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vitality-the resisting force-the foundation of all his efforts. For this we give tonics, for this we keep our patients out of doors, for this we urge the consumption of the largest possible amount of good foods, etc. Every effect of opium, whether in large or small doses, is squarely contrary to what we want in tuberculosis.

Rationally, then, we would expect the use of opium to increase the susceptibility to tuberculosis, and to hasten the disease in those already having it. My own experience, which has been large among consumptivs, accords with this rational conclusion. Consumptivs not infrequently become opium habitues, by reason of an opiate given in a cough syrup, or to ease a pleurisy or some other form of pain or discomfort. Invariably the patient is made worse by the continued use of opium. Opium masks the symptoms while the degenerativ changes go on with increasing rapidity.

If, then, the effect of the continued use of opium upon the one who already has consumption is so bad, we may reasonably suppose that the habitual use of opium would predispose to tuberculosis. Here my experience is not extensiv, yet I have known two morphin habitues to contract consumption. With my limited experience with opium users, this is a large proportion to die of consumption, and it prepared me to believe the statement of one with so large an experience as Dr. Crothers, that all opium eaters die of consumption, pneumonia, or some affection of the liver or kidneys." L. P. BARBOUR, M.D. Boulder, Col., December 5, 1903.

Editor MEDICAL WORLD:-The only case of consumption in two hundred patients treated for the opium habit was sent by a physician last winter. He was single, American, English parentage, age 39, fair complexion, very thin; was using from twenty to thirty grains of morphin daily, hypodermically. Had been in the habit about six years. I felt that he was in the last stage of the drug habit and would live only a short time unless the drug was removed. I began treatment, and in a few days took the drug away. came thru it nicely. Only then did I discover his real condition. I continued treatment, and sent him home at the end of four weeks apparently as strong as when he came. He died in six months.

He

My experience has been that morphin patients, even in the last stage of the habit, are free from disease, unless it may be organic heart trouble, and that, I think, existed before the habit was contracted. I think in the above case the phthisis was contracted some years after the drug habit was formed. I do

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Home Treatment of the Opium Habit. Editor MEDICAL WORLD :-Referring to the morphin habit, page 517, November WORLD, while agreeing with the Editor's comments on advertised home cures, I beg leave to differ most decidedly on the practicability and efficiency of scientific treatment by the physician at home, without any discomfort to the patient. It is only necessary for the patient to follow the doctor's directions, and for both patient and doctor to have patience, and be particular in detail and continue the necessary time required, which varies with different patients.

The principles of treatment are, to give good hygienic and tonic treatment to build up the nervous system, and at the same time, while giving the regular number of doses at the usual time, reduce each one by an amount so small that it will not be missed in its effect, continuing the gradual reduction until none is required. This may be done in powders by dividing them for the patient, but is best done in solution. Ascertain the amount taken, then make a solution to last four or five days, the first one full strength in order to gain the patient's confidence in the efficacy of the drug in liquid form, then reduce the strength of the dose in each new bottle-full prepared, by the fractional part of a grain, that will not be missed or noticed. As the amount of drug gets small a few drops of nux vomica can be added to keep up the bitter taste if desired. with perhaps a few drops of nux, and the The patient will soon be taking clear water doctor can tell him to fill it at the pump. Holland, N. Y. C. A. BUTTON.

Hyoscin in Drug Addiction. Editor MEDICAL WORLD:-Treatment for drug addiction with ext. ergot (Dec. WORLD, page 534) may be all right. I've never tried it; but I have treated something over one hundred cases (some who took 90 to 100 grs. of morphin and 30 to 40 grs. of cocain per day) with hyoscin hydrobromate. I have them cured satisfactorily and ready to return home in from 7 to 8 days. I have never had any bad effects from its use yet, and have never failed to cure a Í take them as they come, old or young. Just discharged a patient who had been "on the drug" 30 years; 57 years old; he was with me only 8 days. Have had them 70 years old. I take them right off the drug at once. That big scare you read about hyoscin treatment in drug addiction

case.

being dangerous-I have found by actual experience with the drug that it is all bosh. I never confine my patients. At no time while under treatment do I prevent them from getting up from bed and walking about the building. I have been treating drug addiction for six years with hyoscin, without a single failure or bad luck. I think the trouble with those who have had trouble with the treatment was that they gave too much of the hyoscin at one time. I give a purgativ at once, and when the patient holds out as long as he can conveniently without his "dose,' I commence with the hyoscin hypodermically, about gr., and keep the patient slightly under its influence for 24 hours, and the work is done. never send them home taking a tonic. I occasionally have one to return for his second treatment, but he is always ready to come with his fifty dollars, and acknowledges that it was his fault. W. S. ROBINSON, M.D.

