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the physician of former times attacht an undue importance to the value of these three series of phenomena, on which his diagnosis and prognosis-and, of course, his treatment-were inevitably based. For him the tongue was the mirror of the stomach. Its mucous membrane being an essential and a specially sympathetic portion of the lining of the digestiv tube, its condition unfailingly indicated that of the latter-more particularly of the stomach, to which was attacht the leading role in the process of digestion. If the tongue was heavily furred, the gastric surface was also loaded with detritus, and an activ emetic was required to free it of its objectionable coating. This often gave considerable relief, but when it failed to do so, as frequently happened, the process was repeated again and again, sometimes with gruesome consequences. In a recent communication (Gazette des Hôpitaux, September, 1903), Drs. Mathieu and Roux have critically examined the value of lingual diagnosis, and clearly pointed out the reasons of its frequent failure. They point out, following Laségue, that the tongue is really a muscular mass, covered by mucous membrane. And they further proceed to indicate the important fact that the investment of this organ is really a false mucous membrane, derived from an invaginated process of the external layer of the blastoderm, and not, like that of the gastro-intestinal surface, from the inner layer of that structure. Accordingly, in pathologic processes, it comports itself more like a portion of skin than of mucous membrane. On this account, the physician must be guarded against attaching too much importance to the information yielded by the time honored examination of the tongue.

The general conclusions at which Drs. Mathieu and Roux have arrived are: (1) The lingual mucous membrane is really a process of the cutaneous investment of modified structure; (2) its furred condition is the result of an "excessiv abundance" of filiform papillas, which form a dense thicket over its surface; (3) its (raw or) desquamated condition is usually the result of a form of superficial dermatitis.

Habitual Abortion: A Misnomer. Habitual abortion, as a medical term, should be allowed to drop out of use. It represents a theory which is no longer tenable; i. e., that the uterus falls into a "habit" of emptying itself at a certain period of gestation. The term "recurrent abortion," as suggested by Taylor, is much better. There is always a cause for recurrent abortion, and it is generally a cause amenable to a remedy. Syphilis is the great and most frequent cause, yet many of us see many cases where syphilis can be absolutely

excluded. Severe lacerations of the cervix are perhaps the next most frequent causativ factor. Another class of cases often presents this feature: Those where the mother or father, or both, are in a poor state of health-where the vital forces of both are at a low ebb at the time of conception and subsequent to such conception; and, also, where there is an unquestionably "strumous " diathesis. In the latter case no better proof of the actual causativ factor could be desired than the therapeutical test; i. e., a thoro course of "anti-strumous" medicin. This generally produces a complete absence of the accident if the attack has been energetic enuf and properly managed. In the syphilitic cases it may be noted that the tendency is toward a spontaneous relief from the misfortune. After a number of abortions, it will be noted that the product of conception is allowed to remain longer in the uterus before the expulsiv efforts are set up, however more deplorable may be the physical condition of the later fetus. In the strumous type the age of the fetus becomes progressivly less at each abortion, unless some radical treatment looking toward the upbuilding of the health of the parents is undertaken. In the syphilitic type, the abortions are usually accomplisht with difficulty or with some such complication as an adherent placenta, obstinate hemorrhage, failure of contractil power in the uterus, etc.; in the strumous type the abortions are easy and quickly completed as a rule.

In recurrent abortions the possibility of mechanical interference is always to be thought of whenever the causes enumerated can be excluded. Many women will repeatedly induce abortion on themselves, even when they have begun to feel the baleful effects of such practises upon their weakened constitutions, rather than undergo the throes of labor or think of "sacrificing themselves" (?) to maternal cares. A properly stern demeanor on the part of the physician will often bring these cases to a prompt confession when warnings of the evils to come would have no effect. If they are allowed to see that the physicían suspects that they have been guilty of producing the repeated abortions and of deceiving him as to the cause, an accusing conscience will oft-times work an amazing change of heart.

In those cases which will not in any measure conform to any of the classes given above, and in many of them which fall in direct line with such classes, ten grain doses of chlorate of potash, three times daily, continued from the third month of pregnancy until its termination, is declared by Taylor to be efficient in checking the "habit."

