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Dr. A.'s example), he leaves the kick there. All that constituted that kick-a mode of the trinity referred to-is translated into another mode, namely, inflammation. It is merely a different expression of the same thing. This is true with reference to any disease. It is easy to logically demonstrate it, but I have not the space to spare here.

"What will make or tend to make a well man sick, will make a sick man sicker." This, too, is self-evident, but I would better logically diagram it. Here is an axiom in physics: "Like causes produce like effects." The truth of this depends upon the fact that effect is projected cause. The sound of a bell is, in everyday language, several removes from muscular contraction, but in the ultimate it is the same thing differently exprest. Like produces like: Ipecac will as certainly cause emesis in the sick as in the well-sickness does not abolish the law of vital responsiveness. A is well, and his death-resisting power is 100. B is so reduced by sickness that his death-resisting power is only 25. Inject 's of a grain of strychnia into A's arm and it will pretty certainly not kill him. Do the same for B and it will necessarily kill him. "Action and reaction are equal"-another physical axiom. A survives because his organism is en rapport with this fact, in relation to the quantity of strychnia given; B's is not, and he dies. There may exist in B chemical or mechanical reasons why only a small fraction of the poison reaches his vital center, and he survives it. This circumstance would reduce the example to one in which B got only a minute dose of the poison, and it does not affect my proposition a particle.

Infinitesimal doses will not make a well man sick, and they will not make a sick man sicker, even if the drug is not indicated. Large doses of any drug will make a well man sick, or a sick man sicker, but right doses of the right drug, being curative, can not make the man intrinsically sicker. It seems to me nothing could be clearer and plainer than this, because if it makes him sicker in the true sense of the word, it is not curative. To be made temporarily more miserable by the right drug (and this sometimes happens), is not to be made sicker. W. C. COOPer.

Cleves, O.

Do not forget special offer of WORLD for four years for $3. Hope you will join our large and happy "family." It is a family of mutual helpers.

369

Attention to the Eyes of the New-Born. Editor MEDICAL WORLD:-In August WORLD, Dr. W. C. Stirling writes (page 322), "Are we justified in putting a strong (?) solution, 2 per cent. of nitrate of silver, in the eyes of every new-born baby?"

I do not consider a 2 per cent. solution as strong; nor do I see that it could do any harm, even if there was no danger of infection. As a prophylactic measure it might be productive of much good. He also says: "Wouldn't it be better for the Doctor to see that the mother has no discharge associated with the gonococcus?" It would be better, if we could have the case well in hand prior to being called to attend the woman in labor; but how many of us ever know anything at all, or even see a case, before being called to attend the labor? In my experience, the majority of women are, from various motives, prone to wait until labor sets in before they decide what physician they are going to have, presumably because they are afraid that, should they select a certain one, they would not be able to get him at the critical time, on account of other engagements. Hence they wait and catch up the first one that comes along. This applies only to the class of patients that could be suspected of serving as a “habitat" for "Mr. Gonococcus." Hence I always make it a practice to have a 2 per cent. solution of nitrate of silver in my obstetrical bag, and use it on all of the above cases, and those that are, or should be "sans reproche," I attend to, or wash the eyes myself, using a plentiful supply of soap suds. Excuse this lengthly reply to Brother Stirling. His article is a good one and timely; but it is only by a discussion and exchange of ideas and experiences that we could ever expect to improve ourselves in any calling. McCormick, S. C.

J. A. MELDau.

Danger in Prescriptions.

Editor MEDICAL WORLD:-It is not always safe to use tempting prescriptions found circulating in current medical publications; indeed, it is prudent to scrutinize carefully those that contain powerful or poisonous ingredients, ingredients, even when found in standard medical works.

A great many years ago I had under treatment an obstinate case of ozena that had resisted all ordinary remedies. Finally I took from a well-known medical work a formula that I hoped might act favorably in the case. I gave it no

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Rule for Accurate Administration of Medicines.-Young Physicians Should Locate in the Country.

Editor MEDICAL WORLD:-I have been a reader of your valuable magazine for a number of years. I have gained much valuable information from the editor and

M. S.-For a snuff. Use ten or fifteen his correspondents, and will say that for pinches a day.

The druggist kindly returned the prescription with a note of inquiry, asking if I really meant to use that proportion of iodide of sulfur. Upon reflection, I conoluded that I did not really mean it.