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Frostville, Ark.

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The Treatment of Tubercular Diarrhea. Editor MEDICAL WORLD:-I notice in the October issue of your journal a well written article by Dr. Louis F. High, of Pineshire Sanitarium, Southern Pines, N. C., in which he refers to iodomuth as 66 more generally satisfactory than any single drug," but that it causes distress after eating, about the third day of its administration. With your kind permission, I would like to state that I have used this chemical very extensivly during the past three years as a healing agent, and that I have given it in doses of ninety grains for tubercular diarrhea, and in twenty to thirty grain doses for dysentery with "more general satisfaction than any single drug" that I ever used before my acquaintance with this one, but I have to say in regard to the appetite and the stomach, that I have never noticed any disturbance whatever. In fact I have often given it for indigestion with the happiest results. I can fully endorse what Dr. Karl von Ruck has said, that I have "saved several lives

with it that I otherwise would have lost." Philadelphia. JOHN H. LOCK, M.D.

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An Alleged Consumption Cure. Editor MEDICAL WORLD:-You will find inclosed a formula for consumption that was circulated in my locality before I began practising medicin. It was sold at $10.00 each, with the request not to let any physician get it or know of it in any way. The way I came in possession of it was as follows: My father was very low with consumption, and some one gave it to him, but it was not used. After his death I was not able to find the owner.

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To prepare the above Prescription properly, all the extracts and powdered roots, barks and herds should be thoroughly compounded and well mixed together, and placed in a bottle holding at least three pints; then pour into the bottle one-half pint of warm water, and shake it up well until the whole mass becomes thoroughly mixed. Let it stand about ten minutes, then add another pint of water with a pound of sugar dissolved in it, after which add one-half pint of Rum or Holland Gin. Shake the bottle well again, and when cold you have a beautiful syrup ready for use. Dose -One large tablespoonful four times a day-one before each meal, and one on going to bed-a beneficial effect will be perceptible after taking the first dose, and it rarely takes more than two boxes to make a perfect

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[This is an example of the many quack 66 cures concerning which such wild claims are made. The "recipe" is printed on a piece of paper about the size of a bank draft, with a neat border around it. The above is an exact copy, without changing a letter or comma. Don't blame our proof reader for the errors, for we directed that it be printed exactly, errors and all.-ED.]

Salmagundi.-Pneumonia, Etc.

word "Salmagundi

Editor MEDICAL WORLD:-I have taken the word "Salmagundi" to mean what Washington Irving meant by it: "Not to confine himself to any one tale." You ask what to do in pneumonia. I can in part agree with all the contributors on this subject in your December issue. As I am one of the "old ones," I fully concur in what Dr. A. K. Van Horne says in regard to "fly" Blisters (big B). I graduated at Jefferson College in 1866-1867, and had a very large practise to attend to for twentyeight years when others came to my help.

Now brother M.D.'s, we will say that a man is taken with a severe chill twenty-four hours before you see him; face flusht, scared look on his face, severe pain in side or breast or possibly back, and in a day or two rust colored sputa-or in other words, a clear and unmistakable case of pneumonia. What is best to do? Well, if a robust, healthy fellow (before this attack of course), I should take my scarificator and scarify right over the seat of the pain and then apply cupping glasses until I would bleed him two to six ounces, or until he

can breathe without pain. If the wet cups do not relieve him of pain, then dry cup as near as possible to the seat of pain; and do not be afraid to use the dry cups. If the pain is relieved (and it will be in nine out of ten cases), then give him five grains of calomel, ten grains of Dover's powder and follow in ten to twelve hours with a tablespoonful of epsom salts.

