she died some years later. Pilocarpin she could not take, as is usual with these cases of asthenic erysipelas, and she owed her life to the tincture of iron in teaspoonful doses. No theorizing can make me believe that many a similar case does not owe life to the same treatment.

In cases where the natural powers of the system are not sufficient to set up the menstrual function at the proper time, and chlorosis and amenorrhea result, a vigorous course of iron has establisht the flow and restored the blood to its normal condition. Frequently a leucorrhea or a diarrhea will continue because there is not enuf vigor in the system, or enuf iron in the blood, to set up curative action, and a good course of chalybeates, given by a doctor who believes in iron and is not afraid to give big doses, will do what all the local treatment in the world cannot do. My old friend Prof. Peter D. Keyser won laurels by prescribing a gallon of bitter wine of iron for a patient who had been the rounds of the Quaker City's oculists without benefit.

In convalescence the patient will frequently lag along in a condition of debility, the disease spent but the recuperative powers too feeble to set up repair, until we give iron; when soon the appetite improves, the strength and courage revive, and the dangerous stage, when stray germs of tuberculosis, etc., are apt to effect a lodgment, passes away and health returns. Quite frequently an acute attack of disease has spent its force, but the patient does not get well, and the affection threatens to become chronic. It may be a gonorrhea, a bronchitis, or a menorrhagia, but under the bracing effects of iron the system revives and throws off the dregs of the malady.

I am so much in favor of Dr. Tidball's proposition (page 419) to castrate criminals that I would like to see a concerted effort on the part of our profession to bring it about. No punishment would have such effect in deterring from crime, for about the last thing any man desires, be he good or bad, is to lose his procreative powers, even if it is thru the advance of age. The enactment and enforcement of a law prescribing such a penalty would render the crimes at which it was aimed infrequent. Dr. Oliver (page 423) speaks of the use of salix nigra for prostatic diseases. There is no remedial principle in this plant so far as known, except salicylic acid; and the question arises whether he would not find

the chemically pure acid more effective and agreeable.

Dr. Atkinson asks for a certain sign of death. The only one is the occurrence of decomposition. Generally the failure of a wound to bleed is good enuf proof, but I once saw a vein opened in a case of status epilepticus and the blood did not flow, and the woman was alive years afterwards.

Carbolic acid may stop the pain of a burn by destroying the nerve-ends, but apart from rendering the wound aseptic it would hardly be of use. I have had the pain of a burn cease the instant I applied pure campho-phenique to the burned surface, and found this favor the healing in a very satisfactory manner.

Dr. Hontz (page 427) asks a suggestion as to the treatment of a case of chorea. The symptoms seem to point to the eyes as the probable source of morbid reflexes, but this the Doctor has apparently investigated. Put the boy to bed, give him glonoin gr. 1-250 gradually increast to full effect; strychnin arsenate gr. 1-134 every two hours, also increast to full effect, and after two weeks add cimicifuga, preferably a decoction of the fresh root, to full effect. A certain amount of mental and moral training is necessary. Forbid visitors, do not try to make the stay in bed too pleasant to the patient, have him practise calisthenics several times daily, and keep his bowels clean and well flusht.

Dr. Wardner's case of sulfonal habit is interesting in that the patient presents symptoms characteristic of morphinism. See if she has not had some of the latter in her sulfonal. Stop the drug at once, sustain her heart by cactus or spartein, and keep her bowels empty and aseptic. When you believe she needs a nerve-stimulant give her passiflora.

One of the family asks if the medical profession is not overcrowded. What does it mean to be overcrowded? There are many more men in the practice of medicin than can earn a living by it alone. Let our friend look around him among other occupations and tell us if he finds any in which the same thing cannot be as truthfully said. There are too many druggists, barbers, preachers, lawyers, and laborers of all sorts. The lawyer may tell you that the great trust companies have taken away the care of estates and many branches that formerly added to his income. The shopkeeper says the big department stores take all the profit out of his trade, as people only come to him for trifles. The

shoemender tells me his occupation is gone, for new shoes cost so little that it is not worth while to have an old pair mended. How the tailor survives is a mystery, when you can buy a decent pair of breeches for less than a dollar, and a summer suit for a seven-year-old boy for a quarter. There is necessarily a constant stream of boys from the farm to the city, as with modern machinery it does not even require one son to replace his father. Every denomination tells of the needs of its fund for the support of superannuated and surplus ministers. Too many laborers, too much coal, cotton, corn, silver, muslin, even too much whisky and half the distilleries in the trust are closed down till the fools can drink up the surplus! Tell me, please, any way a man can earn an honest living without displacing some other man from his job.

