to give syr. of hypophosphites to a yearold baby with no teeth and unable to walk, after seeing the almost magical effect of a ten-days' treatment. I can not conceive that all of the master minds of the profession who have gone before, and those who are still with us, have, with ourselves, been deceived as to the results obtained by this class of remedies. I do not pretend to explain how or why these results have been attained. The theory is that there is a lack of these substances in the system, therefore they should be supplied. Dr. Cooper's theory is well, I will not attempt to give his theory, as he has explained it in a very lucid manner. Now, a noted teacher of medicine has said that when we have facts there is no more need of theories; and it is certainly a fact that we have seen remarkable results from the use of iron in cases of impoverisht blood, or else we have been sadly mistaken. I would not wish to be understood that we should blindly give iron whenever we have anemia, but intelligently inquire into all of the symptoms, make a thoro examination of the case and prescribe the best we know for the good of the patient, and neither give iron in every case, nor leave it out of our armamentarium entirely, as a hobby, simply because we have given lots of study to the question and cannot understand why it should do good.

Dr. Lockhart also, who is a very entertaining writer, seems in my estimation to be in the stirrup riding a hobby; or at least examining some questions thru colored spectacles. Does he really mean to say that therapeutics is the science of guessing? Does he really charge his patients for guessing what remedies they need? Does he believe if every one was free to charge for guessing that the fittest guesser would survive? No, verily. I have read some of his articles which would indicate that his therapeutical skill was something more substantial than mere guessing. I have not the time to notice his article (page 319) in full, but will say that altho a diploma is no evidence that a man is not a bigoted ignoramus, or in fact that the holder has medical skill, yet it is evidence that the man has attended a certain term or time at the place where medical knowledge is best learned.

He says: "The survival of the fittest is an inexorable law of evolution." Let him understand that all legislation requiring doctors to pass a certain length of time at

a recognized medical college, and to pass examination before members of the profession, is part of the weeding out process of evolution, as much so as when healthy, strong male animals crowd aside the weak and sickly for the good of the species.

For the benefit of Dr. Wallace, page 338, I will give the treatment most beneficial in my hands for the conditions mentioned. For congestion of kidney, counter irritation followed by covering the kidneys with a protector of felt or oiled silk. Low specific gravity: above treatment for cause, plenty of water injected to counteract the effect, viz: The accumulation of toxic material in the organism. For high tension pulse, be careful to give no digitalis, but give nitroglycerin, sufficient to get its effect on the pulse, up to 1.100 gr. every fifteen minutes if needed. As to diet, I have formulated no rule. Every case must be regulated by common sense. Medication? Iron, strychnin, potass. bitartrate, are the principal drugs I use. according to indications. Mild climates are the worst, especially moist mountain valleys and the sea coast.

I wish to say a very few words on Dr. Ramsey's case (page 339). I have been called a number of times where nature or the medical attendant had failed to deliver the placenta in abortions at about the fourth month, several times when the stench from putrid placenta almost drove one from the room, and have never failed to empty the uterus by combined pressing on the fundus with left hand and introducing two fingers (not the whole hand) of the right hand into uterus, then by patience, with gentle manipulation the placenta can be removed entire, no matter how rotten. Make fingers of right and left meet at the fundus, and by gentle pressure the placenta will be loosened and be expelled with the fingers. I have never had to use chloroform in these cases unless ergot had been given, causing spasmodic (hour glass) contraction; then a few whiffs will relax the circular fibers. I would lay down this axiom: Never leave a woman after labor or abortion until the placenta has been expelled. It may come all right; and then it may not.

What do the WORLD readers do for that numerous class of female patients who have leucorrhea, uterine congestion and other minor ills, who will use the various vaginal suppositories sold by agents and will not take office treatment? Let the country practitioners give their

Acid borici

Acid salicylici .

dr.

j

M. Fill in No. 0. or 00. capsules. I add such other ingredients as the case indicates.

For prolapsus, I direct the patient to take the genu-pectoral position every night, introduce two fingers into the vagina, spread them open, when the uterus will sag towards the umbilicus and assume as near normal position as it can, and if there are no adhesions and a good pelvic floor, this will do wonders if kept up long

enuf. Sometimes it needs six months, but most women prefer it to ventro fixation, and it is better than pessaries. Introduce one of the above capsules every night, or twice a week. For the various other ailments, as erosion of os, etc., add whatever is needed; sometimes extract of opium is needed for pain. I will not add more to this already lengthy letter.

Philomath, Ore.

C. H. NEWTH, M. D.

The Dual Action of Drugs. Editor MEDICAL WORLD :-Will the same drug stimulate you and depress another man at your right hand?