See him again in twenty-four hours, and if pain has returned, do the same thing again; and if that does not relieve pain, then apply your Spanish-fly blister; let it remain on, right over the seat of pain from two to four hours, or until you notice the skin becoming red; then remove and apply a starch poultice to draw out the serum. Often, yes very often, you can abort a case of pneumonia. If patient should not be relieved quickly, I then use mur. ammonia, sweet spts. of nitre, verat. viride, strychnin, the expectorants, and especially if cough is distressing a soothing cough mixture. You and some of your readers may think I am an "old fogy." I may be, but in this latitude it suits to a T.

I have become very much interested in the controversy between the allopaths and homeos. I am an allopath, but I use any and all things that will help my patients. For fevers there is nothing better than tr. aconite in % to drop doses, given every fifteen to thirty minutes, or possibly one hour apart, when I give only one drop.

As to dyspepsia, I have used everything that the books and my medical brothers would suggest, and yet the only rational treatment is almost starving. After say twenty to thirty days on crackers (one cracker at a meal, 21⁄2 or 3 inches square) and a cup of hot water. Then begin to feed judiciously and you cure your case. Try it, brother M.D.'s.

I would like to know why it is that so many physicians are so afraid of fever. Why my dear sirs, it is, as you know, only symptomatic. Watch what nature is doing; if she is doing too much, restrain her kindly; if she is not doing enuf, give her a lift and push her along. But for the patient's sake, don't try to take the case out of nature's hands by dosing too much. Again, be certain of your remedy; if you do not see good results as soon as you expect, kindly and quietly "rest on your oars and watch the case; do not crowd one remedy on top of another, for then you will not know what did assist in the cure. I say assist advisedly, for that is really all we can doassist old Mother Nature; she does the rest.

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I try very hard to keep up with all progress made in medicin, and some of the newer remedies are O.K.; but the majority-good Lord deliver us! A traveling salesman from a very large city was in my office a week or so ago,

and I counted in his medicin case 260 bottles, all different pills, granules, tablets, pilletswell everything, it would seem that anyone could wish for, and really out of the whole lot you could not have pickt out a dozen "things "things" that you could positivly say that their effect is so and so. He talkt very learnedly about his special medicins, made from better material, etc. Did I buy? No: I had just been supplied.

Yes, as one of your writers says, it is dead easy for an old country M.D. to dispense powders, etc., and "guess" at it; no, not a guess, for practise makes one almost perfect. As to quinin, calomel, rhubarb, etc., it is very, very easy to dose out % to 1 grain, or five or ten grains.

Well, as to all this antiseptic foolishness, is it right? Yes, it is absolutely essential in all cases to be clean; but you can get clean, and that is the end of it; cleaner is not it. Forty years ago, I doubt whether there was 1⁄2 dozen syringes in the county, except the great big pewter "squirt guns" that were about as big as your arm and rarely used. Then women had their babies and never thought of being bathed under six to nine days. It was not right, and I must confess that the odor in the room was fearful; but there was not half as many child bed fever cases as now. Ask any old M.D. that practised before or during the late "unpleasantness between the states," and he will tell you that what I have said is the truth. I make my patients (baby cases) keep themselves clean, and as to feeding, I say to all of them that it is perfectly natural to have children, and that all I require of them is not to overload nor underload their stomachs.

If any of your readers have cases of erysipelas, just let them envelop the affected parts in a starch poultice until the redness all leaves, which will be usually from twenty four to forty-eight hours, and then gently paint with mild tr. iodin, going over the surface quickly and then cover with cotton wool, absorbent cotton, or anything that will effectually exclude the air. When dressing, close every door and window and dress quickly. Try it and see what little trouble you will have. J. R. SMITH.

Stoneville, N. C. P. S.

Since writing the above I have had a case of pneumonia and used the scarificator and cupping, drew about three ounces blood, and before the cup was removed the man said, "doctor, I can now draw a long breath; something I have not been able to do since three nights ago when I had a severe chill." This patient had all of the symptoms of pneumonia, including rust colored, or brick dust sputa. I saw him again today; no return of the pain,

but some cough; wishes to sit up, but I ordered him to keep his bed.

For all grip cases (it is epidemic here), I make them stay in bed from three to six days, according to the severity of the case, and give them tr. aconite, drop doses every one or two hours, and also keep the secretory organs at work and the thing is done. J. R. S.

