traction and only succeeded in snipping away a small bit of the brittle rubber.

The same procedure on the opposit side was followed by a similar result. Then pressing the blades of the forceps as wide apart as the caliber of the urethra would allow, and grasping both sides of the catheter and making steady traction outwards, the instrument was dislodged and taken from its hiding-place. Needless to say he went home a happier man. Now Mr. Editor, with all your elisions why not elide one syllable from each of the following words: Symptom-(at)-ology and system(at)-ize, thus adding to their respectability? JOHN F. NEAL.

Lytle, Tex.

[Your suggestions are in the direction of simplicity in language, where all progress is tending.-ED.]

More About Conditions in the South.-Answers to Quizes.

Editor MEDICAL WORLD:-Judging by the number of letters coming to me asking further information about the South, your circulation is in no urgent need of digitalin. And the interest seems to warrant some further remarks on the subject.

Write to Mr. Fuqua, State Commissioner of Immigration, Baton Rouge, La., and he will send you a pamphlet describing over six million acres of land in the state for sale. Over two thirds of the acreage of the entire state is offered in that one booklet. Practically

the entire state is for sale.

Why? Whenever anyone wants to sell you something, ask yourself why he values your money above his own property, and you may save yourself from loss.

Let me remark here that not once did I meet in Louisiana a single white man who exhibited any wish to leave the state. Nativs remain there, northern men come to stay. But there is a vast area of land there that the owners cannot utilize.

Here is an example: A wealthy planter residing in Clinton told me he had 6,000 acres of cotton land, one-half of which lay idle for want of hands to cultivate it. He had applied at the immigrant quarters in New York, and traveled thru the southern Atlantic states, gathering up all he could induce to come, and had 100 families located on the property, and yet it was half untilled. He made any and all arrangements with them, hiring for wages, taking shares of the crops, renting by the acre, selling at any desired terms; and in all cases issuing all needed supplies until the crops were gathered. This is then taken at the market price, and the laborers receive the balances due them. That this is a substantial sum in many cases seems to matter but little to the

negroes. One man had a balance of $480 to his credit, and in one month had drawn it all out. Askt what he had done with it, he "didn't know;" but he remarkt that if it had been $1,000 he would have spent it all. Now this man will draw supplies for his family for the year, until his next crop is marketed.

The Italians do better; and in a few years own their farms, whose crops of truck soon make them comfortably well to do.

The publication issued by Mr. Fuqua tells all about the character of the lands, upland, alluvium, salt marsh, hard and soft wood, corn, rice, cotton, sugar, mineral, oil, etc. From this one may form an idea as to what part of the state he cares to investigate. Illinois Central also supplies information on these topics; and all the roads allow reduced rates to home-seekers.

The

I do not pretend to know much about farming, but there are things I failed to comprehend. hend. Below New Orleans stretch miles of salt marsh, that a Georgia cotton planter told me was the same formation as the islands on which the celebrated sea island cotton was raised. Along the Atlantic coast such land is very valuable, but this is sold for twenty-five cents an acre. I could not find whether this land had ever been tested for sea island cotton, but concluded there must be some reason it is not so utilized-but people say: "Remember this is the South, and very likely it has never been tried."'

Everywhere we saw whites and negroes working side by side-if there is any prejudice against a white man who seeks to earn an honest living by any honest work, we did not detect it. We were even told that in the State University some of the cadets earned money waiting on tables, etc. If this is so, there need be no fear of any white man "losing caste" by manual labor.

Can the white man work in that climate? Yes, if he is not too lazy. Sixty percent of the cotton crop is now raised by white labor. Every northern man we met treated the idea of climatic inhibition with derision. South is the machinist's paradise-the prices they charge for work are something fierce.

The

During the winter we never saw alligator, snake or mosquito; but are told that during the summer, flies, mosquitos, ticks, gnats, redbugs, and other insect pests render life strenuous. The sort of people who will be turned aside from their plans by such considerations would better not go south-or north, east or west.

Do you want any more?

Indiana, page 262, should begin by investigating the condition of the genito-urinary apparatus, and he will surely find the cause for

the irritability there. And unless he does this his treatment will fail.