Calcium chlorid, 30 grains to the ounce, is one of our most efficient local applications in hemorrhage.

A Common Fault. There is a habit common among the profession which is a relic of the darker days of medicin. We refer to the habit of prescribing such drugs as we know will derange digestion and assimilation, without having fully considered whether the exigencies of the case demand such harmfully meddlesome procedures. In the times when knowledge of physiology, of the rules governing digestion, of the manner in which drugs really acted when ingested was very limited-in short, in the days of pure empiricism, the physician was not expected to think of these things. His entire duty ceast when he had made an attempt at diagnosis, and had prescribed his crude drugs in sufficient quantity. But it is not so now. With our increast knowledge our responsibility has increast. Now the thinking man realizes that drug giving, without full consideration of the ultimate effect of such drugs on the various processes of the body, is often a very injurious plan. We know that study of the dietetics, physiology, and the hygienic considerations influencing a given case, is frequently of greater importance than the mere giving of drugs. After diagnosis has been made, and remedies prescribed, it is yet necessary to consider what effect the indicated" remedies will have beside that of relieving or masking the symptoms. The thoughtless practician who prescribes opium in every case of diarrhea, while he may often succeed in checking the diarrhea, will often fail ignominiously, and will often have a much sicker patient after the medicin has been taken than before. A little bit of thought would have suggested that, inasmuch as this case of diarrhea is due to intestinal indigestion, very probably accompanied by masses of undigested food and putrefying feces within the intestinal canal, the logical procedure would have been to give a flushing purgation. In certain acute cases of rheumatism we admit that it is necessary to give salicylic acid in enormous quantities, for it is then a question of saving the heart before the rheumatic poison has permanently destroyed it; in malignant malarial infection enormous doses of quinin must be given; in a few other instances seemingly reckless therapeutics is justifiable, but the instances are rare.

We plead for a more rational practise along such lines We have all been taught that "if doubtful of being able to do good, make certain of doing no harm."

If you are afraid of the forceps because you do not know how to employ them, you will fail to "fill the bill" in many cases. If you fear them because you know what they have done in inexperienced hands, and yet can use them when necessary, your patients are fortunate.

Hoff's Prescription for Consumption. We have met the gentleman who made the first "batch" of this preparation in this country. When he saw the article on page 246, June WORLD he said, "Give it to those fellows; they are frauds." When he saw the prescription on the above mentioned page he said, "The prescripton is all right. lives in Vienna, and that accounts for the difficulty of an American deciphering the prescription as written." Here is the prescription in plain English as he gave it to us. Turn to the above mentioned page and compare with the following:

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Dr. Hoff

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Did you ever know of a single instance where anyone who took "a flyer" in any of the numerous speculativ schemes that are advertised in circulars sent to doctors, in which the "small investor" did not lose his money? In short, did you ever know of a single instance that succeeded according to promises? Did you ever know of a single instance in which the investor even got his money back? Did you ever know of an instance that was not a total loss? Yet some people think it is "smart" to "dabble in stocks," and "take a flyer" occasionally! Isn't it a supremely foolish thing to do?

I must quote here a sentence in a letter from one of our subscribers: "A pen made from a quill pluckt from the wing of an angel and dipt in the colors of the rainbow, could not induce me to part with another $."

And this from another subscriber. "Mining stocks are generally more worthless, and even more fraudulent, than lottery promises

But here is something rich. Among the many things sent to me is a large, four-page circular, one page of which is occupied by an

imitation type-writer circular to doctors; here is a part of it:

DEAR DOCTOR :-Some time since, while the writer was chatting with the business management of the New York office of the U. S. I. of Boston, the local management, Mr. B, as he was running over a quantity of recent mail, remarkt "Doctor, Doctor," and turning to the writer, he said: "I have more inquiries from men of the medical profession than any other class of people, and I believe that they are the greatest buyers of mining stock." Being imprest with the remark, at the first opportunity I ran thru the stock ledger of the Mining and Commercial Company, of which company I was and still am the secretary, with a view of ascertaining how the medical profession was represented in my own company, and I found it as a class to have the greatest representation. Prominent among them are (a number of doctors are here named) and many others. The thought occurred to me: Why does this class take more kindly to the purchase of investiv securities? I found this answer to the query-First the ratio of their earning from their profession rank high among the professional incomes; secondly their employment and profession gives them little time to study or look after the average business venture; thirdly, the returns from loans and real estate investments are so slight, averaging about 3 percent per year, that there is little incentiv to make such investments. For these reasons they look kindly upon stocks that are safe, offer a greater return in dividends and are accompanied with no personal anxiety or risk.

