OCTOBER, 1904]

able appetite, a drug addiction and absolute slavery to its most deadly effects, than morphin, opium, or any other known narcotic. Please pardon my criticism, but I confidently appeal to the jury of your many thousands of most intelligent and impartial readers for an endorsement of my position.

A nervous, sleepless patient, will like nothing better than to be advised by his trusted medical attendant to take a small hot toddy at bed time. We all know too well how faithfully that advice would be carried out, except the "small"; and how the habit, the drug addiction, the slavery, would be likely to grow until the last state of the patient would be many times worse than the first.

The morphin habit is bad enuf, God knows; but it does not, like alcohol, make a brute out of a man, pauperize his family, and blight and curse all it touches.

For a physician to advise his patient to take alcoholic drinks continuously as a medicin is, in my opinion, one of the most dangerous and damaging things he can do. Lincoln, Ill.

DR. W. W. HOUSER.

Ginseng for Persistent Hiccups. Editor MEDICAL WORLD:-In an editorial article (page 371, September WORLD) you speak quite fully of the above named annoyance, mentioning a large number of remedies, but you do not seem to consider any of them a specific. This, together with my own experience, recent and remote, with the difficulty, impels me to send you the following note of my own experience.

From my earliest recollections, and before, for that matter, hiccups were the bane of my existence. I very soon learned to expect an attack as often as every two or three weeks, and to consider myself very fortunate if the attack was postponed four weeks. Such an interval was the exception, not the rule. I would awake in the morning with a peculiar feeling in my stomach that told me I was in for a day's pull, and so it would prove. I would begin before breakfast and continue all day, and by night I would be sick. The idea of consulting a physician would have been hooted at, and I would have exposed myself to unlimited ridicule. I tried the popular schemes for relief, such as drinking nine swallows of water with out breathing, putting my thumbnails together and seeing how long I could hold them and hiccup, and other schemes bordering on superstition, but with no result. I have been thus specific in detail to show that my case was no ordinary one. This condition of things continued till I was about fourteen years of age, when one day I was helping a neighbor in haying; as we went in to dinner, the lady com

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menced telling of her brother who was at one time very sick and was taken with what was called "death hiccups," but was cured with ginseng root. I listened, said nothing, but made a note of it and resolved to try it the first opportunity. The root grew plentifully in the woods, and I soon supplied myself and commenced to chew it regularly. As a result I noted particularly, I did not hiccup once in three years. I left off the constant use of the root, but the malady did not return. When I commenced the practise of medicin I prepared some tincture by drying the root very dry then grinding it and putting it in alcohol. I have used it in practise and it has never failed me. I have given it to a child of a few days old and to the aged and those very sick, with uniform success.

My last use of the drug was on the night previous to the receipt of the September WORLD. I had just returned from a journey of about seven hundred miles, during which time I had been living very irregularly, hardly eating at the same table twice, and about midnight I awoke with the hiccups. They were in the old form of sixty years ago. I waited some time, but they persisted. I secured some of the tincture, prepared it in water and between hiccups I drank it. No, not between, for I hiccuped and drank it and waited to hiccup again-and am waiting still!

Canonsburg, Mich. C. R. CROSBY, M.D.

Is it -Itis or -Etis?

Editor MEDICAL WORLD:-Will you kindly state in the October WORLD whether the profession has or has not settled upon any definit rules for the pronunciation of medical words of Latin or Italian origin? Twenty years ago nearly all American schools and colleges used the socalled English pronunciation in the study of Latin, all vowel sounds being pronounced the same as in English. A few years later nearly all, if not all, American schools and colleges adopted colleges adopted the Continental or Italian method of pronunciation, in which the vowel sounds are very different, "a" having the broad sound as in "far," "e" as in "fete," "i" as the letter "e."

The dictionaries of today give the pronunciation of medical words of Latin origin the same as they would be pronounced in English. For example, in all words ending "itis" the "i" is long, as in "bron-chi-tis." Are the dictionaries right? or are we to pronounce such words as they would be pronounced according to the Continental or Italian rules of pronunciation? If the Italian rules of pronunciation have been adopted by the profession as they were by the universities years ago, then "bron-chi-tis" should be pronounced

[Doctor, we are sorry to say that both are correct. Both methods have high authority, so it is a matter of taste, or of choice, between the two. We wish some one could decide, once for all, so we might have uniformity; but no one can do this, so usage will have to finally decide it. Where classical ideas and habits of thought are prevalent, as in some of the universities, there the Italian method is likely to be prevalent; elsewhere, the English method is preferred. We decidedly prefer the English method, and we think that it is destined to prevail. ED.]

