Replies to Queries and Comments. Editor MEDICAL WORLD:-Your quotation from Dr. Lamphear seems to me so important that I want to say a few words on the subject. I have no word of condemnation for the specialist, who has done so much for the advancement of our science, but the solid truth is that he has far and away the best of it, and too often is content to take all that comes his way from the family practician without a thought that reciprocity is the life of trade. No one-sided arrangement can be permanently successful. If the specialist takes from the other's practice a share, and gives nothing back, it will result in ruin to the latter. Do not think that you can escape from this conclusion by confining it to individual instances. We are dealing with the question in its broad, or general application. Every transaction we have with our fellow-men results either in a profit or in a loss. If each nets a loss, the inevitable end is bankruptcy.

If the specialist takes all the fee and gives nothing back, he has robbed his benefactor. And the latter has already suffered that certain loss of prestige that follows the calling on another doctor for aid. Have we not all of us noticed the reverence paid to the "head doctor," whom we have acknowledged our superior by thus calling for his assistance? And have we not seen the family show their undervaluation of us by asking his opinion of other matters, and too often calling on him to attend the family in their next illness? These things rankle in the hearts of every one of us. I had to quit calling on a distinguisht colleague and do my own surgery because every patient I sent to him for operation dropped me for him, and I lost the family. And never a dollar came back to me in return for the hundreds I put in his pocket, most of it out of my own.

On the other hand, it is obviously improper for the specialist to bid for cases, and the man who puts up his patients to

the highest bidder is unworthy his title of doctor. The late Dr. Agnew, who had one of the biggest hearts in the profession, was accustomed to hand the doctor a part or all his fee, when he suspected that he needed it. He was sorely missed by many a struggling man who had to choose between his duty to his patient and his duty to his own family.

It seems to me that this matter, like many other difficulties, is best settled by perfect frankness on the part of the attending physician. Let him plainly state the case to the consultant, and let brotherly love and fair dealing rule. And if the latter prove a specimen of the genus hog, why, thank heaven, there are others. Every leader has his close second, and so go down the line until you find a Man.

The dictates of common sense would lead one to limit his consultations to the exclusive specialists, who take no practice outside their chosen field, or else choose one too far off to be a competitor.

The services of a specialist can and ought to be made pecuniarily profitable to the doctor who calls him in. Many times people will pay a city professor a fair fee for surgical specialty work when they would not willingly pay the home man half the sum, altho he might be able to do the work fully as well. Besides, the city man may bring the later improvements to the notice of his colleague, who has not the same opportunity to witness the practice of the great men in the centers. The fees may justly be divided in such cases. and the family doctor be left richer in purse, in knowledge, and in the estimation of his patients. It is to the interest of the consultant to confirm the other in the family, for there will be more work at another time. A few well-chosen words of commendation go so far. Once I remarkt as the doctor left the room: "What a man that is! It is a pity that such a man should ever die, and his priceless knowledge of his patients' constitution. and his skill in handling disease, die with him!" And this was not a bit of flattery, but the sincere expression of my belief. It was a new thought to them that the old doctor they had been familiar with for so many years was respected for his professional attainments by the city professor he had brought so long a distance to perform an operation. And I tell you, gentlemen, the most serious problem to the specialist to-day is the restoration of the family doctor to financial independence.

For

There are two classes of inebriates: those who really want to be cured and those who don't. The latter form a numerous class. As soon as they feel their taste for alcohol becoming impaired they quit taking their treatment. them the only rational treatment would be that in force at that remarkable place, Inquirendo Island, where they dumped into the sea. Now that we possess an assorted lot of islands in the far-away Pacific, we might well devote some of them to this purpose, and expatriate the voluntary inebriates to a place where they would be unable to obtain liquor, but could earn a livelihood in the easiest man

were

ner by, letting the food drop into their

mouths. This for the individual who, by the custom of the island named, had had an inquiry held over his case and been pronounced useless or unfit to be any longer a member of the body politic. There are many such that could be spared, men who live off their relatives and repay them in shame.

Dr. Granbery, page 327, asks the best treatment for gonorrhea. Treat it as any other acute inflammation, in so far as putting the patient to bed, on low diet, with the bowels kept open by saline laxatives. After each urination wash out the urethra thoroly with hot potassium permanganate solution, as strong as the patient can bear. Give internally a grain of calcium sulfid, chemically pure, every hour till the patient has taken seven grains each day. Continue till the smell of the drug is evident to the patient and his friends, on his breath; then lessen the dose to three grains and continue till there is no evidence of the malady remaining.

