length of the usual program. The effort is apparently made to cover the entire field of medicin, surgery, or whatever specialty is the occasion of the meeting. Paper after paper is fired at the listeners, with no reasonable intervals for deliberate discussion. It is not unusual to find half a dozen papers on important subjects crowded into a single session of two or three hours. Those who devise the programs ignore the fact that there may be subsequent medical meetings, and that it will be wise, if not generous, to leave some topics for their consideration.

'The next cause of complaint is the inordinate length of the majority of the papers presented. Even in meetings, where it is well known that only a stated and definit time limit is allowed to each paper, not seldom does the reader flounder in the prolog and introduction until his time has expired by limitation, and then he is either untimely cut off by the chairman's gavel, or perchance, the good nature of the hearers, with more or less forbearance, extends his time, often infringing on the rights of subsequent numbers on the program.

here are very few medical papers presented in the course of a year that could not be profitably compassed in the space of fifteen minutes. Many of them are not worth ten minutes of the time of an audience of intelligent professional men. And yet men of standing and reputation continue to inflict their tiresome compilations upon suffering hearers in secula seculorum.

If those who prepare "literary" papers would at the outset grant that their hearers possess at least an elementary knowledge of the rudiments of medical science - would give Hippocrates, Galen, Arataeus, and the defunct ancients generally a rest and burial-would realize that an assemblage of learned doctors is presumably beyond the kindergarten stage of medical lore-would in short give us something new and up to date, personal experiences and observations, deductions and conclusions from their own field of investigation, it might warrant traveling long distances to listen to something interesting and profitable.

As it is, the social functions of many a medical meeting are all that rescue the gathering from being "flat, stale, and unprofitable."

Those whose province it is to discuss the papers are often sinners likewise. Some so like to hear the sound of their own voices that they are oblivious to the passage of time and to the fact that possibly some one else may have a word to say.

We have all seen the man who comes prepared with a pocketful of specimens, and who, instead of fairly discussing the subject in hand, proceeds to exalt himself and his doings, ignor

ing the debatable points in the subject properly under consideration.

Who has not felt humiliated at the bungling, hesitating, monotonous and expressionless reading, and the stammering, illogical and inconsequential speaking in doctors' meetings? It might be profitable for a goodly number to take a few lessons in elocution. Excellent ideas are often murdered in the rendering, and Spalding's glue can hardly restrain people from vacating their seats, rather than listen to prosy, hum-drum, uninteresting readers who address themselves, and gesticulate to their manuscript rather than to their auditors. It is a relief to have some man rise in his place and deliver himself of ideas in language that is unmistakable, that strikes home and makes itself felt.

There is a great difference between what is barely tolerated and words that are irresistible and convincing.

If these suggestions serve in any way to repress the interminable bores, and rouse to forceful expression readers and speakers, they will have served their purpose and will make medical meetings more interesting and profitable. BENJ. Edson, M.D.

Brooklyn, N. Y.

[It seems that some men are so constituted that they cannot aim directly at the point, whether speaking or writing. What should be done with them? We freely "blue pencil" the useless preliminary verbiage on contributions that come here.-ED.]

Consultation among the Various Schools.

Editor MEDICAL WORLD:-I am interested in your open discussion concerning consultation among the various schools. The question is a broad one and has two sides. However, it seems to me that preponderant arguments are deducible in favor of intra-sectarian consultation. These arguments will naturally fall into two divisions: The doctor's reasons, and the patient's.

The first readily offers itself for division into three sub-heads: Social, scientific, and sectarian.

Socially, common human interests favor liberality rather than bigotry, for after all, the doctor is merely a man, and whenever he permits sect prejudice to interfere with his relationship to the humanities, his value as a healer diminishes. The tradition of all ages points to the doctor as an altruistic and optimistic adviser. Aside from this are the fellowship and sympathy desired and neeeed, from coworkers, by every man. An even more selfish reason for consultation is the mental and social broadening always possible. Whether the consultant is our superior or inferior mentally, socially, or scientifically does not affect the

truth of the preceding statement. The man who is as thoughtful as the medical man should be, will deduce beneficial comparisons, either thru approbation or reprobation.

