Then, the amount and kind of food must be regulated, so that the over-workt, poisoned and starved excretory organs may not be injured. The mode of cooking, too, has to be considered. Wasn't it Fothergill who said, "Frying is a form of cooking invented by the devil to reach peoples' souls thru their stomachs ?"

There are four proximate principles of which our food mainly consists; viz.: Water, starch, albumin and fat.

1. Water should be sufficient in amount to liquefy the solids we eat, to effect solution of the soluble portion, to favor ab. sorption, and to favor elimination. It should be chemically correct, i. e., free from organic or inorganic poison; it should hold in solution a small quantity of salines-table salt added to rain water will do. The popular idea that "manufactured ice is bad because it contains too much ammonia" is incorrect. The ammonia does not get into the ice. The danger lies in the very purity of the water. Anemia has developt after the prolonged use of very pure water. Most of us have experienced discomfort after drinking pure water. A young lady died in New York City from its use. A reference to the subject of dialysis will afford a partial explanation.

Water may sometimes be medicated with advantage to meet certain indications. In 1877-8 I learnt from natives in Hindoostan that sulfuric acid in drinking water would keep away the cholera, and this circumstance has since been confirmed. Three or four years later, Robert Koch (of tuberculin fame) explained the reason. He announced that the water of which the victims drank was always alkaline in reaction, and that the coma bacillus could only proliferate in such medium. This circumstance affords a key to the successful treatment of typhoid fever also, since this disease resembles cholera in its pathology and in its symptomatology-only longer drawn out.

The germs of neither can be killed by any acidulated water we may drink; but, if we thoroly acidulate the alimentary canal, we deprive these germs of the power of proliferating-of producing the harmful spores, and they die in about eight or ten days.

2. Starch: Chemical tests: Suspend some starch in water; apply a drop of tinct. iodin and you get the dark blue iodid of starch (starch is the antidote to iodin): apply to another portion of starch

water Fehling's or Trommer's test, and you get no reaction. Now, if you are a smoker, you can get plenty of ptyalin in your saliva with which to convert all the starch into glucose, in another quantity of starch water. The iodin will then give no reaction, but the copper test will, showing that the starch has been converted into sugar, in which condition only is it available as food. Starch, as such, is insoluble, but sugar is readily so; hence we sometimes examine the feces with the microscope for starch grains.

There is no flesh-forming property to starch or sugar, but it is used in some manner in the economy in tissue-metabolism, and possibly its reduction to the simpler forms of carbon dioxid and water is attended by the evolvement of energy. Latent activity may be produced at the moment of change and stored away in the sympathetic system, to be available for future draft.

3. Albumin in one shape or another is an important constituent of all organic substances. When it has served its purpose in the animal economy it appears in part as urea or some mode of the urates. This substance (urea) is the antecedent of the ammonia in stale urine.

Sometimes, as in typhoid states, we can, by holding a stopper wet with muriatic acid in the breath of the patient (so that the fumes may mix with the expired air), observe a white cloud of muriate of ammonia NH Hcl.

I had a patient with pneumonia. His kidneys were previously unsound, and he became drowsy from uremic coma. I put him inter alia on ammonium benzoate, with some improvement, including a restoration of normal acidity of his urine (glycocol + benzoic acid hippuric acid). A relative wanted another physician who said "we must stimulate him-give him whisky and carbonate of ammonia." I retired in favor of the other physician. Patient died within another thirty-six hours. The family declare that the new medicin killed him. Mineral acids in that case might have done some good, especially the nitro-muriatic, which contains free chlorin which decomposes water, becoming muriatic acid and liberating nascent oxygen, besides arresting free ammonia in its passage thru this series of changes.

Pepsin transforms albumin into peptone. in an acid medium, but papoid and fresh pineapple juice will produce peptones in

I

dependently of the acid condition. sometime get the nurse to steep fresh beef in fresh pineapple juice; this makes a very palatable peptone. Fresh pineapple juice also digests and dissolves the false membrane of diphtheria. It contains also a stimulating ethereal principle.

Conditionally, meats are objectionable, more or less, in warm weather, owing to the creatin and other irritating principles they contain. Cheese is a concentrated and unirritating albuminate, but it is hard to digest, and in a weak stomach it may form acid albumins with corresponding gastralgia or pyrosis. A little cheese eaten after dinner seems to aid digestion: for "cheese is the little elf that digests all, except itself."

