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along efferent nerves in response to impulses reaching them thru afferent nerves." In fact, we may say that all the socalled involuntary bodily functions are the result of this reflex activity. Afferent impulses pass to their center, are transformed and sent out as efferent impulses (trophic, secretory, inhibitory, or motor) along efferent nerves arising from the same center. If the afferent impulse is sufficiently strong, the corresponding center of the opposit side of the cord is likewise affected and a bilateral reflex results. If still stronger, other centers are involved until all the muscles of the body are thrown into activity. Kirk further states that muscular contractions produced by reflex activity are often more sustained than those produced by direct stimulation of the motor nerves themselves.

As we have seen, efferent fibers from a nerve center pass in three principal divisions, consequently impulses reflected from this center will pass in these three directions, and the tissues supplied by these three nerve divisions will be affected regardless of the route by which the exciting afferent impulse is conveyed to this particular center. Abnormal impulses from a diseased viscus pass to the associated center or centers, and other abnormal impulses are reflected out, not alone over the fibers passing back to this viscus, but also over the other fibers passing from the center or centers, which fibers, as shown, supply tissues in other parts of the body. As a result of such reflexes, abnormalities or secondary lesions are set up in these other tissues. Regardless of the location of the primary trouble, the tissues in and along the spinal column will be particularly affected, as two of the three nerve divisions mentioned supply these parts, sending branches to the vertebra, the vertebral articulations, the muscles moving them, the skin over these tissues, as well as the meninges of the cord. These secondary lesions may take the form of congestion, inflammation, increast or decreast functional activity, with resultant muscular, ligamentous, or fascial contractions or relaxations, trophic changes, etc., the resulting lesions depending on the tissues afflicted and the nature of the primary lesion. Congestion and inflammation with soreness and tissue contractions are more markt in recent cases, while contractures, relaxations, trophic changes, and bony subluxations are prominent in chronic conditions.

Unless these impulses are of sufficient strength to affect the corresponding centers on the opposit side of the cord, these reflex secondary lesions will be confined to that side of the body from which the afferent impulses

arose.

Lesions similar to those just described as

secondary to visceral abnormalities may result primarily from traumatic or other causes, in which case the viscus will be affected secondarily. A recent case illustrates well this fact. A patient in whom repeated analyses of the urin had shown nothing abnormal received a severe sprain of the back about the eleventh dorsal; urinary symptoms developt and albumin was found in the urin for about two months, or until the lesion produced by the sprain was removed by appropriate treatment. The albumin then disappeared and has not since returned.

Abnormal conditions along the spine, especially areas of tenderness, as associated with internal disorders, have been observed by others than osteopaths. The lame back with uterin and kidney trouble, and the pain under the right scapula indicativ of hepatic disorders, are known even to the laity. DaCosta in his surgery says of gastric ulcer: "The pain is very violent in the abdomen and also passes to the back, being located between the eighth and ninth lumbar vertebrae" (he evidently means dorsal instead of lumbar). Hilton, in his "Rest and Pain" notes the frequent association of sore spots along the spine and many internal disorders. He seems not to have determined the exact pathology at these points in many cases; but only to have concluded from the pain and tenderness that some abnormality existed there. Absolute rest in bed was his chief treatment, and by this means he succeeded in curing many cases after ordinary methods by other physicians had signally failed.

Perhaps no more concise and convincing consideration of this subject has come from a medical source than that given us by the late Dr. Hammond. In his treatise on diseases of the nervous system, and more particularly in his monograph on "Spinal Irritation," he gives the results and conclusions arrived at from his personal examination and treatment of one thousand cases, with nearly as many from other eminent observers. His observations may be summed up as follows: (1) That areas of tenderness along the spine are common, and to use his own words, those who refuse to believe it "must necessarily belong to one of the following categories: Their experience must have been very limited and therefore they cannot see, or they must have been endowed either with restricted powers of observation or with minds so constituted as to cause them wilfully to close their eyes to the facts that they did not care to see." (2) That the patients in many cases are unaware of the existence of these areas of sensitivness until called to their attention by an examination. (3) That this sensitivness may be seated in the muscular, cartilaginous, liga

