Several more letters have been received from Dr. B. M. Jackson, of Omaha, Neb.-you know upon what subject, for I never knew him to write on any but one subject. We cannot give space to these letters. This is not only my judgment, but it is also the earnestly exprest wish of a number of our readers. There is one point, however, in a letter from him dated May 19, which I must recognize and meet. His letter starts out this way:

SIR: I am informed that you graduated from a medical college which organized less than one year prior there-to. Is this correct? After you graduated, did any one hold you up for an examination or a $50 fee?

There are four pages of this letter, but the above is the point that I want to meet, and meet it squarely. Yes, the statement is true. It was my final course. I had attended medical college before, at Louisville, Ky. Before going there I had read medicin about three years, under preceptors, as was the custom at that time. After the course at Louisville I did about a year and a half of practical work, and then came up for a final course and graduation at Indianapolis. The college chosen was the Central College of Physicians and Surgeons, then newly organized. I was attracted to that institution by the able Professor of Practice, my friend the now lamented Dr. G. C. Smythe, of Greencastle Ind., and by the distinguisht surgeon, Dr. Joseph Eastman, who only last year passed to the silent majority. But the college, like John Brown's soul, goes marching on," and has made a record that every graduate may be proud of.

No, I was not "held up "for a State examination, nor an examination fee, as that was not the law at that time. If it had been I would have obeyed the law as I have always tried to do. My associations and inclinations have always led me to be patriotic in my public relations, and true to the profession and its highest ideals, in my professional relations. Not that I believe in passivly lying down" and have no independent opinions. I think my record shows that I believe in independent criticism in order to advance healthy progress; but I believe in patriotism first.

As to being "held up" for a $50 fee, I here append the examination fees required by the different States: EXAMINATION FEE.

Alabama.....

Arizona........

Arkansas

California

Colorado

$10 00

10 CO IO OO 20 00 10 00

EXAMINATION FEE.

New Mexico....$25 co New York .......... 25 00 North Carolina.... 10 00 North Dakota... ....... 20 CO Ohio 25 00 The Board may, in its discretion, dispense with the examination in case of a physician duly authorized to practise in another State; in which event the license fee is $50, accompanied by certificate or license issued by such other State. Oklahoma.... Oregon....... Pennsylvania.... Rhode Island South Carolina

South Dakota........

$5.00

10 00 .......... 15 00

15 00

5 00

20 CO

Tennessee............................... ........ 10 00

Texas...................

Utah

...... .......

Traffic in Tinsel.

15 00 15.00

5 00

10 00

10 00

10 00

20 00 25.00

so evidently they have chosen the wiser course, and have concluded to "quit," at least for the present. But after "resting on their oars '' awhile, they will think that the effect of our exposé has "blown over," and they will begin putting out their lines again, and try to sell their 65 cent" certificates," decorated plentifully with tinsel and blue ribbon, and gotten up to look like diplomas, for from $15 to $25, to the foolish or vicious hangers-on to the medical profession, with which to deceive the public. This kind of business can't go on in the medical profession as long as the present Editor lives and controls THE MEDICAL WORLD. If any WORLD reader receives literature from the "Christian Hospital," he is requested to send it here immediately. We have stopt this nefarious certificate selling game, and we will keep it stopt. If you know any doctor, or pretending doctor, who has bought one of these certificates, make him so ashamed of it that he will be glad to burn it up.

Do You Want to Buy a Degree?

A correspondent sends to Amer. Med. a letter from a socalled college in Detroit, which is self explanatory.

Doctor, Being Fin. Sec., of above, from March 1st I desire to inform you we are just now Issuing Honay Degrees to some of our best U. S. &c. Prof. and men up in standing. Knowing of your medical standing and profession if you are of the Desire and looking for LL. D., in Harness, write me Early when I will send 22 you a Rekord of data" for filling out for the board to pass on, the only expence $10 for Issue of Same. Waiting a kind reply I am Dear Doctor Yours Very Respectfully E. M. LL. D. Fin Sec

Fourth of July Injuries.

