Country Surgery.-Whiskey Vomiting.— Cure for Stomach Diseases. Editor MEDICAL WORLD:-Man 70 years old, subject to retention of urin and to relief by catheter. Taken as usual. Doctor could not insert catheter. Consulting doctor also failed, and lacerated and bruised the parts greatly in effort. Decided to insert trocar above pubis. Proceeded and drew off urin. Case left with the patient's son, a farmer, who said he could operate. The son plunged trocar in at same place every twenty-four hours until urin passed naturally. Recovery complete; no trouble since; three years ago.

Farmer, aged 35; been drinking considerable, but not at time. Vomited everything; no other symptoms. Thought bad water caused it. I thought bad whiskey. Tried

many remedies, blister, morphin, bismuth etc., no abatement of symptoms. Put case on 10 grain doses of mixture, 3 parts acetanilid, I part soda, every three hours. Immediate relief. |

For all ulcers, wounds, any kind of case, apply acetanilid freely.

After trying all the fine-spun remedies for thirty-five years, have discovered that a dose of soda bicarb. three times a day, with an occasional full dose of epsom salts, and a spare fluid diet, cures all non-malignant stomach diseases.

I glory in your position on "almanac journalism." No doctor should either patronize the Brief, nor prescribe the proprietary remedies pusht by the editor. H. J. PARKER. Clayton, Ill.

Hypertrophic Cirrhosis of Liver.

Editor MEDICAL WORLD:-I present the following case of a rather rare disease. July 17, 1903, J. J. R. came to my office for examination, tho he said he did not feel sick. Male, aged 52, weight 190 lbs., which had remained about the same for years. About a year previous he noticed he was turning yellow; on this date the jaundice was complete and very pronounced. Had been a free drinker for years, with occasional spells of drunkenness lasting for several days. Physical examination revealed a greatly enlarged liver extending down to and protruding the umbilicus. Distended liver with smooth edges distinctly seen and felt thru abdominal walls. Spleen enlarged. Heart and lungs sound. No pain, only sense of fulness over the liver. No ascites and no swelling of feet or legs. Temperature normal. Stools rather dark, otherwise normal. Urin loaded with bile, no albumin. The urin decomposed rapidly, and twelve hours after being voided it became dark in color, coagulated in appearance, and very offensiv. The diagnosis

was hypertrophic cirrhosis. I told him frankly his condition, and advised him to let all alcoholic drinks and everything which contained alcohol alone.

He

On July 31 I was called to his home to see him. Against instructions, he had been drinking; in fact been on a spree. I found him with a temperature of 101°, sweating profusely, partial coma, aroused with difficulty, relapsing at once into stupor- cholesteremia. Under treatment he pulled around and in four days was about as he was on July 17. Treatment was continued, he coming to my office. was at my office on August 12, with condition unchanged. Could direct his farming, as he had done for years, and was in good spirits. On the 14th I was again called to see him. Found him in complete coma, slightly accelerated temperature, sweating as before, a bloody, frothy saliva of offensiv odor running from his mouth, full quantities of dark colored bile loaded urin passing involuntarily. The day before, when he seemed as well as he had been for some time, he drank between a pint and a quart of hard cider, and in twelve hours he was unconscious. He never regained consciousness, and died on the 16th, forty-eight hours after he was taken. All of the secretions and excretions were colored with bile, decomposed rapidly, were very offensiv, and decomposition began almost before life was extinct. Altho the disease had so far advanced that a fatal termination was near at hand, he could attend to his business, travel for miles or work as he had done for years, and but for the jaundice he would not have applied for medical aid.

Hypertrophic cirrhosis is rare, nearly all cases of cirrhosis being of the atrophic variety. Tyson says these cases always have an alcoholic history; Butler, in his Diagnostic Internal Medicin, quoting Osler, says "there is not usually an alcoholic history."