A Form for Statement of Accounts. Editor MEDICAL WORLD:-Observing the various forms of statements, etc., from members of the family, I would present the one in use by myself. Noting the one presented in the August WORLD is mild, and the one in September WORLD is exceedingly strong, I believe this one to be just about between the

two.

I also inclose a case record card, as compiled

by myself, which speaks for itself as to its convenience. One can carry same in pocket, and as we are not infallible, important questions sometimes may be forgotten. It answers as acute or chronic records, impresses the patient that you are not neglectful, then with the symptoms underlined on the card, they afford ample time when returning to the office for further consideration for diagnosis. I have them for sale; they are not copyrighted, as I believe we should all stand with an open heart to one another. I can furnish them to the family as reasonable as they could have the composition (type-setting) done alone.

I am in most hearty sympathy with your attitude toward those who swindle the people (and the profession). They outrage justice, and are a foul disgrace. I trust they may be transported to Hades, to his Satanic Majesty, that they may deal with the old fellow who rules there, in place of fastening themselves upon honorable professional men.

HERMAN H. LAHKE, M.D.

1542 Linn Street, Cincinnati, Ohio. [We suggest that those who are interested send a postage stamp for a sample of the case record cards, and terms, and if the terms are too high, you can have some printed for your use by your own printer. The bill form follows.-ED.]

Meningitis.-Clay in Inflammations. Editor MEDICAL WORLD:-In THE WORLD for September I note an article in which the writer urges clay poultices frequently applied to the head and spine for the relief of menin gitis. I shall try it It is simple and humane. I believe in clay. But before I speak of clay I wish to relate my experience in the Indian Territory with meningitis. It was It was in the midst of an epidemic. It seems that every one stricken with it died.

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A good old woman, part Indian, said to me, "Dock, are you curing any of them?" "No not one, so far." Well, you'd jis as well follow my treatment then, they won't no more'n die no how."

I said, "What is your treatment?"

She said, "Put fifteen drops of tr. belladonna in one tumbler of water; put fifteen drops of tr. aconite in another glass of water; give a teaspoonful of one, one hour, and the other the next hour, and so on."

I tried it. In such an emergency I would try anything. I treated eight more cases; six recovered but one relapst, leaving five cures out of eight cases. Gentlemen, when your cases are all dying, don't fail to try the old woman's remedy. A man would rather live unscientifically than to die very scientifically.

Now about the power of clay as a poultice. A few years ago I was called six miles into the country to see a very old man. He had been riding on the hounds of a wagon and dragged his leg over a stump five days previous to my visit. I found the leg broken, very black and swollen, with signs of gangrene. I thought of antiphlogistine (which is Colorado clay perfumed and ground), but it would have taken several dollars to buy that kind of clay. So I told them to send out to the hills and get a half bushel of clay. Directed them to keep leg in clay mortar for 36 to 48 hours.

I noticed a peculiar grin on some of the faces of their wise old neighbors. I reflected about it a moment, as I was a new doctor in that community. However, I turned and drove home.

After I was gone one of them askt my name. A wag replied, "that's Dr. Henry Clay, sir; he treats altogether with clay." I am told these fellows, wise or otherwise, had considerable merriment over the clay doctor.

But when I returned thirty-six hours later all had changed. In place of a solid swollen leg I found the clay had pulled out the inflammatory exudate, the swelling had disappeared, circulation was establisht, and the limb was receiving its nourishment. The tissues of that limb were soft and flexible like the other limb. I put on a splint and the man made a perfect recovery. With a leg rapidly becoming gan

grenous in an old man, amputation would in all probability have proven fatal.

After this the clay doctor was the big man in that neck of the woods That was in the Indian Territory. I have used clay in pneumonia I shall use it in meningitis.

I have applied a clay mortar (previously boiled and cooled) to pull out old inflammatory exudates in an old ulcerated leg. Thus you establish the circulation and nourishment to the parts. Then any antiseptic will heal the ulcer ARTHUR C. BELL, A.M., M.D.

Dallas, Texas.

Case of Strychnin Poisoning. Editor MEDICAL WORLD:-A boy came running into my office saying that his father had swallowed some tablets and had spasms.

I at once suspected strychnin poisoning. Went to house with chloroform and chloral in my bag. Arriving at the house I found near the bed a bottle containing about 500 tab. trit. of strychnin sulf. gr., by Wyeth & Bro. The wife said that her husband was drunk, and while she was absent from the house he had taken a number of these tablets.

