause. Or, put the tissues in a state of tonicity by giving strychnin to full effect. The arseniate has succeeded in this disease, in doses of gr. 1-30 three to ten times a day.

Dr. Hunter (page 295) has one of those

19

Lard.

singular cases of herpes preputialis that give A Case of Strychnia Poisoning Treated With so much trouble. I have been consulted about many such, with the same history. An illicit connection is the starting point, no venereal disease ensues, but this herpes appears at intervals for many years. I think the future will show some specific micro-organism to be the cause, that makes the prepuce its habitat and occasionally arouses to activity. It may be objected that such an organism would be removed by thoro cleansing with antiseptics, but thoro antisepsis is by no means an easy thing to secure; and the germs may live beneath the surface. Wash well with solution of chlorinated soda, diluted enuf to avoid irritation but no more, including all the genital organ in the ablution; then apply europhen freely as a dry powder. Repeat this every day, being careful to use no soap, but borax, if a detergent is needed. I have succeeded in this way, tho there is a tendency to recurrence on exposure to vaginal secretions to which the patient is not acclimated.

Editor MEDICAL WORLD:-As considerable has been written recently about the antidotal power of lard in strychnia poisoning, I will report a case in point, trusting it may be of some interest to the readers of THE WORLD.

A few days since I was hurriedly called to see a man who, one hour and a half previously, had swallowed, by mistake, two ounces of Hall's solution of strychniajust two grains of sulfate of strychnia. The poison was taken just before supper upon an empty stomach, and when called to supper he was too sick to eat. I reacht his bedside within five minutes and found him lying upon his head and heels, with his back scarcely touching the bed. His muscles were very rigid and he seemed to be on the verge of convulsions.

I gave him a hypodermic of apomorphin 1 gr., and ordered a pint of melted lard which I forced him to drink; also gave him a teaspoonful of tannic acid dissolved in a cup of warm water. I repeated the apomorphin three times within thirty

minutes, making in all grs. He was terribly sick for a little while and vomited freely, after which his muscles began to relax, and in the course of an hour and a half he fell asleep and I left him for the night. On the following morning the first man whom I met on the way to my office was my patient. He was a little sore over gastric region, but has felt better than usual ever since.

Did the lard or the Lord save him?
Hayesville, O.
E. V. KENDIG.

Post Partum Douch is Seldom Advisable.

Editor MEDICAL WORLD: Recently I have read several articles in the different medical journals in regard to the post partum douch. Some praise, others condemn it. Some grow eloquent in praising and dilating upon the many advantages, and the much good that may be accomplisht by thoroly washing a woman out with some antiseptic solution after childbirth. Twenty-seven years' experience in obstetric practice has convinced me that there is nothing in it but harm. I have practist in the country among the common class of people; some very common; poor people, who, by the way, come nearer representing the human race in its natural condition than any other class of people we have in our country. Their diet is plain, dress common, but comfortable; they take exercise enuf to make them strong and healthy. Taking everything into consideration, they are a fair class of people to test in practice. Compared with what the modern obstetrician calls antiseptic these people in their surroundings are entirely anti-antiseptic. Yet the mortality in child-birth among this class of people is very small. I have in particular noticed the practice among the "granny" women, and I find actually fewer cases of septic diseases than among that of medical men. I had not seen a case of septicemia for years until I met with a case a young physician had waited on, and he tried to use modern antiseptic precautions. By some means or other he got her in a very septic condition. If we will use common sense in treating obstetric cases, it is worth all the antiseptic theory in existence. Parturition is not a pathological condition, but a physiological process. If natural, that is, if everything is in a normal condition, as regards mother and child, the less we do the better will be the result. Nature has furnisht her

helps and safe-guards; she lubricates the canals with mucus to protect the parts during the passage of the child; when the placenta is forced from its extensive connection with the uterus, the uterus and passages are bathed with blood. The white corpuscles, acting as disinfectants, are ever ready to attack and destroy diseased germs. Now if we take the case in our hands, discard the protection that nature has given the parts by washing out the uterus, removing all vaginal secretions, in place of doing good we are most sure to do harm. Of course there are exceptions to all rules; if the soft parts are lacerated and bruised, or in any way diseased, then appropriate attention is required. I am speaking of normal labor. Most practitioners are inclined to consider themselves "the Doctor," and make themselves meddlesome in such cases. Remember that when you go to a case of labor you are not to consider yourself a "doctor" unless something comes up to be "doctored." You are only to consider yourself a spectator; then ready for any emergency that may come up.

It is the physician's duty to be ready; to keep himself scrupulously clean; see that he carries no disease germs about in his clothing, or in that "old obstetric bag" of his. With hands washt clean with good soap, make a digital examination just sufficient to make sure that all is right; use as little force as possible; disturb the vaginal walls as little as possible; never handle the inside of the uterus if it can be avoided. If possible, make one examination suffice. In removing the placenta never finger inside of the genitals. It does no good unless the placenta is adherent; in that case, of course you must remove it. Use no injections in either the vagina or uterus after the placenta is removed, unless there is a complication calling for it. By observing these rules, I believe you will reduce your cases of post partum fevers and complications to a minimum.

There is one thing I have frequently noticed in practice among women; many women before marriage suffer from inflammatory troubles about the uterus, caused by improper conduct during their menstrual periods, and frequently, I believe, by improper dress. These women in labor are apt to have these old troubles renewed, lighting up a cellulitis, which frequently, owing to the condition of the parts, is apt to terminate in suppuration. My opinion is that these troubles form the

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