A medical lecturer some time since stated to his class that in hypertrophic cirrhosis where the craving for alcoholic drink was strong, probably hard cider might be given with advantage. In this case hard cider no doubt brought on the cholesteremia which resulted in death. GAVIN RAWLS.

Carrsville, Va.

Experience with a Collection Agency. Editor MEDICAL WORLD:-Seeing the account of the methods of the International Collection Agency of Syracuse, in the June WORLD, will relate my experience with the hope that it will prevent other doctors from falling into the same trap.

Almost two months ago a man called upon me, saying he represented the International

Law and Collection Agency of Dayton, O. He said that all I had to do was to pay four cents for every claim filed with them for collection, and when creditors settled, to pay the company 50 percent of the amount collected.

Well, I thought that half a loaf was better than none, so signed the contract and sent in a list.

Later I read over the contract and discovered that instead of paying four cents for each claim filed, I had to pay four cents every twenty days for each claim filed, until six such payments had been made. So instead of paying four cents for each claim, I will have to pay twenty-four cents.

As soon as I noticed that, I wrote to them and wanted them to cancel the contract on the ground of misrepresentation of contract, but of course they wouldn't.

I have been in this deal two months now and they have not collected a cent for me. "It is all going out and nothing coming in." Am I compelled to remit every twenty days? If it isn't too much trouble, let me know in the July WORLD. J. B. MOUNT.

Buffalo, N. Y.

[That is only a small penalty for the error of not carefully reading the contract before signing it. You may be glad that it was not a "contract note" for about $35. When will doctors learn not to sign any paper until they carefully read it and understand its contents? In the above case the doctor need not send any more claims. As to the claims already sent, we cannot decide how far he has involved himself without carefully examining the contract, which he did not send.-ED.]

The Comstock Collection Agency Again. Editor MEDICAL WORLD:-Find inclosed $1 for renewal of my subscription to THE WORLD. A short time ago I had occasion to resort to various remedies in an obstinate case, with little results. I tried to call to mind a remedy that I had used years ago but could not locate it until I dug up the numbers of THE WORLD of 1888. This may be retrograde, but the remedy is doing the work.

In the May number I see some mention of the airing of the Comstock Collection Agency. Please find inclosed 10c. for a copy of that issue. Some time ago the agent of that company called and I made a contract with him to collect, and signed an agreement on a percentage. In a few days I got an agreement, a duplicate. He said that he had misplaced his, and he wanted me to mail it to the company. I did so, and sent in a list almost $1,400. I received a letter soon stating that I should have sent about $3 in stamps. My understanding was that no money of any kind was askt-just

the list. But I sent the money, and soon there was a bill paid. I notified the company, and they sent me an agreement (heavily underscored) in which it seems that I have agreed to make a report every ten days, and send 2c. for each name five times, and that all the money collected is theirs until $35 has been sent them, and postage, which will make about $50. Also I see that any failure upon my part to live up to the contract makes their $35 DUE.

I guess they have taken the fisherman's instruction: "When you catch a sucker, bump his head." I have another list almost ready that I will not send in until I hear what THE WORLD has to say, and I have an understanding with the company as to whether I am to pay 25 percent to the company, or all, and furnish postage. If I signed the kind of article sent to me today, I am a victim to auto-suggestion (by mail, postpaid), and must go to a specialist at once and be dehypnotized. J. H. GUINN.

Arkansas City, Kan.

[Now this is a surprise-two surprises! First, that a WORLD reader could be caught in the Comstock trap, and second, that the Comstock people are still operating. This is the first we have heard of them for about a year. But, as we have often said, schemers, when exposed, will lay low awhile, and then "bob up serenely" as tho nothing had happened. Doctors in the vicinity of the above address should be on their guard; and Dr. Guinn should read up some more back numbers of THE WORLD, and learn all about the Comstock Collection Agency. When will doctors learn to close their ears to what traveling agents say, and when a document of any kind is handed to them to sign, read it carefully before signing, and also exact a duplicate to keep for reference, and see that the duplicate is a true fac simile of the document signed? How often will we have to go over this? In a few months some other good doctor, but careless business man, will write us confessing that he has been a "sucker." Sometimes we think that all the blame should be put upon the suckers themselves, particularly after they have had good opportunities for getting their eyes opened. Of all men, readers of THE WORLD should have their eyes open. At the very least, they should know what they sign. Doctors should get their collecting done on commission, without any fee; and the collecting firm should furnish their own postage. There are young lawyers in nearly every community who will undertake such collections on a commission basis.—ED.]

