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given about an hour before the sweating is expected to begin. It is best given in a powder placed on the tongue, and washt down with sweet milk or water. It is not soluble in water, and the alcoholic solution is too stimulating and besides difficult to take, on account of its extreme bitter

ness.

It is naturally to be expected that the remedy would prove of value in all cases of exhausting sweating, such as frequently supervene upon typhoid fever and after grip, especially as it is claimed that the drug has also an hypnotic effect, inducing refreshing sleep.

Recumbency After Childbirth.

It is a matter of general interest to the profession to determine the period necessary to keep the patient in a recumbent position after parturition. The consensus of opinion has been in the line of conservatism, enjoining at least ten days, and apparently attributing many of the illnesses of married women such as the various displacements of the pelvic organs, incomplete involution of the uterus and inflammations of the uterine and ovarian tissue, to their being "too smart" and getting up too early. In contradiction to this has been the fact, opposed to all theory, that aboriginal women seldom suffer from pelvic disorders, nor do the Irish peasantry, and that these women are proverbially early in getting up and about. To such extent is this practice carried sometimes among savages that it is said that in certain African tribes the woman is scarcely delivered of the child than she arises from her bed, and proceeds to wait upon her husband, who takes her place and duly observes the lying-in period.

Theoretically all the evils named should follow too early rising from confinement, but once in awhile some iconoclast arises, and in defiance of all establisht medical tradition, dares to ask reasons for the ap

parent contradictions, and will not be satisfied with vague and sometimes cutand-dried explanations.

Certain obstetricians of note, sufficient to free themselves from the charge of undue seeking after notoriety by the advancing of unusual opinions, have recently been discussing the matter of a ten days' confinement to bed, and take the view that getting out of bed is not fraught with the danger generally attributed to it. In support of their position they adduce the fact that the practice of getting up at once is common among the poorer classes, and that these women as a rule make a far more satisfactory recovery than do the women of the richer classes.

Well-known facts are adduced in the argument, and an ingenious bit of inductive reasoning that the upright position. favors the escape of the urine discharge, which often remains to the point of putrescence when a woman lies down, and that this discharge is solely to blame for the appearance of inflammatory conditions, whether acute or chronic.

THE WORLD has probably as many practical obstetricians among its subscribers as any other magazine publisht, and with a view to getting some data that will be of interest in this discussion, it asks for facts bearing upon the question from the observation of the physician, not from hearsay. Make your replies as brief as possible, but give your experience of ill-results due in your judgment from either a prolonged or a short period of recumbency, and bolster your facts with statistics when possible, and let us decide on the merits of the question.

So-Called Medical Advertising in the Lay

Press.

Is there a doctor who picks up his daily paper but has a feeling of disgust when his eye is caught by the prominent exploitation in its columns of some quack remedy? ranging from the "little liver pills" guaranteed to render the taker, no matter how

aged, into the blooming picture of youthful health if directions are only followed until some named number of bottles or boxes are taken, to the ingenuous regulator of "female disorders" and the blatant restorers of "lost manhood."

There has been much talk of regulating the social evil, but we venture to say that a goodly portion of it would regulate itself were certain of these disgusting and lying advertisements refused admittance to the pages of the daily and weekly press. Fewer men would enter upon excesses were they not assured by the "Daily Howler" that "sure cure" waited upon their application for certain nostrums, and 'fewer girls would be led astray were it not for the confidence they begin to feel in "The Lady's Friend," "The Monthly Regulator," or the "successful practitioners" apparently endorsed by their favorite journal.

In England the evil has been met by appropriate legislation, and now the papers publishing advertisements of abortifacients are considered liable to suit in the event of ill consequences from the use of the nostrums. In addition, by ceaseless effort on the part of individual physicians, a public : sentiment has been created stigmatizing : such remedies as either cheats or criminal, and that the papers who depend for their support upon the patronage of these manufacturers are, to say the least, immoral. In certain instances a traceable falling off of reputable advertising and of subscriptions has followed this course, and in con- sequence certain of the better class of daily journals have begun to exclude this class of advertising from their columns. The evil is uncontrolled and apparently uncontrollable in this country however, and it is possible that public opinion may not have so salutary effect here. Still it is well worth trying, and we ask that every doctor within the reach of this utterance begin at once to exert every measure of influence he may have against this evil. This will have a measure of success, perhaps immediately apparent.

But the other side of the picture, also of great importance in its influence on the public health, the advertising of means for self-medication, is more strongly intrenched, and is perhaps more difficult to overthrow. We allude to the cough medicines, soothing syrups, cathartic pills, various and sundry secret cures, many of them rich in morphin and alcohol, that are sold by the thousands of bottles, and which too often are productive of ill results easily recognizable by the medical man as due to the patent medicine, but too often attributed by the laity to the natural course of disease. Any attempt on the part of the practitioner to show this fact is apt to be attributed to personal motives by the laity, and thus they buy again and yet again, and the various patent medicine men wax wealthy on credulity and pursue their lying course unimpeded by all the efforts of the conscientious physician. It is hard to get people to believe that even a good remedy, self-administered, has elements of danger. To them the headache of typhoid fever is the same as that from pressure on the brain or from eye-strain, and each and every headache is given an indiscriminate dose of the favorite nostrum, sometimes until it is too late to inaugurate effective scientific treatment.