4. Fat is not absorbed as such, but is first emulsified by the bile, and then saponified with the aid of part of the pancreatic and intestinal secretions, in which condition only is it absorbable. The fat is split up into glycerin and fatty acids; the latter combine with bile and other alkalies to form soaps or absorbable salts. Its mission seems to be connected with tissue metabolism and the production of animal heat.

Albumin may undergo fatty degeneration, as in the case of the transformation of leucocytes into pus-cells. Adipocere is formed by the albumins of a dead body undergoing fatty degeneration, and the resulting fats furnishing stearic, margaric and oleic acids to combine with ammonia and metallic bases; privation of atmospheric air is essential to this series of changes.

There must be a relationship between the kind and amount of food we eat, and the amount of work performed. The following table from McKendrick shows the quantity in avoirdupois ounces of the different materials of dry food required under different circumstances:

II. The second system in our scavenger business is that of the urinary organs.

At this stage of the review of our work of school days, it will be well to examine some samples of urine. Suppose we have (1) an unusually pale urine, in large quantity (according to twenty-four hours' measurement), of low density-anywhere between 1002 and 1012, reaction neutral, and giving negative results to tests for albumin and glucose: that suggests polyuria, or diabetes insipidus. Or (2) we have a urine also of low sp. gr., but decidedly heavier than the preceding specimen, say 1015 that would suggest albumin, and that the kidney is the seat of the trouble. Heat slowly in a test-tube (or spoon, if the former be not available); a white precipitate is either phosphates or albumin. Add a drop of vinegar; if the precipitate dissolves, it is phosphates; if it becomes more pronounced and separates into flocculi, it is albumin. Or (3) the urine is of high specific gravity-above 1025; it is usually pale in color and large in amount: glycosuria or diabetes mellitus is indicated. If we should discover that the glycosuria is due to ingestion of too much sugar, or that the liver is the source of the trouble (in which case we are justified in assuming that the case is probably curable), it is common to call it glycosuria; if, on the other hand, due to a lesion about the calamus scriptorius of the fourth ventricle of the brain, it is called diabetes mellitus. Fill a test-tube with the urine, add some fresh yeast, invert the tube containing the urine and yeast in a dish containing more urine, and leave in a warm place twelve to twenty-four hours. Any displacement of the urine, any lowering of the column, is due to evolution of carbon dioxid, which, along with alcohol, is formed from the sugar by the yeast. We may also apply the copper tests of Fehling or Trommer (taking great care not to mistake a precipitate of peptone for glucose), the picrie acid test of Johnston, the bismuth and potash test of Boettger, the potash test of Moore, or the phenylhydrazin test.

Our ally the pharmacist is the proper man to do this part of the work; but, as a rule, his analysis is unreliable, and he wants a larger fee than we can afford to pay, or than our patients can pay us. When we find a capable, trustworthy, and reasonable man we ought by all means to encourage him by employing him to do the work; but, unfortunately, when we have found such an one, he has already prob

ably begun to lay his tracks for a medical education, whence he elbows his way into the ranks of the medical profession, there to persuade his former customers that he can supply them with "something just as good" in the shape of treatment, so that we are again reduced to the necessity of performing our own urinalysis.

There is a very convenient" physicians' pocket reagent case" gotten up by Messrs. Parke, Davis & Co. of Detroit, containing a new adaptation of an old method of ascertaining specific gravity of fluids by glass balls of different density, the lighter ones being above and the heavier below in a tube. All balls of lighter density than the urine in the tube float, and the densest one that rises indicates the sp. gr. of the urine. This is the most convenient, practical, and perfect arrangement I have yet seen. There is also a booklet of instructions and a complete set of tests in the shape of tablets. With this beautiful little arrangement all the ordinary tests may be made, both qualitatively and quantitatively.

III. Our third system of elimination is that of the lungs. About 900 grammes of carbon dioxid are eliminated in twentyfour hours, which is food for plants; they generously separate, by means of the chlorophyl in their leaves, the carbon from it, and give oxygen back to the atmosphere for us to respire. An increase in the number or depth of respirations favors the elimination of CO2. Vegetable food and muscular activity favor it. It is diminisht during sleep.

In bronchial catarrh and in pneumonia, elimination is interrupted. These conditions seldom occur in warm weather, hence we imitate nature and make an artificial summer temperature in the sick room. The se- or rather ex-cretion is probably too viscid to be moved by the cilia lining the bronchial tubes, so that we make an atmosphere of steam around the bed. There is perhaps an engorged venous-system with distended right heart calling for stimulations; ammonia vapor in the steam is not only a stimulant of circulation and respiration, but it is also a solvent of mucus. There has probably been some degree of leucocytosis, and pus-cells may be found in the bronchial excretion; ammonia will dissolve the pus. Septicemia may complicate our case, and the stomach may be in such a condition as to obstruct medicaments via that channel. It is more rational to anticipate this complication by

combining an agreeable antiseptic like oil of eucalyptus with our ammonia and water vapors, to be constantly inhaled by the patient from a bronchitis kettle over a coal oil stove placed near the bed.