Dr. Girk, page 264, may find atropin useful for his salivated friend. Give enuf to dry the mouth and keep up this effect for a few days, using local remedies as suggested. A dram of tincture of hydrastis in a cup of water is a useful lotion. Or better, use a granule of berberine as a lozenge every hour.

Whatever Dr. Vital's case, page 264, has, it is not rheumatism. That is a disease of the fibrous structures about a joint, always febril, and changing from one joint to others, with acid sweat and urin. The description reminds me of a case of abscess in the head of the tibia, relieved by trephining. Possibly there is a needle that may be found by x-ray examination. That should be employed at any

rate.

Asthma, Dr. Krebs, page 265-I have yet to find a case in which the following combination does not discount potassium iodid for efficiency and quick effect: Mercury biniodid gr., iodoform gr., phytolaccin gr., of each three granules; arsenic iodid gr., one granule; these then to be given together before each meal and on going to bed. Continue and increase the doses till slight irritation of the eyelids shows saturation, then slightly lessen doses and continue. But you cannot cure any asthma if you neglect to keep the bowels clear and aseptic, and keep down the diet to the needs.

Dr. Higdon's case suffers from auto-toxemia of intestinal origin-nothing more nor less. Page 265.

As to W. B.'s case of backache, there is not enuf evidence for a diagnosis; but what there is points to disease of the anterior surface of a lumbar vertebra-abscess, cancer, aneurysm. If no examination has been made for three months there may be a development that will clear up the mystery. Use the x-ray.

So they have whoopingcough in Virginia, page 266. Now is the chance to test the claims of those enthusiasts who think calcium sulfid will prevent or abort this malady. Don't say a word to them but begin giving from to a grain every hour till the breath smells like a last summer's egg, and see if the child can develop this affection while so saturated. If already infected, add to this enuf atropin to slightly dry the throat and keep it so. Of course you will keep the bowels free and aseptic thruout, for we are talking with real docWILLIAM F. WAUGH, M.D.

tors.

Chicago, Ill.

If

A splendid eye water for routine use in conjunctivitis is made by adding an ounce of camphor water to two ounces of a saturated aqueous solution of boric acid. It may be used freely in the most sensitiv eye.

The Removal of Growths upon the Skin. Editor MEDICAL WORLD:-Few general practicians will condescend to attempt the removal of the nevus, mole, or the ordinary wart, much less the incipient epithelioma, by any other than surgical methods. Only wise caution, ignorance, or inexcusable timidity can explain the facts. The plea of conservatism is not tenable, since both the specialist and the quack remove these growths without more accidents or ill effects than any doctor's every day practise will show. Ignorance! A general practician should not be ignorant of any thing in the domain of medicin. Hoping that my article will interest practicians derelict to their interests and duty, I will give my methods of removing the various growths.

Warts: The verruca are the most common of disfiguring skin lesions. More common in children, they may be found at any age and in any location. They are prone to appear on the hands. Every physician is familiar with their appearance, and it is only rarely that a case may present features which render diagnosis difficult. They may be flat, filiform, or brancht; and about the genitalia may present widely varying characteristics. Excepting the genital wart, I remove them most easily by applying glacial acetic acid several times a day. The patient is given a small vial of the acid and instructed to apply a drop on the end of a stick three times a day, avoiding enuf being used to permit it touching the healthy skin. If the wart should become inflamed, he is instructed to suspend applications for forty-eight hours, or until the inflammation subsides. The wart goes, I have a satisfied patient, and he tells his friends about it, and he returns when again needing a physician. The venereal wart only differs from the ordinary form because of moisture, irritation, or compression. It is best treated by cleanliness, mild antiseptics, and drying powders; but if single, small, or filiform, may be clipt off with scissors or bistoury, and dusted with calomel, iodoform, or boric acid.