Is it not time that the profession ceases to stand helplessly by, and rouses itself to some active measure? Here is a subject for debate by the WORLD family. Let us hear from you, one and all, with no uncertain sound. "In a multitude of counselors lieth wisdom." Who will formulate the just solution to the problem of how to overcome this evil?

Who and What is a Quack?

In recent medical literature no expression has been used to a greater extent than that of quack, and so much virulence has been shown in the applying of the term. and the giving of the tu quoque that a definition may not be out of place. Perhaps

the broadest definition is that of "an ignoramus who is unacquainted with the elementary laws of anatomy, physiology, pathology, etc." But the thought naturally arises that, altho this is quackery, it is not all of it, since the opprobrium of quackery seems to apply, and justly, to some educated men. Can it be defined by embracing all practitioners not legally constituted? No, for many licensed practitioners, educated men, too, are undoubted quacks. Quackery cannot be distinctly and epigrammatically defined, and can be only known perhaps by its combination of all of these with the use of unusual methods, and its opposition to methods sanctioned by scientific men.

Doctors differ among themselves, but this only shows the difficulty and the intricacy of their work, and is one of the strongest possible arguments against allowing totally incompetent people to practice the science and art of medicine. The law at present takes cognizance as points necessary to constitute a legal practitioner, the having studied for a number of years at a properly recognized medical school and the passing of certain examinations. In most States none but such can legally sign a medical certificate as to the cause of death and only such can hold any medical or surgical post under the government; hence there does not seem any valid reason why any others than these should be allowed to practise.

To these points the profession has by common consent added as a part of quackery the direct or indirect method of advertising, and the use of such methods as those practised by so-called ChristianScientists, osteopaths, etc. The recent attempt in many States to obtain a legal foothold for these sects is viewed with much interest, and it is to be regreted that a measure of success has attended the efforts of these quacks to obtain legal recognition, since they can only succeed in lowering the tone of the profession and the estimate placed abroad upon American medicine. The governor of Oklahoma

recently vetoed a bill prohibiting the practice of Christian-science and faith-cure in that territory, and the gentle war is on in Massachusetts in regard to the application of the osteopaths for legal recognition there. there. It is interesting to note that the latter have magnanimously consented to undergo an examination, but that they except from the list of branches in which such examination is to be conducted practically all of the allied sciences which constitute medicine as practised to-day. They also desire representation on the State Board of Medical Examiners, and seem to have acquired a certain support in their efforts. It is interesting to note the progress of these fads, altho it is to be regreted that they will be able to do so much mischief before they are finally overthrown. We bid God speed to our brothers who are working so energetically thruout the Union for the overthrow of quackery and the advancement of the profession, and enlist in their behalf the efforts of all progressive physicians.

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These are quotations in twenty-fiveounce lots. A duty of 25 per cent. is to be calculated, but that will not account for the exorbitant excess charged to American consumers above the prices charged the consumers of other countries. This injustice is made possible by our patent laws. If foreign manufacturers persist in taking advantage of our laws to overcharge us, we should change our patent laws, and make them similar to the patent laws of Germany. It is right to protect an inventor against infringement, but he should not be protected in such monstrous overcharging as is illustrated above, which are some of the most extreme cases of such overcharging.

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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 fewest 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.

Heart Disease.

-

- It would Editor MEDICAL WORLD: hardly seem credible that anyone should deliberately set out to write upon so indefinite a theme as "heart disease," but that is just what I have started to do.

Recently there came under my care a young woman of considerable reputation as a public singer, who for some years had suffered much, physically, but a great deal more mentally, thru the thoughtlessness or ignorance of some doctor who had cruelly told her that she had "heart disease.'

She had subsequently been examined by several physicians, some of whom had told her that she had no heart trouble, others that she had functional disturbance of the heart. To a physician this latter statement would have no serious significance, but to the laity such a big-sounding name is neither soothing nor reassuring.

The

The real trouble in this case was indigestion-flatulence-which so often causes disturbance of the heart's action. induced symptoms are frequently somewhat alarming to the friends, but the doctor seldom considers them more grave than an attack of hysteria.

In this case the attacks of vertigo and fainting were the more alarming, as this young woman was not wholly convinced that she had not "heart disease," and the fear of sudden death, once rooted, haunted her continually. Long brooding over her impending fate had made her melancholy and hypochondriac.

Being cured of her dyspepsia, she is altogether another person-cheerful and sunny in disposition.

This is but a sample of many such cases that I have seen, and I have no reason to think that my experience has been an exceptional one. Doubtless every physician in general practice meets such cases, and

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What business has any doctor to frighten a patient by telling him that he has "heart disease? The term has no proper place in nosology. It really belongs with those other popular terms that no physician should sanction, such as "liver affections." "kidney complaint" and "stomach troubles," all broad enuf and suggestive enuf to answer the purposes of patent medicine advertisements, and induce the suffering to buy and take the promising

nostrums.