Will the same drug stimulate you now and depress you half an hour later?

Don't pronounce these questions absurd just yet.

We will for the present confine our attention to one authority of enuf prominence to satisfy most medical men-not because he's a worse sinner than others, but because he is the best and most recent authority at hand.

In Practical Therapeutics, ed. 1897, p. 47, we find him saying: "When aconite is given in moderate medicinal doses, it exercises no markt change on any part of the organism, save the circulation, which becomes somewhat slower by stimulation of the vagus centers," and then comes in the dual effect on the next page: "If large doses are used, the pulse becomes still more feeble and slow and the arterial pressure falls from depression of the vaso-motor center." Upon the same page a little lower down he gives a clear description of stimulation increast until the

"When aconite is taken internally in excessive amounts, it causes tingling of the mucous membranes wherever it touches them, which sensation finally amounts to severe burning" (stimulation): "this soon passes away" (exhaustion), "and is followed by a sense of tingling about the lips and finger tips or all over the skin " (stimulation), "at the same time the patient feels relaxt; the pulse at first becomes weak and slow, but later rapid and running, so that it feels a mere trickle under the finger" (approaching exhaustion). "Death may be gradual or sudden, the slightest movement of the body which can throw any strain upon the heart stopping that organ in diastole" (paralysis), for "the viscus refuses to respond to stimuli." Why? Because the condition of exhaustion has been induced by overstimulation.

As to veratrum viride, this writer quotes Wood with approval (p. 388,): Veratrum viride slows the pulse by a direct depressant action upon the heart muscle, and by stimulating the pneumoThat this misty teachgastric nerves. ing does not exist with these two drugs only, we will instance a couple of others.

Alcohol, of which Hare says: "It acts first as a powerful excitant and afterwards when given in very full dose, as a most active depressant and paralyzant of the nervous system. *** It stimulates the heart muscle and increases the rapidity as well as the force of its beat.*** "Along with the stimulation of the heart, a rise of arterial pressure ensues, largely due to increast heart action and partly to vaso-motor stimulation. * ** In very large toxic doses alcohol depresses," (exhausts) and finally paralyzes the heart and vaso-motor system as well as the nervous system. *** 66 Respiration is stimulated by small doses of alcohol and decreast by large ones. *** Its chief uses are as a rapidly acting stimulant in all forms of cardiac failure due to shock or poisons, and as a systemic support and stimulant in low fevers and in prolonged wasting diseases, in old age and in convalescence from acute disease. ***There is danger of pneumonia from failure of the right side of the heart in sub-acute and chronic alcoholism, and the physican should always be on the lookout for this complication."

With these statements before us, is alcohol a stimulant or is it not? The pres

ent writer believes it is always a stimulant, and what is called depression is the exhaustion of over-stimulation, and that it would be difficult to differentiate this condition from the extreme exhaustion induced by physical exercise, provided the history and the odor of alcohol were absent.

Strychnin-of which the same work (p. 288) makes these statements: "The rise of arterial pressure which it causes is due to the stimulation of the vaso-motor center," and with intervention of merely a punctuation mark, goes on to say, "If very poisonous doses are injected intravenously, a fall of arterial pressure occurs instead of a rise, which is due to vaso-motor depression."

The writer finds it very difficult to be lieve that a drug is a stimulant one moment and a depressant the next, or a stimulant in one patient and a depressant in another lying beside him. He much prefers to believe that once a stimulant, always a stimulant. He therefore thinks that aconite is always a stimulant and verat. vir., always a depressant of the ganglia controlling heart pulsations.

An example will make the idea clear, and we select a remedy of ancient lineage and in common use among members of the Regular and Eclectic Schools, as well as the followers of Hahnemann-ipecacuanha. The establisht fact that it will not act if the pneumo-gastric nerves are severed, demonstrates the necessity of vital force to secure its action, which brings it within the scope of this discussion. Its time-honored and pre-scientific use in the large dose as an emetic is well known even to the laity. The use made of it by Hahnemann's followers in the minute dose was made widely known to the regular profession by Ringer. The regular profession has thoroly proved its efficiency, and both effects are cordially accepted by the Eclectic School. The U. S. Dis. states that ipecacuanha in small doses is a stim ulant to the stomach, and Hare says: "Locally applied to mucous membranes, ipecac acts as an irritant; emesis is due to the irritation of the stomach and to an effect upon the vomiting center in the medulla. (Pract. Therapeutics, ed. 1897, p. 234.)