IV. The skin is the fourth organ of elimination in our lesson. Normally it secretes sebaceous matter, and excretes 1000 to 2000 grammes of sweat and about four grammes of carbon dioxid in twentyfour hours, besides such substances as sulfur (from albumins), aromatics which may have been ingested (like garlic), urea, etc.

In diseased conditions the perspiration has a peculiar odor. The subjects of mania, and especially those of melancholia and dementia in its earlier stages exhale a peculiar odor. The source of this odor is perhaps the materies morbi which demoralizes the nerve cells. The liver is also, perhaps, in some way concerned, as deep percussion over the right hypochondrium often elicits tenderness in those charged with unsound mind.

The importance of the bath cannot be over-estimated, both in health so-called, and in disease.

In hyperpyrexia the fashionable antipyretics depress high temperature only in proportion to the amount of cutaneous activity induced, and, sometimes too, in proportion to the amount of nervous and vascular depression. The cold bath has done harm by deflecting nerve and vascular currents towards internal organs, but there is usually no objection to warm sponging, gradually cooling the water.

A remarkable case of pneumonia I saw with my friend Dr. Hume of Frankfort, showed a temperature of 104° F, rapidly rose to 107°, and began to cool only when cold water was injected into the rectum. Patient eventually recovered after inhaling over 70 gallons of oxygen gas. Louisville, Ky.

ROBERT WALLACE.

Sulphonal Habit.

Editor MEDICAL WORLD:-I recently met a case of sulphonal habit. A girl of twenty years had been taking the drug over eighteen months, it having been given her by a physician during an attack of typhoid fever to relieve nervousness and procure sleep. As she convalesced, she continued its use until she could not do without it. When I saw her, about two weeks ago, she was taking about ten grains six to eight times in twenty-four hours. Her supply became exhausted one night, and the next

Treatment of Typhoid Fever. Editor MEDICAL WORLD:-In the treatment of typhoid fever there is a golden mean. In all forms of treatment, any extreme is a fad, and all fads die out in time. The method I have tried with success avoids all extremes, and yet all cases are not treated exactly alike. The patient, in a given case, must be studied as much as the disease. If seen as soon as the fever begins, and a diagnosis can be made. with certainty, I give a calomel laxative of to 1-10 of a grain every hour until there is a copious but gentle evacuation. Then I give a grain, more or less, of calcium sulfid three or four times a day and the sulfo carbolates alternately. I never use any antifebrifuge but sponging in cold or tepid water, according to the individual and range of fever, which produces a stimulating, followed by a soothing sensation. I also give a 2 to 3 per cent. solution of chloroform every one-half to one hour while awake, and keep it up until the fever begins to decline, and then I stop it. For food I give any soluble substances that the patient likes, especially the acid phosphates in water ad libitum, ice-cream or any other frozen preparation as preferred; soups, baked apples and cookt fruits, with skins removed, etc. Raw apple scrapt is often very appetizing, and the acid furnisht helps to keep the bowels moving normally. I also give strychnin, 1-40 to 1-60 gr. t. i. d. all thru the disease; it stimulates all the organs and functions, as bowels, kidneys and appetite. Later I give digitalin if the heart seems weak. The chloroform and acid phosphate is especially agreeable to the patient, and I often prescribe them in solution together. I never have constipation or diarrhea in consequence. For tympanitis, if bad, I give a few pills of salol and turpentine on abdomen.

My greatest trouble with this treatment is to keep the patients from eating too much, or such as I interdict. They are paler when allowed to get up, but have

lost only a few pounds in weight and are on the street feeling about as usual in one week after the fever has left. I never had hemorrhage from nose or bowels if I saw the case in time. Of course, if seen after ten days or two weeks have elapst, I have to combat the conditions somewhat differently, tho in the main they are treated as above. I never purge. I give sweet milk or buttermilk, as they prefer, and it agrees. Study the patient and don't treat the name of the disease.

Everett, Wash.

J. S. McILHANY, M.D.

Constitutionality of State Medical Laws.

