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there was a vial of carbolic acid, which she uncorkt, and sitting down, spilled the contents in her lap. Her father stript off the clothing and ran with her to the drug store where I soon saw her lying in an insensible state upon the counter with heavy stertorous respiration, frothing at the mouth, and very pale. It required stimulants and narcotics to bring her out of the shock, so intense was the pain and depression of vital power. She finally slowly rallied, but the sores produced by the acid were troublesome and long in healing, and the discoloration is now, many months after, plainly to be seen. The child had not swallowed any of the acid. By the way, I see since this accident, somebody says spts. camphor will allay, at once the burning produced by carbolic acid. Won't alcohol do the same? Arcadia, La. J. ATKINSON, M. D.

Editor MEDICAL WORLD:-In regard to lying abed after confinement, my experience is that a woman that lies on her back for nine days poisons herself from lack of drainage. Let her get up when she feels like it, and if she has a bearingdown, dragging sensation, involution is not complete. She must keep quiet until she can walk around in comfort, but keep her off the flat of her back.

Chicago, Ill.

HARVEY A. WHITE, M. D.

Constantly Search After Knowledge. Editor MEDICAL WORLD :-Please find inclosed one dollar for a year's subscription to THE WORLD. I like THE WORLD because it publishes the questions and answers of the different state examining boards. An epitome of the laws of the different states up to date, governing the practice of medicin, would also be of interest. My husband and I are in co-partnership in the practice of medicin and surgery. Reading these questions has incited a desire to brighten up, and we are both now walking compends." Our idle hours are devoted to quizzing.

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It has been a good many years since my husband made room scarce on the front seat at college, while I am recently from college. We are trying to blend the experience of the past with the wisdom of the present. I am glad this is the "examining board era." Some who have graduated are not thoro. Some have assumed to know what they do not know. The physician in practice is liable to for

get his text-books. He needs to hold daily communion with them, and he needs to be arraigned for examination once every five years at least. The "lords of creation " may in the practice of medicin have a prestige due to the education of the people and the physical prowess due to heredity; but when they come to the facing of a medical examining board, woman, if she has attended a "regular" college, her supremacy will be shown. Women at college learn their lessons well, without evasion or assumption, and they possess retentative memories, one of the greatest faculties of the mind. The political or commercial doctor, who lives wholly on the knowledge he gained in the dim and distant past, ought to be relegated to the rear of the procession, where he belongs. Of all the professions, ours is the noblest. We watch man's coming at birth, mitigate his suffering in life, and soothe his pathway to the tomb. Whenever a physician fails to find in our profession a livelihood, and in the investigation of its different branches a solace that satisfies his mind, he ought to drop out. With a good preliminary education, the progressive physician has a mind as broad as an intellectual ocean "whose waves touch every shore of human thought." MAUD MEAD, M. D.

Oberlin, Kansas.

[All our readers can make the examination questions that we have been publishing the most valuable part of the magazine.-Ed.]

A Reply to Dr. Newth, Concerning Medical Legislation.

Editor MEDICAL WORLD:-I would like to say to Dr. C. H. Newth (page 374, Sept. WORLD), that I prefer riding a hobby successfully to making unpremeditated dismounts from the back of a bucking cayuse.

If therapeutics is not the science of guessing, what in the name of Esculapius is it? I had never understood that medicin is an exact science, or indeed anything but an experimental science. Is there not in every case of disease a dynamic force—a vital resistance to disease and to drugs, an unknown quantity, that can only be estimated, conjectured or guessed at? Has a method been discovered whereby the dynamic force can be weighed or measured or known positively, so that we can say to this or that patient you will get well without medicin, and to another, you must have certain drugs in certain combinations at stated intervals, and that any deviation

from this exactment will result in death in just so many days, hours and minutes? Nothing short of this would be exact science; anything short of it would be guesswork. In fact, to admit the existence of an unknown quantity in the relation between drugs and disease is to admit that therapeutics is the science of guessing. The contradictory evidence of our textbooks and medical periodicals is sufficient evidence that most physicians do their own therapeutic guessing. Scarcely any two prescribe the same remedies in the same quanities for any given disease. Take typhoid fever or pneumonia, for instance, and write out all the prescriptions for them that have appeared in a half-dozen medical journals and as many text-books for the last six years, and see what a confused mass of evidence you will have. Is it fair to call such a conglomeration of contradictions a science?

