confined to those who can indulge themselves thus. There is much bad cooking among those in moderate circumstances; sour bread, beefsteak fried to death, absence of vegetables and fruits from the table, not because they are unobtainable, but from sheer lack of enterprise. People in quite humble circumstances can have a varied and attractive dietary if they will only manage well, buying each fruit and vegetable when it is the cheapest, at which time it is also the best. Thus the bread,

meat and coffee dietary, to which a surprising number of people confine themselves, can be greatly enlarged without adding to the expense. The broad gauge

physician will curtail or enlarge the dietary of his patient, according to indications, rather than give tonics, laxatives and digestives, or in addition thereto.

Treat the patient, his condition and habits, rather than his symptoms or the name of a disease. Treat him with proper habits, proper diet, and plenty of water, then add a little medicin if necessary. This may not be the most popular course at first with some patients, but the broad gauge man will insist upon it always, and after a while he will have the complete confidence of the community and the patronage that he deserves.

"External" Medicin.

In some of our colleges we have professorships of "internal medicin. But internal medicin is not the "whole thing." When we consider the possibilities of external applications of heat and cold, electricity, poultices, blisters, baths, etc., we find that there is a large field for external medicin. Will not one of our scholarly contributors take this subject up at an early date?

The approach of cool weather brings to our minds the importance of our "outsides." Many people use only two weights of under garments; a summer weight and a winter weight; and they usually drop the one and resume the other on a certain date-according to the calendar rather than according to the weather. A variety of weights should be at hand, and they should be changed according to the weather, and with but little if any reference to the almanac. Care in this respect, particularly in the aged, in children and in all whose resistance is not the strongest, will prevent many an illness, with more or less serious consequences.

ORIGINAL COMMUNICATIONS

Short stories on the treatment of diseases and experience with new remedies are solicited from the profession for this department; also difficult cases for diagnosis and treat

ment.

Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors.

Copy must be received on or before the twelfth of the month for publication in the next month. Unused manuscript cannot be returned.

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the feu est possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than anything else.-RUSKIN. RECORD,

READ.

REFLECT.

COMPARE.

Medical Reminiscences.

No. 2

MY FIRST FEE.

Editor MEDICAL WORLD:-Strange to say, I never rendered a bill for my first fee and I never expected to get it. In fact it was a surprise to me. When I made my daily calls, at a charitable institution, on Christmas morning, for a doctor knows no holidays, I found the inmates assembled in the sewing room. The Matron returned my cordial "Merry Christmas" with what seemed to me a lack of warmth; a false note rang in her greeting and she mystified me still more by handing me a pill-box, saying, "There has been a good deal of feeling manifested concerning you by the inmates of the home, and they have delegated me to tell you just what they think of you."

As I had previously been on the best of terms with these unfortunate women, I was somewhat taken back by what appeared to me, at first sight, to be a token of dissatisfaction. Appearing as cheerful as I could under the rather disheartening circumstances, I opened the pill-box and found a shining ten dollar gold-piece therein, with a folded paper, on which was written: "To Leon Noel, with heartfelt wishes for health, long life and prosperity."

Needless to say, there was a revulsion of feeling from disappointment to the realization of appreciation and esteem, in itself an honor, often sought and seldom attained.

It would be very romantic if I could affirm that I always kept this gold-piece and cherisht it as a talisman, wearing it as a watch-charm, or having lost it, it would incite sympathy if I should aver that highwaymen held me up on a dark night, in a desolate street, while I was

hastening on an errand of mercy, and robbed me of this charm, or, that while I was away from home, thieves broke in and carried away this precious souvenir, but I can not say any of these things truthfully.

Still, I think that the use I made of my first fee was a laudable one.

With it I paid my first assessment to the Medical Association, and possibly as a reward, I was made delegate to a national convention at which I not only imbibed wisdom, but many of the good things of life as well.

It would be gratifying if money had always come in as freely, and with as much expression of gratitude, as did my first fee; but like all medical men, I met rebuffs, questions of veracity raised as to the number of visits, and requests for an itemized bill, promises to pay, propositions to trade, and absolute refusal to pay.

One of my first hard-learned lessons was, that you can't mix medicine with friendship. For example, there was a man and he had a farm. Sometimes he would send for me professionally, and as I had to drive out of town, he would ask me to take supper. After urgent solicitation I yielded to his invitations several times. One evening, when pears were ripe, he askt me if I would not like some. I was diffident about taking them, but he insisted, saying that he had more than he could take care of, that they were rotting on the ground, and calling to his man, he put almost a bushel of these pears into my carriage. The man told the truth about their rotting; I think some of them rotted on the way home, and the balance rotted over night. The few that did appear good were false-hearted, and as they were thrown into the garbage barrel, I thought of the man who was so free with his blessing, because, as he said, it didn't cost him anything and wasn't worth anything.