As a scientist, any opportunity for pathological review should command a willingness to consult. Scientific experience and research is of value, whoever its medium. Every scientist must have learnt something of value. The real student rises above school limitations in matters of original research. The man in the scientist prevents his classification as a mere sectarian. The sciences of anatomy, pathology, etc., recognize no sect, and it is as often diagnosis, as treatment, that brings us to our knees. I once consulted with an elderly allopath. He did not wholly understand the rationale of my treatment, but admitted the point after explanation. There was a stubborn feature in the case under consideration which seemed unaccountable, owing to absence of objectiv symp. toms. My consultant, after a long résumé of the mutually perplexing case, said, "Have you suspected syphilis?" I had not, but his suggestion offered a solution of the whole problem. Could he have done more for me if a member of my own school? His leading question was the result of experience and research. Might not this be true of any consultant of any school in any particular case?

As sectarians, there are numerous reasons for professional communion. As one of your contributors says, pathology, symptomatology, and therapeutics are best represented in differing schools. Is not that a fact, if we will let

ourselves admit it? And should it not be taken advantage of? If the difference between your knowledge of one of these three fundamentals, and that of your neighbor, should justify your calling him, and you do not, for school reasons, and a life is lost, aren't you a long way toward being a murderer? Or if, as an individual, he has buttrest himself firmly in some department of science, can you lose by conferring with him? Is dogmatism compatible with an increasing civilization or with your own best business or moral interests? Then, there is the individuality in treatment. Do you know of many physicians in any given school who treat exactly alike? Are doctors machines, any more than patients? The results of such individual experience cannot fail to benefit somewhere. Above all else, in choosing your confrere, should you look to his ego? Lastly, I believe free consultation would redound to the benefit of all sects. It must be true that each can learn, in some things, from every other, and learning means elimination of errors. Thus can each school be taught its own errors and bettered, and the entire medical body be leavened with the disseminated knowledge. While absolute

medical unity is chimerical, and should be such, methods as herein suggested will remove removable friction.

From the patient's view-point, the matter is one of his paramount right to the best obtainable treatment. What is a certain school to him if he die? The correlativs of the arguments used in discussing the physician's phase of the question, apply with full force here. All the arguments of selfishness and also of altruism are his in favor of consultation. Not all consultants will be ideal; nor will all patients recover if a consultant of differing school is called, but I believe nothing but good can come from a discriminate choice of consultants from different sects.

Cleves, Ohio.

WALTER S. BOGART, M.D.

Prevention of Mould in Aqueous Solutions. -Long Continued Typhoid.

Editor MEDICAL WORLD:-Some time ago, in THE WORLD or some other journal, I saw a prescription given for the preservation of solutions of epsom salts and other solutions from moulds, which we know so soon form on and spoil such aqueous solutions. The simplest and cheapest way I ever saw or tried is to keep a little pure chloroform at the bottom of the stock bottle; the vapor is continually present at the top, and as it is death to all kinds of moulds, it very effectually prevents their growth in any solution, and it gives a sweet, pleasant flavor that helps to mask nauseous mixtures. I have never seen it in print, but have used it for many years, and no doubt others have done so also.