But look at it from the other standpoint. How many really proficient doctors are there? Thousands of people die every week for want of help that is within the reach of their doctor if he only knew it. How many really capable lawyers can you find, to whom you can entrust your affairs with the confidence that they will be lookt after well and honestly? Try to get a really well-fitted suit, or pair of shoes, or a good carpenter, or hostler, or dentist, or druggist, or to buy a first-class ham, and see if a scarcity does not speedily develop.

Don't rail at the trusts. They have made production and distribution cheap. We get sugar for about five cents a pound instead of thirteen cents in 1876. I get potted chicken for seven cents at the Fair, for which the local grocer asks me fifteen cents. And I am to be considered as well. as these worthy tradesmen who want the trusts and big stores legislated out of existence. And the claim that I lose the custom these men might bring me is too vague and uncertain to weigh against the certain advantage of cheap goods. And to oppose the cheapness of goods is to turn the wheels of civilization backwards, and check the development of the human mind. Not that it could be done; for when any change is manifestly for the advantage of the consumer, that change wil become fixt and persistent, the older orm becoming obsolete. We may theoretically oppose the consolidation of railroads, but when we get in a car at New York and ride thru to California without change, we will not again go over a route by which we must get out and change cars

and re-check baggage a dozen or more times.

In all directions the same tendency to aggregation into large masses is manifested. The heroes of antiquity were the men who upheld the independence of small communities against the more powerful neighbors. The tyranny that justified such opposition is a thing of the past, and a Tell would be out of a job at present. The modern hero is the man who can induce a dozen little communities to lay aside their bickerings and unite into a state large enuf to command the respect of her neighbors. As the federal principle, local self-government and a strong central power to direct national affairs becomes better understood, and its operation approximates the ideal in efficiency and purity, there is reason to hope that the world will become one vast federation, and war will be as much a thing of the past as piracy and the slavetrade.

The varying exigencies of medical practice demand a force of physicians in advance of the average need, hence the average doctor must have some other source of income to support him during the season when patients are too healthy. The material advantages of the clubdoctor system will make that communistic method prevail in the future, as the lines

are

more closely drawn and economy becomes more urgently required. Less work to do and fewer to do it, as sanitary science is popularized by the growing intelligence of the masses. Fewer epidemics, more promptly stifled in the

outset.

But the need for good doctors, for better doctors, is and always will be present. Just ask any prominent city doctor who he would get to attend his wife in a dangerous illness. He will tell you that Prof. always diagnoses a woman's case as hysteria; Prof. is a therapeutic nihilist and does nothing; Prof. is a belly-ripper and knows nothing else; Prof. always advises the latest novelty that has come to his notice, and so on. A good, experienced, level-headed, allround physician is a rarity, even in the cities, among the men whose names are most prominently before the profession. Add to the really incompetent ones those who have not altered their therapeutics since they left college, those who would have saved their patients if they only could have kept sober, the mercenary, the

lazy, the very few libertines, and the ideal doctors are not any too plentiful.

And how far is the profession as a whole from perfection! Take as one instance the existence of typhoid fever. Every doctor knows, or ought to, that if in every case of this affection the stools are disinfected by being past into a vessel of white wash, the further spread of the malady from infection by that case is absolutely prevented, and that by this means the disease would soon become extinct.

it is not extinct. Every doctor knows that thoro vaccination would extinguish small-pox, that thoro municipal hygiene would lessen the death rate to about eight per thousand instead of eighteen, that the fees we earn but that go to the barkeeper instead of into our own pockets would make the whole medical profession rich, and that the tubercle bacillus has a certain life history that would permit us to extinguish it if all the world knew it.

It is not necessary that all of us should be competent to recognize Raynaud's Meniere's, Duchenne's, Morton's, Albert's, and the rest of the proper-name diseases to make ourselves good, everyday doctors, deserving and getting the confidence of our communities; but if we all fully comprehend the above short list of truths and put them in practice with all our energies, there need be no more talk of overcrowding and hard times in the medical profession. WILLIAM F. WAUGH, M. D. Ravenswood, Chicago.

Medical Reminiscences. No. 3

MY FIRST PATIENT.

Editor MEDICAL WORLD:-My first patient was a little one but his case was a curious one. It was a puzzle to tell what ailed him. Here was a boy five years old who had been previously in good health. Suddenly without any premonitory symptoms, without any malaise, he was stricken down with fever and his body was covered with red blotches, intensely swollen and itching like fire.

Of course scarlet fever came to mind and urticaria was also suggested, but neither of these seemed to exactly fit the case. I ordered a harmless fever mixture and a cooling lotion and went to my office to read up. After looking from A to Z I didn't know as much about the case as I did at first.

