love you, because you will become lovable. Pardon the sermon. None of you need it more than the writer.

I cannot agree with all of Dr. Cooper's axioms. The first is only measurably true, since an effect may remain after the removal of the cause. A bullet wound will be still a wound, tho the missile has passt clear thru the body and out again. The second is a gratuitous assumption, so easily disproved that I will not take time to quote examples of its absurdity. When mustard reddens the skin, what nervecenter is affected? The sixth is unproved and unprovable. The eighth is only true when the definitions are made to fit it. To the whole article it may be answered that it is assumed gratuitously that treatment should be uniform, while the fact is that many roads may lead to the same goal, and as no two cases absolutely coincide, uniformity is not a possibility. Hyper-medication is an evil, as hypo-medication is an evil, and the only defensible rule is the dosimetric "dose enuf."

Dr. Smith asks, on page 160, for the treatment of chronic coryza. Try this: Wash out the nostrils with a fountain syringe, using an ounce of distilled hamamelis to a quart of warm water three times a day; then atomize a mixture of europhen and petrolatum, one part to eight, with an oil atomizer. Make this a habit for the rest of the life, or until the catarrh is really cured. Lack of persistence is what renders the treatment of chronic catarrhs so futile.

Dr. Watson's boy has an affection too serions for off-hand prescribing. Take an afternoon off and give him a thoro examination, for the case looks like one of reflex origin. Meanwhile I think he is wrong in keeping the child drencht with bromids. They may be the cause of the sensory paresis he describes; they only cover up the disease and do not cure it; they depress the vitality and have a bad influence on the mental development of a growing child. Better lessen the irritability of the nerves by keeping the bowels empty and aseptic, restraining that good appetite in proper limits, and give cicutine hydrobromate, cimicifuga and hyoscyamin in doses enuf to produce evident physiologic effect.

On pages 148-9 Dr. Lowell remarks that I failed to credit the followers of Hahnemann with the use of calcium sulfid. The sulfids were utilized as medicaments long before his day, but the homeopathic school deserves credit for keeping their memory

alive. From them, probably, Ringer took the hint, and from his recommendation arose the modern use of this agent. But his therapy was nullified by his inefficient doses, which also he owed our homeopathic brethren. The idea was advanced by the French, who especially directed attention to the great value of the sulfids in diphtheria, tho they, too, were hampered by the little doses. To Burggræve is justly due the credit of opening the eyes of the profession to the inestimable value of this remedy, as a means of combating infectious processes, and destroying microbes in the blood and the tissues. The homeopathists carried this diamond around in their pockets for all those years and never realized its value.

The importance and scope of the sulfid therapy may be appreciated by the following data from an interesting paper in the Archives Provinciales de Medicine for March, 1899, by Lada Noskowski. He had noticed that the men who worked in sewers, and those who dwelt near the outlets of sewers, were rarely victims of microbic affections. This is not in accord with my own observations, for I found that the district which adjoined the opened sewers in Philadelphia were notably liable to just these diseases. Micquel found in the sewer water an anerobic bacterium that disengaged sulfuretted hydrogen.

Rosenheim discovered a similar organism in fresh urine that contained sulfhydric acid. These destroy erobic bacteria, and by their avidity for oxygen deprive the anerobic bacteria of that element, which is essential to their pathogenetic activity; for they live erobically within the body, reproduce with excessive rapidity and produce powerful toxins. Deprived of oxygen they live erobically, multiply slowly and produce only pepsins useful in digesting food. The leucocytes therefore get their work in, in better shape, and make short work of the intruders.

By experiments on dogs he found that the toxic dose of the acid was 35 milligrams per kilo, while 25 produced no bad effects. The antidote is iodin, which instantly stops all symptoms due to the acid. The dose of the acid for adults he recommended was 10 centigrams, which could be doubled without danger.

The wide range of its usefulness was shown by the list of affections in which he found it of value:

1. Intestinal infections. Asiatic cholera, cholerine, diarrheas and dysenteries, in

digenous or exotic, infantile cholera, green diarrhea and the gastro-enteritis of children are cured with great ease, if the lesions are still susceptible of cure. Sulfohydric acid, in small doses, even, disoxygenizes the intestinal liquids, and renders bacterial life impossible. In doses a little larger it disorganizes the bacteria by abstracting the oxygen from their bodies.

2. Infections in which the bacteria live in the organic liquids: Malaria, erysipelas, eruptive fevers, or in the small intestine inaccessible to enemas, as typhoid fever. Sulfhydric acid can here only act thru the intermediary of the blood, which, partially dishematosed, furnishes the bacteria too little oxygen for erobic life.