In treating contusions and lacerations caused by 4th of July explosivs, be sure to open the wound freely, and allow free drainage. The shock of the explosion frequently causes disturbances not visible on the surface, far from the visible seat of injury; particularly is this true of injuries of the hand, the most frequent part injured, the shock following the sheaths of tendons. These deep injuries, and possibly deep implantations of gun powder, are very likely to cause tetanus if not freely and completely opened.

In June WORLD, page 231, second column, 29th line from the top (about the middle of the column), by some slip the word aristol got in in place of aspirin in some of the earliest copies printed. If you have one of these, take a pencil and cross out aristol and write aspirin in the margin.

The itching of eczema may be relieved by painting the affected part with three percent aqueous solution of potassium permanganate and allowing it to dry on the lesion.

ORIGINAL COMMUNICATIONS

Short articles of practical help to the profession are solicited for this department.

Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors. Copy must be received on or before the twelfth of the month, for publication in the issue for the next month. We decline responsibility for the safety of unused manuscript. It can usually be returned if request and postage for return are received with manuscript; but we cannot agree to always do so. Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than anything else.-RUSKIN. COMPARE RECORD

READ

REFLECT

The Principles of Prostatic Obstruction and its Relief.

Editor MEDICAL WORLD:-The prostate gland lies against the outer surface of the apex of the bladder, and the urethra passes thru it as do also the seminal ducts. There are strong layers of pelvic fascia on both sides of it, above and below, which hold it firmly from underneath. They are part of the pelvic floor, which in man is very firm and unyielding.

It consists of glands, fibrous tissue, and muscle in varying proportions, and has scanty blood supply itself, altho to reach it one has to cut thru plexuses of veins which are just outside its capsule among the layers of supporting fascia. It greatly imfluences an operation that three-fourths of the normal prostate is muscle, which is continuous with the vesical sphincter, and assists in controling urination.

The enlargement which occurs in men of advancing years can cause protrusion upward and backward only, because the pubic bone is in front, and below the support of pelvic fascia and levator ani muscle cannot be overcome. Therefore, a large prostate encroaches almost entirely into the bladder and somewhat upon the rectum. The overgrowth may be general and symmetrical, and then causes very little obstruction or retention, but usually it is in irregular lobules protruding anywhere they can, like uterin fibroids composed of many little tumors. If one of these presses against the urethra it causes partial or complete obstruction; if they make it crooked they do the same. Sometimes a little mass with a long slender pedicle hangs just where it blocks the passage, and all the rest of the prostate is normal. Quite often there is a thickening of tissues around the beginning of the prostatic urethra that has contracted so much as to cause retention, and is so rigid that it cannot voluntarily be relaxt. In any of these conditions the catheter is required frequently, perhaps cannot be dispenst with at all, and only part of them are hypertrophic conditions. Examination by usual methods may show

hypertrophy, a normal sized gland or even atrophy. Prolonged obstruction, complete or partial, results ultimately in relaxation and enfeebleness of the bladder itself, progressivly less expulsiv power, and less ability to resist or recover from cystitis, which after several intermittent attacks becomes chronic.

The inflammation extends into ureters and kidneys, and the patient dies of uremia, septicemia and the exhaustion from pain, and from being deprived of rest by day and night.

The indications are to remove the obstruction, retain all tissues necessary to preserve normal functions, and drain the bladder if there is cystitis, and there nearly always is. Early operations removed all the prostate. this they exceeded the requirements and caused the few post-operativ complications, incontinence and permanent fistula, for, as I mentioned earlier in this paper, the prostate lies against the neck of the bladder and more than half its bulk is of muscular fibers surrounding the beginning of the urethra and continuous with those of the vesical sphincter. Their removal deprives the man of that much ability to retain his urin directly, and indirectly still more by weakening the insertion of the sphincter fibers. Also, when the whole of the prostate is removed, it is in some cases impossible to avoid removing a strip along the floor of the prostatic urethra, which still further weakens the power of retention, as that divides all sphincter fibers in that region. Furthermore, it removes the ejaculatory and seminal ducts, which are within the prostate near the median line and behind or below the urethra, and I have learned that men of 65 and 75 are very unwilling to be deprived of them.