Accepting these statements as true, in accordance with the views just advanced it must be stimulant to the stomach and irritant to mucous membranes in large doses. We will assume a normal organism, and beginning with a minte quantity we

As

will administer the drug to it in gradually increasing doses. At first no appreciable effect is produced, but at a certain point. as the dose is increast, slight heat in the stomach is experienced. As the dose continues to increase we have successively nausea, secretion of mucus, emesis. suming that we have an organism in which the vitality is deprest, manifesting itself locally by nausea and vomiting, and we begin giving ipecacuanha. In the minute dose, which in the normal organism produced no appreciable effect, the stimulating or irritant action raises the vital force in the stomach to the norm and the nausea and vomiting cease. Gradually increase the dose and we get successively warmth in the stomach, nausea, increast secretion and emesis.

"Few remedies are so efficacious as ipecacuanha in checking certain forms of vomiting." (Ringer's Handbook.) As to the kinds of vomiting, he says they are in adults, (1) vomiting of pregnancy, (2) nausea and vomiting during lactation, (3) nausea and vomiting at menstrual periods, (4) the morning vomiting of drunkards. (5) morning vomiting of general weakness met with in convalescents. This is confirmed by Hare. (Pract. Therapeutics, 1897, p. 235.)

A condition common to all these diseases is the deprest vitality, and it is this condition of deprest vitality manifesting itself by nausea vomiting for which ipecacuanha is a specific remedy thru its local stimulating effects. The dose being just too small to stimulate the stomach beyond the norm, checks the vomiting. By increasing the dose, over-stimulation occurs, ending in the production of emesis. If the vomiting is produced in the first place by an irritant, over-stimulation is already present and ipecacuanha in any dose is useless as a means of relief.

In the opinion of the writer, the dfficulty has arisen thru attributing two actions that are opposed to each other to the same remedy-the so-called dual effects-and that this error is made possible by the failure to use a distinct idea of the difference between depression and exhaustion, for tho in some respects similar, they are far from being identical.

For instance, a man may be so deprest by a blow over the solar plexus that he may be unable to move; the vitality is all present but is temporarily held in abey ance and nothing but rest is needed to remove the depression. But if the inabil

ity to move is induced by want of food and continuous labor, the vitality is exhausted or gone, and it will require outside aid in the shape of nourishment in addition to rest to restore the vitality and remove the exhaustion.

It would seem to be demonstrated that authorities fail to use the word necessary to express clear ideas when describing the effects of drugs. For, if these clear ideas are possest by the authorities themselves, their language leads to much confusion of thought among their readers.

And, notwithstanding their reiterated statements to the contrary, the questions asked in the first sentences of this note should be answered in the negative.

GEO. W. AYLSWORTH. Collingwood, Ont., Canada.

Should Belladonna Enter Into the Composition of Laxatives?

Editor MEDICAL WORLD:-Ever since it has been the fad, I have wondered why belladonna is added to laxatives, and have been surprised at the alacrity with which the great majority of the profession follow without thinking or questioning. They just follow. The effects of belladonna are well known. 1st. It arrests mucous secretion (and others.) 2d. It paralyzes circular muscle fiber. 3d. It diminishes sensibility, all of which are contra-indicated in constipation. We often see ipecac prescribed to promote mucous secretion, with belladonna, which arrests it. We see strychnin and aloes prescribed to stimulate muscular contraction in connection with belladonna, which counteracts muscular contraction. We see these and other drugs ordered to excite sensation, along with belladonna, which allays sensation.

But, says one, it prevents griping, and the dose is so small it can do no harm.

In the first place, the doctor who prescribes a laxative that will gripe makes a mistake. Belladonna prevents griping by diminishing muscular contraction and sensibility; at the same time it no doubt diminishes secretion. If it does these things it does harm. Then the dose is not so small as it appears. The effect of belladonna continues for from one week to ten days. If a dose equivalent to s gr. of atropin be given three times a day in one week we have accumulated the effect of gr., not a dangerous dose, but an unpleasant one, as it produces dryness of throat and dilation of pupils, and aggravates

all the unpleasant pathological conditions that exist in constipation.

But, says another, the pills always act. Certainly, because the doseage of cathartics is sufficient to overcome all the antagonism of the belladonna, so far as the bowels are concerned. I have before me

B

Aloin
Cascarin

Podophyllin res

Ext. belladonna. Make one pill.

gr.

gr.

gr.

gr.

There is enuf cathartic in this pill for a physic, and ten times as much as is usually needed in a laxative pill, with the belladonna left out. For cases that go for two to four days without action, I usually give aloes grain, or podophyllin e grain, or one drop of the fluid extract podoph. with a tonic, three times a day. In two or three days it will act, and in a week or two it may be diminisht. The smallest amount that will do is what should be given.