I then askt myself the question: Why not go with my investment direct to that class most willing to give it consideration? (Then the letter goes on with its argument.)

This gives doctors a chance to "see themselves as others see them." Look again at those three reasons, the second one, particularly: "Their employment and profession gives them little time to study or look after the average business venture." How true! This is why they are so easy." A business man would look into the matter and see the bottom of it, and then he wouldn't go in; and what a business man does go into, he "looks after to see that there is no cheating. That's the kind of men that the usual mining company doesn't want. They want 'easy' ones, like doctors; and it is sad to say, they get them. Are you one of them? If not yet, how soon do you think it will be before you are roped in. Promises will be bright and positiv; will you "tumble"? The chances are that you will, unless you keep the counsel of THE MEDICAL WORLD before you all the time, particularly at the critical moment. And when will I ever get paid for saving all of this money to the medical profession? In heaven, I suppose; but if the few rag-tag tail enders will pay up their subscriptions, I will be satisfied here-and also if our many friends will influence new subscriptions for us.

You

Now look again at the third reason. ought to be able to lend your money in your community, with good real estate security, at an interest of at least 5 or 6 percent. True, you can't "get-rich-quick" at that rate, but it is a fair rate of interest, and you shouldn't

want more. To show you what a good return it is, suppose you try paying it awhile; you will find it to be quite a burden. But the main thing is safety. When you earn your money, you want to get the good of it yourself. Think of you trudging around in the rain, mud and darkness earning more money, while some swindler is drinking champagne on the money that you previously saved.

The Removal of Skin Cancers.

The general practician must continually strive to perfect himself in every branch of practise, or progressivly lose prestige and see his patients drift to the quack or to the specialist. Perhaps there is no simple procedure more generally ignored than the removal of growths upon cutaneous surfaces. The markt tendency to recurrence of malignant growths, and the possibility of benign lesions assuming a malignant form, seem to have so horrified the average practician that he is anxious to refer the patient to the specialist, or willing to see them writhe in the horrors of the quack's treat

ment.

If the real facts were known and appreciated by the profession, such conditions could not mantain for any length of time. Moles and warts are easily removed by simple measures, and even epitheliomas yield gracefully to the strong caustics. Shrewd men study the tactics of their enemies even more than they consider their own, and it is the duty of every practician to learn all he can of the means and methods employed by both the specialist and the quack; of the specialist that he may improve and perfect his own knowledge, and of the quack that he may save himself loss of patients and be able to explain their reckless treatment and nefarious schemes.

It is along such lines that the general practician must do battle for existence. He can not hope for relief in legislation or diminisht competition. Competition will gradually grow more stern, and the struggle for supremacy yet more bitter, until even a modest living will not be within the reach of the inefficient practician.

The patient must always risk the results of treatment, and the chances are that he will take vastly lesser chances in skilful hands than under the ministrations of the quack. The qualified specialist will handle the case scientifically, and if you mantain your position, you must learn to do as well. Neither your conscience nor the law require more of you than "reasonable knowledge and skill." Any graduated physician may attain to vastly more than such a degree by study, attention, and work. If you do the studying and give due

attention, you will have patients who will furnish the work.

Many practicians are too dignified (?) to act as beautifiers. The best paying work of the specialist is generally "cosmetic" in character. We would rather be less ignorantly dignified; would prefer to know more, earn money, and benefit humanity. The patient of average intelligence will have more appreciation of the value of your services if you can remove a mole skilfully, than he would if he knew you could remove the lime from atheromatous arteries. But this is not the greatest feature. It is often possible to permanently remove an epithelioma when it first appears by application of caustic; where, if the case be treated expectantly or neglected, it may ghoulishly disfigure the person of the victim, or even destroy life itself.