Next morning, when I called, I hitched

my horse in the yard and as I past thru the woodshed I stopt a moment to speak to the "old man" and the secret was solved. It was simply a case of fleas. The place was fairly alive with them and they had bitten the little fellow until they had caused a flea fever. It was a serious case, too, for the boy was delirious from pain and nervous irritation, but the cause being removed the effect subsided.

Since that time I have seen many cases where insect bites have been responsible for many obscure cases of nervous irritation and more or less acute disorder, and I have no doubt that fatal disease might ensue even from excessive flea poison. or from that other bug not mentioned in polite society.

After this first case came many of the usual diversity in character and type, but they were all down in the books, or at least something that approximated them, and it was not difficult to name them; as for the treatment, that was a different matter complicated by ignorance-on the part of the family or patient, and often upset by the remedies and suggestions of old women who were renowned as herb doctors.

Of course I never made mistakes-that is in my own opinion-at that time, but looking back to-day I fear that I should follow a widely different method in some cases. Still the patients were of rugged nature and the vis medicatrix pulled them thru in spite of drugs for good or bad.

Some time later, while I was attending a patient suffering from an old gun-shot wound, the mother spoke to me of her little boy, who was suffering from vague symptoms. The child had a poor appetite, was constantly scratching his nose, was restless and ground his teeth while asleep. This suggested worms but no worms were in evidence.

On the principle that an emulsion of oil of chenopodium could do no harm and might do good, and would at any rate settle the worm question, Meig's and Pepper's formula was ordered.

The result surpast my most sanguine expectations. The mother handed me a small package one morning, shortly after, which she said was the result. The pack

age contained three slender, cylindrical objects, about 2 inches in length, tapering at each end and apparently ciliated at the extremities.

At first sight I thought I had discovered a new kind of a worm, but the suspicion grew that they were just plain, ordinary

tooth-picks. Microscopical examination proved that this was true. The little boy had been chewing tooth-picks until the ends were frayed into a brush-like form and then had accidentally, or purposely perhaps, swallowed them.

This unexpected denouement carried a lesson with it, since it showed that one may have symptoms of worms and yet have none; and it also proved apparently that the symptoms caused by some worms are reflexly those of irritation pure and simple.

One summer afternoon I received a telegram requesting me to go to a certain picnic-grove, a short distance from the city, stating that a little girl had fallen from a swing and broken her nose. Hastily putting such articles as I thought would be useful in such a case into my bag, I hastened to the station. The more I thought of the matter, the more puzzled I became. "How," said I to myself, "do they know her nose is broken? Why should they telegraph for assistance? Why didn't they bring the girl to my office?" When I arrived at the picnic grounds, my puzzle was solved. The girl had broken her arm and the telegraph had broken her

nose.

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Every physician has, of course, had numerous cases where the man or woman indulged not wisely but too freely in the flowing bowl. I had my quota, and when a man who was a regular patient had gone off again," as the note exprest it, I supposed I should find him at home stupefied with alcohol or perhaps fighting snakes and devils. When I arrived at the house, I found that he had literally gone off. The house situated in the suburbs was on the outskirts of a marsh, and the man, driven from home by his rumcrazy imagination, had fled to the marsh. Naturally, it was a case where medicin was useless and advice was the easiest if not the best thing to give. Strange to say, the man spent a night and a day on the bleak marshes, hidden in the cocks of salt marsh hay; and needless to say, when he returned to the bosom of his family, he was very much in need of medical attendance. Searchers had been over the marsh, but it was vast in extent and the man had assumed the rôle of the proverbial needle in the hay stack, which is so difficult to find. Most physicians have had more or less experience with revolvers, usually in stopping up the bullet holes. Once it was my unpleasant experience to have one fired at

me by a temporarily insane girl. She was within three feet, facing me, and the act was so sudden that I hadn't any time to say a Pater Noster or to think of my past life. The bullet struck a button on my coat and was thus deflected, doing no harm other than tearing the covering from the button. The bullet was found on the floor in one corner of the room, and I still have it in my possession as a proof that I was not born to be shot. At another time, a bullet was fired into my office thru the window, struck the marble mantlepiece, was deflected by that across the room where it struck a metal placque and was again deflected so that it made a complete tour of the room, finally leaving its mark in the base-board.

One night I was rung up about two o'clock in the morning, and upon answering the call, found two special officers (they usually travel as partners), one of whom informed me that his partner had been shot in the thigh. He was placed on the operating chair, but upon examination no bullet wound could be found. A further search led to the finding of the bullet in his trousers pocket, which fortunately for him had a quantity of loose change which had checkt the progress of the bullet. The shock had slightly bruised the flesh and the policeman's vivid imagination did the

rest.

