ins reabsorbed from the bowels into the blood, it does not follow that passing these substances thru the delicate renal structures does them any good.

Have all of you found the exceeding efficacy of quinin arsenate in malarial ailments? A gentlemen from Louisiana was seized, shortly after his arrival in Chicago, with remittent fever, distinctly malarial. He took a scruple of blue mass and one twenty gr. dose of quinin, followed by small doses of a saline laxative, full doses of sulfocarbolates, and quinin arsenate, gr. every two hours. Five days cured him. Left him on the sulfocarbolates, a morning saline, and iron arsenate. In the district from which this patient came the fevers have assumed a grave type, many cases being fatal and I have had inquiries as to whether it may not be a form of yellow fever. But it is purely malarial, only that these people have taken so much quinin that they are "immune" against its effects as a remedy.

On page 377 Dr. Harman asks whether belladonna should enter into the composition of laxative mixtures. His objections are well-founded, but they are based upon the action of this drug in full physiologic doses. Brunton says that belladonna acts by sedating the inhibitory nerves, diverting the stimulus of the accompanying cathartic to the accelerating intestinal nerves. Wood credits very small doses with this power of paralyzing inhibition, and thus increasing the stimulant effect of any agent quickening peristalsis, while large doses paralyze the muscular fibers. Cushing, whose new work on therapeutics is far in advance of most of the other American treatises, credits atropin with preventing the griping caused by the cathartic ingredients. It will thus be seen that belladonna or atropin is a useful component of laxatives if given in very small doses, but in large ones it antagonizes the cathartic action. Most of the laxative pills contain far too much belladonna, if the quality of the extract employed is good, but so rarely is this the case that they generally, tho ignorantly, meet the desired indication.

WILLIAM F. WAUGH, M. D.

Ravenswood, Chicago.

Dr. Waugh's book on Treatment and THE WORLD one year for $5.

I hope you will continue your Monthly Talks. I am having parts of them publisht in one of our local papers.-JNO. M. SEASE, MD, Little Moui n, S. C.

Therapeutic Philosophy.

No. 7.

Editor MEDICAL WORLD:-This last of my series of papers will be, in the main. devoted to the treatment of certain diseases. I will turn from the destructive to the constructive. To many of those who have thought it worth while to read my preceding papers, this will be a grateful change, for most doctors-same as other people-would rather be told what to do, than what not to do. Now here comes the rub; I could with a degree of certainty. tell my brethren what not to do, but I cannot tell them what to do-I can only tell what I do. I am sure that whatever measure of clinical success I have had has depended very, very much more upon my abstention from doing wrong things, than upon the certainty that I did the right things.

In number four of this series I exploited (briefly) my theory as to the modus operandi of drugs. In saying "my theory I simply mean the theory which most strongly commends itself to my judgment. I suspect that for reasons dependent upon forgotten memories, there is not much that I can claim as original about it. It will be noted that the shock theory results directly from the truth that drugs are necessarily heterogeneous to the animal organism. Any treatment I may recommend will always be affirmatively related to these interdependent truths. I may remark, en passant, that any favorable results from serum therapy could-and as I believe woulddepend upon the verity of my theories; for what is more shocking (physically and esthetically) than the injection of an animal poison into the blood?

To cure is to prevent. This a fundamental, inflexible and eternal truth. This truth constitutes the basis of the Healing Art. If you perform a cure, you simply prevent a farther progress of the disease, that is all. Any damage which may have been inflicted by the disease, nature looks after, not you. To cure is to abolish the cause, and this is to prevent further ravages of the malady. The clinical success of the physician who is not controlled by these basic truths, will be inversely as the square of his dosage. To direct treatment against mere effects is to violate the fundamental principles I have named. To treat the effect a shortage of red globules; or the effect-softening of the bones, as in rickets; or the effect-neurasthenia; or the effect

fever, is to waste precious time, and to diminish the patient's chances of recovery. The doctor who goes to the bottom of things will never make the fearful mistake of trying to directly supply a lack in the system. Nor will he give antipyretics, and he will be extremely cautious in the use of analgesics, and so-called palliatives, etc. All of this is frightfully heterodox, I know, but by all the deductions of science, by all the analogies of nature, by all the conclusions of doubtless philosophy, and by each cosmic canon, it is right. Many a reader of this will have to stultify his whole past, and vault a deep and wide chasm, to get onto the plane I have pictured. How many will do it? Very, very few, for I have not attained to that eminence out of which flows authoritativeness.