When I rendered a bill to this hospitable man he rendered a counter-charge of suppers at a dollar apiece, and pears at four dollars a bushel and came very near squaring accounts. He always reminded me of the patient who received a bill of twenty-one dollars for seven visits and four dollars for medicine. He wrote the doctor that he would pay for the medicine and would return the visits.

There was a patient who was a cabinetmaker by trade. He was my patient and the Lord knows whose patient he wasn't. He was a peripatetic patient, looking for

sympathy and a job. His bill amounted to some ten dollars. He askt me if he couldn't make me an instrument cabinet to settle the bill. He said it wouldn't cost much, for, as he was out of work, he would make it for the cost of the material and time. This cabinet, when it materialized, was about a foot high, about eight inches wide and eight inches deep, with seven drawers in it. In fact, it was very small, but the bill was another matter. Sixty dollars was the amount, leaving a balance due to this invalid cabinet-maker of fifty dollars, which he insisted was his due. On the principle that misery loves company, I did not feel as sorry as I should, as this man had settled other accounts, with other physicians, on the same satisfactory (to himself) basis.

There was another man. He claimed to be a doctor. Once he was a blacksmith, with large and sinewy hands." He mistook his strength of muscle for magnetism, and he set up as a magnetic physician. His patients sat on a stool, and when the doctor waved his hands above them they felt the magnetism. It was down in the cellar and came up stairs on a wire attacht to the leg of the stool. Incidentally the doctor stewed herbs in cheap whisky and sold these decoctions for five dollars a bottle. Incidentally he uttered vague dissertations upon Egyptian and Rosicrusian mysteries. All of which disgusted wise and honest men, mystified the simple and the ignorant, and filled his pocket with money.

This man, like many others who heal by faith, fell sick himself, but could not heal himself. As he had curried favor with me, he called upon me to minister to him. In a few days he recovered and called to see me to thank me for my attention. Incidentally he askt me how much he owed me, and I foolishly replied "Anything you see fit to pay." Taking his purse from his pocket, with much ostentation he fumbled over the contents, and after much hesitation drew out a silver dollar, which he weighed for some moments in his fingers, and finally dropt back again. Then he drew out a quarter, held it between the palms of his hands for a while, then placed it on his forehead, and muttering an unintelligible lingo, he handed it to me with the remark, "I have put an Egyptian charm on this quarter, and as long as you have it in your pocket you will always have a pocket full of money to keep it company." A little later in the day I

wanted some cigars, and as this quarter, with the Egyptian charm on it, had not charmed my pocket full of money, I spent it for cigars. If anybody has been particularly fortunate it is very likely that he has got hold of this charmed quarter, but I do not begrudge him the ownership. The man who gave it to me, by the way, is dead; and it was told me, on good authority, that his spirit attended his funeral; that's the kind of a man he was.

There was another man and he was a failure. He failed systematically and regularly about every six months. He had a daughter and she had consumption. By careful attention I carried her thru many crises, and she was grateful. While her father was in business he tried to even accounts, in trade. His trade, by the way, was that of dealer in kitchen ware. I got pots and pans, brooms and brushes and such like trifles, for myself and all my friends, even if they did come high, for there was a vast difference between the trade price and the trading price. Finally the family moved West, seeking for new places to fail in. I sent him bills for a period of several months for a sum of several hundred dollars. One day I received a letter informing me that he had failed again; that I had never done his daughter any good, but made her worse; and that he had been advised to sue me for malpractice, adding that he would like to be a doctor, and ride around in a carriage, and live like a prince. I answered him that if everybody paid their bills as promptly as he did, most doctors would live like paupers and reside in the poorhouse; also advising him to let medicine alone, for he certainly would make a failure of it.

Few doctors have practist any length of time who have not been solicited to accept trinkets, usually of slight value, as tokens of esteem.

As all others have done, I accepted such trinkets, and was in a fair way to have a unique collection of odds and ends from all parts of the world. The first present was a Japanese tea-pot with a chipt nose, which made it look as if it was suffering from hare-lip; then I received a couple of Kaffir spears; then an ugly looking spear, set with rows of shark's teeth which were said to be poisonous, and which therefore kept me in constant suspense lest someone should be injured thereby.