The average patient understands but vaguely the learned distinctions between functional and organic diseases of the heart-between hypertrophy and dilatation-intermittent and dicrotic pulseaneurysm and arrhythmia-bradycardia aneurysm and tachycardia and well-meant but mistaken attempts at explanation, so far from making matters clear, serve rather to confuse, mystify and frighten.

The dominant idea of "heart disease" is the ever-present liability to sudden death. It is this that begets perpetual fear, and is the skeleton at every feast. It is harder to endure than actual physical pain.

We know that people with well-recog nized heart affections, even structural lesions, do live to a good old age, while others in whom no such thing has ever been suspected may die suddenly from failure of the cardiac functions.

My preceptor in medicine was a man of recognized skill, and noted for his method and exactness. He accomplisht the greatest amount of work with the least apparent outlay of force or effort of any man I ever At the beginning of his medical knew. He was told that career he had occasion to consult a physician for some ailment, he had "heart disease." He used to say that when this was announced to him, his knees smote together and he had barely strength to stagger home. Fresh in his mind were the teachings of his text-books, lectures and clinical observations, and death speedy and sudden stared him in the face.

He resolved to give up the prac

tice of medicine, and actually applied for a clerkship in a mercantile house. Fortunately, the head of the firm knew his capabilities and promise of attaining dis tinction, and he persuaded the frightened young man to put out his sign and devote himself to the high calling for which he had fitted himself.

So, notwithstanding his heart diseaseand valvular at that he took up his lifework, and did an immense amount of it, in private practice, hospital work and literary work, stood high in the medical college faculty, was for many years its secretary, reached a good old age, beyond the allotted time of man, outliving two wives, leaving the third a young widow.

The moral of this sketch is that people with "heart disease," even organic disease, with reasonable care, and even without it, may and do live to three score and ten, four-score or four-score and ten years.

The purpose of this paper is to plead with the multitude of doctors all over the land, who read this journal, to beware of unduly or recklessly frightening their patients with the Shibboleth, "heart disease."

Tho it may be but a functional trouble, and you explain that it has no grave significance as threatening life, the awful words sink deep into a receptive and fruitful soil, and probably will never be wholly uprooted, but will return again and yet again, and cause years of untold and useless misery.

But shall we not inform the patient of his true condition? Let us see. Is it probable that you can convey to his mind what you may conceive to be his actual condition? And even should you succeed in this, will it ease his suffering, quiet his fears, prolong his life or make him happier? If not, then when you find the dread words rising to your tongue, and you are about to say "you have heart disease,'"-please don't. Brooklyn, N. Y. BENJ. EDSON, M. D.

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[We predict that life insurance companies will, before many years, become willing to accept many "heart disease" risks, even when the values are appreciably affected.-ED.]

Notes-Sulfhydric Acid.

Editor MEDICAL WORLD: Either the April number of THE WORLD was even better than usual, or your correspondent

was

more receptive than usual; for I never read it with greater interest. Your subscriber from China is quite right as

to the importance of the drink habit in physicians. Alcohol is a paralysant, mentally, morally and physically. It may seem as if a surgeon had more nerve when stimulated by alcohol, but who would care to take his chances with a drunken operator if he knew it? A man will take more chances and it may be that the chance is on the right side, but suppose it is not? How many disgraceful tales of this kind are discreetly covered up, while the lucky ones are always told. There are too many reasons for the use of alcohol by physicians, but they may be all comprised in the one selfish one of wanting to do all the work, and keep that rival out of the field. Greed begets greed, and self-preservation compels one to treat his competitor as the latter treats the former. A country doctor had been regaling me for an hour with the shortcomings of his neighbors, when he suddenly stopt, and added: "I know it's mean in me to talk this way, but they compel me to do it in self-defence." I appreciated his feeling and realized his difficulties. I would like to say to my many professional brethren that if they try the practical application of the Golden Rule, as a sound business principle, they will have no reason to regret it, as a policy, and they will find it far pleasanter in its practical workings than the selfish, greedy game of grabbing, backbiting and over-reaching. When we catch our unscrupulous competitor in a mistake, it is only human nature to feel like letting the family and the community know of it. But unless one can rely on his own infallibility, he will at some time make an error himself, and give the other man his chance to even up matters. There are very few men who can speak evil of the man who persistently speaks well of them. And if they do, it does them more harm than the man they are villifying. Curses come home to roost.

But there is a still more serious aspect of this matter. Every man has in him the possibilities of good and of evil, in the extremest degree. Circumstances develop a Nero, a de Retz, a Xavier or a Luther. The Jekyll and Hyde drama is repeated in each of our lives. Good or evil grows in the heart with every exercise of the corresponding qualities. Let us cultivate hatred and nurse our grievances, and the utmost ill we can do our enemy will be as nothing to the harm we have done ourselves. Speak no evil, think no wrong, find excuses for the erring, and men will

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