ANEMIA: This term applies properly to but one condition-a state approximating exsanguinity. It is a consequence of hemorrhage. It is not a disease. The thing to do is to supply the lack, in exactly the same sense as that in which you would replenish a boiler needing water. It is all mechanical, both in relation to the patient and his physician. The direct remedy would be transfusion; the indirect one, natural reparation.

If hematology were a completed science, it would contribute largely to that pleasing and showy accomplishment-minute diagnosis. As it is, we can reel off the verbitudinosities of its nomenclature to the dazed wonderment of the innocent layman. What unlearned mortal, who is not pachidermatous, could withstand a fusillade of erythrocytes, megalocytes, microcytes, macrocytes, oligocythemia, polygocythemia, normoblasts, megaloblasts, poikilocytosis, etc., etc. It is handy and sometimes effective to grab altisonance by the butt end and swinge it about the consciousness of a knowledgeous and nosy individual. But alas! a knowledge of hematology does not help us even a small bit in the treatment of anemia. It is not so little as prognostically valuable to the careful and experienced physician. In whatever disease, we must experiment with drugs, that is all.

The authorities give a great number of causes of anemia, thus: loss of blood, lactation, protracted diarrhea, chronic leucorrhea, typhoid, or some other form of fever, malaria, deficiency of food, light, warmth or fresh air. This is the list that Hartshorn gives in his "Essentials of Medicine." Other authorities extend the

list of causes very considerably. The treatment infallibly given by every medical writer in the world (excepting me) is iron. Iron italicized; IRON Small-capped; IRON with pot-bellied exclamation points to it; chalybeate iron of the most ferruginous type: IRON, a billion times repeated, world without end-Amen! Too strong? No, sir. It has been at once the idol and the crux of the ages-the latter because of its stubbornness with reference to assimilation. The gnawing puzzle in this relation has been, how to convert an essentially non-assimilable substance into an assimilable one. They are working at it yet, tooth and toe-nail. Now, doctor, brush away any orthodox cob-webs which may have accumulated in the corners of your inmostness; do this for a bit, and read on. You may settle into the conclusion I arrived at long ago, namely: that of all "legitimate" literature, the past and present prevailing literature of anemia is the most anemic.

You have a case of anemia which is caused by excessive lactation. If you be-lieve that the way to destroy an effect is to remove its cause, and you happen to be independent enuf to give your common sense free swing, what will you do? You will seek to replace excess with temperance. To do this would be to remove the cause of the anemia. The cause being abolisht, the effect would cease. No one with a forehead half an inch high will dispute this. But, dear Doctor, this will not do. Only a few writers will tell us to do anything excepting to give iron, and they all agree that whatever else we do, we must give iron. Iron then is the remedy for excessive suckling. It is the remedy for protracted diarrhea. It is the remedy for chronic leucorrhea. It is the remedy for typhoid, and many other fevers. It is the remedy for malaria. It is the remedy for deficiency of food, or light, or lack of warmth, or foul air, or squalor, etc., etc. It does not make a bit of difference what school of medicine a writer may belong to, his advice is to give iron in anemia, always. The astounding feature about the whole. business is, that all doctors of all schools have always insisted upon causal treatment, and that in the face of this, they don't attempt to treat any thing but mere symptoms.

In treating any disease, I try to remove the cause. I don't make an exception of anemia. If the case is a mother reduced by excessive nursing, I have the excess

abated, and I have her environment improved as much as possible. This is actually all that the case calls for, but for moral, if no other reasons, I give her such treatment as is supposed to improve nutrition. If the anemia has resulted from protracted diarrhea, I address my attention to this. In such a case all doctors will do the same, but how many will be able to refrain from giving iron for the attending anemia? And so I manage all cases of anemia whose causes are evident. But in a great majority of cases the cause is not readable. Three-fourths of them will be girls from fourteen to twenty-five, and the largest factor in the etiology of their cases is a specific form of malassimilation. We all know this is true, because anything which will improve their nutrition will, to that extent, help their anemia. A routine treatment is not adaptable to anemia; it is not adaptable to any disease. It is practist only by back-age doctors. In most cases of anemia nux vomica is a prime remedy; it is good in most atonic conditions. There is a class of cases in which strychnin does better than the nux. I have not differentiated them, but in cases calling for one of them, I try the nux first. If it is unsatisfactory, I substitute the strychnia. If the patient is highly nervous, I give ignatia instead of either of the others. If there exists a cholemic tendency, I combine podophyllin with one or the other of the above-named remedies. If there is anorexia, I substitute hydrastis for the podophyllin. If that is not satisfactory, I replace it with calumba, or calisaya, or some other vegetable drug of the bitter class. There are cases which call for some one of the mineral acids, each of which has a specific indication. Hydrochloric acid is the most frequently needed. Some cases require cactus grandiflorus; some, pulsatilla; some echinocea, etc., etc. Some form of manganese is a most excellent remedy in many varieties of anemia. It seems to nudge the blood-maker as almost nothing else does. Taking anemias as they run, it is, without doubt, more frequently indicated than any other single remedy. It is good even when handicapt with pepsin and iron. Pepsin is neither a medicine nor a food, and iron is merely an astringent, being strongly contraindicated in anemia, but manganese has the power to over-ride these and make itself curatively evident in the condition miscalled anemia. Manganese, nor any salt of it, or product