If all women cared as much for their health as they do for their looks, Dr. Ritter's sensible letter ought to be reprinted and placed in the hands of every girl. But they rarely do, and while the knowledge that constipation ruins the complexion may induce them to keep the bowels open, until health is considered the most beautiful thing a woman can possess, they will continue to despise it and tightly lace their waists. A doctor can usually cure one of them by supplying a more agreeable and hygienic support to the waist, but he cannot well dispense the remedy to all his lady patients who stand in need of it.

Dr. Higgs, page 338, asks for help in a case of thoracic pain following an injury. The only feature mentioned that throws

any light on the nature of the injury is the shifting character of the pain. This may indicate a traumatic neurosis, but not necessarily. She may have caused an aneurism, dislocated one of the thoracic organs, or injured a vertebra, the osteopaths would say. Only a thoro physical examination would enable one to make a clear diagnosis. Meanwhile, give her potassium iodid and bromid, a dram each every day, keep her bowels open, give rather low diet, and place around her chest a firm bandage stiffened with whalebones, like a corset, to limit motion and give the injured parts a chance to heal. Would a little arnica internally be of value? It is worth trying. Coed a

Personal preferences rule in recommending batteries, but I prefer the combined galvanic and faradic, as each may be needed. But the little pocket faradics are cheap, handy and effective, and I would not willingly give up my static machine. As a rule, the firms that advertise are the best to deal with, for if they did not give satisfaction to their customers they would soon be unable to advertise.

Dr. McDonnell's case, page 338, is not an ordinary one of desquamative nephritis. The enormous loss of albumin shows either amyloid disease of the liver and kidneys, or else it is one of those exceptional cases of which I have seen but few, and have never had an opportunity to hold a post-mortem on. post-mortem on. Nitro-glycerin is of no value in such cases, nor is the iron of any appreciable benefit-at least that has been my experience. Try her with the following: Sodium acetat, one ounce; acid benzoic, one dram; chloroform, half a dram; water, to make eight ounces. Mix, and direct: A teaspoonful every four hours, night and day. Diet of skimmed milk and freshly pressed fruit juices exclusively. Never mind the waste as long as the kidneys keep up the excretion. An egg a day will replace the lost albumin. Such losses sometimes accompany pyelitis. Keep the child in woolens and protect her from cold and colds.

A Brother, of Tennessee, page 339, has a case of epilepsy on his hands; at least that is the only diagnosis that seems to fit. He should examine her genitals, rectum, and the other sources of reflex irritation for the cause. Meanwhile, empty her bowels and keep them clear; restrict her diet to non-albuminous articles exclusively; cool her head with gelseminin; and moderate the motor excitability with

give the bromids. They only depress the patient and never cure. Test the urine daily to see if the uric acid is excreted, and if the excretion falls off, give glonoin and colchicin in full doses to restore it quickly. A case recently came to me in which the urine was examined immediately after a convulsion, when we expected to find a free uric acid excretion. Instead there was not a trace discoverable. Another fit was therefore to be expected, and it came promptly. The next urine showed a trace, and the spasms were milder. The suppression of uric acid before the epileptic paroxysm is the most notable feature of that disease. What brings about this suppression? When we answer that question we will have unraveled the pathology of epilepsy. Will the forced excretion of this acid prevent the paroxysm? Can we prevent it by rigidly excluding albumin from the diet? What are the best means of forcing the excretion? Please answer, brethren. I have answered many of your queries, and it is your turn now.

WILLIAM F. WAUGH, M. D.

Ravenswood, Chicago.

Therapeutic Philosophy.
No. 6.

Editor MEDICAL WORLD:-It was my main intention, in this series of letters, to expose some prevailing medical errors and abuses. In this case, mine has been the unpleasant position of the iconoclast. Who does not hate an iconoclast?-the heartless destroyer who wrecked our warmest and dearest illusions! His is a chilly and thankless task, and especially so, if he does not substitute new idols for those he may demolish. Under hasty contemplation, his achievements are liable to be regarded as negative in character; an endless iteration of dont's and no-sirs. But a little reflection will cause a revision of this conclusion, and one will be made to see that nothing else in the world is more positive than the advancefulness of iconoclasm. The iconoclast removes the obstacles to progress. The right maintains an eternal onward stress, but it is hindered by wrongs in its path. The iconoclast removes these. Is not that positive work? Which is the better; to know what not to do, or to know what to do? The question is an impossible one, because we cannot know what to do without first knowing what not to do.