mentous or nervous tissue, may be accompanied by hyperesthesia of the adjacent cutaneous areas, and must not be confounded with diseases of the vertebra. (4) That the cord itself may be and frequently is hyperesthetic at such points. (5) That various systemic disturbances -eccentric symptoms-result from or are associated with these areas of spinal tenderness, and that by far the most important and noticeable symptoms of spinal irritation are to be found in distant parts of the body. (6) That these eccentric symptoms bear a distinct anatomical and physiological relation to these areas of spinal tenderness. (7) That these sensitiv areas may develop quickly-often in a few hours. (8) That they may result from traumatic, sexual, emotional, mental, hygienic, or dietetic causes, or may develop from acute and infectious diseases. (9) By appropriate treatment, chief of which is counter-irritation over the spine, these sensitiv areas may be removed and with them the associated eccentric symptoms.

From the causativ factors ascribed to this condition by Dr. Hammond, we see that these areas of spinal tenderness may be primary to the eccentric symptoms as when due to trauma; or they may be secondary, as when resulting from sexual, emotional, mental or dietetic

causes.

As previously stated, reflex muscular contractures are often more sustained than those produced by direct stimulation. The same is true of other reflex activities. Thus abnormal impulses, as from an irritating substance in the alimentary tract, cause reflex secondary lesions along the spinal areas in reflex nervous connection therewith. These secondary lesions being of reflex origin may outlast the exciting cause, in which case they would reflexly affect again the tissues primarily at fault. By so doing the secondary lesions become an exciting cause, and may prolong or aggravate the already abnormal condition of those structures which were the original centers of disturbance. This fact explains, at least in part, why disease often lingers or becomes chronic after the original cause has been removed. Thus we see that Hilton, Hammond, and others, showed wisdom in treating such spinal lesions, whether they are primary or secondary to the eccentric disorders complained of.

While these and other eminent observers have recognized the existence and significance of these sensitiv areas along the spine, they have failed to recognize the equally important lesions of muscles and ligaments when associated with soreness and pain; nor have they observed the very frequent subluxations of bony tissue and their relation to disease. The recognition and consideration of these lesions

is a distinctiv feature of osteopathy. The subject of osseous subluxations, which has been a source of so much amusement to those who prefer ridicule to investigation, will be considered in our next article. Peoria, Ill.

W. A. HINCKLE, M.D. (To be continued.)

From an Osteopath.

Editor MEDICAL WORLD:-In regard to Dr. U. G. lles' article in the March WORLD, page 115, would say it plainly shows rank prejudice and ignorance towards osteopathy. The idea of speaking of Dr. Still as the rankest of quacks is too absurd to even notice. Just as soon as the medical profession can show better results than the osteopaths, then they can call us osteopaths what they wish. osteopaths what they wish. I ask any M.D. to name one case where osteopathy failed and medicin cured. The osteopath can give you five cases to the opposit condition and have plenty left.

In regard to Dr. Taylor's article, would say I read the article in full, and investigated fully and find that the two students he spoke of as graduating from the Kirksville School never even entered the school. I will quote you part of Dr. Taylor's article which appeared in the New York Medical Journal, of January 16, 1904. He says:

"It is a constant surprise and disappointment to me, having given much attention to manual treatment, to note how pitifully ignorant are the leaders of medical thought, not only of the whole subject, but of its gravity, its resources and its enormous possibilities. It is doubtful whether, if a hundred of the accepted leaders in any community (in America) were called upon to express opinions on the subject, it would be possible to find above two or three who could formulate such based upon either knowledge, experience or appreciation of fundamental principles. Yet, any man with an M.D. to his name will give you off-hand a definition of osteopathy, and it is usually far from flattering. Still these 'osteopaths' have forced themselves upon the attention of the public, and thence upon that of the profession, more upon the sheer merit of their methods than by the boldness of their assumptions. It cannot be denied, it can certainly not be disproved, that these methods are not highly efficacious."

These words, coming from one who has partially investigated osteopathy, are worthy of repetition. All the osteopaths ask is a fair investigation from a non-prejudiced mind, which is, you must admit, hard to find in the medical profession. I presume this article as a whole isn't worth publishing in your magazine,

but if you see fit to publish Dr. Taylor's views, I would be very grateful. F. E. GAMBLE. Fremont, Nebraska.

