majority of the cases of septic fever following child-birth.

J. M. HAMILTON, M. D.

Old Town, Tenn.

The Patent Medicine Question. Editor MEDICAL WORLD:-In the June number of THE MEDICAL WORLD, page 240, Dr. Benedict presents a well-written but pessimistic article on the ever-recurring subject of patent medicines. Near the close of his contribution the Doctor asks: "Can anyone think of a better plan ?" and says: "If so, let us hear from you, that we may usher in the beginning of some plan to maintain our standing before the world."

That is a laudable ambition, and I accept the invitation, altho my view-point is the very antipode of that of Dr. Benedict. I view this question from the point from which I have accustomed myself to view all questions affecting the general public-from the standpoint of the basal principles of our government; that a free, enlightened people are capable of self-government; that the natural force of evolution, untrammeled by vicious legislation, will eventually make natural selection the best selection; that the people should have the greatest freedom in their choice of government, their political, religious and social affiliations; in their choice of officers, religious and medical advisers, teachers, food, clothing, medicine and all other things that pertain chiefly to the individual, yet do not encroach too closely upon the rights of others.

The argument that the individual should have no right in the choice of remedies in any case of disease, that the choice of remedies is, in every case of sickness or accident, the "physician's prerogative," smacks sharply of tyranny. The tyrant is always an egotist. The survival of the fittest is an inexorable law of evolution, and if the medical profession cannot stand in competition with the patent medicine trade and force it out of existence without legislative aid, it deserves oblivion. there is such a thing as a discriminating public conscience, and medication by the profession is more satisfactory than self medication, the profession has nothing to fear. To confess to fear in this matter is to confess to inefficiency. After an experience of more than twenty years in the professional harness, I am convinced that inefficiency and consequent lack of confidence in the profession is the chief cause

If

for the use of patent and self-prescribed medicines. There are minor causes that will be noted in their place.

The profession has set for itself a high standard of education in anatomy, physiology, chemistry, etc., but the standard of therapeutics and practice is deplorably low.

Here everything is a sort of scientific hodge-podge-a dumping ground for experimental garbage. I fear no successful contradiction when I say there is no such thing as scientific therapeutics- a system of therapeutics that can be measured by the standards of true science. In this realm everything is rank empiricism, and it is doubtful whether from the very nature of things it ever can be otherwise. In every case of disease there is an unknown quantity, a dynamic force that can only be estimated or guest at. Science knows no guess-work. If therapeutics is confessedly the science of guessing, why should the laity be deprived of their right to do some of the guessing? No one will deny that it is to their guess-work experimentation that the profession owes the great majority of its most potent remedies. Witness the recent discovery, by the profession, that lard is a good antidote to strychnin, when that knowledge was the common property of the neighborhood in which the writer lived more than thirty years ago. Not only that, but in more than one instance a keenly discriminating public conscience has forced the profession to recede from some of its pseudo scientific death-dealing positions. Witness the indiscriminate use of the lancet and the mal-administration of calomel less than a half century ago.

The patent medicine men cannot in justice be accused of having ever foisted upon the public anything comparable with the atrocious medication that has in times past received the endorsement of some part of the medical profession. If we compare the ethical basis of patent medicine with some of the present day professional fads, the escutcheon of the former will, to the unprejudiced mind, appear several shades the brighter. No one will deny that vaccination and antitoxin have caused the death of innocent children and seriously impaired the vitality of others. In the use of these things, science has not demonstrated in what cases they can be used without danger of deleterious or fatal results. In view of these facts, what is the ethical basis for their continued use?

Simply the idea that a doctor has a moral and legal right to jeopardize the lives and health of an uncertain number of his patients in order to protect others, not from the certainty, but the remote possibility of disease or death.

This view of the matter finds the sanction of law in the legal maxim that "there is no crime where no crime is intended."

In Georgia, the State Board of Health ordered a wholesale vaccination of the unvaccinated; but the courts of that State have decided that the State cannot be held responsible in the way of damages for the evil or fatal results of the practice or the use of impure vaccine by its agents. Surely no crime was intended, but the Board of Health, as agents of the State, must have known positively, if it had carefully studied the history of vaccination, that a number of deaths would certainly follow the execution of the order. Such an order could only be executed under the specious plea that the State, as principal, is not responsible for the acts of its agents when they offer human sacrifice on the altar of science. The ethical basis of the order is the same as that of Weyler's famous reconcentrado order. The only difference is in the matter of expediency and the natural revulsion of public sentiment at killing many instead of few. Is this the true ethical basis of all medical practice? That it is the moral basis for the medical practice which many State legislatures and Boards of Health are endeavoring to force upon the people, under the guise of public protection, needs no argument. Many physicians insist on this ethical monstrosity as a basis for their own practice, but, in seeming oblivion to the inconsistency, clench their fists in spasms of indignation when the same moral code is applied to patent medicine men, Christian scientists and unlicenst practitioners. Patent medicine men are certainly not fools, and there is ground for fear that they who, in comparison, call them knaves, slightly overestimate the professional purity. There are doubtless some knaves among patent medicine men, but are there none skulking behind the gauzy code of professional ethics?