Moles: The ladies are our best patients when moles are considered; and we always give them due attention. The nevus pigmentosus may appear on any part of the body, or it may be congenital. The laity generally ignore them unless they appear on face, neck, arms, or breast. Most patients will suffer their presence for years through fear of "cancer developing" if anything is done toward removal. While they may be safely removed by electrolysis or excision, we have always preferred to treat them exactly as we treat warts. We always get good results, without a scar. Freckles Lentigo is familiar to profession and laity. Blondes are more susceptible than

Zinci oxidi.

Hydrarg. ammoniat

Ol. theobrom.

Ol. ricini.

Ess. rosae

ää fl. 3 iiss. gtt. x.

Misce et signa: Apply night and morning as directed. If the emunctories are kept activ, this will remove most "liver spots," if the treatment is persisted in for sufficient time. In obstinate cases one may remember that the discoloration of the cuticle is the result of an irritant, and that this irritant may be external or internal, and that one may learn the cause by careful investigation. Once the cause is known one may act more intelligently. We always inquire carefully regarding possible external irritants, and we look out for malaria and Addison's disease, and complete our examination by ascertaining the condition of the uterus as regards endometritis, pregnancy, tumors, etc. If you find the cause, a little thought will enable you to dispose of the "liver spots" to your own and the patient's satisfaction.

Lichen pilaris: Keratosis pilaris are small papular elevations surrounding the hair follicles, and are a true hypertrophy of the epidermis. The elevations are dirty grey in color, and each is pierced in the center by a hair. It occasionally causes some itching, but only the most aggravated cases present evidence of inflammation. Frequent bathing in hot water with abundance of good soap, followed by vigorous friction of the skin with a ruf bath towel, and the final application of vaselin or other simple ointment will bring about a rapid cure. The disease is the result of filth.

It is prone to attack the extensor surfaces of the arms and legs, but may appear on any part of the body.

Corns: Clavus spares few adults. Most common on the feet, they may appear on any portion of the body as a result of long con

tinued irritation.

The socalled soft corn is but the ordinary corn macerated by continuous perspiration. The source of irritation must first be removed. If great inflammation be present, we keep a piece of lint around or on the corn, soakt with linseed (flaxseed) oil, day and night till all soreness is gone; then we apply the following, night and morning for several days, then soak the corn in hot water for a few moments and it readily separates from the sound skin and may be pickt out. One course does not cure, and the application is repeated till there is no longer any hardening of the epidermis, when properly fitting shoes or removal of irritation will permit the skin to assume a healthy condition. The application is made up as follows:

Salicylic acid.
Tinct., iodin

Ext. can. indica
Collodion

gr. xxx. minims x.

. gr. x. drams iv.

Cutaneous horns result from hypertrophy of the epidermis, and are found on face, scalp, or penis; they are most common in the aged. They are easily cured by excision, and cauterization of the base with carbolic acid.

Hirsuties: Excessiv growth of hair may disfigure the face or form, and ladies are often anxious to part company with such growths. The hair may be removed temporarily by applying hydrated calcium sulfid as a thick paste, allowing it to remain until the hair is dissolved or irritation is complained of; 3 to 20 minutes may be required; the skin is then sponged clean, and annointed with lanolin. The hair soon grows again, but if the applications be repeated often enuf, occasionally one secures entire destruction of the follicle. Electrolysis is only practicable for small areas, and frequently the destroyed follicle causes an atrophy of the cuticle, with a consequent depression in the skin which serves as a lodging place for perspiration and dirt, and the after condition of the patient with permanent "" black-heads " is worse than the first. Simple epilation is the most reliable method. It takes time, but is not very painful when properly performed. Each individual hair is firmly graspt close to the skin by small forceps and quickly removed by a jerk.

If

Birth marks: Angioma are common. not on an exposed portion of the body, few patients give them much consideration. It small, they may be readily removed by ligation by the subcutaneous method; by electrolysis; by excision; or by the repeated use of caustics. It is not practicable to remove a large birth mark; often the resultant scar and the possible contraction of the subcutaneous tissues leaves a worse disfigurement than before. The small birth mark may be removed by re

peated applications of silver nitrate, tincture iodin, or caustic potassa; so soon as the eschar separates another application is made. It is better to employ operativ procedures in the larger varieties.