The Brief.

THE

I don't receive the Brief any more. WORLD has evidently been cut off the Brief's exchange list. But I happened to see it prominently exposed for sale to the general public at a news-stand on Chestnut street, so I bought a copy of June number. I learned from the newsdealer that he handles the Brief every month, and I see in the magazine called the Bookseller, Newsdealer and Stationer that the Medical Brief is in the list of "returnable publications," which means that any newsdealer can return any unsold copies of the Brief, thereby taking no risk of loss in handling it. Is the Brief leaving the doctors for the general public?

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As was predicted, the editorials in the June number do not push proprietaries by individual name as freely as the editorials of a few months ago did; only one editorial in June issue is guilty of this, sanmetto and neurilla getting a boost on page 437; but proprietaries in general are boosted freely and repeatedly. The first editoral, entitled Organizations" is decidedly anarchistic. The opening sentence is this: Organizations have always been an obstruction to progress and enlightenment." Is not such a sentiment surprising in these enlightened times? The argument goes on and winds up with a defense of "independent medical journals." Can the almanac organ of half a dozen or more proprietary medicin companies, all owned or controled by the editor, be considered an "independent medical journal ?" This and other editorials try to make anarchists of all the doctors who can be thus influenced; the effort is to make every doctor a free booter, not only indifferent to, but opposed to his local medical society and all other medical societies! It seems that the editor would like to see the profession put back

into the dark ages, if that would help him to push his proprietaries, and perhaps it would. And he can hire medical college professors and foreign hospital men to help him do it, as is plainly evidenced by the last two issues, [tho the most of the contributions by these distinguisht men are not of much interest or value to the busy family doctor, an unduly large proportion of these articles being on eye diseases, and similar subjects outside the general field. But the object being to get the name, and supposedly the influence, of prominent medical men to bolster up a proprietary medicin almanac, any kind of an article will do.

We thought that "Old Doc" would, for once, just for the sake of appearances, give his characteristic "Well, boys," without boosting any of Dr. Lawrence's proprietaries; but he don't. Neurilla and chionia come in for his favors this time.

Beginning on page 489 is a thinly veiled trap for morphin victims, winding up with a boost for celerina, which, in Dr. Lawrence's family of proprietaries, might be styled as the oldest daughter-a nice, respectable girl, the only objectionable feature about her being the way her father boosts her in the reading columns, and she cannot be blamed for that.

The "Brief Talks," which according to the evidence that comes to this office cost Dr. Lawrence $5.00 each, are beginning to be invaded boosters; for example, there are three boosts in the first column of page 492.

Beginning on page 507 is a two page write up for papine.

We thought that this ventilation would clear the answers to queries of proprietary boosts, but they still continue-and how long will you continue to read them? Seng, celerina, chionia, sanmetto, neurilla, iodia, ecthol, etc., all get boosts.

How can we, without taking too much space, give you an idea of the contents of the big pile of letters touching on the Brief, that have been saved out from the subscription department, as per our instructions, during the past few weeks? We will pick out a few typical ones, as representativ of all the rest, and we will ask you if you don't feel inspired to help clear medical journalism of the incubus of commercialism?

C. F. TAYLOR, M.D., Dear Doctor-I take pleasure in enclosing my check for $3.00 for THE MEDICAL WORLD for the next four years, and will add a word of commendation for your course in the exposing of fakes in medicin and journalism, as well as in the various swindles that are made plausible to the busy physician by slick-tongued promoters or circulars that fail to find words enuf to express the return of fabulous wealth to the investor.

Your course toward the Brief is that which should be endorsed by every thinking medical man. When

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Editor MEDICAL WORLD: - Inclosed find postal money order for $3.00 for four years' subscription to one of the best "all-round" medical journals publisht. I admire your loyalty to the profession. You are right. Show up "Dock" Lawrence and all of his kind to the rank and file of the profession. The Brief with its noxious "gas comes regularly to my desk (its "gas" makes fine kindling). We need more of your kind of journalism. Yours, in the interest of the profession, W. B. HOOSer. Fairfield, Mo.