I then addressed a note to the publishers of the book aforesaid, calling attention to this questionable formula. I am sorry to say that subsequent editions of the same work still contain this formula, unaltered. I venture to say that no person has used this compound snuff a second time. If any one is in doubt as to its action and effect, let him try it just once, and he will be

satisfied.

This incident is recalled by a formula that I find in an advertising pamphlet just received. Doubtless this pamphlet has been sent to thousands of physicians in various parts of the country. There is no chance for mistake in the symbolism for ounces and drams, for the quantities are plainly set down in words and figures.

Here it is:

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"Of all the journals I have had to drop on account of the hard times prevailing in this section, I cling to THE WORLD first, last and all the time." E. H. Winkler, M. D., St. Charles, Ark.

"I like THE WORLD and have great sympathy with you in your efforts at reform, but here one must have a "pull" to do anything."-H. Clay Carson. M. D., Sugar Grove, Va. WORLD one year and Dr. Waugh's book, $5. You need them both.

the average M. D. there is no better journal printed. Much has been written on disease, its pathology, symptoms, cause and treatment; yet we do not all look thru the same glass, and cannot always see as others see.

What I wish to call attention to is the manner in which medicine is administered. So many times we prescribe one or more preparations to be given every two or three hours, separately. Sometimes it happens that the nurse left in charge of medicine forgets which one comes at a certain time, and the medicines are not given as directed. Frequently the memgiven as directed. bers of the family take turns in giving medicine, and the trouble is renewed by the last one not telling which medicine was last given. To avoid these troubles I have adopted the following plan which has workt well for me:

Let us take it for granted that there is a time-piece in the sick-room, and let meditime-piece be a clock, its strike will tell us cines be given at the even hours. If the

that medicine time has come.

Say we commence at 1 p. m. Give one tablet every three hours, at 1, 4, 7, 10 p.m., and 1, 4, 7, 10 a. m.

One teaspoonful of solution in a little water, at 2, 5, 8, 11 p. m., and 2, 5, 8, 11

a.m.

Nourishment, at 3, 6, 9, 12 p. m., and p.m., 3, 6, 9, 12 a. m., each day.

If you will carefully study the above plan you will readily see that the nurse or any one who takes charge of giving the medicine cannot go wrong or be misled as to what medicine comes.

I have adopted this plan and find that anyone who is capable at all of giving medicine, can give it on time.

If the patient sleeps, say from 10 p. m. to 4 a. m. each or any night, commence with the medicine that should be given at the time the patient wakes: i. e., nourishment at 4 a. m. by our card of directions. Now my brother physicians, try this plan and you will be astonisht how plain and easy it is for any one to follow direc tions.

Another subject upon which I wish to

THE MEDICAL WORLD.

say a few words is concerning locations for young physicians:

We are aware of the fact that during the last ten years, at least, the towns and cities are getting more than their proportion of physicians, according to the population of cities and towns as compared with the country. As a result, the cities are full of physicians and the country is deficient. The country physician is getting along better to day than any time previous in my recollection. Very few country physicians who are active, industrious men are not making plenty of money, so to speak, for one in our profession. We hope many of the young men who go from the various medical schools will come to the country and not go to the cities and merely eke out an existence.

I am aware that in cities there are a few men who enjoy a lucrative practice and do well; but it is not so with the average. And further, there is no better place in the Union for the young man to take his chances than in our State, West Virginia. This State is coming to the front in coal, oil, farming, etc. I have observed a number of young men who started in the practice of medicine in obscure country places, who placed themselves on a solid financial foundation in a few years-say ten to fifteen years.

What more do we want? Besides, we are respected and better treated, as a general rule, than in the city. So, in conclusion, I say to the young men, study this question and decide to try a country practice, and take a look at the State of West Virginia; and if this State does not offer you a fair show, tell me I do not understand what I am writing about. J. L. SAMMONS.

Calis, W. Va. Treatment of Gonorrhea.-Vaginal Douche After Labor.-Impacted Colon. Editor MEDICAL WORLD:-In your issue for August, page 312, treatment for gonorrhea is askt for, and my plan of treatment being a little different from that generally given in "the books," I submit it for the benefit of WORLD readers. It has given me general satisfaction. A case will best illustrate my method of treatment. F. C., age 21, laborer, called, stating that some thing was wrong. Examination showed a well developt gonorrhea; free discharge with inflamed and pouting orifice. Put him on saturated solution of equal parts of sulfates of magnesia and soda, with 3 to 5 drops of fld. ext. phytolacca dec. and

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10 drops of fld. hydrastis without alcohol, for each teaspoonful, with direction to take a teaspoonful every three hours until bowels moved freely, then often enuf to keep them freely open. Within two or three days, soreness, redness and pouting were gone. I then gave him a solution of permanganate potass., gr. j to ounce, to use as an injection morning and evening after passing water. During first week he was bothered with priapism, which a few doses of brom. potass. would relieve each night. In veterans a stronger solution sometimes becomes necessary, but for beginners one grain suffices.