The Standard Dictionary gives the following definition of "guess: ""To judge, estimate or conclude from slight indications or on merely probable grounds; anticipate or presume without sure knowledge or adequate evidence; hazard a supposition about. To conjecture correctly, hit upon the right statement or solution." There is nothing positive about a guess; it simply admits the existence of an unknown quantity in the mental equation.

Therapeutic guessing, then, is nothing more nor less than the ability to proportion drug medication to the dynamic force of the patient.

The first step in the evolution of therapeutics is the ipse dixit of some supposed authority. The second step is an individual experiment based on that ipse dixit. The third step is skepticism tempered by reason. The fourth step is the discarding of authority. The fifth step is a confession of ignorance, and happy is the man who can take the sixth step and build for himself a rational system of therapeutics. He will be able to demonstrate, in his own person, that the "fittest guesser will survive."

Dr. Newth admits my contention when in his reply to Dr. Wallace he says: "Every case must be regulated by common sense"-not by the rules of so-called therapeutic science.

Tho I cannot charge Dr. Newth with riding a hobby, it is very evident that he is trying hard to ride the lane of evolution backward. But it won't go, and the rider is very liable to make an unpremeditated

dismount. It is God's lane, and tho legislatures may retard its operation for a while, they cannot annihilate it.

As it is, the weak and puny animal that would naturally want a barbed-wire fence ten feet high to keep the strong and vigorous from "pushing them aside for the good of the species," so it is the weak and puny of the human race that want barbed wire lanes to keep the strong and vigorous from pushing them aside for the good of the species. As a general rule, it is not the humanitarians in the profession, but the men afflicted with intellectual inertia that cry the loudest and longest for protective laws.

I am glad to notice that THE MEDICAL WORLD and other influential medical journals are beginning to see the injustice of state laws regulating the practice of medicin, as evidenced by the demand for a National law. But the American flag should mean more than "equal liberty to all." Slaves may have equal liberty, so may the subjects of the most despotic tyrants. The American flag should mean that every American citizen should have the liberty and guaranteed right to follow the dictates of his own conscience so long as his acts do not infringe the rights of others, or until he is convicted, by a jury of his peers, of doing that which is detrimental to society. If we are to hold our present course in the direction of legislative tyranny over the individual, permit me to say in all sincerity, that I believe the coming nation will be spelled damnation with a big D. J. W. LOCKHART.

St. John, Wash.

66

Lard and Strychnin. Editor MEDICAL WORLD:-I wish to say to Dr. Kendig, of Hayesville, O., that for many years the effect of common lard in strychnin poisoning has been known among the piney woods ruralists of North Carolina. Verily, the Lord has revealed to babes and sucklings that which has been kept from the wise and prudent.' After the civil war almost every son of Ham believed in social equality sufficiently to possess himself of the inevitable yaller dog, which proved quite detrimental to sheep husbandry in these parts. A small portion, gr. strych. sulf. on a tempting lump of lard it was thought would remedy the evil; but it would not work, and it was soon found that by some means the lard rendered the drug ineffective. Now every owner of a worthless cur, when by acci

dent (?) it gets a dose of strychnin, knows the remedy to save his pet. The Doctor's lard, with the help of the Lord, saved his patient. In what way the lard acts upon so rapidly fatal a drug, but little is known; but it is a well-known fact that hogs are not affected by even very large doses of strychnin.

Some time ago I found among some samples of "pyroctin" two doses of ten grs. each. I knew nothing of the drug, only what the label said-"a fever killer -and was led to give it to a charity patient with all the characteristics of typhoid fever. To my surprise his temperature descended from 105 rapidly and alarmingly. I found the patient bathed in profuse perspiration, and very weak. rallied, tho, after I gave a stimulant, and I found that the expected long attack was aborted.