Dr. Benedict presents for our consideration a number of patent medicine formulæ. The most I have to say of them is that in a general way they are an improvement over hundreds of prescriptions written by prominent physicians and many of

the detestable mixtures kept in our drug stores for prescription use. Certainly Pinkham's Compound is an improvement

the time-honored prescriptions of savine, ergot, aloes et myrrh, etc., ad nauseam, for female complaints. In view of these prescriptions and mixtures, and the beastly examinations many women are subject to every time they suggest ovarian, uterine or vaginal symptoms, the wonder is that the demand for Pinkham's Compound and Pierce's Prescription is not larger than it is. In my own practice many cases have been cured after Pinkham's Compound and Pierce's Prescription had failed to give relief. Keep ahead of the Big Bottle procession and it won't hurt you. The formula for Piso's Consumption Cure is not less scientific than nine-tenths of the formulas for cough mixtures found in our text-books and medical journals. I have known several persons cured of dyspepsia by the use of Kennedy's Medical Discovery after "regular" physicians had failed to give relief and in some cases aggravated the disease. In these cases Kennedy's Medical Discovery proved to be a "powerful alterative”— it altered the minds of these men and their friends in regard to the ability of their doctors and the medical profession.

When a patient comes to me with the complaint that this or that patent medicine did no good, I at once determine to let him know that the advice of a physician is cheaper and better than newspaper advice; and if I fail to do this, I feel that I have dishonored myself and the profession. Never give a patient a chance to be cured or even benefited by a self-prescribed or patent medicine after your prescriptions have failed, and there will be no trouble about "maintaining our standard before the world."

Pressing forward for the right.

Keep your shield and honor bright;
And if a brother chance to fall,
Do not crowd him to the wall.
Better lend a helping hand,
Than with austerity to stand
Seeking legislative aid

To keep him down.

Taken as a whole, the Doctor's article is little more than a confession of ignorance and incompetence on the part of the medical profession, and a piteous appeal for help to lift incompetent physicians out of the slough of despond. I would gladly lend a helping hand to get them out, but confess to having no sympathy with the

Teach these medical mud-daubers that there is a high standard of medical education that they wot not of. "When the blind lead the blind, both will fall into the ditch." They have become so brainweary learning the minutiae of anatomy, physiology, chemistry, bacteriology, etc., that they lack the energy to learn the essentials of therapeutics. Teach them that most of their load of college cram must be left in the slough; put the staff of common-sense in their hands; teach them that a diploma or State license confers neither a patent right or trade-mark on medical knowledge and skill; that legislation is impotent to make them successful physicians; stimulate ambition with the essence of hope, and the wail of despair will soon change to a shout of victory; and the phantom corpse of the profession will no more rise up to frighten them.

Then will Science sit enthroned
Upon the "Rock of Ages,"
And her regal splendor fill

These bright and glowing pages.
DR. J. W. LOCKHART.

St. John, Wash.

Reply to Quercus.-Experience. Editor MEDICAL WORLD:-In your July number, Quercus, Ontario, Canada, asks of your readers seven interesting questions, the fifth being as follows: "Is it not better (considering the work of 'diploma mills') that each contributor to THE WORLD or any medical journal in the United States be required to name his alma mater for M. D. and for M. A., etc., etc.?"

My answer is, no. The name of a man's alma mater is no evidence that he is competent to write intelligently for such journals. At best, a man's alma mater is a diploma mill; it cannot furnish him with brains. It was not the alma mater of the immortal Harvey, nor that of the illustrious Jenner, that gave to the world knowledge of the circulation of the blood, and vaccination. Nearly all of the great truths known to science have been wrought out with brains, " on the flaming forge of life." Therefore, bearing in mind that "the Knowledge that a man can use is the only real Knowledge", let every writer, titled or untitled, who can add to the world's "real Knowledge" appear in a fair field with no favors.