Remarks on Pneumonia by an Eclectic. Dear MEDICAL WORLD:-Your remarks regarding the little patient of Dr. A. K. Van Horne, page 550, December WORLD, have aroused my ire. You say the patient didn't have pneumonia, but an acute congestion. When I attended college, pneumonia was described as consisting of three stages: Acute congestion, red hepatization, and gray hepatization. Wouldn't that cover the case?

Now as to the cause for the increast deathrate, my notion is that it is the result of the present day teachings in the colleges of the dominant school. The authorities (?) and therapeutic nihilists (usually the same) drill into the students that pneumonia is a germcaused, self-limited disease, that can't be influenced by medicin. What can you expect the poor boys to do but sit idly by and let the disease take its course? Certainly they will have to give some medicin to quiet the fears of the patient and his friends, and offer an excuse for his bill. If the patient gets well, good doctor; and if the patient dies, "the Lord giveth, the Lord taketh away. Blessed be the Lord."

Any eclectic or alkalometrist (eclectic regular) that doesn't abort or cure every case of pneumonia in from thirty-six to seventy-two hours should study his drugs more carefully. However, no one would expect them to have such results in a moribund case that had been dosed with opium.

I would suggest to any regular that is losing, or even allowing his cases to run seven to fourteen days, that he procure the literature of the above and study their indications for aconite, veratrum, belladonna, gelsemium, bryonia, sanguinaria, calomel, podophyllin, epsom salts and the sulfocarbolates.

Louisville, Ky. J. C. MITCHELL, M.D. [We see nothing to modify in our remarks referred to above. Would you call every acute and temporary congestion of the lung pneumonia? We would not.-ED.]

Lactic acid results from the fermentation of milk sugar or lactose, and it is becoming more probable as investigations proceed, that rheumatism is caused by lactic acid; therefore, do not put the rheumatic case on a milk diet and do not commend milk in those of a rheumatic or gouty diathesis.

The Fly Blister in Pneumonia. Editor MEDICAL WORLD:-I was interested in reading the articles on pneumonia in December WORLD, especially the one by Dr. Van Horne, as it fully corroborates my views and experience in the use and utility of the fly blister in that disease. I am an old practician, and if experience amounts to anything I should have it. I desire to emphasize his remarks, where he says: "I know that a fly blister rightly applied, has been the determining cause that enabled many to recover from pneumonia." From my experience in hundreds of cases, I feel assured that the Doctor is right.

The

For four years after commencing practise, owing to the bad results I had seen in the use of blisters, I eschewed them and used mustard, wet and dry cupping, fomentations, etc. results were not satisfactory. Then, as a dernier ressort, and with some misgiving, I resorted to blisters, by the then new method of leaving the skin intact, which corresponds in

the main with Dr. Van Horne's method. The

results were usually most gratifying, and my patients would recover so quickly that I frequently lost the opportunity of making a large bill.

The old method of blistering was barbarous, and it is no wonder that the people and even doctors were disgusted with it. Hence its employment fell into disuse.

My method is this: Having ascertained by careful percussion and auscultation the exact spot to apply the blister, I proceed as follows: Cut a piece of heavy muslin the size desired, spread it with a properly made cantharides cerate (the prepared plaster is usually too stiff to lie flat on the surface), then apply the blister over the affected part, and over it a compress of several plies of soft muslin or cotton batting, and secure by a bandage or adhesiv straps. Bathing the part with vinegar before applying the plaster is an old but a good idea. Let it remain on a child from one to one and a half hours, on an adult from two to three and a half hours, as required, to cause burning and redness of the skin, as from a mustard plaster. It should be noted, that a blister takes effect on children and thin-skinned persons more quickly than on adults with thick skins. Therefore the nurse should be instructed on these points, and when reacht, to remove the plaster and apply a poultice, previously prepared, of bread and milk, with oil or lard over it to prevent sticking when removed. Over this apply the pad and bandage. Let it remain four hours, then remove it and open the blebs carefully, with a needle or small knife blade. Don't break the skin or you will "spoil the job." In this manner apply and remove three or four poultices, opening the blebs after each

removal. Then apply a cloth smeared with cerate or castor oil, changing them three or four times in twenty-four hours, and in three or four days the blistered surface will be well. In double pneumonia, congestion of one lung may precede the other several hours or even days, in which case I blister them in succession as required. If the business has been properly done, there will be no slufing or ulcerating surface as in the old way, nor does it cause as much pain as a mustard plaster.