The patient was 48 years old, strong and well built; a habitual drinker. My entrance into the room brought on a convulsion. I learned that he had taken the drug about two hours before I arrived; that he had not eaten that day (it was then I p. m.).

The tetanic convulsions affected nearly every muscle of the body. The limbs were tossed about and were very rigid; the head was thrown forward and then backward; the entire body was very rigid. Opisthotonos was developing gradually. Pulse was 200, temperature 100.5°. The least noise brought on a convulsion, as did also the pricking of the hypodermic needle. These convulsions lasted about 30 seconds, and then all muscles became relaxt, only to become rigid again at the next. convulsion. The abdominal muscles were hard, as well as those of the chest. Eyeballs did not stare. Patient was entirely conscious thruout attack. Was unable to tell just how much strychnin was taken.

Treatment.-Stomach pump brought up almost nothing; hence washt out stomach. (This did little or no good, as in two hours almost all the drug was absorbed). Stopt stomach washing at once and gave hypo. of apomorphin

gr. which caused vomiting inside of six minutes. Every act at vomiting brought on a convulsion. During convulsions I gave inhalations of chloroform which of course instantly aborted spasms. Between the convulsions I gave morphin sulf. 4 gr., hypo. every twenty minutes for three doses. I then gave per mouth (after vomiting stopt) twenty grains of

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The Strychnin Habit and Its Treatment. Doctor, did you ever stop to think how many "strychnin fiends," if I may so call them, you have made of your patients?

Many physicians will give a patient who is suffering from some slight disorder and temporary weakness a prescription for strychnin. Usually this is all the patient needs, and after a short time he feels all right, with the exception that he feels weak and "run down" without the medicin he has been taking; he, therefore, keeps on taking it without the doctor's erder or knowledge. Soon he is a confirmed habitue, and cannot get along without it. He naturally goes to it, as the morphin and cocain fiends do their beloved drugs. Of course the strychnin habit is not as pernicious a habit as the two just mentioned, but there comes a stage when poisoning sets in, his jaws feel stiff, he can't sleep, his sexual desire becomes extremely great, and he has a "smothery feeling" in his chest, with other kindred symptoms. He soons finds out it is this potent poison that is causing these disagreeable symptoms, and he cuts down the drug for a while. As soon as the superfluous strychnin is eliminated, then there is a craving for more, and he starts in again. He keeps on again until he is overcome by the poison, or borders on the verge of insanity or neurasthenia. In the advanced form of the trouble there are constant twitchings of various muscles, producing a condition resembling chorea. There is also a great emaciation present, possibly resulting from the insomnia and diarrhea.

Patients soon find out the advantages of the hypodermic syringe, and will usually employ it; others will "eat it, in the form of tablets or sugar of milk triturations which some "good" (?) druggist will put up for them.

The treatment is simply to withdraw the drug suddenly, and give fifteen grains sodium bromid t. i. d., p. c., and one one-hundredthgrain doses of trinitrin between meals. For the "eaters" give a one-grain tablet of quinin sul

fate in lieu of the bitter strychnin. The quinin will not form a drug habit; of that you may be sure.

Prophylaxis is, for physicians to try and use less of the drug than they do. Some men seem to think that strychnin is the "universal panacea," judging from the way they prescribe it. When I was a drug clerk, nearly every other prescription that I put up contained strychnin; often times for short periods every prescription would contain the drug, and many of them from the "biggest doctors" in Denver. Understand, I am not condemning strychnin, which is a useful drug and oft-times a life saver. I am only cautioning about its

careless use.

I would like to hear from the "familee " what drug habits they've come across. I've seen opium (morphin), atropin, codein, cocain, digtalin, cannabis indica, bromid, chloral, chloroform, arsenic, hyoscin, and trinitrin finds. DR. F. AMMON.

Lawson, Colo.

Poisoning by Wine of Colchicum. Editor MEDICAL WORLD:-On the 23d of last February four Indian boys, pupils of the Hoopa Valley Indian Boarding School, drank sixteen ounces of the wine of colchicum root. Early in the morning of that date two of the boys entered the school dispensary and stole the drug, which was mistaken for port wine, as afterwards developt. It was carefully secreted until after the boys had eaten their breakfasts, when they were joined by two other of their schoolmates, and the four went into an unoccupied building within the school campus, where the bottle containing the wine was passed around in regular order until the last drop was drained from it.