The methods of operating depending upon cauterizing grooves thru the obstruction are faulty. They fail in cases that do not bulge into the bladder, but obstruct by pressing along the urethra because they do not always relieve and do not prevent recurrence. They

are dangerous from hemorrhage, shock, and post-operativ septicemia, and they fail to provide continuous bladder drainage, an essential in the majority of cases. Supra pubic operations may be done upon enlargements that are entirely within the bladder, but as no one can determin before long whether they are, they are very poor surgery. The perineal incision and exploration of the bladder by one finger passed thru an opening in the membranous urethra is the only way by which one can know the condition of the whole prostate. It also enables the operator to discover any complications within the bladder and remove one that is curable, such as stone or tumor. Thru the same incision in the urethra a retractor is passed by which the tissues are controled during opera

I read that article. I have been careful that the temperature of the water should not be higher than the normal temperature of the body. I have never had a chill or elevation of temperature to follow this procedure since I have taken the above precaution. A number of my professional friends have observed the same change in results. Unfortunately, nearly every writer who advocates such a douche, specifies that it shall be hot.

I am fully convinced that I have seen several cases in which lives have been saved by frequent and prolonged douches. They are particularly valuable in cases of late infection, due to retro-displacements and consequent retention of lochia. But unless we unlearn the dictum of the hot douche, we expose our patients to a very real danger.

In

I was interested in the query of the Texas physician as to the propriety of charging clergymen for medical services. I hope he will not change his attitude in this matter. case of a poorly paid clergyman, any physician will make a reduction in his bill, just as the grocer or dry-goods merchant would do. But it is impossible to render services for nothing, to one who is able to pay, without a loss of respect on both sides. There is a still greater objection to such a custom. It sometimes places the clergymen in an embarrassing and unfortunate position. Suppose a member of his family is taken sick in the night. He will hesitate to call a physician if he knows the service is to be rendered without charge; while if he knew that a charge would be made, he would gladly and promptly send the call.

I recall a sad case, illustrating this point. A druggist was taken with cholera morbus in the evening and sent for a physician, an intimate friend. The condition improved, temporarily, but about 3 a. m. he became much worse. Knowing that the physician would make no charge, he would not allow a call to be sent till morning. The delay was fatal. The tremendous loss of fluid had left him pulseless and all efforts were unavailing. A hypodermic of morphin a few hours earlier would have saved his life. Cincinnati, O.

Wм. D. PORTER.

Whooping Cough. Editor MEDICAL WORLD:-Page 266-7 of your June issue has a query and reply from you as to best treatment for whooping cough. Tho the main points of what follows have recently been publisht, in my opinion it is worthy of wider distribution and elaboration to attract attention. About twenty years ago my only son, a weakly child, was attackt with whooping cough, and in two weeks had failed so much that there was no prospect of his weather

ing the storm. Having exhausted the remedial measures then known to the regular profession, in despair I askt my druggist if he knew of anything likely to be of use. He replied that he had just recieved Roche's embrocation, which he had specially obtained for a child of a wealthy Scotchman temporarily living in the town, who said "the well-to-do at home never use anything else for whooping cough.' Roche's embrocation is a red oil of which there is about 11⁄2 ozs. in each bottle. The instructions accompanying it are, to rub one teaspoonful into the epigastric region while, the part is exposed to radiant heat, once every twenty-four hours. Of course these are not the words printed upon the bottle, but as I have not seen them for years, I give the idea. Here, this bottle costs $1.75, and it is claimed that before the twelve days are past the disease will be practically cured. I took a bottle home and it filled the bill. I prescribed it for others until the idea that drugs act upon disease thru the ganglionic nerve centers (see Canadian Journal of Medicin and Surgery for February and June, and the Eclectic Gleaner for June this year, for my later words on the subject) got possession of my mind. Since then I have prescribed the 11⁄2 ozs. of oliv oil (plain or colored) used in the way directed for Roche's embrocation, because I believe the heat and massage over the solar plexus to be all that is curativ about Roche's embrocation. We have had a number of epidemics of pertussis during the twenty years, but I have no recollection of any difficulty in this treatment if the instructions were faithfully and intelligently carried out; but the rubbing in of a teaspoonful of oil on a space six inches in diameter takes from twenty to sixty minutes, and not unfrequently this time is grudged; so that of late years I have added the nomeopathic specific drosera, one drop in water 3viij; a teaspoonful to be given after each paroxysm of coughing. The latter will be attended to when the oil is partly or wholly neglected, and one or two prescriptions are all that will be needed in any uncomplicated case of whooping cough. Of course hygienic measures should not be neglected.