This with me has been quite satisfactory, and my patient don't carry his ad

vertisement on his breath.

I fully agree with Dr. Hamilton (page 318) in regard to the vaginal douche after confinement. With an experience of over 33 years in country and in city practice, I have never had a case of puerperal septicemia, and have never used the vaginal douche except in cases of miscarriage with dead fetus, or where there has been much difficulty in applying instruments and delivering the child. My rule is to thoroly cleanse my hands, not with sublimate solution, but simply with boiled water and good soap, and I have many times used home-made soft soap.

Dr. Keller's case, on page 340, reminds me of one I saw in 1896. A young married woman about 25 years of age had been under the care of some very intelligent physicians; she had been an invalid for over three years, able to be out of bed but very little in that time. When she got out of bed she could not straightenleft side seemed too short, and limbs not under good control; appetite poor; unable to sleep at night. Suffered pain in the back most of the time, but when lying in bed she lookt fairly well. After seeing her several times and examining her, I came to the conclusion that there was impaction of the lower bowel, and quite likely some ulceration at or near the sigmoid flexture of the colon. Put her on minute doses of mild chlorid every third day for a time, followed with infusion of senna and magnesia sulfate, until free purgation followed, and between times the fountain syringe and rectal tube were used. This, in connection with tonics, was continued for some two or three months, she improving all the time until she was able to be about the house, and she has continued to improve, and at

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Unexpected Death During the Course of a Fever.

Editor MEDICAL WORLD:-Please give your views on the following case:

I was called in the afternoon of July 24, '99, to see Miss H., age 13 years; large for her age and had always been healthy. She had been suffering seven days, was taken with a chill followed by fever, which continued to the time of my visit. She complained of no pain except slight headache. Subsultus tendinum was rather markt. Tongue coated, but not very heavy light color in front, but brown further back, with red edges. Complained of bad taste; had slight tenderness in right iliac region. On the fifth day Dr.

who had been in charge until I was called, had given a large dose of podophyllin that moved the bowels eleven times the next (sixth) day of illness, and at noon the seventh day it was repeated. I was called at four o'clock that afternoon and found her with a temperature of 102°, pulse 120; complained of no pains or aches except slight headache; drank some water, but had no desire for food; did not sleep much; kidneys acted fairly well; no sweat. Her menstrual flow started about the sixth day, it being her regular time. She had been this way for several months, but regular from the beginning. About midnight of the seventh day she became delirious, and about three o'clock commenced to sweat, which soon became profuse and cold. At four o'clock a. m., I was sent for again. The boy said she was delirious. I supposed it was due to fever, and I sent some acetanalid with caffein cit. to support the heart, and told the boy I would go as soon as I returned, as I was almost compelled to visit the lady I had started to see; but before I could get back the girl was dead. She died at eight o'clock that morning. I was giving her quinin sulf., potass. bromid, zinc sulfocarb., bismuth subnit. and salol, and also the above antipyretic. I thought I had a case of slow fever with a malarial element, to contend with; expected her to be quite

sick, but had no thought of her dying at that time. Please give diagnosis and

cause of death.

Golden, Mo. G. D. QUINN, M. D.

[Were there any dark discharges from the bowels? The case was probably typhoid fever, and the large doses of podophyllin might have caused hemorrhage from the bowels, resulting in death. Sudden and unexpected death during the course of typhoid fever is unusual except from this cause.-Ed.]

Malaria, or Its Kin.

Editor MEDICAL WORLD:-It was with much interest that I read, very carefully, the article written by Dr. W. B. G., in July WORLD, page 281, on Acute Bright's Disease." The article was interesting to me because it explained so accurately and so conclusively a condition so prevalent and so frequently met in the swamps, (and also the hills) of S. E. Missouri and Arkansas. I was pleased that the Doctor had a doubt as to his case being one of Bright's and it occurred to me that if he had had two or three years in the above-named above-named region, he would, beyond any question, have past his case along as one of frequent occurrence, instantly recognizing it as that terror of conditions that we call, for want of a better term, "chronic biliousness" and its sequelæ. I am aware of the fact that the condition intended to be conveyed by that term is questioned by some, but the term is one that expresses, admirably, such conditions as above referred to. Of course there are degrees of intensity in different cases. Upon the peculiar action and characteristics of such troubles I have been able to find but little literature, and I take it for granted the condition found in his case was new to the doctor or he would not have askt for an expression from others.