of its acid combinations, is a constituent of the blood. Some physiologists have doubtfully named it as an inconstant element of the blood, but such a statement contravenes natural consistency. It makes no difference whether it is such or not, it is a medicine, for it is very pronouncedly heterogeneous to the system. There will yet be evolved a straight manganic product which will be the ideal remedy for a large class of anemic cases. It is understood, of course, that in these, as in all other similar cases, I exhaust hygienic appliances, including sea-bathing, change of air and scenery, etc., where the latter is possible. Where it is impossible to go to the seashore, I have anemics, neurasthenics, etc., bathe in a solution of seasalt. It can be obtained at any drug store. A necro-biotic condition necessarily represents a more vitiated state of the assimilative function, and I cannot see that it calls for any great variation of the treatment for plain anemia. There is a great opportunity for drug testing in all these morbid states depending upon elective faults in various classes of cells. If we would give two-thirds of our time to the study of drug action, and the other third to the branches collateral to therapeutics, how much better physicians we would be in a practical sense. The working fact of this stupendous fabric we call medicine, is the fundamental truth that the right drug is promotive of cure. It is a humiliating thing to acknowledge, but it is the truth, that the better the clinician, the poorer the general medical scholar. Medical learning should constitute a specialty, for learned doctors have their uses; not, however, at the bed-side. Closet students and doctrinaires have a mission, but its sphere is small and inconsequential. Actually, what has Koch done for diseased humanity?

Owing to lack of space, I can only glimpse at rachitis and neurasthenia. In both conditions more depends upon hygiene than upon medicine, so far as we now know. Gentle exercise-passive in rickets,-plenty of fresh air and sunlight, massage and skilfully-applied electricity, nourishing and digestible food and wholesome moral surroundings, sea-salt baths, etc., these hold the major share of helpful promise. I meet specific conditions with specific medicines, but it would require pages and pages to give details in regard to the drug treatment of these cases. Twenty different drugs may be succes

sively called into requisition in the treatment of either disease, but they are to be selected, not under the tissue-feeding impulsion, but with reference to their catalytic effects.

This completes my series of papers. Very few editors would have publisht them, because of their heterodoxy. It is rather an astonishing fact, however, that since the first article a number of eminent medical editors have insistently invited me to contribute like articles to their journals. It was kind, progressive, and above all, brave, in Dr. Taylor to publish them. From my heart I thank him for his noble courtesy, and I thank THE WORLD readers for the generous spirit in which they have received them.

In

Treatment of Autumnal Fevers. Editor MEDICAL WORLD:-As the autumnal fevers have set in, it is possible that some brother M.D. might be profited and aided in saving a life by me jotting down a few lines from my note-book of experience. I have treated quite a number of cases of remittent fever in the last twenty-five years with success. I say success because I never had a case to die on my hands that was of a remittent form. The typhoid types I believe to be autotoxic; that is to say, they are due to absorption of the effete matter accumulated in both the upper and lower bowels. the typhoid type there is imperfect elimination. This class of cases require heroic treatment from the beginning; clean them out and disinfect them before there is any abrasion of the mucous membrane. This has always been my plan of treatment. First I take into consideration the age of the patient; second, the corpulency or leanness of the patient; and third, the idiosyncrasy of the patient, if any. These items are for the purpose of regulating the dose. If the patient be robust, I give ten gr. calomel with two gr. of ipecac every four hours until I get six or seven free actions from the bowels. After I obtain that number of operations I flush the colon with water at 112°, using a sufficient