On his letter head, the writer of the above announces himself as follows:

F. E. GAMBLE,

OSTEOPATHIC PHYSICIAN,

GRADUATE OF A. S. O.,
Kirksville, Mo.

Osteopathy as I View It.

Editor MEDICAL WORLD:-Anent this subject of osteopathy, there seems to be an effort made upon the part of the decent profession to cope with this monster that has shown its head above the medical horizon. Is not the profession busily engaged in battling a man of straw? It seems so to me. I am forcibly reminded of a hundred and one crazes that have taken possession of the public mind since the great one of the Salem witchcraft. Perhaps the first was the famous metallic tractors that set Europe and the eastern part of the United States wild along about the beginning of the last century. Now, you can hardly find one of these famous instruments outside of a museum. Then, within the memory of a great many, came the blue glass craze, then the sweating craze, and quite recently the Brown-Sequard elixir of life craze; all with their multitudes of followers. Where are they and their devotees now? Why, gone into the oblivion of all untruth. Within the last few weeks we have witnest the bursting of one famous curativ bubble. May we not expect the craze of osteopathy to soon go glimmering in a like manner? Tons of white paper and gallons of good printers' ink have been wasted in fighting this thing, and the result has been to give advertising to its promoters. This is the first time that I have been tempted to grab my typewriter and rush into print on this subject, and I should not do so now only I see my favorit journal being too much taken up with a subject that cannot do me nor the busy doctor any good.

We were told two thousand years ago by a philosopher from Galilee that "an evil tree could not bring forth good fruit." That is a truism just as much here in your Uncle's territory as it was under the territory of Cæsar. It chanced that I knew the now famous (?) Dr. A. T. Still. In fact, the early part of my life was spent in his home town. My home was within fifty yards of his office, if office it could be called. He had no standing among the profession at that time, nor did he ever have. His credentials consisted in a long, lank personality garbed in an old, snuff-colored suit of butternut jeans, surmounted by an overcoat that always had the appearance of just being

ready to go off on its own account. I cannot recall having seen him with such a thing as a collar or tie on, and if my memory serves me right, his acquaintance with the dirt-removing properties of H2O was very limited. The worthy doctor would bundle up some herbs and simples in an old handkerchief, and, with a stick in his hand, travel all over the surrounding country disposing of his wares. He, as Dr. Iles says, laid claims to supernatural powers, and as such imposed upon the ignorant and credulous. At that time Kirksville was a local option town, and a large share of his work was in writing prescriptions to a corner drug store for liquor. If, at that time, he had any grey matter underneath his hat, he managed to keep that fact a profound secret from those who were his everyday companions. I do not feel that I am drawing the picture at all too strong. I should not mention these things at all, but I feel that it is necessary, in order to show the regular profession that they are directing their arrows of attack against an object who is more an object of scorn than a foeman worthy of their steel. Poor old Still will soon totter into his grave, and as soon as the fake loses its head, it will totter along the same road.

My observation has been that the graduates of osteopathy may be roughly divided into two classes: Those who are ignorant and those who are dishonest. Candor compels me to further add that the first class contains by far the greater number. I was in Kirksville during the winter of 1898, and took particular pains to size up the personnel of Mr. Still's classes. By far the greater number of them were men and women who had come directly from the farms and workshops, lured thither by the glittering prospect of an easy living. It was very easy to sit in the lecture room and pick out those who had a college education, and almost to a man those who had, had upon their faces the stamp of insincerity. Nor could it be otherwise. To sit for one hour and listen to the inane rot ladled out to those students as scientific teaching was certainly enuf to turn the stomach of a healthy buzzard.

I have met many of the graduates of osteopathy in activ life, and have always tried to get at the depth of their knowledge of the fundamental principles of the one subject that they must, perforce, be familiar with in order to carry out the tenets of their profession, namely, anatomy, and without a single exception I find them densely ignorant upon even the primary principles of the science. A skilful cross-examiner, with a knowledge of his subject, can prove this for himself in five minutes' talk with the best informed graduate of the fake if he cares to do so.