I have treated my share of typhoid fever cases in the past forty years. I have tried most of the abortivs for the same and the different modes of treatment that worthy men in the profession have found so successful in their practise. I have been blest with good success under the intestinal antiseptic plan of treatment, and have a good deal of faith in it, even tho some of our professional brethren try to show us that the proportion of the antiseptic to the body avoirdupois can never be sufficient to affect the disease working bacillae ; even Nothnagel in his late work on the subject gives little credence to the good they do in that direction, but notwithstanding the adverse opinions of so many, I feel confidence, to a great extent, in their beneficial action, and I use them in every case. Some years ago I had a typhoid case that hung on for sixty-two days in spite of all the antiseptics I gave, with a fever line of about 100°. I never had one of these cases again until the past fall, when I got four of them, three in one family and one in another many miles away, all boys from 5 to

11 years old except one girl 5 years old. Some started in with high fever from time I first saw them; others moderate fever; but after pushing intestinal antiseptics, all fell in a short time to about 100°, sometimes little over or under, and they all kept this up for over eight weeks and two for ten weeks. I gave these four children during treatment about 2 oz. of sodium sulfocarbolate; there being no diarrhea, I did not use the zinc salt, but did use bismuth salicylate, salol and beta napthol, and should have tried the new treatment with Merck's sodium bisulfate, of which I got in 2 oz. to give it a trial in the bombardment of the bacillae, but they weakened, health returned and the fever gradually left them, so I have not given it a trial yet. They had arsenite of copper continuously. These cases never felt very ill after the fever got down to the 100° line, seemed in fact so well that a stranger would think very little ailed them. fever stuck there steadily right along, in spite of all my antiseptics. Of course I cannot say what it would have been if they had not had this treatment, but I feel confident the antiseptics held the temperature down, because each time I slackt up on the dose the fever rose a little. I began to doubt my thermometer and tried three or four others, but they all told the same tale. Can you or any of the brethren give a reason why in these cases the fever should keep up for such an abnormally long time? I treated them in regard to nursing, feeding and medicin on about the general plan that I treat all my ⚫ typhoid cases.

But the

THOS. D. HULME, M.D.

Commerce, Iowa. [Was there not some local irritation somewhere that kept up the fever? Was there delay in the healing of the bowel ulcerations? Was there a lack of vitality to overcome the disease? Was there double poisoning, in some way. that would induce a double course? Brotherhood please discuss.—ED.]

Incomplete Bony Development and Queer Placental Attachment.-Removal of Beef from Throat.

Editor MEDICAL WORLD:-On December Io, at I a.m., I was called to see Mrs. X., primipara. The uterus was well descended and pains were moderately severe, but as they continued to wane I left, after having been with the woman about twelve hours. I gave a prognostic guess that labor would come on in about twelve hours-midnight. It over-ran a little, labor setting in about 3 a.m., and the woman was delivered about 4.30, which was a few minutes previous to my arrival. Being in

formed that the child was dead, I proceeded to investigate, and found a deformity and complication which I do not remember of having read about. It was not a spina bifida, and was not hydrocephalic; but there was a lack of osseous development extending from the frontal bone back over the superior and occipital parts of the head, down to the lumbar vertebrae. This structure was about two inches in width, and was rather cartilaginous in character, but presented a reddish, beefy appearance. There were no signs of protrusion of meninges of either brain or cord, and no tumor of any kind existed. There was absence of all bones of the skull except portions of the frontal and parietal. Now, the queerest thing of all was the fact that the placenta was closely adherent to the child's back and occiput. The child and placenta were envelopt in a tenacious membrane on which I used scissors to effect an entrance. The placenta must have had very little uterin attachment. Had I expected to find the placenta thus inclosed, a closer examination before puncturing might have enabled me to have ascertained just the extent of attachment. There was entire absence of the child's neck, but aside from these malformations, the child was normal, and the full period of gestation seemed complete, or nearly so.

I read in THE MEDICAL WORLD once some doctor's experience in removing a piece of beefsteak from an old fellow's throat, a hypodermic of apomorphin being the remedy. Recently an old man, while intoxicated, became choked on a piece of meat two inches square and about a half inch thick, which I caused him to expel in just five minutes via the apomorphin W. F. MARRS.

route.

Jewett, Ill.