Three of the boys were between the ages of sixteen and twenty, and the fourth about twenty-four. From one of the youngest I learned that the drug was drunk between the hours of eight and nine in the morning of the 23d; that, so far as he was able to judge, they each drank about the same quantity; that neither of them experienced any uneasiness or discomfort up to about one o'clock in the afternoon; that within half an hour after eating lunch at noon all four vomited very freely, from which they obtained a degree of relief; that the three younger vomited only three times more during the entire afternoon, and that by six or seven o'clock in the evening they had been completely relieved; that the oldest young man continued to vomit at intervals of from one-half to an hour until six in the evening, when the severity of the symptoms was increast, so much so that the young man

himself, as well as his associates, became alarmed, and I was sent for.

I saw the patient first at 7.30 p.m. of the 23d, and it did not take long for me to decide the character of the case I had to deal with, notwithstanding the young man guarded his secret so well that I was unable to ascertain anything that would give me a clue to the origin of the trouble. His pulse was very weak and thready, his breathing rapid and shallow, and a cold, clammy perspiration was on the surface, all indicating a considerable degree of prostration. Every effort to get at the cause of the trouble being in vain I began meeting the indications with such remedies as I considered applicable. I gave him sulfate of strychnin and nitro-glycerin hypodermically and succeeded in giving some relief thereby, the action of the heart becoming more regular and its volume increast. Patient seemed to breathe deeper also. After I had administered the fourth heart stimulant hypodermically I left the care of the case in the hands of a competent nurse for the night and retired, with instructions that I should be called if my patient got worse.

I was sent for at three the following morning, the messenger saying that my patient was thought to be dying. When I entered the room it did appear to me that the end was not far away, but I decided to change the treatment and remain with him until morning. I procured two ounces of alcohol and began giving him teaspoonful doses every half hour, and contrary to my expectations the young man began to improve from the first dose. After the fourth teaspoonful had been given he went to sleep and slept about two hours. He awoke feeling much better and called for a glass of milk. I allowed him to have four ounces of sweet milk with lime water, which was retained. I continued the alcohol at longer intervals thru the entire day, and by 5 o'clock p.m. of the 24th, patient sat up and was able to take as much nourishment as I allowed him to have.

At four o'clock in the afternoon of the 24th I was called away, about six miles from my office, and did not return until nearly nine that evening. I was surprised and vext to find that the relativs of my patient had taken him to his home out on the reservation, about five miles from the school. The removal was accomplisht over the protest of the nurse, and in their rush and anxiety to get him away before my return, the medicin was forgotten and the treatment ended at the time of their departure from the school. If I had returned before dark I should have followed and forced his relativs to return the young man where he could have had proper care. At six o'clock

in the morning of the 25th a messenger arrived at the school to report to the Indian agent that the young man had died at three o'clock that morning. This report did not surprise me at all, but, as I informed the relativs afterwards, there was absolutely no necessity for this young man dying; if the treatment had been continued he would have gone on to complete recovery.

There are at least two points worthy of consideration in the cases here reported: 1. The quantity of the drug taken at one time. 2. The length of time it remained inoperativ in the stomach. Prof. H. C. Wood states in his excellent work on therapeutics that death has been produced by two drams and a half of the wine of the root, and that recovery has taken place after an ounce was taken. In these four cases four ounces each was taken. I account for the drug remaining inoperativ for so great length of time to two causes: In the first place the boys had eaten a very hearty breakfast almost immediately before the wine was imbibed, and secondly, the drug is very slow of absorption. There are two important features connected with the case that ended fatally that I can. not account for satisfactorily to myself: 1. The fact that four boys drank almost the same quantity of the wine, three recovered with very little gastric disturbance, while the fourth and oldest one died from the effects of the drug. 2. There was an entire absence of purging in all four cases, which is usually one of the most prominent symptoms, according to recognized authority. J. S. LINDLEY, M.D.

Hoopa, California.

Locations.

Editor MEDICAL WORLD:-Judging from the numerous letters I have received regarding my observations in Louisiana, there has been some misapprehension, which I wish to set right. It has not imprest me that there is an opening for physicians as such in that state. Every town visited seemed fully supplied, with the possible exception of Bay St. Louis, a resort on the gulf coast east of New Orleans. Here there is a great concourse of residents of the southern cities, during the summer when the gulf breezes are delightful. In winter there is quite an influx of people fleeing from the northern cold, so that this pleasant place has a busy season all the year round. As well as one could judge from a two weeks' visit, there is room here for a physician who uses modern methods-and in that I may say frankly I mean the alkaloids. Wherever we went, as was inevitable, people began to ask "the old doctor" about their ailments; and after a little friendly dosing with these remedies there would be a group of patients anxiously inquir