Wrinkles may be obliterated by regular and persistent massage of the affected skin with cod-liver oil or lanolin. Use the index finger, and with a stroking motion exert considerable pressure along the long axis of the wrinkle. Use the selected unguent freely. Applications are best made before retiring, and as the lubricants are harmless may be continued at the discretion of the patient. Usually five minutes' daily inunction will result in rapid cure. Epithelioma: The skin cancer is the hardest problem to tackle without thinking of the knife; yet actual results show much more favorably toward the use of caustic. In the earliest stages, the patient will often submit to an application when mention of operation would scare him to some other physician or confirm him in his determination to die with out interference. One must remember the ignorance of the laity; we must remember the quack advertisements they have read, until they are morally certain they know much more of their individual case than any doctor ever can; hence we must humor them, in order to control them. If we are not equal to the task, we would better retire gracefully. We must not forget all they know about "roots; we will remember that they know that a cancer cut out, always returns; we need to be judicious, and get rid of the growth by whichever plan we can induce them to accept. majority of patients will select the caustic. Zinc chlorid and arsenic are the most popular agents. The zinc is used by taking one part zinc chlorid and three parts flour and making a paste with a saturated solution of cocain hydrochlorate. The arsenious acid was first used by Marsden, who recommended two parts of arsenious acid and three parts of powdered acacia with enuf water to make a stiff paste. This is applied over a slightly larger area than that covered by the cancer, to the thickness of 4 inch. Marsden warned against covering more than one square inch at a time; but if the area be larger, one may use the zinc paste at the outside and the arsenious acid paste in the center. Either paste is covered with lint, and left in position 24 to 48 hours; it is then removed and poultices applied. The sluf is slow to separate, but usually comes away in 5 to 10 days. Robinson advises that the paste be removed at the end of 24 hours, as he fears absorption of excessiv quantity of the drug if the application be continued longer. If the paste acts properly in 12 hours there will be markt inflammation and edema; if this does not

The

appear, after waiting 12 hours more the paste is removed and a new application made. After the sluf separates, the lesion is dressed with any simple antiseptic ointment. Healing is usually kind and uneventful. Tumor is less likely to occur than after the use of the knife.

Let the general practician pay more attention to such "foolishness" and it will be better for his patients, and better for his bank account. Neither the specialist nor the quack has any right to usurp this field, and no practician should either refer such cases to the specialist, or permit them to drift into the hands of the quack. A. L. RUSSell. Midway, Pa.

The Treatment of Disease in General, with Especial Reference to Typhoid.

Editor MEDICAL WORLD:-In the Independent of May 5, appears a letter written by Herbert Spencer to Dr. Lewis G. Janes of Brooklyn, now for the first time made public, closing with the following observation: "In my earlier days, I constantly made the foolish supposition that conclusiv proofs would change beliefs; but experience has long since dissipated my faith in men's rationality."

In somewhat similar frame of mind I approach the subject of the treatment of disease, especially of typhoid fever. My views will be advanced with no expectation that they will be accepted by any large number of physicians, but with a faint hope that they may awaken inquiry in the minds of a few, and in some measure aid in the consummation, for which we all devoutly wish, the shortening of disease, and the lessening of its mortality. Many of these views are not original with me, but are held by a constantly increasing number of men. There are some, however, which I have evolved from my own experience and observation, during a long life in both civil and military practise.

"It

In the editorial remarks in Scribner's Magazine for May, under the heading "Tonnage in the Professions," I find the following: is the opinion of one of the oldest medical instructors in our country that the schools of today aim to turn out more graduates, and better students of medicin than ever before, and that they succeed; but they do not turn out as good doctors, on the average, as they did forty years ago.' "The proportion of good doctors in the multitude issuing from the modern school is probably as great as the old schools turned out; the positiv number of the less competent is necessarily larger."