He

Will you tell us what "pyroctin" is, and where does it come from?

Faison, N. C. V. N. SEAWELL, M.D. [The preparation mentioned is doubtless one of the numerous mixtures, with a coal-tar derivative, most likely acetanilid, as a base.-ED.]

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An Unanswered Question.

The farmer sat down by his lamp to peruse
His paper, containing the neighborhood news;
A heading sensational greeted his eye,
In glaring display type, full half an inch high :
"A terrible cata-strophe!" (thus it occurred
He stumbled sometimes at a difficult word):
"An awful explosion of dynamite causes
"A fatal result! A full list of the losses!
The tragical fate of Bartholomew Bliss!
"His dwelling reduced to a mass of de-briss!"
And then to his wife, who beside him was sitting,
Just rounding the heel of a sock she was knitting,
He read the account of the fearful event,
That in language as follows substantially went-
But only in substance; for we shall omit
The long introductory portion of it,
And the reader's forbearance not needlessly tax
With a statement of minor, irrelevant facts,
As to why it was needful to set off the blast,
And who it was talked with Bartholomew last,
Or where or by whom was the dynamite bought,
Or how or by whom it was conveyed to the spot :
Nor stop, as the newspaper did, to explain,
Why all the precautions they took were in vain
Suffice it to say that the stuff, when unloaded,
By accident fell to the ground and exploded;
So far as relates to Bartholomew Bliss,
And the accident to him, the paper said this:
"IIis osseous structure was afterward found
In numberless fragments bestrewing the ground;
O'er dozens of acres, all riven and scattered,
Were parts of the poor man's encephalon spat.
tered;

A bone that is thought by the surgeons to be
His os frontis was lodged in a butternut tree :

His clavicle struck on an awning, from which
It rebounded, and later was found in the ditch:
On a fence by the schoolhouse, impaled on a sliver
A schoolboy discovered a piece of his liver;
One kidney and two of his vertebræ fell
In Emerson's orchard, not far from his well;
The shaft of his humerus dropped from the air
Before the bay window of Widow St. Clair;
His fibula and his os calcis, 'tis said,
Have been found in Phil Henderson's strawberry
bed;

A little ways east of the depot there fell a
Small three-cornered bone that is called the
patella;

A part of the pelvis was thrown to the top
Of Lewis Levanceleur's carpenter shop;
The coronoid end of the ulna came down
Just back of the mill in the north end of town;
In front of his dwelling-house Alpheus Keyser
Picked up a superior canine and incisor;
Tom Peterson's dog in the evening brought home a
Small bone that most probably was the zygoma:
By the side of the road, near the end of the
bridge,

They discovered his left supraorbital ridge;
On the top of the post-office, four stories high,
Fell a strip of integument torn from his thigh;
In Sullivan's dooryard, 140

Rods distant, the children picked up his aorta;
In front of the market, still farther away,
Some fragments of organized tissue, they say,
Were discovered, supposed by the doctors who've

seen 'em

To be minute remnants of his duodenum !"

When this, and much more, the old farmer had read,

The woman looked up, and inquiringly said, As the sound of her needles a moment was stilled, "What I want to hear about is, was he killed?”

With strict inquisition and countenance solemn, The farmer in silence re-read the whole column; And then, at the close of his careful survey, Regretfully answered, "The paper don't say!” Washington, D. C. J. L. MCCREERY.

Cerebellar Disease.-Chorea.

Editor MEDICAL WORLD:-Mrs. H., aged sixty-two, strongly-built, and of good family history, having had for two years paroxysmal attacks of occipital, and sometimes vertical, headache, began in October, 1898, to suffer from almost daily attacks of vertigo. These seizures occurred at any time during the day, and were obviously independent of reflex or temporary causes. Later, in severe attacks, the patient experienced double vision, sensations of external objects revolving, inability to hold up her head, and occasionally vomiting. Between attacks the patient went about her work, and seemed quite well.