It is thirteen years since I wrote to THE

ing a word of my experience. I have never lost a case of typhoid fever since I began using the Woodbridge tablets. I have demonstrated time and again, that the administration of calcium sulphid is the best abortive treatment for all cases threatened with suppuration.

Those of the profession who have not tried the above will do well to test them for themselves, and report thru THE WORLD. J. G. ATKINSON.

Bristol, N. B., Can.

How to Manage Your Prescription Business.

Editor MEDICAL WORLD:-The average man will think nothing of spending a week's wages on a picnic, an excursion, or as a fee to some lawyer to "make a case against a fellow sinner; or he will lose five to ten dollars on a horse race, or a little game of "draw;" but that same man will almost have a fit of gastralgia if he has to pay his physician two dollars for a visit. So he casts about for some less "costive" method for recovery. But he loses every time, because he spends more for various nostrums-so called cureallsthan the service of the physician would have cost; and, after all, he has to call in the doctor at last to save him from the effects of his self-medication. For the man who medicates himself has a fool for a doctor and an ass for a patient.

There is no one subject on which the people are so ignorant, and yet on which they think they are so well informed, as that of their bodily ailments and how to cure them. Each one has his own private formula handed down from father to son, with many additions to, and omissions from the original, but with an assurance of curative qualities that would appall the educated physician and even stagger the most blatant quack. With his head full of this superior knowledge, because he knows the names of the drugs in his prescription, he goes shopping from drug store to drug store, seeking the cheapest price he can get.

Many of these prescriptions come from physicians. For some reason, sufficient for themselves, they have written the common English names of the drugs, and, as a consequence, the patient knows apparently as much as the doctor. Now, when the physician writes a prescription in plain English he cuts off more or less of his legitmate income, because when the patient knows the names of the different

ingredients he buys them just as he would any sort of wares, without consulting the physician.

In

Again, the physician cuts off his legitimate income where he writes a prescription for some patent medicine, or nostrum. A vast number of these frauds claim to cure every ill that flesh is heir to. curable diseases are cured by these greatly advertised and much vaunted patent humbugs with an ease, promptness and facility that completely knocks out the educated physician. Yet, frequently, doctors will write prescriptions for some of these cheats. He loses his patient, very justly, too, because the patient finds that he can buy the proprietary article without the aid of the physician; and the physician loses his reputation also, for his patient sees that the doctor is prescribing for him that thing which he is denouncing to the public as a humbug, a cheat and a fraud. It has been well said that the physician who prescribes a patent medicine is too lazy, or too ignorant, to be a good doctor.

When a physician writes a prescription he should remember that he is putting into it knowledge that has cost him many years of hard study and much good money to secure. He should employ only technical terms and officinal names. The prescription should always be written very plainly, for it thereby makes a good impression on both the patient and the druggist. One great fault with the majority of physicians is the utter carelessness of their chirography. Many doctors seem to be possessed with the idea that poor writing indicates great genius, or, possibly a profound knowledge, when really almost everyone else thinks that illegible scribbling means ignorance and illiteracy. It frequently happens that prescriptions are brought to the druggist that can hardly be deciphered; it takes the combined intelligence of every one in the shop to determine exactly what is meant. Even then, after the customer has gone, it is a mooted question with the dispenser whether the patient has got what the doctor ordered. Sometimes all that prevents a deadly mistake is the druggist's knowledge of doses, as it is not possible to tell from the written directions just what quantity the doctor ordered.

Always write the directions plainly and in full on the prescription. Never, under any circumstances, say: "Use as directed."

Use your own prescription blanks. Do not be the tail to any druggist's kite. Blanks do not cost very much. Have the printer get you up a neat tasty headline, giving your office number and hours, and your residence. Have a line printed at the bottom reading: "Do not refill, do not give a copy of this prescription." Any honorable druggist would respect this request. If one disregarded it, see to it that he had no more business from you. Jos. R. PERRY, PH.D., M.D.

Indianapolis, Ind.

Ophthalmia Neonatorum.

Editor MEDICAL WORLD:-Not long since I was in an Eye Hospital and heard a young M. D. lecture on ophthalmia neonatorum. He said that every practitioner should carry a 2 per cent. solution of nitrate of silver and put it in the eyes of every new-born baby, to prevent the disease. After a practice of sixteen years, I have seen only a few cases, and could trace every one of them back to a specific cause. I believe that all the severe forms that call for nitrate of silver come from a special micro-organism. The mild type, nonspecific, has a tendency to recover without invading the cornea, and will get well with a simple eye-wash. Why should we carry a strong solution of nitrate of silver and put it in the babies' eyes when not more than one in every three or four hundred will need it? Wouldn't it be better for the doctor to see that the mother has no discharge associated with the gonococcus? It has been proven that inoculation with healthy lochia has failed to produce the disease.