Editor MEDICAL WORLD:-I read your proposal for a National medical law with deep interest, but am not sure such a law is necessary. Before me is the Declaration of Independence, and it says: "We hold these truths to be self-evident: that all men are created equal; that they are endowed by their Creator with certain inalienable rights; that among these are life, liberty and the pursuit of happiness." Now I turn to Article 4, Section 1, of the United States Constitution: "Full faith and credit shall be given in each state to the public acts, records and judicial proceedings of every other state; and the Congress may by general laws prescribe the manner in which such acts, records and proceedings shall be proved and the effect thereof."

Recently it has been sought, in the exuberant desire of medical boards of health. to create themselves into courts of final jurisdiction, sitting on the acts of medical men within their state jurisdiction. On appeal, at least two state Supreme courts have declared such powers assumed under state laws ultra vires and unconstitutional; and the men whose licenses were canceled, were, by order of the courts, restored to practice.

Now we come back to state jurisdiction; there can be no doubt but that each state has a right to protect its citizens from ignorant charlatans under its police powers. But has a state legislature the right to meet a citizen at its borders who has in an honorable and legitimate way prepared himself for the profession of medicin by graduation out of the best colleges, or one of them, and say, "you cannot pursue life. liberty and happiness in this state, no matter what your qualifications may be. until you are examined and past upon by

a law infringe on Article 4? or does it not?"Full faith and credit shall be given in each state to the public acts, records, and judicial proceedings of every other state." The public acts and records of the state of Illinois prove most conclusively that I have the inalienable right to pursue the practice of medicin in this state. I can "live" only by my profession and the practice thereof, as that is my legal calling; but the "Liberty" to do so is denied me in Minnesota, and I am debarred of the "happiness" guaranteed by the Constitution of the United States, the liberty and the right to live, by the medical act of Minnesota. Just what subtle legal reasoning a learned lawyer would employ to prove such an act constitutional, the lay mind is at a loss to understand; but to the lay mind all medical acts that are for any other purpose than the protection of life and limb are wholly mischievous, exclusive and not within the meaning of either the declaration of independence or Article 4, section 1, of our constitution. My proposition is to carry a test case to the supreme court of the United States, and if it is then found that states have such medical police powers, then let us appeal under article 4, section 1, for a declaration of both Houses that the practice of medicin is of right on production of public acts and records in any state, the inherent right of every citizen wherever our flag floats, and we have jurisdiction. If the Editor of THE MEDICAL WORLD and its readers are prepared to respond to the sentiments of this letter and believe with me that such laws are unconstitutional, a subscription of $1.00 forwarded to the Editor would be ample to test a case and settle this burning exclusion question.

S. EDWARD MCCULLY, M. D. 73 Twenty-second St., Chicago, Ill. [We believe that every state has a constitutional right to determine the standard to be required of those who practice medicin within its borders. Therefore we decline to "hold stakes" for the abovementioned purpose. At the same time we favor a National enactment, creating a National Board of Medical Examiners, or more than one if necessary, a certificate from which to give the bearer a right to practice medicin anywhere under the jurisdiction of the United States.-ED.]

Editor MEDICAL WORLD:-Will you and the readers of THE WORLD tell me what course of treatment to pursue in the following cases?

First. A young married man, complains of sexual weakness. Says he cannot gratify his wife's sexual passions because emissions are premature, occurring in a few seconds after introduction. Erections are fairly good, and he is capable of intercourse from three to four times per week. His general health is fairly good, tho he suffers somewhat from gastric catarrh. Sleeps well and does not have nocturnal seminal emissions when wife is away for a week or two. Penis small and cold. Urethra not excessively tender. Never masturbated to excess, but has indulged in sexual intercourse on an average of three times a week since his marriage, two years ago. Only a few times previous to that.

What can be done to render his sexual powers and organs normal?

Second. A young man, age 25, single, is engaged to be married in the course of a month. Complains that he suffers from nocturnal seminal emissions, and in sexual intercourse emission takes place on introduction. Erections are vigorous, but organs are small and end of penis cold. Has never had intercourse "more than a dozen times," tho he masturbated from sixteen to eighteen on an average of three or four times a week, and from eighteen to his present age on an average of once a week. has no stricture, but was operated on for one six years ago. General health below par, but is fairly strong. He dreads his wedding night and wishes relief.

He

Please give me your opinion of these cases. I can't find satisfactory treatment in my text-books, and am doubtful whether tonics or sedatives are indicated. What effect would electricity have? Can an abnormally small penis be enlarged? THE WORLD is my most valued of five journals. For practical information for general practitioners I have not seen its equal. Alabama. "SUBSCRIBER."

[These cases need disciplin, and not medicin. As a placebo, and as a help in in