3. Infections of the respiratory organs. When there are no lesions or losses of substance, the cure is obtained easily. Mixt infections of the lung, with loss of substance, are more rebellious to treatment by the enemas. In tuberculosis of the second or third degree he obtains some cures and many ameliorations. The patients live many years in a relatively satisfactory state, if they continue the treatment, at least at intervals. Under its influence the tubercle bacillus becomes less virulent and proliferates more slowly.

4. Diphtheria, an infection in which the bacteria are outside the organisms, with a pathologic product that does not participate in the circulation: The doses must here be large and frequently repeated. The local use of sodium sulfhydro-sulfate is a powerful aid. This is decomposed by the carbonic acid of the air, disengaging sulfhydric acid. Speedier action can be secured by painting with lemon juice.

It might be thought that the use of this active agent would be weakening to the patient, but on the contrary, the respirations are quickened, hematosis and metabolism stimulated, the nutrition increases, phagocytosis excited, and the invading bacteria enfeebled by the deprivation of oxygen.

The difficulty of controlling the admin istration of this acid has led us in America to prefer the sulfid of calcium, and most of the reports are based upon this agent. The adult dose is one grain, and this may be repeated four to six times a day.

It will be seen that Lada Noskowski says nothing of the use of the acid in gonorrhea, but this is perhaps its most important application. The druggists are catching on," and the drummer will soon follow suit. Only last week a phy

sician brought me a box of capsules which had aborted a fully developt gonorrhea in three days, remarking: That's more than we can do." "Speak for yourself," I replied, "calcium sulfid will often do it in that time." The capsule consisted of sandal oil, cubebs and calcium sulfid.

My own modest contributions to sulfid therapy consists of its use in gonorrheal rheumatism. To date the record is an unbroken series of cures.

WILLIAM F. WAUGH, M. D. Ravenswood, Chicago.

Therapeutic Philosophy.

No. 2.

Editor MEDICAL WORLD:-True to that progressive and fair spirit which has always characterized THE WORLD, its Editor has askt me to continue these articles. It is far from certain that my lucubrations will hold a quid pro quo with reference to the reader's time and patience, but may not every honest writer say this? At least I feel certain of courteous treatment from the WORLD readers.

I want to say more about hypermedication, the worst, and most common of all medical faults. What are the causes of hypermedication? They depend upon the abuse of the right drug and the use of the wrong drug. We have but very few right drugs, within the strict meaning of right

ness.

The leading one is quinin in ailments characterized by periodicity. Remembering what a right drug costscenturies of travail mid Galenic hosts-is it not shameful for its beneficiaries to abuse it? There is a ton of quinin given for every ounce that should be given. Quinin is a remedy only where there is periodicity, associated with a moist skin and cleaning tongue. In this condition, it is positive and infallible; in any other condition it is harmful. I beseech you, test this in the uttermost spirit of fairness, and see if I have not stated the truth. Mercury has been equally abused. This will be hardly questioned. Drawing from all the schools there are, perhaps, twenty drugs which may be called semicertitudes. About all of us abuse them. It is easily seen, then, that one form of hypermedication consists in the over-use of the right, or partly right drug.

The other form of overdrugging consists in the use, and excessive use, of wrong drugs. The fact that we do not, and cannot, know they are wrong, is adversely off

set to an immeasurable degree by the fact that we do not, and cannot, know they are right. Whether a precious life shall be saved or lost, often depends upon whether we do, or do not, give, and push, the wrong medicine. It will be very rationally, and pertinently, objected here, that the development of a drug therapeutics would be rendered impossible, by a universal adhesion to the practice of giving nothing, if not the right, or partly right, drug. This springs a question which is all-involving in its scope and moment. If it is a fact that the ingestion of a foreign substance is vitally expensive, then it is true that the establishment of a drug's precise sphere of action costs many human lives. If the unindicated exhibition of a certain drug one-millionth kills the patient, and a million doctors exhibit it, then one life has been sacrificed for the sake of other future lives. Has the doctor a right to contribute toward the death of a fellow being in order (not certainly) to make it possible for a future doctor to contribute toward the life of a fellow being? I leave this question for moral philosophers and casuists to toss on their ethicological horns. It is certain that there is but one way of dissipating the moral phase of the question, and that way would inhere in a dependence upon professional drug provers. If a man wants to sell his own life by toxic inches, he certainly has that privilege.

I have said that hypermedication consists in abuse of the right, and use of the wrong drug. The immediate cause of this is a blind spirit of helpfulness on the part of the doctor. Blind, because not justified by hard realities, but by the strange force of occult mysticism. Back of this is an element of the drug idea which has all the force of an inborn superstition. There is hardly anything else so actually untrust worthy as a drug, and yet we will all of us talk and write about the virtues of a pet remedy with a burning eloquence that would, by conversion, illumine a Websterian period. It is true that in these latter days there is a commanding con. tingent of physicians who write more temperately along this line. Generally, the Generally, the doctor is a psychological puzzle; for, altho in intervals of his strongest sanity he may be almost a medical sceptic, he will, at the bed-side, push drugs with a zeal that is nearly religious.