If belladonna was left out of the heart tonic tablets it would be an improvement. Belladonna is a remedy that should be continued more than a few days.

Now, Mr. Editor, if I have started the doctors to thinking and to using the knowledge they have instead of following the untherapeutical and unpathological use of belladonna in laxative pills, along with other discarded fallacies, I am happy. Lancaster, Ohio. G. A. HARMAN, M. D.

The Injection Treatment for Hernia.

Editor MEDICAL WORLD:-From the inquiries received, concerning my article in the August number of THE MEDICAL WORLD (page 326), I should have given fuller details of how I treat cases of direct hernia that cannot be retained by a truss.

I first retain the hernia as much as possible and give a few treatments of the weaker fluid, which soon contracts the opening sufficiently to control it, after which the progress is much more rapid.

It is advisable to put such patients to bed for a few days till the hernia can be retained by the truss.

If the patient cannot be quiet until the herniæ are under control, in cases of bad double ruptures, valuable time can be saved by treating one at a time, as it is frequently possible to retain one of the ruptures with a truss when both could not be.

The following questions were also received: "Do you consider the injection treatment entirely free from danger?" "In how large a percentage of cases in your practice do you have abscess occurring after the operation ?"

The treatment is free from danger when properly administered, or such is my experience, as I have given over 3000 injections without unfavorable results, and have never had a case of peritonitis or abscess, but the anatomy of the parts should be carefully studied as well as the different varieties of hernia.

There is no question but that the injection method will soon be the principal treatment for hernia, especially if Assmy's

statements are correct.

In the July issue of the "New Albany Medical Herald," page 145, appears the following, "Muscle Atrophy as a Cause of Post operative Hernia ":

"Assmy conducted a series of experiments upon animals with the idea of determining in what wise the danger of hernia after abdominal operations might be obviated. He carried many of his incisions to the right or the left of the median line thru the main portion of the rectus muscle, afterwards closing this incision by buried sutures, bringing the various structures which had been divided in close contact with each other. A subsequent examination of those animals showed that there always resulted an atrophy of that portion of the muscle lying between the incision and the mid-line of the body, and that this atrophy corresponded exactly in its features with the wasting observed after division of the nerve supply. As corroborative of these facts, the author also observed that after an operation practised on the human thru the rectus muscle, the portion of the muscle lying to the median side of the incision atrophied completely. Upon these facts the conclusion is drawn that the extra median incision may be followed by hernia, not only because the scar tissue virtually stretches, but also because from division of the terminal branches of the intercostal nerves which supply the rectus, this muscle atrophies, and hence is unable to withstand the intra-abdominal pressure.'

If there be atrophy of the rectus muscle due to division of the nerve supply, is it not equally true of the other muscles divided by an operation for hernia ? C. FLETCHER SOUDER, M.D.

Philadelphia.

A Cure for Malarial Hematuria. Editor MEDICAL WORLD:-I read many articles containing ideas on practice, but I like these ideas to be put into practical use and then afterwards talk of proven results. We all have ideas in our minds, but they are of little or no value until such value is proven.

I propose to give you a proven fact concerning the treatment of malarial hematuria. I started out from the Jefferson College in 1866, laden with many beliefs which soon proved to be fallacious when it came to saving life.

We fought too much against the laws of nature, we broke down instead of holding up the physical forces, and consequently, soon saw the temple swept to ashes, for we added fuel to the flames. Seeing too much of this, I resolved upon a more conservative life-saving method if I could find it. I studied physiology more closely and reasoned from common sense principles.

I am a native of Kentucky. I never saw a case of malaria hematuria until I went to South western Arkansas. There I met a fellow physician of the Jefferson. He extended me all courtesy, and I visited with him his sick. One day he went to see one of these cases. We found the patient dying. Said he, "We never cure these cases; they all die." I said I would like to take a tilt at one from the beginning. He replied, "You shall have a chance." The next day while in his office, in came a man from a river bottom with a bottle of urine, looking like fresh blood. "There," said the doctor, "is a genuine case. Go and take it from the start." I followed the man to the scene.

Patient as yellow as an orange; incessant vomiting; chamber half full of this urine. I had before me my first case. I knew nobody's treatment and consulted. no author. I explained to the patient that I was sent out by his doctor, who could not come just then; that I would represent the doctor, who would visit him later. This was satisfactory. I began my treatment. I said to some of the visitors who were a dozen or more: "Good men, with your help we will make an effort to save this man. Go at once to the corn-crib and bring me one dozen ears. Put water in that pot and put on a big fire, and let this corn come to a boil as quickly as possible." It was soon done. We put one ear at a time under the sheet that the man was lying on, until we had packed it on each