Now, permit me to explain the theory of the action of the blister and why it is of more therapeutic value than any other counter irritation. It is a method of local depletion, better than the abstraction of blood. By this method we secure the discharge of serum (the watery part of the blood) from the part, and the congestion is relieved somewhat in proportion to the amount of exudate. This is the way by which the blister relieves any congestion. Please note the difference between counter irritation and vesication; by the one we secure no discharge of serum, by the other we do.

The Editor in his remarks, speaks of one of Dr. Van Horne's cases as being "acute congestion that might have led to pneumonia.' Why bless you, my dear Editor, is not congestion the first stage of pneumonia? and is it not a fact, that about fifty percent of the deaths from pneumonia occur in the congestiv stage?

In regard to the internal medication, the use of "belladonna, bryonia, arnica, aconite acetanilid and gelsemium as indicated," recommended by Dr. Lum, I find no fault, but in passing would say, veratrum viride in this disease, given in one to three drop doses every hour, until slight nausea is produced, if there be high arterial tension, high temperature and bounding pulse, will reduce temperature and fever, more readily and permanently than anything else. It is the king of sedativs!

As an expectorant, if one is needed, I prefer powdered ipecac, sanguinaria and lobelia, equal parts. Add a teaspoonful to a teacup of hot water, sweeten and add a dessertspoonful of vinegar. Dose half to one teaspoonful every two or three hours as needed to keep the cough loose.

Antiphlogistine has been highly lauded in lung troubles. I had an attack of pleuropneumonia over a year ago, had a poultice of it applied in the evening and remain till next morning. No result. Then had mustard applied, which gave a little relief. At noon had a blister applied. In two hours and twentyfive minutes it was removed and a poultice applied. In three hours from the application of the plaster the severe pain was gone; it grad

ually faded away. I expectorated a little blood for about thirty six hours, but no cough followed. The congestion passed off by resolution.

A most important factor in the treatment of pneumonia as in all congestions is, to equalize the circulation. Fomentations should not be employed, except in the early congestiv stage, as they are liable to cause mucous engorgement, shut off the ingress of air, and the patient will die of suffocation. In pneumonia many die of socalled heart failure, and why? simply because stasis blocks the blood current. Then what should be done? Relieve the congestion and thereby prevent stasis; the circulation will become normal and the heart will be relieved of its burden. I make it a point to apply a blister as early as I can locate the congestiv area.

Recently cold applications, even ice packs, are being used by some physicians and in some of the hospitals. They surely retard resolution and prolong the disease. I cannot see how they can benefit a pneumonia case, but they may enable the doctor to make several more visits.

It is a sad commentary on the profession that so little progress has been made in the treatment of pneumonia and kindred affections, when we have so many remedies at our command, by the use of which they should be cured. Rather than trust my life in the hands of some doctors and hospitals I know of, I would if I could, submit my case to some old fashioned lady, skilled in the use of "root and yarb" teas and applications, such as her "mother made.”

Did space allow, I could relate many instances, in illustration of the curativ results of blisters in pneumonia, pleurisy, basilar brain troubles, etc.

Franklin, Pa.

J. R. BORLAND.

[Please read Dr. Van Horne's article (p. 549, December WORLD) and our comments following again. He "prescribed the usual remedies at 10 a. m.," called again and applied blister between 5 and 6 p. m. of the same day, and returned at 10 the same night and received the "cheerful greeting" that "Eddie is getting well," and that practically ended the case. Do you call that a case of pneumonia? We emphatically do not. As we said, we have dissipated such acute congestions in children in from 4 to 24 hours by simply wrapping the chest in cotton or carded wool and covering with oiled silk. These cases are not pneumonia. While a student, the writer was assisting temporarily in a hospital. One cold night we were aroused by a cry of fire. We jumpt up, rusht out in the cold, and gave directions to the help until the flames were extinguisht.

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