Now, for Heaven's sake, let's let this thing die quietly and in peace. The good old WORLD has a mission to perform, and that mission is not doing the Twentieth Century St. George act. It is not necessary to slay any dragons; they will die soon enuf. Remember that Lincoln said, "you can't fool all the people all the time." The public is a great big sheep; it goes off after some bell wether with a little louder bell than another, but it always gets back in time. CHARLES S. MOODY, M.D. Sand Point, Idaho.

[That's right; let us have frankness and candor. But it should be extended to both sides. There will be no harm in allowing an M.D. who believes there is something in osteopathy to give us a peep into it, so we can judge, each for himself. Dr. S. Weir Mitchell could not get his rest cure to "work" until he combined massage with it. He wanted to build up the wreck by forced feeding and conservation of the nerve force. The forced feeding demanded exercise to keep up the digestiv and other functions, but the exercise dissipated the nerve force. Here was a dilemma. He happened to think of massage (passiv exercise), which would keep the physiological functions in normal activity and at the same time conserve the vital energy, allowing the nerve force to accumulate. This was the way out of the dilemma, and it led to a now celebrated and well-establisht method of treatment. I mention this merely to illustrate the importance of one of the applications of manipulation massage. Most physicians habitually neglect the importance of and possibilities in manipulation. Osteopathy is a method of manipulation elaborately workt out. Yes, it is "a man of straw" as to any claim of it being a wonderful discovery, for manipulation is one of the oldest things in the healing art; but in these days of the microscope, modern chemistry, etc., it has been shamefully neglected. In subacute and chronic conditions it has wide application and great possibilities for good. Let us, of the regular profession, give to the people these possibilities, and thus no longer leave this gap open to be occupied by intruders.-ED.]

In an ungrammatical and rather illiterate article not worth space, from a man who puts "Dr." before his name, occurs the following, which we present exactly as written:

Only a few years ago My Wife was an Invilid, Medicine of Any Kind done he no earthly good After consulting with several of the best Physicians and Surgeons, after several years of these conditions a friend advised My Wife to try Osteopathy they believed It would help her So like the drownding Man I grabed at the last straw. I took My loved one to one of the Graduates of Dr. Stills School of practice he Diagnosed her case giving Me the reason why

these conditions existed and It appealed to a Common sence of Reasoning. so I left My Wife in this Osteopathic Physicians Care, and in three weeks she began to change for the Better and in Six Months she gained and looked So Much better that some of her Friends hardly knew her She gained about 18 pounds and could walk a couple of Miles and not be fatigued that is six years ago and She is able to do all her own house work for eight or ten person. And I can't hire her to take one drop of the Simplest kind of medicines.

This illustrates what kind of work the oste

opaths seem to be doing-getting close to nature. The same thing is being done in numerous sanitariums all over the country, conducted by regular physicians, but natural methods are largely neglected by the bulk of the profession in private practise. However, if the above poor woman continues to do "all her own house work for eight or ten persons,' she will break down again, and have to again go to the "repair shop."

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This is the "Christian Hospital," of Chicago, which seems to be again raising its head to the surface. It was thoroly exposed in WORLD for July, 1903, pages 294 to 296, which see.

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All the various kinds of "bait there exposed are contained with the above letter, the only change which I recognize being a bad attempt to blot out the name of Dr. J. B. Murphy on the sample certificate. policy of frauds is, when exposed, to "lay low" awhile, and then, after they think the exposé has been forgotten, "bob up serenely as tho nothing had happened. They think that no one will be as vigilant concerning the interests of the profession as the frauds are persistent in the pursuit of money; and that is generally true. generally true. No one likes to hash up the same fraud time after time. Doctors should note exposures and remember them. However, we are always glad to be informed when an old fraud resumes business either at the old stand or elsewhere, so we can announce the fact, and refer to the original exposure, as we do above.

Later: Another set of these circulars has just been received from Dr. Ira C. Ballard, of Leesburg, Ala., they having been sent to him from Lincoln Park Sta., Chicago. Are these people trying to work our southern friends? Do they think that southern doctors can be "roped in" more easily than those in other

We venture that they will be disappointed. THE WORLD has a large circulation in the South, and WORLD readers have their eyes open.-ED.]

Speculation, with Examples.