A whale's tooth and a walrus tusk; the

remnants of a collection of sea-shells; the nucleus of a collection of minerals; a stuffed bird occasionally and a variety of heterogenous objects gradually accumulated and became a source of annoyance, but they were offered with such effusiveness of good will that I could not resist taking them. Alas! for human frailty! When reckoning day came, I discovered that these trinkets were of priceless value -to those who had given them to me. Then I made up my mind that never again would I accept a present from a patient. One little box alone, around which a thrilling story had been wrapt by an old sea captain, who claimed that it had been made by the natives of Borneo, cost me twenty-five dollars, altho it was first given to me as a "token of esteem." Years afterwards, in Birmingham, I saw these boxes turned out by the thousands, and I had my suspicions that Birmingham was the nearest my old sea captain ever got to Borneo.

There is still a pleasant side even in the matter of fees, and many patients are grateful. I can dimly remember, when I was a youngster, that my father had a patient who manufactured candy and icecream. How sweet that man's memory is to me, for he brought unlimited supplies of all manners of sweets, and used to send around ice-cream by the gallon, but poor man, he's dead now, and I have never met one like him since. The nearest I have ever come to such a man is when some friendly druggist, with an eye to business, has offered me a peppermint drop or a chocolate cream or a glass of soda.

There was another patient, a woman, well related and highly educated, but alas! not well balanced mentally. I knew her but a short time, for she was committed to an asylum. The first time that she came to see me she askt me if I liked cream-cakes, and I said that I did. That night a box was delivered at the house containing a hundred cream cakes. The family was somewhat in doubt as to the advisability of indulging in those cream cakes, but having tried one on the dog and a portion on the cat, and finding that they survived, we came to the conclusion that they were safe, that they were not loaded, and accordingly ate them, and the supply continued to come regularly for several weeks.

Another patient was an Italian, a young man who had run away from home in Italy because his father wanted him to be

to me.

a priest. He kept a fruit stand, and being thrifty past for well-to-do in the Italian quarter. He was recommended to come to me by an artist, and with the Italian warmth of affection became much attacht Certain afternoons of every week I held a reception for Italian patients introduced to me by this man, and altho these people were lowly, their gratitude was sincere and their payment, small tho it was, was prompt. These people always indulged in a sort of a surprise party when they came to see me, bringing the choicest of fruit and Italian dainties, which, tho they were strange in form and make, were none the less acceptable, but I never could make up my mind to accept their cordial invitation to dine with them.

When we went to Europe, in the summer, this little family sent to the steamer a large basket of the choicest fruit that they could find, and proved that the humblest minds are sometimes the richest in gratitude and good will.

Once it was my good luck, and only once, to be remembered by a patient in his will. A valuable watch had been presented to him, and he was anxious that I should have it, but desired that it should remain in his wife's possession until her death. Some six months after, she died, and a gentleman waited upon me with a copy of her will, bequeathing to me the watch, a French clock and a picture. He also stated that he was the executor of the estate, and that, as he wanted to give his son a watch, he hoped I would take twenty-five dollars and let him keep the watch. As I knew that the watch cost some two hundred dollars, I told the man that I preferred the watch, not for its intrinsic value, but as a remembrance of a man whom I esteemed.

These are but a few of many incidents which I might relate concerning fees, but they will suffice to show both sides of a question, on the one hand full of annoyance,vexation and insult, and on the other fraught with manifestations of gratitude.

Notes and Comments. Editor MEDICAL WORLD:-Let me reiterate the advice given by the Editor to write out your experience with the summer complaints now, while their memory is fresh in your minds, to be filed away until the next hot season opens. Otherwise much valuable material may be lost. Things look so different when one has had time to forget. The old reliance on calomel and chalk mixture will reassert itself when the memory of their failure has dimmed. May be we did not use them skilfully enuf in those fatal cases; and next time we will be doubly careful, and they must succeed. Do not Professors Bigman and Oldfogie say calomel is the best of intestinal antiseptics? Does not opium check peristalsis, chalk neutralize acidity, bismuth allay irritation, ipecacuanha stimulate healthy secretion, rhubarb sweep out the trash and leave a healthy bowel, the tannins, mineral acids and silver astringe and pepsin digest albuminous food? And surely, with these good things, we must succeed. But as each successive season shows the fallacy, the use of the intestinal antiseptics, and the application of the principles of practical sanitation, are forced upon the profession. And it may be accidental, or it may be significant, but I do not recollect seeing in the columns of our WORLD a letter telling of the doctor who has fairly tried these remedies and gone back to the old way.