The iconoclast teaches us what not to do, and by so and by so far advances us. Doing no thing is an advance upon doing the wrong thing. If, possibly, my arguments have made visible to some of my readers certain errors which were before invisible, I can afford to be hated as an iconoclast. I know the average medical reader wants to be told what to do; it is so much easier to follow directions than to discover the facts upon which they depend. But if he wants to make a good doctor of himself, the thing to do is to think and test for himself, availing himself, of course, of all the light he can get from others. I have, so far, given but hints relative to treatment in certain conditions. This is because (1), I do not know that my treatment, cleansed of certain errors, is any better than yours would be if freed of these errors; and, (2) because I set out to give you philosophie truths, rather than to give you my method of treatment. I have made a special study of medical errors and abuses, and you know life is not long enough to permit one to thoroly canvass this field, and at the same time make an exhaustive study as to the right in drugs. I have called attention to gross errors only. There are multiplied thousands of lesser ones whose ultimate eradication must depend upon an increasing realization of the truth of this aphorism: There is hope for the physician who will admit that he commits malpractice every day of his professional life.

I have discust the tissue-feeding notion as it prevails in the general profession. I promised to examine Schuesslerism. I could not help it, because the tissue-food idea culminates in Biochemistry." This tissue-feeding school is but little better or worse than any other one-ideaism. However, it is only its negativeness which saves it from being the worst of all. All the others, such as mental healing, hematherapy, osteopathy, etc., etc., are legitimate fractions of legitimate medicines, but "biochemistry" is not, and can not be such. It is a consequence of the eternal nature of things, that Schuesslerism must be wholly right, or wholly wrong. I wish I were as certain of getting to heaven as I am certain that it is wholly wrong. This fact is a painful one, for no greater blessing could be distilled upon the world than would be this system if it were a true, and not a false one. Many intelligent and conscientious men believe in it (some of them esteemed

friends of mine), but this is because they have not subjected its philosophy to logical dissection. That they should not have done so is not strange, since the doctrinal essence of the system has been accepted by all the doctors of all the ages. Actually, Schuessler did little more than to expand an idea which is as old as medicine. His immediate inspiration depended upon the misconstruction of a physiological enunciation. Moleschott had said: "The structure and vitality of organs are conditioned by the necessary amounts of inorganic constituents. It is owing to this fact that the proper estimation of the relation of the inorganic substances to the various parts of the body, an estimation which neither proudly disdains other momenta nor indulges in extravagant hopes for itself, promises to agriculture and to medicine a brilliant future." There is a little more of exactly the same tenor. After quoting this, Dr. Schuessler says: "These words caused me to found a biochemic therapy."

Now altho Moleschott's involute and turgid phraseology throws a nebulous glamour about his statement, it is plain that he merely wished to lift the inorganic elements into greater prominence. The mere ash left after combustion had been regarded as only waste, to be excreted; but this physiologist, falling in with the hints of one or two others, took the position that "the substances remaining after combustion-the so called ashy constituents-belong just as essentally to the internal constitution, and thereby to the basis of the tissues which gives to them their form and determines their species, as do the substances volatilized by combustion." Moleschott did not mean to teach that the structure and vitality of organs are conditioned wholly by inorganic constituents, but that is the construction Schuessler put upon his language, and that was Schuessler's fatal mistake. If Moleschott had written the word, partially before his word "conditioned," as he should have done, we would have had no biochemic system of medicine. But even if this physiologist had posited that vital processes depend upon functions of inorganic materials alone, how great would one's mental grasp have to be to enable him to see the fallacy of such a position? It is a consequence of physical consistency that the inorganic and the organic elements are of equal importance, a fact which ought to fall within the per

spicacity of a school boy. Both are necessary, and necessity is insusceptible of degrees in importance-necessity can be neither increast nor diminisht. In the processes of metabolism these elements co-operate and are completely interdependent. These facts are fundamental and irrefragable; no less so than are the axioms underlying mathematics, and yet Schuessler has founded a medical system whose doctrinal essence contradicts them! If some sciolist should found a medical system upon the postulate that, the whole is not equal to the sum of all its parts, he would simply duplicate Schuessler's achievement. The absurdity of his basic idea would be a little more evident, that is all.

Schuessler assumes that the inorganics (excepting water) are the histogenetic workers, and that any form of disease depends upon a quantitative diminution of a particular class. This assumption is traceable to nothing else than his misconstruction of Moleschott's statement. Το assume that, under collision, either element is more active than the other, is to deny that action and reaction are equal, and, therefore, to give either of them precedence in importance is to exploit a large streak of high-colored nescience. If we put an alkali and an acid together, which begins its work first, and which works the more actively? But if one class of molecular elements were more active than the other, how should we differentiate it? and if we could do this, what scientific reason would we have for totally ignoring the less active class in our medical philosophy? As a bracer, Schuessler quotes Virchow, who says: "The essence of disease is the cell changed pathogenetically." Virchow should have been less slouchy in his method of statement. The cell, doubtlessly, pertains very directly to disease, but it is not the essence of disease, unless disease is a form of matter. Even if his dictum were true, it would not help "biochemistry a little bit. The biochemic scheme depends upon the total dominance of inorganics, the absurdity of which I have shown.