We should see that careless bathing of the child with soiled towels and sponges is avoided.

The question is, are we justified in putting a strong solution of nitrate of silver in the eyes of every new-born baby? W. C. STIRLING.

Sulphur Springs, Texas.

[Specialists have so often witnessed the sad sight of infants' eyes destroyed by neglect of the proper treatment at the proper time that they feel very strongly on this subject. Hence the extreme advice above mentioned. This is a very proper practice among the lower classes in cities. where such danger to the babe is very frequent, but in the average private practice not among the above-mentioned classes. we believe the course mentioned above by the Doctor is the proper one.-Ed.]

Pulmonary Embolism.

Editor MEDICAL WORLD:-The two following cases have proven exceedingly interesting to me and to those I have had in consultation, and may prove of some interest to your readers, and at the same time teach us how exceedingly careful we must be in our prognosis of cases of similar nature.

Mrs. M., aet 33, multipara, engaged me to confine her with her sixth child. She gave a history of fairly good labors, and physical examination, including urinary examination, gave me sufficient encouragement to lead me to believe that her case would be one of plain sailing.

When I was called to her bedside I found that the os was lacerated by some previous labor and that practically nothing was left of the perineum. Head was presenting, R. O. A., and pains were steady, regular and strong. The child was born about two hours after my arrival, and placenta was exprest by Crede's method about fifteen minutes after the birth of the child. Uterus contracted firmly and remained so.

I bandaged firmly and left patient to rest, called the following morning and found everything progressing satisfactorily.

In response to an extremely urgent call that evening I hastened to her and found her in a cyanotic condition with hands and feet cold, feeble, rapid pulse, respirations 44 to minute, and complaining that she was choking. Uterus was still contracted and there was no flooding. The members of her family were extremely excited, and had not only sent for me, but also for nearly every doctor in the neighborhood. Diagnosis was agreed on as pulmonary embolism, and an extremely unfavorable prognosis given, and I was thus left alone in my misery to shoulder the responsibility and break the news to a despondent father of a house full of prospective motherless children.

I prescribed absolute rest and drop doses of one per cent. nitroglycerin solution to be given every two hours, and left my patient. I called early next morning and found her still alive and in a slightly improved condition. Respirations were reduced to 35 and pulse was slightly fuller and less rapid. Called same evening and found still more improvement. She slowly and steadily improved daily. No further complication appeared, and after three weeks rest in bed on a liquid diet she recovered fully.

Mrs. W., multipara, aet 40, extremely nervous temperament. Was called to see her and found abortion threatening at 8th week with excessive hemorrhage. On examination I found os patent and fetus presenting. I emptied vagina, doucht with creolin solution and packt with cotton tampon. Returned after eight hours, removed tampon and with it fetus and membranes intact.

Two weeks after she called at my office and directed my attention to a small painful nodule immediately under the center of the right clavicle. The spot was painful. I prescribed cold application and pressure. I called at her house two days afterwards and found spot exceedingly painful, red and semi-fluctuating. The upper part of right arm was swollen and there was an edematous area about six inches in diameter around the point of tenderness. I diagnosed case as venous thrombus, and as swelling was immediately under the skin, I opened it and peeled out an inky black clot the size of a walnut. I packed wound with gauze. Patient recovered fully in four days. Swelling of arm went down and edema disappeared.

Three weeks after this, patient called again at my office and declared that there was another swelling on the opposite side, and as she contemplated a trip to the West, she wanted me to immediately remove it.

When I examined this side I found no point of tenderness or swelling, but instead there was a large diffuse area of edema. I diagnosed thrombus, but could not locate it and prescribed absolute rest with arm in sling.

Had a consultation on following day and found patient's left arm, chest, neck and upper part of right arm swollen, but no localized swelling. Favorable prognosis was given.

This condition remained unchanged for a week, when I was called and found patient considerably worse, with dyspnea, cyanosis and complaining of choking. Diagnosed pulmonary embolism. scribed hot oxygen gas inhalations and nitroglycerin with very little effect.

Pre

Patient died following day of asphyxia. New York City. GREGORY COSTIGAN.

B. D. DeKalb, M. D., of DeKalb, Iowa, wishes to say to A. Jasme (see July WORLD, page 294), that if he will anoint his face and hands with cedar oil, he can probably fish in comfort.