Arsenic remains the drug of choice in the treatment of chorea; it is ably supplemented by hyoscin, chloral, bromids, and iron.

Comstock Collection Agency. A New Jersey brother writes us urgently as follows:

DR. C. F. TAYLOR, My Dear Doctor:-I have refused to pay the Comstock Collecting Agency for no services rendered to me, except I signed a contract as a great many others have done. They have issued a summons on me to appear at Hightstown (a remote part of the county) before a justice of the peace, next Monday. Will you kindly inform me at an early date what you would advise me to do.

We wrote the Doctor that one of their favorit schemes is to bring suit in a distant part of the county, hoping that the doctor will pay rather than suffer the inconvenience, loss of time, etc., that attending court in a distant part of the county would involve. However, for details we could only refer him to WORLD for last year. In order that others may post up, should they have occasion, we give the following references in detail:

46

beginning on page

163

205

260

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April

page 396 page 496

Rip Van Winkle, when he awoke from what he thought was a sleep of one night and went down to his nativ village and found that no one knew him, said, "How soon forgotten! And so we are reminded now. Just last year we showed this thing up thoroly and completely, and already doctors are again unwittingly signing "contract notes," and being sued on them! "How soon forgotten!" If I should be called away from the editorial chair, by death or other cause, I suppose it would be another case of "how soon forgotten," and schemers would play upon the profession with old time energy, to their great profit, and corresponding loss to the profession.

Acetanilid..

Bicarbonate of soda

Citrated caffein

M.-Dose, 5 grs., repeated as necessary. Whitesburg, Pa.

70 parts

. 20 parts 10 parts

J. A. KELLEY, M.D.

Med. Dep. Wooster University, Cleveland, Ohio, 1874

Journals.—Proprietaries.—Coaltars.—

Preachers.

DEAR DOCTOR TAYLOR:-Today's mail brought me five medical journals, but as usual I never open the others until every single word in THE MEDICAL WORLD has been read and digested. THE WORLD is the journal for the busy practician. and especially the country doctor. We all had plenty of theory crammed into us while in college; and since then when we want more beautiful or pet theories we can find them in the latest text-books. What we want and what we need is an exchange of views and experiences; something not found in the text-books

I certainly admire the stand you take in exposing frauds, which would catch many a poor busy country doctor. My friend, uncle and colleague who admires and reads the Medical Brief more than any other journal, was caught in the Comstock collecting trap-but I was prepared for them by THE MEDICAL WORLD. Yes, I received literature and sample certificates from the "Christian Hospital" of Chicago; and daily I receive letters and circulars from investment concerns asking me to invest in corn, wheat, timber, mining, oil wells, etc., but what small investment I can make I make at home, by loaning money to farmers and taking a mortgage on the real estate.

I admire the stand you take in regard to

journals pushing the use of proprietary medicins in their reading columns. Great Scott, where is the medical profession drifting to? Why some of the doctors in this community never use a materia medica or the U. S. P.; all they want is a list of proprietary medicins. Has the medical profession, the greatest of all professions, come to the place where they are willing for the proprietary commercial man to do their thinking and prescribing? No, not I.

Almost daily, while in consultation with some of my neighbor physicians, they will suggest some one of the proprietaries, and I always reply, "Doctor, we are capable of formulating our own prescriptions." I never will use anything that I do not know the formula of.