Apparently a Double Placenta. Editor MEDICAL WORLD:-Recent issues of your valuable journal have recorded several remarkable cases of labor, which recall to my mind a case in my practise which was at least remarkable to me, having never seen nor read of a similar case. Mrs. J., primipara, gave birth to a well developt eight-pound boy, labor normal. With little trouble I delivered the placenta, which was double, or rather two placentas with about an inch of membrane intervening between the two. What caused it thus? Was it originally a twin conception with death and absorption of one fetus? There was only one cord. Krum, Texas.

J. C. GOSE, M.D.

Conservatism in Medicin. Editor MEDICAL WORLD:-In the December number of THE MEDICAL WORLD appears an editorial on "Therapeutic Cowardice," which may perhaps be misleading to some extent. The writer has high appreciation of the editorials in THE MEDICAL WORLD generally, and even this one may be adapted to the needs of those of long service in the profession, especially if they be level headed; but for tyros in the service it seems to bear a little too strong on the bit; in other words, may cause rashness on the part of young men, and older ones too, who have not given therapeutics a thoro study. It is unfortunately true that too much medicin has been given in the past, and even today the same is true to less extent.

Men

who have been in the profession for fifty years and more, know something of heroic medication, when venesection was used almost invariably to the detriment of the patient, mercurials used to the loss of teeth and to shattered constitutions, tartrate of antimony to the point of turning inside out, to say nothing of endless purgation with drastic medicins. It is not forgotten that the deathrate of typhoid fever in those days was about 33 percent, and now it is only 1 or 2 percent under proper treatment, which includes scarcely any medicin. In those days Cook's theories and mercurial medication held sway, and doubtless did great damage.

Owing to this over-treatment, the way was made plain and easy for the introduction of eclecticism, homeopathy, and, in later times, for Christian science, and healers of various kinds. The tendency of the profession is continually toward less medication, and the people demand and will have less physicking. It is a notorious fact that the vis medicatrix naturae is sufficient in the vast majority of cases to effect cures if only a fair showing shall be given it. This wonderful restorer of lost balance should never be overlookt or ignored. It is too true that

many, especially young men, give it little heed, and attribute cures to medication when in many cases the cure has been effected in spite of medicins. All doctors of much experience know this to be true.

As doctors grow old in experience, they place less faith in medicin and more in the efforts of Nature to restore the lost balance in disease. Their own shortcoming in efforts to relieve disease, assisted by investigations to find the truth, has taught them this valuable lesson.

Of course it is understood that the editorial does not favor over-medication, nor heroic treatment, only under certain conditions, and to produce certain effects thought to be desirable. Now, to meet these indications with powerful medicins often puts too great a risk on the life of a patient, especially when used by the inexperienced and thoughtless. Many a time the practician cannot see his way clearly, and in that case it were better to trust to nature, and render her whatever aid may be plainly indicated. Better to be on the safe side than to take extra risks, and in nine cases out of ten it will redound to the good of the patient.

Some effects thought to be desirable in the treatment of disease are very questionable; such as the reduction of the pulse in certain diseases, and the reduction of heat in others. Forty-five years ago Norwood's tincture of veratrum viride was considered the sine qua non in the treatment of pneumonia. The medical journals were filled with its wonderfully curativ effects in this disease. To the writer the idea seemed to be based on a false theory. It was believed by him that the pulse should come down because the disease was being subdued, and not from the effect of a powerful heart depressant, the pneumonic pathological condition still existing. Such treatment did not seem to be consistent with science nor common

sense.

About that time two healthy negro men in the prime of life were taken down with the disease and occupied the same room. One of them was treated in a mild way by the writer, assisting nature, and the other was treated heroically by another doctor with veratrum. He said in two or three days that his patient was doing well, the pulse down from 120 to 70.

The writer remarkt to him that when the pulse of his patient came down to that point he would turn him over to the cook. The result was, in a few days the patient with the deprest pulse went to his grave, while the other recovered in due time. Repeated observations of a like kind seem to prove that such treatment is not only of no good, but is full of harm.