Editor MEDICAL WORLD:-While renewing my subscription, I cannot help saying that THE WORLD is the best medical journal I ever read, and I have read them all, the Brief not excepted. If all others were to take the stand "Ye Editor" does against fakes and frauds, it would be a boon to humanity. Previous to my taking THE MEDICAL WORLD, about every hundred dollars I could get together I put into "get rich quick" schemes. (Well yes, somebody profited by it, but not I.) The good advice given to doctors by THE WORLD has resulted in benefiting me hundreds of dollars, and many others I doubt not.

Doctors, I am not buying any more gold bricks. And for all future time I will buy only what wheat I need for flour for family use. Every week brings mail from concerns urging the buying of corn. Well, yes; but only to feed my team thanks to THE MEDICAL WORLD. W. S. L. KNepper.

Conklin, Mich.

[In this connection I will tell about a very unusual occurrence. About the middle of March a doctor wrote asking me the standing of a certain firm of cotton speculators. I replied stating that I did not know the firm, and that it was out of my line to investigate and give commercial reports; referred to the course THE WORLD has taken concerning speculation, and further said that if he was determined to speculate, to please let me know the results. He replied April 10 (being ample time for communicating with the firm in the meantime), inclosing a full statement of his dealings with the firm, which showed that he had been speculating with them since August 8, 1901, showing great profits. Why did he ask me so late as the middle of March, 1904, concerning the firm's standing, when he had been speculating with them (very successfully, according to the detailed account, and his letter) since August 8, 1901? The plan seems to be indicated by the following: He says in his letter that he has "had numerous letters of inquiry about the Co. from doctors, and have always answered them by citing my own dealings with them, and a statement of my account" etc. And he further says: may save me considerable correspondence if you will publish statement and such of my letter as you see fit." The above are the parts of the letter that I "see fit" to publish; also this comment: Do you not see how a company could render very satisfactory accounts,

"You

accompanied by the cash, to one doctor, in order to make a sort of decoy duck out of him to refer other doctors to? Of course the decoy would have no knowledge that he was being used in that way, unless he would think strange that doctors are always referred to him. And wouldn't it be a cute thing to use THE MEDICAL WORLD as a decoy, thru this doctor who has made nearly 200 percent on his money in a comparativly short time? If that is the scheme, it won't work. The doctor is doubtless perfectly innocent, but there may be a "fine Italian hand" behind him. Speculators are cunning. They know how to use an innocent figure head. Doctors, stick to your money. And you, whose letter is quoted from above, but whose name need not be publisht here, look out; better stop now, while you are ahead; if you continue you are likely to lose all you have gained and more too.-ED.]

Don't Trust Confidential "Tips.”

Many New York physicians and doctors in other cities mourn the sad ending yesterday of Dr. Lorenzo J. Kohnstamm. Until two years ago he had an office on Madison avenue, and had a practise that was worth $12,000 a year. Two years ago he had noticed symptoms of paresis, and without informing anyone he began a study of his case. When he had confirmed his suspicions he relinquisht his practise, sold his art collection, and then, as the fight became hopeless, settled his affairs, and came to Bellevue Hospital, where he died of a general paralysis, ending in insanity. Dr. Kohnstamm was educated in this country and Europe, and was a member of the Medical Societies of Paris, Vienna, Brussels, and Berlin. It is said that in trusting "tips" given by his patients Dr. Kohnstamm had, in recent years, before he went to the hospital, lost more than $80,000 in Wall street.-hila. Ledger, April 20.

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Death Probably from Internal Hemorrhage. Editor MEDICAL WORLD:-You ask the question on page 169, April WORLD, "was the last bowel movement black, showing presence of blood?" No; the blood was bright and fresh looking following the stools, but her urin the last day was scanty and lookt suspicious of blood; yet it was passed without pain. Did not complain of pain over the region of kidneys or bladder. I was suspicious of internal hemorrhage, but there was no sudden lowering of temperature. Had passed a fair quantity of urin in morning just before consultation.

On page 170, replying to T. M. Lippitt, you say: "Barberry. Myrica Cerifera. The wax and bark are used." This is the first time I ever knew that the barberry had a wax, and I thought it was known as Berberis Vulgaris. The uses of the barberry you give are correct, but the fruit of the barberry, which is plenty

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