Other cases occurred in which the imagination also played an important part. A girl, whose family I attended for a number of years, came to me with a small tumor which was constantly growing. In spite of treatment it continued to increase in size and an operation was decided upon. On the appointed day a number of surgeons assembled to assist at the operation, but when the patient was prepared there was no tumor to remove. The girl was intensely nervous and the tumor was probably due to hysterical simulation.

I met most of my freak patients at a charitable institution at which I was assistant physician. The patients were women addicted to the excessive use of alcohol, opium, cocain or some other harmful drug. Such little things as a patient drinking three or four ounces of soap liniment, or swallowing a few drachms of tincture of iodin in their efforts to brace up, were not unexpected. Once in a while one patient would appropriate another's medicin and occasionally the yeast would disappear, and then the woman who was responsible for it would "raise Cain."

I went to see a patient one night but I never attended him. A poorly drest man called upon me, about eleven o'clock at night, and requested me to go to see a friend of his who was a very sick man, so he said. I started out with this man, suspecting nothing out of the ordinary, but my expectations were doomed to disappointment.

The locality to which I was called was not a savory one or a safe one. Only a few days before a dispensary doctor had been stoned by a mob in this vicinity. I therefore used a little extra precaution and kept my eyes bright, otherwise I should have been done up and myself in need of a surgeon and perhaps an undertaker.

As we past a dark side street my companion excused himself for a moment saying that he wisht to get a friend to come and stay with his sick partner, telling me that if I would take a short cut across a vacant lot, a street or two beyond, he would meet me on the other side and show me the sick man.

I knew the locality but slightly and I did not think the time a good or safe one to explore it. Still I did not want to leave a sick man in his need. But, I thought, there was no reason why I should'nt interview a policeman, and as luck would have it as I turned back to find one I almost collided with one.

་་

Have you seen a short man with black hair, wearing a light coat and a black hat go by ?" said he to me. "Yes," said I, "a man of that vague description has just gone down the street. I am on my way to see his partner whom he says is sick." Then I proceeded to tell him the circumstances.

"It's lucky you met me," said he. "That man's Shifty Dick. I'm after him with a warrant. He and his partner are crooks. What number did you say he gave you? Number 1713? Is that so? There's no such number on the street. The house isn't built yet where it ought to be. The site is right in that hollow you were going to take a short cut thru. Say, we'll swap coats and hats. I'll doctor 'em all right; I'll give 'em a pill or two that will make an impression that they won't forget. You go down to X street and tell the lieutenant that I want a couple of men up in Murphy's hollow. They'll know where to come."

Accordingly I hurried down to the station, told my story, and was summoned

next morning, to identify and testify against Shifty Dick, but it was another doctor who dug the bullet out of his shoulder and took the stitches in his partner's head.

I was held up another night, or rather on the edge of the evening, but the outcome was ludicrous rather than serious.

Just as I turned from a side street some miles out of town to get onto the main street, on my way home, a man hailed me and ran along by the side of the carriage. I involuntarily checkt my horse and drew up to the curb-stone, and the man putting his hand on the dasher jumped into the carriage.

He was an utter stranger to me and be fore I had time to ask any questions he made his explanation. He told me that I didn't know him but he knew me. He saw me every day in town. In fact he lived on the next street. He was in a hurry to get home, and as I had no one with me he thought that I would be willing to take him home. His very audacity made me acquiesce in his modest request. and he entertained me with stories and anecdotes all the way home, so that I really enjoyed his company.

We arrived in town in due season and as we drew near Dr. Blanc's office he naively said: "It's an awful mean trick. Doctor, but if you don't object I wish you would leave me at Dr. Blanc's door. You see my wife is sick and the Doctor is our family physician. I was in a tearing hurry and I didn't think of the meanness of the thing when I askt you to bring me in town. Forgive me, won't you?" Of course I couldn't do anything else but forgive him. with good grace, assumed if not felt, but I did wish I was driving a tip-cart so that I could have dumped him at the door like a ton of bricks.

I might tell of other patients, some that I have had and some that I have not had, to use a Hibernicism, some good and some bad, some in the highest walks of life. even to rope walkers, and some in the lowest gutters, some rich and ungrateful. some poor and humbly thankful; some of sunny disposition even tho they know that they are doomed to a life of suffering for which there is no release this side of the grave, and others fretful and complaining even if they only have a sore toe; some so virtuous that even a minister would feel ill at ease in their presence, and others so vicious that the devil himself would be ashamed to associate with them; some