After a few years' trial, the profession gen

erally came to the same conclusion, and the remedy went into disuse, or nearly so, along with venesection, mercurialization, large doses of tartar emetic, etc.

The antipyretic treatment of disease thru the depressing effect of the coal tar preparations was originated by the Germans, and was par excellence the treatment demanded in this country some fifteen or twenty years ago. The Germans saw the error of their ways and called a halt on that line, followed finally by the medical fraternity in this country; but not before many a poor fellow suffered the consequences. I well remember that in 1888 in one locality as many as twenty cases of grip, disposed to go into pneumonia, succumbed to this treatment, one after another; while a different treatment by others had no such fatality indeed, scarcely any. The idea is false in theory and most harmful in practise, as is now generally admitted.

To reduce the pulse rate and the temperature, if possible to do so with safety, it is only necessary to avail ourselves of the help given by nature's therapeutics, which are ever at our command. In bringing them into full play, no risk need be taken on the life of the patient. "Therapeutic cowardice," says the editorial, "is not overcome by knowledge of drugs, many of the most learned being the most timid." This is perhaps true; but why so? It seems they have been made more cautious because of having learned the great potency of many drugs and fully realized their danger in over-dosage. It further says, "Experience alone does not do it, for that also begets much caution." But why? Simply because experience has taught them many valuable lessons that the young still have to learn, one of which is to stay the hand in case of doubt and uncertainty. It is not so much "a spirit of kindliness" that actuates men of experience as it is a conscientious discharge of duty to the patient from the best lights shed on the case. It is quite plain why "the young and inexperienced practician shows more therapeutic bravery." Undoubtedly, because he lacks the "knowledge of drugs" and "clinical experience" at the bedside. A half century ago this "tyro bravery" found no place in medical doings. For the past two or three decades it has, however, come prominently to the front, not only in medicin, but in all other professions. From the obstacles in the way and the nature of the calling, it is more difficult to sustain in medicin and do no harm than in any other pursuit. Because of so many inventions and practical improvements in the onward march of progress, the people seem to have concluded that the younger members of various professions have all the new "wrinkles." But it does not

follow necessarily that this is true, especially in medicin, since older men have the benefit of extensiv information thru medical journals, new books, and the post graduate course; besides, they have experience, which is so valuable as to more than offset any disadvantages.

It would seem really that younger men of today need a little restraint than otherwise. Only a few years ago one of twenty-six years arose in a state medical society and declared that he had entered the abdominal cavity in search of diseased ovaries and fallopian tubes in fifty-three cases in the previous eighteen months, with only one death, and that was a crazy woman. As he lived in a small town in an out-of-the-way place in a new country, this was thought to be first-class work, perhaps about as well as any of the big gynecologists did in the same length of time in Chicago or New York City. Much might be said opposed to the new "rage for cutting" in appendicitis and other like troubles which would indicate the necessity for conservatism in all branches of medicin. B. F. HART, M.D.

Seattle, Washington.

[The above remarks are very sensible. The trouble is that we reach so many different kinds of physicians that it is impossible for us to meet the needs of all in a single editorial. Many need the editorial referred to, and many, like the above writer, do not.-ED.]

Bee Sting in the Larynx.

Editor MEDICAL WORLD:-A boy sixteen years old was brought to my office from a neighboring village about twelve o'clock in the night, about a week ago. He was suffering intensely from dyspnea and pain in the throat. His brother had obtained some honey from a hollow tree in the woods, and the whole family ate heartily of it. Shortly after supper the boy experienced a sensation of fulness in his throat, and later pain with dyspnea. These symptoms grew rapidly worse until, in a few hours, he could scarcely breathe. He first supposed there was a piece of wax in the throat, from the honeycomb. Accordingly vomiting was induced with a view of expelling or dislodging the same, but of no avail. He was then hurried to a doctor.