The biochemist's knock-out therapeutic argument inheres in the following illustration:

"In agricultural chemistry we add as fertilizer that element most lacking in the soil. *****The same law of supplying a lack applies to biochemical remedies," etc. That this illustrative mesalliance should impose upon thousands of in

telligent people is perfectly astounding. It shows how superficially a very large class of people examine the arguments and conclusions of authorities. You see the example cited does not apply to the point they would illustrate in any possible sense. If certain elements are lacking in the soil (the plant's food), the plant will languish; if certain elements are lacking in a human being's food, the human being will languish. Manure the ground and the plants will revive; manure his food, so to speak, and the failing (starving) human will revive. The example given applies to dietetics alone. Would the "biochemist" attempt to restore the etiolated plants by inducting into them from the sixth to the twelfth attenuation of ammonia, or of the phosfate of lime or of potash? Particularly would they do this if the soil in which the sickly plants grew had a plentiful supply of ammonia, etc., etc.? Not to answer these questions affirmatively is to condemn biochemistry.

Now I wish in my soul that "biochemistry" were right. It is easily practised; the medicine is ideally pleasant, and it is absolutely harmless. But if there is anything optimistically positive in drugs rationally employed, it is our duty to antagonize a dogma whose merits are wholly negative, so far as drugs are concerned. I do not mean that the tissue salts are not medicinal; I mean they are not curative, given under" biochemic" indications. If "biochemistry" as practised by Schuesslerites, is, so far as drugging is concerned, harmless, this is far from true of it as practised by the schools which give medicine in sensible doses. If the administration of the "tissue-salts" by a Schuesslerite is malpractice for a negative reason, the same performance by all other schools excepting homeopathy is malpractice for a positive reason. If my arguments against the tissue-feeding notion are sound, then every time we give iron for anemia, lime for rickets, etc., we do an act which subserves error and which helps to perpetuate an evil. The "biochemic" system of practice is built, with rigorous consistency, upon the theory that if one salt is assimilable, and therefore curative (as they hold), the whole of the twelve salts are the same. Granting the premise, we must accept the conclusion, for it would be logically and physiologically inescapable. We do grant their premise every time we give iron for anemia, lime for rickets, phosphorus for neurasthenia, etc. It fol

lows that in practice we completely endorse "biochemistry," while professedly we do no such thing. In this, we are guilty of a form of self stultification which is creditable to neither our brains nor our hearts. The constitution of "biochemistry" is such that if one-twelfth of it is true, all of it is true. This is perfectly plain to every reader. every reader. As a perfectly legitimate outcome of the "biochemic" idea extended to its natural limit, Schuessler's system comprehends all there is of therapeutic truth. That is what he claims, and, admitting his premise, his claim is an absolutely consistent one. With reference to other schools in their relation to "biochemistry," it all whittles down to this: Those who give iron in anemia, lime in rickets, etc., endorse "biochemistry "; and to endorse this system is to condemn all other systems, whether we do it in words or not. To do this knowingly, and remain out of the Scheussler system, is to be guilty of a moral obliquity which is many degrees worse than inconsistency.

My next will be the last of this series of papers. It will be devoted to legitimate therapeutics, and will include what appears to me to be the rational treatment of anemia, rachitis, neurasthenia, etc.

On page 324 of the July WORLD, Dr. Alumbaugh gives me a few jocose raps. He is too intelligent a man to have been in earnest, as every reader will see. I suspect he wanted to call out a little elaboration from me, just for the fun of it. So here goes: I submit that if the possibility of effect is sequential to the actuality of cause (and this is undeniable), then to dissipate an effect we must abolish its cause. The effectness of effect derives its certitude from the causeness of cause, because under final analysis effect is seen to be mere projected cause. Whence, only the destruction of cause will abolish its socalled effect. But the proposition is selfevident to all sane people.

This marvelous temple of flesh and blood-it is perfect and self-sufficient. No disease originates within it de novo; the occasion always exists in the environment. Fetal malformations and hereditary taints do not constitute exceptions to this fact. The initiatives of these are extra to physical personal selfness. Out of that mighty and momentous trinity: force. matter and motion, all phenomena are evolved, and the immediate manifestation depends upon peculiarity of movement. If a horse kick a man in the belly (as in