The gist of the above was publisht in the Medical Brief a couple of months ago, and when I received a check for five dollars for the 100 words my hat became so tight that I thought I should have to purchase a new and larger one; but the last few issues of THE WORLD have saved me that expense from that cause. I am not a subscriber to the Medical Brief, and think your position in regard to it. et al. is correct, and your reward sure, provided you can stand it to wait long enuf; for medical men, tho easy game when approacht

while worrying over a puzzling case or cases, are not ungrateful to their friends when they recognize them. My only regret is that you did not begin before the silica splint man and the Comstock agency "pulled my leg." More power to your elbow. Faithfully and fraternally yours. GEO. M. AYLSWORTH.

Collingwood, Ont., Can. ["Wait long enuf?" I can hold out as long as the medical profession lasts and remains true to its ideals. ED.]

Dysentery.

Editor MEDICAL WORLD:-Of the four varieties, the (1) acute, (2) amebic, (3) malignant, and (4) chronic, I have seen two epidemics of the second-one in 1884, the other in 1901. My experience as physician is limited to the latter. It is usually confined to the tropics, but occasionally becomes sub-tropical. The duration is usually from six to eight weeks, and it often proves fatal. Treatment is per rectum, at seat of disease, and consists in high enemas (with rectal tube) of ichthyol in warm water, once daily. Large doses of subnit. of bismuth are given internally, with a small amount of salol (if adult); opiates in limited quantity to produce rest. Diet confined to milk, whey, and rice-water. Cold pack and sponge to reduce temperature. This method has been very satisfactory to me.

But most of our dysentery belongs to the first-the acute catarrhal type, which runs but a few days to a week, and rarely proves fatal under appropriate treatment. First, administer a saline purge or mercury, in small repeated doses, and followed by castor oil or Rochelle salts. Give bismuth every two hours, and the following every twenty to thirty minutes: Spts. camphor

Tr. capsicum

Tr. opium

Tr. opium camph.

Sig. 15 to 20 drops every 20 to 30 minutes. Diet, starchy and limited.

Zij

SS

two hundred days of sunshine, in which there was not a cloud to mar the sky, and over one hundred days more that were days of sunshine. The real facts, Doctor, are that we have over 300 days of sunshine every year, and that the city is located seven miles from the base of Pike's Peak, and that the sun rises here as early as any place of the same longitude, and sets but thirty minutes earlier. The hours of sunshine in Colorado Springs are greater than in any other city of the United States. I trust that this will set you right about sunshine in Colorado Springs. This city is known the world around as "The City of Sunshine.'

B. B. GROVER, M.D.

Colorado Springs, Colo.

[We had received the impression somewhere that Colorado Springs was in the mountain shadows during the early forenoon and late afternoon of each day. We are pleased to have the facts.-ED.]

A Business Method Worth $1,000 per Year.

Editor MEDICAL WORLD:-For five long years I struggled to keep up with my professional brethren, always doing a good business, but booking an average of one thousand dollars a year in bad accounts. Possibly once a year, perhaps oftener, I sent out statements. At the end of five years I was one of the collection agency "suckers."

I

I began to think something was wrong. found the cause in myself. Bills for my own purchases were either due on delivery of goods, in thirty days or in sixty days. My debtor's bills seemed not to be limited; in fact never came due. Two years ago I resolved to be my own collector. I actually destroyed by fire every memorandum and old account, which in bulk if paid would have amounted to over five thousand dollars. I believed it was not too late to start over again. I personally framed this form of blank statement. [See next page.]

I was somewhat timid in sending out the first batch, but after that it was a regular routine. Some of my patients and debtors were insulted (temporarily only), but an explanation that it was my method of doing business, and that each and every one of my patients got the same thing, never failed to clear the atmosphere. I have never lost a patient by this method.

Between the 25th and 28th of each month a list showing every account is made out. I check each name with a number, either 1, 2, 3 or 4.

Number 1 gets a statement of his account as per blank, simply showing amount.

Number 2 gets the same with the following