Altho uncounted billions of drug misapplications seem to strongly buttress

edical scepticism, it is still a fact that

the drug-idea is founded in truth. The establishment of one therapeutic certitude realized an epoch which holds, at once, an answer to all the past, and a promise to all the future. It is now settled that the right drug, in any sickness, is promotive of recovery.

Before proceeding to the discussion of specific therapeutic wrongs, it is proper that I review the fundamental aspect of the Art Curative. I have concluded that all drug cures are affected thru shock. This shock may be expresst in sudden, violent disturbance, or in a series of lesser perturbations, or in a long succession of refined antagonisms. We get our first hints of this shock theory from those coarser happenings, whose relations to cure are so obvious that any one can see them. Thus we do know that whether the theory holds good to the end or not, shock does cure. Every doctor can recall instances in which the truth of this is illustrated. My great-grandmother had suffered long and severely from sub-acute rheumatism. One day in mid-winter she started on horseback to visit a married daughter. She had to cross a creek which was lightly frozen over. The horse plunged and threw her, and she sat down with great emphasis thru half an inch of ice and two feet of water. This was an all-round shock, being both physical and mental in its character. But it completely cured her rheumatism and there was never a return of it. I could report many similar cases, and so can every doctor, and not only every doctor, but almost every intelligent layman. There have been then, untold millions of such cures-sufficient to put an eternal quietus upon the swallow-and-summer proverb, in this relationship. To me, this shock-cure fact furnishes the true, actual and only foundation of therapeutics. It is a demonstrable fact that shock will cure; it is not a demonstrable fact that anything else within the strict confines of therapeutics will cure. By "strict confines," I mean the sphere of judgment and action whose peculiarity depends upon medical education. The intelligent layman can practice hygiene, psychurgy, etc.; the chemist can prescribe antacids, antidotes, etc.; the surgeon can cut and mend, but only the physician can apply pure therapeutics.

Intrinsic to the rough and-tumble methods of rough-and-tumble doctors, there is a redemptive irony, and it depends upon the shock-cure fact. In all cases curable

by coarse shock, a huge dose of the wrong medicine may effect a cure. There is no telling how many lives have been saved by heroic bleeding; but these fortunate results had to depend upon the efficacy of shock-unless it is true that sick people have too much blood. What is true of venesection is true of all other coarse methods. There is only a class of diseases (and their victims must be robust) which can be cured by rough shock. The The analogue of curing by general shock would be seen in the act of shaking a house to drive out a mouse. You may succeed in driving out the mouse in that way-a way always more or less damaging to the house-but how much better it is to locate the mouse and then shoot it. Fortunately the modern trend is from the roust-about method, and toward the specific mode. "Fortunately," because under old-time haphazard horse-dosery many are killed, or partly killed, for every one who is cured; and because under specific medication, about none are killed if none are cured.

The fact of all facts is evolution. Obediently to the eternal stress of the "Unknown Cause," it is in perpetual selfassertion. The result is progress, ever progress-indeed, evolution is progress. Even seeming recessions are consistent phases of evolution, for Nature cannot contradict herself. Back, back thru the perspectifying chiliads, in the dawn of hnman intelligence and in an unknown place, there happened a coincidence out of which was evolved the beginning of therapeutics. A prognathus man with an exaggerated nictitating remnant and excessive vermiform appendix, noticed something. This primitive man, who was ailing, received an extrinsic shock and became immediately well. None before his time were sufficiently intelligent to note such a coincidence. He became a doctor-the lone, first doctor. He applied the one treatment for every variety of sickness. Later, he noticed a cure from intrinsic shock. Some bilious, root-eating neighbor --in a fit of abstraction-got hold of the wrong root, and after a cataclysmal emetocatharsis, got well. Here, then, was the beginning of drug medication, for our doctor took the second hint. What a therapeutic record since that dim era! Leaping from the dark Then to the blazing Now, and leaving the murderous medical past half buried in merciful oblivion, we can see what evolution has done.

He

The pre-Adamic doctor did not reason much; now, some of the doctors do. killed or injured a hundred for every one he cured or helped; now, we (the world over) do not kill or injure more than half that number for every one we cure or help. The world does move, and its rate of movement is rapidly increasing in "these piping times."

I find I have exhausted my space in the treatment of generals; in my next I will get down to the discussion of particulars. Cleves, O. W. C. COOPER, M. D.

Notes and Comments.

Editor MEDICAL WORLD:-Circumstances have arisen during the last few years that show more than ever the necessity of a change in our patent laws. Not only are we almost robbed in the prices of certain drugs (page 98, March WORLD), but in many other respects are our patent laws greatly defective. greatly defective. If the doctors would take the matter in hand and thoroly ventilate it, the people who buy and use drugs would join with us in asking for a change. Medical societies should discuss the matter and speak out boldly in favor of a change.