At this time, in October, 1898, I made in my office an examination of her case, and found external to the cranium no cause

for the trouble. The existing condition of the gastro-intestinal tract and accessory glands, the kidneys and the circulatory apparatus, seemed to be entirely normal. Likewise my search for some of the numerous diseases involving the eye, ear or nasal functions, was made in vain. All reflex causes thru external, local or general conditions, as far as we could discover, were easily cast aside. These causes often act by disturbing the normal rhythm of the vaso-motor apparatus, thus altering the blood-supply to the brain. Having made the diagnosis of cerebellar disease, as to whatever other structures were involved, further phenomena were awaited. They were soon forthcoming. Within a month the patient was observed to stagger and was noticeably "thick-tongued," while her seizures maintained their original character. The above symptoms intensified until there was a total loss of equilibrium with motor aphasia, the patient not being able to even sit alone, and her speech becoming unintelligible. There was partial left hemiplegia, both motor and sensory functions being confined to arm and leg. The arm was the more affected, especially the thumb and index finger. When at its maximum, further minor symptoms were noticed as follows: Some dysphagia, partial retention of urine, incoordination of coarse variety, pain in left arm, a degree of muscular weakness, and slight irritability. At one time there was a rise in her temperature, and I have found her temperature subnormal. A microscopical examination of her blood revealed no leucocytosis. Patellar reflex remained normal, or slightly exaggerated; no paresis of the trunk or facial muscles. This patient's mind, hearing, taste and eyesight remained acute and normal.

The functions of the cerebellum, as well as many other portions of the brain, remains obscure, and a neurologist well says that "the more he studies cerebral localization the deeper becomes the mystery." The brain is a complex whole, and the structures which compose it are more or less intimately connected. The functions of such organs as the crura, thalimus opticus, corpora quadrigemina, internal capsule, pons, corpus callosum and others, are probably not exclusive, and doubtless are presided over by higher centers.

On this subject of cerebellar disease, one need only refer to the 100 cases reported by Krauss in Osler, to the forty-nine cases by N. B. Carsons of St. Louis, to the five

cases of L. J. Hammond, three cases of J. H. Bryan, one case of Thomas C. Smith, one case by A. D. Conachie and case by A. L. Hamilton, to be convinced of the many unknown functions of these organs. Abscesses involving the major portion of the cerebellum occur, without producing one recognizable symptom during life. With few exceptions, observations in a number of cases of disease of some particular structure of the brain show a want of uniformity in the symptoms produced thereby. One by one, however, new facts are discovered and hung up as additional stars in the firmament of brain localization. We gladly acknowledge further sources of information from the pen of Dr. Risien Russel, Vienna, and L. Burns, Moscow, to which we add E. J. Mellish, A. I. Bouffleur and A. D. Conachie of Chicago, besides Osler and Hammond.

This patient for three or four months has been some better. The treatment has been with tonics and reconstructives, and conditions have been corrected as they appeared.

I would like a suggestion in a case of mild chorea in a strong, bright boy of ten years. He has been afflicted more or less for two years. The most prominent features are a blepharospasm and an involvement of the nasal and oral muscles on both sides. At times his eyes become red and the conjunctivæ congested, independent of their use. We have vainly tried to convict some organ, or find some condition responsible for the trouble. Leading features of the treatment have been Fowler's solution (now fifteen minims t. i. d.), phosphate strychnia, and, at intervals, various combinations of bromid, of potash, gelsemium and belladonna, with a modified rest treatment. W. C. HONTZ, M.D. Syracuse, Indiana.

The Four Systems of Elimination.

Editor MEDICAL WORLD: Autotoxemia may be due to ingestion of materials unsuitable prior to eating, or becoming so under morbid conditions of the system after eating or drinking, as when the liver acts abnormally, or the respired air is bad enuf to impair oxygenation, or when, under depressing mental influences, inhibition of the glandular or trophic nerve influences admits of the anomalous condition.