"Coaltars" are all right when not especially contra-indicated. Beware of them in any disease where there is an extra work for the heart to perform, such as in pneumonia, or a general debility or weakness of muscles (which of course includes the heart muscle) as in typhoid fever. When I give any coaltar derivativ I give acetanilid, either alone or make any combination suited to that particular case.

Yes, the preachers here are regularly supplied with samples and literature of antikamnia. They use and recommend its use, and some few of them become antikamnia fiends. Do I charge the clergymen? Well, yes, I most certainly do. I charge them the same way and price that I do other people, but I don't collect it the same. My experience is that the preacher is the hardest customer we have. He is a particular, pettish patient while sick, and when well will work schemes and tell lies just like any other fellow to avoid the payment of his bill.

Does the WORLD family charge a doctor's widow who is worth more than the physician called?

The Doctor who aborts all his cases of pneumonia-cures them all without a single death, is the man who can't make a correct diagnosis of pneumonia, or has not yet shed his umbilicus in the practise.

Long may the Editor live to publish the best journal in the world.

is prescribing, and he should prescribe according to the needs of each particular case; but some proprietaries are better prescriptions than some doctors can write, and better from a pharmaceutical point of view than some druggists can put up. We admire the doctor who is self reliant, and able to think for himself, but until all doctors are so, there will be a useful place for proprietary mixtures. Then there are proprietaries which require special facilities or machinery for their production. They occupy a useful place. The protected chemicals, each of which represents a scientific discovery or creation, belong to a separate class.-ED.]

I believe that the harm which the coaltar products produce is far in excess of any good that might be derived from their use. There is no doubt whatever that their habitual use weakens the heart and so unfits it for any unusual strain which might be at any time demanded. Evidently the wide use of the coaltar products is the real reason of so many sudden deaths from pneumonia and other diseases which have become so exceedingly fatal in the past few years. The heart weakened by phenacetin is not able to cope with the strain and so succumbs, and the death certificate is made to read pneumonia when the afore-named drug was the real cause of dissolution.-P. E. Howes, M.D., in the Eclectic Review.

The Medicinal Versus the Surgical Treatment of Diseases of the Veins.

Editor MEDICAL WORLD:-So many inquiries have come to me from all parts of the country asking for further information in regard to the treatment I suggested for enlarged veins, in the June WORLD, page 248, that I am obliged in self-defence to ask you to publish the following, which I trust will be of use to the brethren who may have cases of diseased veins on their hands. And first permit me to say that I owe much of my success in the treatment of diseased veins to Dr. J. Compton Burnett, the brilliant homeopathist of London, who has given us a most valuable monograph on the subject, and also to the splendid article on "fluoric acid" in Hughes' Manual of Pharmacodynamics. Quoting from Dr. Herring, he says that "under its use, e.g. fluoric acid, in dilutions from the fifth decimal upward, has proved curativ of chronic diarrhea, secondary syphilis of the throat and tongue, osseous caries, whitlows have been blighted, fistulas (lacrymal and dental) have closed, varicose veins have shrunk to half their size, fresh hair has grown on a bald head, moist palms have regained their healthy dryness, chronic rhinitis has been cured and rectal troubles alleviated." "My own experience with it" (fluoric acid) says the author Hughes, "in old cases of varicosis of the leg such as we see at the hospital is very favorable." Now, laugh if you will, doubt if you have a mind to, but if you are an

earnest investigator and seeker after truth, try it for yourself and be convinced.

When I first read the above article I did not sneer nor doubt; I simply investigated for myself, and I found, wonderful to relate, that the half had not been told. With an extensiv private and dispensary practise, among all classes of nearly every nationality, I have found that most cases of general varicosis, hemorrhoids, varicocele and varicose veins yield nicely to the simple medicins that I make use of. But before I mention them in their order, allow me to quote from Dr. Burnett on "General Constitu"There are,' tional Venosity." says he, "certain subjects whose venous systems are exceedingly prone to ail; if they have any thing wrong with their hearts, it is pretty sure to be the venous side of it; if they get dyspepsia, it arises from congestion of the portal system of veins; if they suffer from headaches, it is from venous stasis; if they get constipated, piles develop at once; if they stand much or wear a tight garter, they get varices of the legs; if the uro-genetic system gets irritated or injured and fails to get tone-giving natural relief, they have varicocele, or menstrual troubles from dilated veins of the ovaries and broad ligaments, as the case may be. They are constitutionally venous, and suffer from passiv venal congestions at all turns." Here, indeed, is a gold mine of most valuable information for the thinking investigator, and here we have given us the cue to the successful treatment of those troubles that are so common and usually annoying to the average practician.