Dr. Aylsworth (page 375) has put his finger on the weakest spot in our armorthe action of drugs. We know very little of the intimate nature of this action; in fact, since Headland wrote his book over thirty years ago, no better theory has arisen than the one Dr. Aylsworth attackt. The difficulty has been that the drugs with which tests were made were of such variable composition that equally trusty experimenters reported directly contrary effects from them. But with the isolation of the active principles this has been changed; and if anyone will study the latest editions of Brunton and Wood, he Will see what has made a new therapy possible.

Dr. Easton (page 385) asks for treat ment of sunburn. As a boy I employed a preparation known as camphor ice, and since that time have found nothing better. "Toadstool poisoning" is an uncertain term, since there are several poisonous fungi with different toxic principles. The fly amanita contains muscarin, an alka

loid directly antagonized by atropin, and eliminated very rapidly thru the kidneys. The indications are, therefore, to empty the stomach, neutralize the muscarin with atropin, and support by food, strychnin and tincture of iron until the poison has been eliminated. The death cup or poison amanita contains phallin, which acts like serpent venom, dissolving the blood-corpuscles and causing death by asphyxia. The symptoms are slow in appearing, about eight hours after the poison has been swallowed. Phallin is a toxalbumen, and is destroyed by heat (coagulated); hence thoro cooking renders it innocuous. It is so deadly that one-third of a raw cup killed a boy twelve years old. There is no known antidote. The treatment consists in emptying the stomach, combating the symptoms of muscarin, if it also is present, and sustaining the strength with strychnin. Transfusion of blood should be practist. No known remedy stops the No known remedy stops the action of phallin on the blood-cells.

If J. M.'s case (page 385) was really erysipelatous, he would find a full dose of pilocarpin quite effective. But it looks to me more like a form of angio-neurotic edema. Keep the skin wet with a solution of mercuric chlorid, one to 1,000, and let this be applied whenever there is a sign of a new attack.

I have just had two cases of gonorrhea treated with silver citrate locally and calcium sulfid, seven grains a day, internally. One case was well in three days; the other in eight. The injection was not irritating, and, like the nitrate, seemed to convert the inflammation into a simple urethritis.

Perhaps we are all given to the riding of hobbies; and the frequency with which I have written and talkt of intestinal antisepsis has certainly justified the allegation that this is a hobby of mine. But it is a pretty good sort of a hobby to ride, as the following case will show :

A distinguisht jurist from a Southern state came to me recently. He had spent five months with the best physicians of St. Louis in various sanatoria. I mention this because if ever one has the opportunity to reach correct diagnosis it is when he has the patients under his own eye in a sanatorium. And this gentleman surely had diagnosis enuf. Every care had been taken, and pains lavisht upon his case. He had profound neurasthenia, malaria and Bright's disease; and had been pronounced incurable. I found the

diagnosis correct in so far as the presence of albumin and casts in the urine was concerned, and the neurasthenia could scarcely have been more complete. His digestive power was almost nil, emaciation and debility markt, sleep very imperfect. But the resources of his physicians seemed to have been exhausted when the diagnosis had been made-they diagnosed and did nothing. This is a common occurrence with a certain class of highly-cultured physicians.

My own diagnosis went a step farther. The patient's bowels were loaded; he had some flatulence and abdominal uneasiness. The spleen was not enlarged, which disposed of the malarial theory. His heart was very weak, but under moderate doses of cactus it responded in a way that indicated the soundness of this organ. Under a diuretic the urine rose to sixty-eight ounces daily, and the kidney affection evidently had not seriously impaired its eliminative power. I then turned my attention to the bowels; began to empty them by colonic flushings and repeated doses of barabana water, an agent I want to recommend for obstipation. The first effect of liquefying retained fecal masses is to intensify the symptoms of auto-toxemia, as absorption is increast, so that the neurasthenia deepened into melancholy. But as the bowels were emptied and rendered aseptic, the mental condition improved, the appetite returned, the digestion was carefully nurst, and strength began to grow. Small quantities of food were given frequently, the predigested. foods and pure fruit juices first, then other articles added gradually. The albumin has disappeared, he sleeps soundly without hypnotics, enjoys his full meals, rides ten or more miles on his bicycle without fatigue, and is recovering rapidly.

Now, if there's anything here indicating skill beyond that to be expected of a medical student, I fail to see it. Why did not my colleagues cure this simple case? Because they forget that the alimentary canal is with reason termed prima via; because they neglected to see that it was emptied and disinfected, and one of my pet theories. is that this is the first duty of the doctor; because they were satisfied to rest on their diagnosis of neurasthenia and Bright's without ascertaining the cause of these affections. And I verily believe that constipation and auto-toxemia are to be credited with most cases of nephritis. For altho the kidneys may eliminate the tox