Over eating of nitrogenous or fatty foods, especially in warm weather, is apt to induce uric-acid-emia. In this condi

tion the body becomes hypersensitive to changes of temperature, and a slight atmospheric depression may interrupt dermal excretion and thus induce migrain, biliousness, "cold," or even pyrexia. This is one view of endogenetically induced blood dyscrasia.

There are four channels of exit for the elimination of the various matters, useless or harmful, in the economy, namely: (1) the intestines, and along with this system we may include the liver and the uterus during the child-bearing period; (2) the urinary organs; (3) the respiratory system, and (4) the skin.

I. The intestines furnish a receptacle for the insoluble portion of our food, and for certain excretions, till they can be conveniently disposed of. Constipation is often due to atony of the bowel, especially in brain-workers and those who don't exercise enuf; to partial obstruction, also from neglect to respond to Nature's calls, or to methodize one's toilet; to insufficiency of water to properly dilute the meal. In this connection it is to be remembered that a badly-acting liver, by secreting a bile poor in quality or deficient in quantity, may admit of distension of the bowel, since bile is an intestinal tonic, antiseptic and laxative. In this condition we should examine the skin and conjunctivæ for pigmentation, and if the tongue be large, flabby and scallopt, and if it is protruded hesitatingly; if it be tremulous, that will show atony; if it be white-coated, that will show acidemia and nerve-weakness; if it be brown-coated, that will show cholemiadefective elimination of bile pigment, i. e., effete hematocytes, which condition is usually accompanied by a sense of weakness or drowsiness.

The treatment of such conditions implies nerve and intestinal tonics, alkalies, stimulants, antiseptics and cholagogs.

I have the pleasure of knowing two veteran physicians, one of whom has been branded a "strychnin crank," and the other a "camphor crank." If I meet the one in consultation, and the patient be deprest, he is in the habit of saying, "Strychnin is the best stimulant"; if I similarly meet the other, I know in advance that he will say, "Camphor is the best stimulant." I don't yet know which is the higher authority, but I would trust. my life to the skill of either. I am, however, vain enuf to imagine I have made a step in advance of either by adopting the theories of both.

As to the cholagog, calomel is popular; but experiments on young animals demonstrate that the suboxid of mercury is deposited in the liver, spleen and bonesbottling up trouble for advanced age; patients who have used it are readily salivated, soon lose their teeth, and complain of sensitiveness to cool and damp air; however, many patients, on our authority, use it indiscriminately and recklessly. Let us who are nick-named "allopaths" compromise with our homeopathic brethren and give ipecac (which is a glandular stimulant thru the spinal system) instead.

Our prescription, then (referring to the authority of the late Milner Fothergill), would be something like this:

Pulv. Ipecac

Pulv. Ext. Aloes
Camphor
Menthol.
Strych. nitr.

aa gr. 1

gr.

M. Ft. Cap. 1. To be taken just before eating. If we multiply the quantities by twenty we have a convenient prescription for the pharmacist as well as the patient. The strychnia in particular should be thoroly incorporated by trituration with the other ingredients to avoid such an unpleasant experience as I have had. A certain druggist, in preparing this prescription, used crystalline strychnia and incorporated the mass with his spatula and slab only. The patient experienced no inconvenience from the first few capsules, but, one day, soon after taking a capsule, she was so affected that a physician, hurriedly called, diagnosed "strychnia poisoning.

The camphor and menthol liquefy one another and so form a menstruum with which the powders may be formed into a mass capable of easy division, and so obviate the necessity or excuse of the pharmacist to use mucilage or other septic abomination. The aloes completes the ideal by its known property of acting on the lower bowel.

After preparing and dividing the mass, the pharmacist should wash his hands, and observe care in filling, to avoid the capsules tasting of the aloes.

As to the alkali: It is well to remember that alkaline carbonates are "hard on the stomach," especially if the tip of the tongue be red, which it often is in our cases; and that the vegetable salts of the alkalies are transformed, in the blood, into corresponding carbonates; so that we may with advantage use the citrate or acetate of sodium, potassium, or lithium.

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