I admire the stand THE WORLD always takes against medical as well as political fraud. I have observed your "Monthly Talks" ever since you started them. They are "O. K.," every one of them. Your attack on the methods of the Medical Brief is just in line with the idea I have sustained for years. Doctors are looking for true, impartial facts, and not material, every word of which is molded to the interests of advertisers. Keep right along in the path you have mapt out. Stonington, Maine. B. L. NOYES, PH.G., M.D.

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Editor MEDICAL WORLD:-Find inclosed check for $5.00 for my subscription. I am enjoying your expose of the proprietary medicin pushers and hope you will keep on being a knocker." If it is necessary to help you out, I'll double my subscription, and undoubtedly many others would do the same. I don't know how far the $5.00 will carry me, but let me know when there is more due. Only be sure and don't shut me off; and if I should die before my subscription expires, you can send it free to some other brother. Yours for honesty and square dealing, PAUL PLUMMER.

Collinsville, Conn.

Have taken the Brief for more than 20 years, but I'm done.-DR. J. M. CARLTON, Wet Glaize, Mo.

Editor MEDICAL WORLD-I will venture two opinions relating to the present fight THE WORLD is making against almanac" medical journals: First, the Editor will come out of it with more professional friends and consequently more subscribers than he entered with. Second, that THE WORLD has more long-time subscribers than any other medical journal publisht. Honesty and consistency are jewels most people recognize on sight, even tho scarce. It is insulting the intelligence of the profession to ask its members to pay $1.00 per year to a journal teeming from end to end with puffs (slightly disguised) of proprietary articles owned by the editor. I believe, Mr. Editor, the profession will stand by you in your attack on this form of swindle the same as it has in the past on get-rich-quick investment schemes. In the latter you did the profession a service, the value of which no one can estimate. S. M. MANN, M.D.

Grafton, Iowa.

DR. C. F. TAYLOR, Dear Doctor:-Inclosed find a letter from the editor of the Medical Brief, which explains itself. I promptly returned the check with thanks, saying that, as I am a member of the A. M. A., I could not accept the offer.

The real object of the Brief is so apparent that I

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DR. C. F. TAYLOR, Dear Doctor:-Inclosed please find $1.00 in payment of subscription for MEDICAL WORLD for 1904. I have so many journals to read, regular, homeopathic and eclectic, that I have thought several times to drop THE WORLD and one other old school journal, but the stand you have taken against unethical journalism, and your evident sincere desire to aid in every way possible the medical profession, has decided me to stick to THE WORLD if I have to drop all the other journals. Your political opinions are in strict accord with my own. Am pleased to observe that you are not afraid to attack the methods of the "Brief," because it is rich and powerful; you will find that it is not quite as powerful as the whole medical profession, so adhere to the admirable policy you have adopted and we will give you our support. Brockton, Mass. F. E. LADD.

[That is true. "The Brief is not as strong as the whole medical profession." Dr. Lawrence got his financial strength from the medical profession, but what has he ever done for the profession? His advertising pages frequently contain fakes and frauds, but it seems that he cares only for the money that comes his way, however much the profession may be cheated; and the reading columns of the Brief-well, the profession is getting "onto" them.

But maybe the Brief is going to leave the medical profession and go to the laity, like antikamnia. A few days ago I received a letter from a man in New York, asking for employment, saying as follows:

"I understand the Medical Brief is placing their journal on the news-stands, and I thought you might use a man in the same capacity."

I did not answer the letter. THE WORLD belongs to the profession, and not to the laity; and it is devoted to the interests of the profession.

Query: Will the medical college professors and other "high-up" members of the profession continue to write for the Brief, even if it goes to the laity? Yes; for unfortunately some of the biggest "grafters" are in the upper ranks of not only our profession, but of every other profession. They talk the loudest of high ethical standards, and are the first to violate them all. The nice talk is meant for the students; but there is a wide difference between their preaching and practise. Of course this does not apply to all the professors and other eminent men in the profession, but that kind of men can easily be found in this class.

The moral stamina of the profession exists in the ranks more largely than in any other class; it is with this class that we cast our lot and plight our faith. -ED.]

There are many other excellent letters that we would like to quote from, but space bids us call a halt.

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