In a practise extending now over a period of eight years, I can assure my colleagues that my success in the treatment of all these troubles, by simple medicins, has been most gratifying. There is no secret about it, and if physicians would only throw their skepticism and bigotry and prejudice to the winds, and investigate for themselves, there would be considerable less of suffering in this old world of ours. But mark you, the law of similia similibus curantur must be faithfully obeyed. It is only in obedience to law of any kind that we reap any kind of benefit. For myself I am willing to sit at the feet of the masters, and when they tell me to do this or do that I faithfully obey, and I always find that my obedience is rewarded. When they advise me to give ferrum phos. 3x, five grs., t. i. d., I don't curl up my lip and say to myself, "Well I guess five grs. of the plain drug store ferric phosphate will do just as well." I have learned the lesson of obedience.

There is a difference between a crude and potentized drug, but I have not time nor space to unfold the mysteries of potentized medicins, and so to be brief and to the point, let me say that I find in my own experience, which is but

the result of the experience of better men than I am, that generally speaking most cases of general varicosis, varicocele and varicosed veins will be slowly but surely cured by the persistent use of ferrum phos. 3x, and fluoric acid 6x, prescribed according to the indication for each drug. For instance, ferrum phos. acts brilliantly in the old, and fluoric acid in the young, and both in alternation in the middle aged.

Hemorrhoids may be cured with a few weeks course of nux vomica 30 and sulfur 30. Sulfur is a wonderful remedy. I do not know what I would do without it. Not your crude sulfur of the drug or corner grocery store, but the drug in the potentized form, as prepared by some good homeopathic pharmacy. Almost any dilution above the twelfth will do. For myself I prefer the 30th. Somehow I find, like the masters, that it is more enduring in its effects! By the way, sulfur is the great portal system remedy with Rademacher. I do so wish that every reader of THE MEDICAL WORLD might read and ponder the article by Dr. Burnett in his " essays" on the medicinal treatment of the veins. Well, to cut a long story short, I am constantly curing scores of cases of piles, quickly and pleasantly, with nux vomica 30 and sulfur 30 in alternation. Some are cured in a fortnight, others in a couple of months. What diet shall I prescribe? 'I never bother about the diet. Local applications? Why, bless you, there isn't need of any. I think only once or twice I did prescribe applications of a little Pond's extract of hamamelis, but only once or twice.

Varicocele: Most of my varicocele cases, and I treat some tough ones, are cured with ferrum phos. 3x and fluoric acid 6x, in alternation. Occasionally I have to call in to aid these superb remedies (I quote from Burnett's Essays), aurum met. 3x, when the testicles are very small and weak, and in those suffering from mercurialism; silicea 12x, when there are sweaty feet or when there is the history of suppression of the pedal perspirations and when there are chilblains; phos. acid 3x, when associated with phosphaturia and pain in the testicles; pulsatilla 3x will suit many cases and be especially called for in the obese and those of lax fiber and tearful mood; your sandy headed man of the blue eyes, for in

stance.

And now, to summarize, the vein remedies which I have recourse oftenest to, I find are the following-I will mention the most important ones in their order: Ferrum phos. 3x, fluoric acid 6x, hamamelis 3x, aesclus hip. 3x, nux vomica 30, sulfur 30, silicea 3x, rhus tox. 3x, aloes 12x.

In closing let me say it is quite possible the good Editor of THE MEDICAL WORLD and