Spelling reform in chemistry (page 99) is greatly to be desired. THE MEDICAL WORLD is doing a good work in spelling reform, and Dr. Leffmann's article comes in good time. Every one can see the advantage to be gained by the changes he suggests.

I am glad to see Dr. Waugh (page 101), whose articles I always read with interest and profit, is still pleased with his treatment for pulmonary consumption. Other physicians in other parts of the country should try his treatment and report at the end of a year. In this way much may be learned about the treatment of this dis

ease.

My experience in the quinin rash (page 108), is that a persistent use of the drug "drives it out," as the old women express it; and it soon ceases to cause any unpleasant symptoms. But Dr. Holstein's case, simulating smallpox, was unusually severe, and in his case it was probably necessary to stop the quinin.

I think Dr. Sanders is right (page 114), when he thinks doctors are mistaken when they say they never have any lacerations or puerperal fever. But in all localities where malaria at times holds high carnival, we may expect fever after confinement sometimes, and this

fever is often mistaken for puerperal. Malaria may aid in causing puerperal fever, by opening the door, as it were, for the more potent poison. Like Dr. S., I seldom, if ever, give ergot after delivery. After a practice of more than a quarter of a century, I am not yet able to say it has ever done any good. Twenty or more years ago it was used much more frequently than now.

With all deference to the opinions of others, I can have but one as to a "Nice Point in Ethics" (page 119). Dr. Alter should make known his secret to the profession, and trust to some other means to make money. To hide any discovery that may save life or relieve suffering, unless a money consideration is forthcoming, is not to imitate the great men of the past in our profession, nor the great Healer of soul and body. C. KENDRICK, M. D.

Kendrick, Miss.

Calcium Sulfid.—Hepatic Colic.—General Obstetric Conduct and Management.-Drunk

enness.

Editor MEDICAL WORLD:-I am glad to endorse the suggestion of Dr. Eede in the April WORLD, even if I am not able to add much to the department.

Just how calcium sulfid does the business in suppurative cases I do not know, but that it is useful in -grain doses every hour to saturation, I do know.

I have never used either chloroform or olive oil in hepatic colic. My treatment in the five cases I have had was colon irrigation, as hot as the patient could bear. It was successful in each instance. Time: Ten minutes to three hours. Free catharsis brought the stone in the evacuations next day on every occasion.

There are some good questions under your "General Obstetric Considerations." The question of how one approaches a lying-in woman not only has a great bearing on one's general practice, but often is of the greatest importance in that particular case. In the first place, don't talk about the weather to the patient. She has something else besides the weather on her mind. Be calm. Throw all the human sympathy and kindness you have in your nature into your voice, touch and manner. Always treat her as if she were the highest lady in the land. It has been my fortune to attend several labor cases as well as to do a good deal of other work in houses of prostitu

tion, and the ready response of those girls to sympathy and kindliness was gratifying indeed to one who wishes to be classt as a gentleman. In making your examinations, use every possible precaution to prevent the exposure of your patient. She will remember it afterward- to your advantage. Make your examinations first and gain what information you want and talk afterwards. Your endeavor to impress on the mind of your patient the importance of obeying you implicitly, and of relying entirely on you will be much more effective after a thoro examination than before. Don't expect that you can reconcile a primipara to the handling necessary in a thoro examination by any amount of talk. She knows what you came to do— do it and talk afterwards. I always use the ante-partum douche if the woman has leucorrhea, or if she has been examined by any one prior to my arrival, I always use the post-partum douche.

I use chloroform during the second stage nearly always.

I use strychnin or quinin to strengthen the pains whenever there is the least possible excuse. Also caulophyllin to effect whenever it is useful, and that is in most labors.

If the pains are a little weak or irregular, I give strychnin arseniate, 1-134 grain every hour to effect, and if the soft parts do not dilate properly, I give caulophyllin, 1-6 grain every half-hour to effect.

Normal labor may be physiological, but the fact remains that the physician can do a good deal to make it easier and quicker, and that without interfering in the least with nature.

I believe a physician's diploma should be revoked for drunkenness. If a man hasn't sufficient respect for himself and the balance of the human race to keep sober when life is at stake, he is not fit to be granted the privileges of our profession. The country doctor is a man who has the respect of his community-if he has not it is his own fault--and he should endeavor to keep himself worthy of that respect.

I believe, with Dr. Cooper, that hypermedication is a serious fault, yet I do not believe in allowing the fear of hypermedication to interfere with the use of active remedies in the effort to control disease. Have reason with you when you choose your drug, then push it to the physiological effect, and you will have no cause for regret. E. I. RAYMOND, M. D. New Windsor, Colo.