amount to put the gut on a stretch to the ileo-cecal valve. This will soon pass out and drain the upper bowel of part of its contents. Keep the bowels open with Epsom salts. The next thing that demands your attention is the skin. Give the patient a hot bath, with sufficient soap in it to cleanse the skin of all oily matter that may be deposited, checking perspiration. The outlet thru the skin is just as essential to relieve the blood of the toxic poison as opening the fountain in the bowels. If free perspiration does not occur after the bath is taken, and antipyretics are given (remember to watch the effects of your antipyretic, let it be gelsemium, veratrum, aconite or any of the coal-tar preparations; they are all heartdepressants, and your patient's heart is already in a weakened condition), and if you fail to get a free perspiration, then try massage with a weak Faradic current, putting the positive pole to the sole of the feet and using the negative in your left hand while you massage with the right. Commence at the neck and rub the entire body, including the upper and lower extremities. Let the sitting be forty or fifty minutes. Then if your patient does not sweat freely in three hours, use the cold pack. Here in the country I fix it in this way: I have water fresh from the spring or well put in a wash-tub; I wet a woolen blanket in this; I have the bed protected by old quilts, then spread the wet blanket on the bed, have the patient stripped of all clothing and rolled up in the wet blanket; then plenty of cover is piled on. The shock to the skin carries them in imagination to the North pole; but as soon as reaction takes place, which is within a half an hour, they think they are transported to the infernal regions. They will sweat and steam like a boiler. Keep them in this sweating stage for at least an hour, then take them up, dry them off well, and put to bed. Give a little whisky or brandy, and the sweating will commence again. At this stage, give quinin, one grain, every two hours, with stimulants to keep the temperature from going below normal. More patients die at this time than any other, and ninetenths of them die between eleven o'clock at night and seven o'clock in the morning. There is less vitality at this time than at any other; consequently four-fifths of the deaths from all causes in disease are between eleven at night and seven in the morning.

With our Editor, I believe the case was one of typhoid fever, but in the absence of more markt symptoms, cannot think death was caused from intestinal hemorrhage. I think that in the plethoric condition of the patient, the large dose of podophyllin, and the menstrual epoch, will be found the clue to the fatal issue.

At the menstrual period all the blood vessels of the abdominal viscera are engorged, preparatory to the natural function of the uterus and its appendages. Now then, create the abnormal and violent peristaltic action of the intestines that will occur from such drastic catharties as podophyllin, and what is the result? Naturally, the engorged vessels will empty themselves, and cause congestion in some more or less remote part of the system. In my opinion, this congestive condition occurred in the brain, and the patient died from acute congestion of the brain. Nature attempted to rid the system of the "flood tide" by one of her emunctories-hence the relaxt skin. Dr. Quinn speaks of the profuse sweat, but it was not sufficient to eliminate the burden, and the brain, with its vessels already enfeebled by the congestion incident to all febril conditions, was literally swampt under the influx of vitiated blood.

Such cases as Dr. Quinn's should make us all think, and think hard. Some of us will get the next similar case, and the losing of these cases, whether due to any fault of our own or not, does not tend towards medical reputation, either individual or general.

B. A. SOUDERS, M.S., M.D.
Winchester, O.

Blindness Due to Meningitis Spontaneously Recovering.

Editor MEDICAL WORLD:-This case I wish to report, as it has been one of interest. Boy, B., 8 years old; white. Was called to see him April 1st. Temperature 102°; accelerated pulse, headache, and all symptoms common to acute meningitis. I diagnosed the case meningitis, and the treatment used was cold and hot application to head and spinal column. In about the third week of his sickness he became blind. After about two months' severe sickness he began to improve and I dis charged him perfectly blind. About July 15th his sight began to return, and at present writing, August 28th, his sight is very good and continues to improve. is getting so he can stand alone, but can't walk; is improving all the time. Just before he was taken, another one of the same family was taken, a boy older than this one. He died in three days with meningitis. S. M. DORRIS, Bandana, Ky.

Heart on the Right Side. Editor MEDICAL WORLD :-A few days ago I was present and assisted in conducting a post-mortem, held by request on one of my brother doctor's patients. This man had been in delicate health for some nine years. Illness dated from an attack of grip. His health previous to this was not of the best. He was a sufferer with and died of that dreaded disease, consumption. The interesting and striking feature in the case was that his heart lay on the right side. The post-mortem showed the right lung to be wholly gone. so far as lung tissue was concerned. There was, however, the roots of the bronchi, showing that a lung had once existed. The heart was found wholly on the right side, lying at least half an inch to the right of median line. The apex pointed directly downward, resting near the diaphragm. The heart was in a healthy condition. The pericardium was attacht to the anterior portion of the chest. The attachment was a perfectly normal one, no indications of any exudate ever having been present, as the membrane was not thickened, but perfectly smooth and firmly attacht. On the left side the lung seemed at one time to have filled the whole chest cavity, the pleura being attacht where the pericardium normally should have been. It is my belief that the heart was always on the