His case resembles many I have seen, some grave and some mild, and from close observation I have drawn conclusions that I will try to give as plainly as possible.

There is a daming up of the bile ducts. The secretion from the liver and gallbladder that should flow freely into the intestines and act as a digestant and disinfectant, cannot pass, on account of congestion.

Results: This bile and its bile products are absorbed into the general system. The poison produced by fermentation in stomach and bowels, that the bile is supposed

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to prevent (and we believe it does), is also absorbed into the general system. Results again: Headache and fever; pain in limbs, back, kidneys, liver and spleen; enlargement and congestion of liver and spleen; edema; scanty, high-colored urine with high sp. gr. and acid reaction, albumin and anasarca. All of the most prominent symptoms of various diseases, sometimes of one and sometimes another -pneumonia, Bright's, consumption-and I have seen it simulate diabetes mellitus and cerebro spinal meningitis.

Is it not a fact that when one function of the human organism is out of repair, congestion of other organs is liable to occur? and specially congestion of the liver, which undoubtedly exists in all these troubles, produces grave symptoms by the absorption of poisons into the general system that should have been eliminated by that organ.

Bear in mind the four escape valves of the human system: the bowels, the kidneys, the lungs and the skin; and when any one of the outlets for waste products is clogged, it throws extra work upon the other three, and like an invading army, overcomes the power that is trying to hold the fort. Hence congestion: bronchopneumonia is a fitting term for such congestion in the lungs; Bright's is a fitting term for such condition in the kidneys; edema is a fitting term for accumulations of such waste products in the tissue cells. The point I desire to make is, that under such conditions we fail to recognize the true base of the troubles. What better proof can we ask to establish the seat of trouble in the Doctor's case than his own words? "lumps of thick bile were found in the stool" after giving the calomel. In other words, the great dam was broken down by the action of the calomel, and nature again was allowed to perform her functions properly. A little watchfulness will sometimes clear up great doubt.

Well do I remember a case in my own experience where the severity and prominence of symptoms indicated that the patient's lease on life would soon expirea case in which several good physicians said there was no hope. Edema was so prominent that pitting was pronounced at any point on surface of the bodybody anasarca. Lungs congested, cough and spitting of great chunks of mucus. The urine presented every indication of Bright's in its most grave form. Liver and spleen were swollen out of all proportion. Con

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sulting with an able physician of some thirty years in the service, we gave her up for lost, and hinted, in as mild manner as possible, that she would probably live two weeks. The case drifted out of our hands and was lost sight of for almost a year, when she appeared again, hearty, robust and well. Naturally, we were interested in tracing her history, for we supposed her dead. We learned she had fallen into the hands of a "swamp" doctor of no repute, but who had sense enuf to know how to give calomel and quinin in that country. This so-called doctor had put her on a strictly anti-malarial treatment, which means ten times the medication that the same case would have required had it been in Illinois. Where we use one grain of calomel in Illinois, in that country we use ten; and quinin in the same proportion. So I want to conclude by saying that the description of the Doctor's case is a perfect word picture of what we call "biliousness,' call "biliousness," "bilious malaria," or "malarial poisoning." If the Doctor cannot credit the word of one who has been there, let him try it for two or three years, and he, like myself, will become frightened as to his own safety and that of his family, and seek a climate more healthful and more free from malaria and its kin. Such cases as I have cited are rare in this section, due to a more favorable climate and less decaying vegetation and stagnant water; but there are few localities where such a condition cannot exist under malarial influences.

Mattoon, Ill.

W. L. SHANK, B.S., M.D.

Replies to Drs. Cooper, Lockhart and Others in the August "World."

Editor MEDICAL WORLD:-I am pleased to find that we have doctors who are not afraid to advocate their views, even tho they are not in line with establisht teachings in our text-books. We may not be able to agree with them, they may be only riding a hobby or exploiting a fad, still it does one good sometimes to have his inherited views or opinions stirred up by such articles as Dr. Cooper's "Therapeutic Philosophy."

Very few of us who have practised medicine a few years would have the temerity to withhold iron from anemic. patients, especially after time and again witnessing the glow of health return to the pale ears and prolabia after a short course of iron. Neither would we neglect

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