The superiority of the doctors of the present day, over those of forty years ago, it seems to me, consists mainly in diagnosis, hygiene, and preventiv medicin, rather than in the

treatment of actual disease. Then doctors were compelled to rely on themselves to a greater extent, to use their own reasoning powers, their own common sense, and did not so blindly follow precedent and authority. The great hindrance to progress in the better understanding of disease and its treatment is the intellectual inertia, which prevails among the majority of medical practicians. They accept the views of self-constituted authorities without bringing these views to the bar of reason; it is so much easier to take your opinions from some one else.

Again, I am confident that the antidotal theory in combating disease is utterly wrong; that we place too much reliance on drugs, and too little on the natural recuperativ powers. We are apt to regard disease as a positiv force, or entity, which we are to drive out or antagonize, instead of a condition which will often right itself with very little aid from ourselves. Nowhere is the chaotic state of the medical mind more evident than in the treatment of typhoid fever.

The following confession, taken from an article in the Boston Medical and Surgical Journal, written by Dr. Henshaw, will show that I have not resorted to hyperbole in my remarks: "Within the last few years more than fifteen hundred remedies have been suggested for the treatment of typhoid fever; all sorts and kinds of food have been advocated, as of special value in the diet; hydrotherapy and antipyretics have been advised for the reduction of the fever; attention has been called to the value of intestinal antisepsis; while the special symptoms, arising during the course of the disease, have been relieved, experimentally at least, by almost every resource of the pharmacopeia."

Medicins are given with no intelligent idea of their therapeutic action. A man reading the reports of cases in the medical press, would find abundant justification for the opinion exprest two years ago by Dr. Bull, of New York, that "medical practise is empirical and probably always will be." A few years ago, in one of the medical journals there was a symposium upon the value of quinin in malarial hematuria, in which about fifty doctors participated, one half declaring that it was curativ, and a like number condemning its use in no measured terms. Not one man gave any reason why quinin was useful in one class of cases, and the contrary in another. Not one man gave any evidence that he ought to know or cared to know., A physician should be as familiar with the action of his medicins as a mechanic with his tools; yet how hazy are the ideas of most doctors as to the action of the commonest remedies. Many give calomel as

a cathartic, when it is the poorest of all cathartics, producing greenish discharges accompanied by griping pains and hemorrhoidal distress; others claim it as an antiseptic to the intestinal tract, when, as Dr. Gilman Thompson writes in a paper read before the New York State Medical Association, "It is a decided misconception to regard calomel as an intestinal antiseptic. There is grave doubt whether any of it is converted into corrosiv sublimate in the intestin." Many give it to "act on the liver," by which I presume they mean to cause the liver to disgorge bile into the duodenum, when it has been many times proved by actual experiment in case of biliary fistula that it does not do any such thing. In a subsequent paper I will give my views upon the action of calomel, if the patience and forbearance of the Editor holds out; now I will simply state that my experience convinces me that in the mercurials we have a direct stimulant to the sympathetic nervous system.

Again, 90 percent of the statistics that are given to substantiate the claims of any kind of treatment are of no value, until it is a common saying that "you can prove anything by statistics." A very good specimen can be found in the May number of this journal by Dr. J. L. Thompson, of Limestone, Pa., under the title "Nourish Your Typhoid Patients." The Editor has kindly placed it in immediate juxtaposition to my article in the same number. In this communication he claims to have been in practise ten years, during which time he has treated 314 typhoid cases in accordance with his method, without losing a case. United States census of 1900 gives two places in Pennsylvania of this name, one of which has too few inhabitants to pay for counting, and hence is markt with an x; the other is credited with 206. The inhabitants of Limestone, Pa., must be by this time very nearly immune to typhoid fever.

The

Dr. W. Gilman Thompson, in the paper to which I have referred above, claims that the mortality under the modern treatment of typhoid fever is but 7 percent. There were 1,665 deaths reported to the State Health Commissioner of New York last year, which, on Dr. Thompson's estimate, would give 23,785 cases occurring in the state during the year. Now, I claim that in the smaller towns and country districts the mortality should be much nearer zero-indeed, I would in these localities advocate calling a coroner's inquest after a death from typhoid-we know that in the local epidemics, like that at Ithaca, the mortality was more than double the estimate given by Dr. Thompson; the same observation applies to the epidemic which occurred at New Haven last year.