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somewhat in its course, and has made strenuous sample copies to the laity? Addresses of dysefforts, accompanied by liberal bank drafts, to peptics, rheumatics, etc., can be purchast by hide its true character and get contributions the thousand. Maybe doctors are not ordering from those supposed to be above reproach. the Lawrence list as activly now as formerly, Money will do a great deal, but it can't close and maybe the enterprising Doctor is taking the eyes of the rank and file of the profession his proprietaries directly to the general public after they have once been opened. The policy thru the Brief, like Hostetter's Bitters, thru of the Brief will be better than formerly Hostetter's almanac, which we all remember in for awhile (I have been expecting for several our childhood. months that it would temporarily discontinue I could fill pages with letters of appreciation its almanac feature entirely), and then, about of our service to the profession, but I will next October or November, hoping that the bother you with only one more, which may be doctors had forgotten our exposures, blossom taken as a type of its class : out as a full-fledged almanac again. Those of
Editor MEDICAL WORLD :-As proof of my appre: you who are receiving “sample copies” watch ciation of the stand you take on the very unethical it and see.
commercialism of certain medical journals, notably
the Medical Brief, please find money order for $3., my I wish to thank the profession for the enthu- subscription for four years. W. C. QUINCY, M.D. siastic encouragement and the large and sub- Lowell, Ind. stantial support that I am constantly receiving in this matter. Wide-awake doctors realize
Three Notable Achievements. that it is the profession's cause that I am up- The medical profession has accomplisht three holding, and they plead that I continue in the notable achievements in recent years which good work. That is my expectation, for I not sufficiently appreciated. They are consider it a privilege to work, or even fight, purely medical in their nature, yet they are for the medical profession. I have done more economic in their results. Perhaps first in of such good work than any other medical edi- importance is the discovery of the relation of tor, and I expect to continue it as long as I mosquitos to the spreading of yellow fever. live and am in medical journalism.
Formerly the occurrence of a case of yellow *
fever in a port meant consternation and quarShall I attempt to give you an idea of letters
antine, with probable failure to prevent its received from the profession concerning the spread; and this meant a terrible epidemic above? Here is an example:
with further extension of quarantine, and death
to commerce. I send $3., which place to my credit. May the good
Now the yellow fever patient work that you are doing continue till you stop such as is simply screened off so no mosquitos can the Brief.
E. B. THOMPSON, M.D. bite him, and thus carry the infection. The Barney, Ga.
patient is not avoided, nor treated as an eleHere is another :
ment of danger-except as to mosquitos. A Editor MEDICAL WORLD :-I inclose a wrapper sent
non-immune could sleep with the patient and to a layman, a friend of mine here, who handed it, covering two “ Sample" copies of the Brief, to me. not catch the disease ; but let a mosquito of a The last mark of distinction between it and an ordi- certain variety bite the patient, and he carries nary medical almanac is now removed with this distributing to the laity. You have been none too severe
infection to all others whom he (or she-it is in your editorials on the Brief. Very truly,
the female that does the business) may bite. New Castle, Ind. 0. J. GRONENDYKE, M.D. Here we have the secret by which deadly epi-.
The wrapper which the Doctor inclosed has demics with the ruinous quarantine may be the following printed on it: “Sample copy. prevented—and think what this means to the The Medical Brief, J. J. Lawrence, A.M., tropic and sub-tropics. By means of this disM.D., Proprietor. Office: St. Louis, Mo." covery, yellow fever has been banisht from The Medical Brief is printed in large type- Cuba, and in time it may be entirely stampt large enuf to be read 15 or 20 feet away. The out all over the world, and become only an address is in manifold typewriter, and the slipecho of history. bearing the name and address is pasted on the In close relationship with this subject comes wrapper. It reads :
malaria, with its mode of propagation thru the Mr. W. G. Chambers
body of another variety of mosquito. This New Castle Ind
mosquito is a " night bird ;'' during the night
he (or she, rather) goes about carrying infecYou see there is no pretense, in the form, tion to those “ exposed to the night air !" that the addrest is a physician-it is just Malaria is prevalent near swamps and in places plain “Mr.” Addresses of the laity in just that where “miasm" abounds; hence the name : form, to be cut apart and pasted on, can be malaria-bad air; but it isn't the air ; it purchast by the thousand. How much of the is infected mosquitos. The lamented GailBrief's boasted “circulation” is composed of lard, our grand old professor of Practise, grew eloquent over the night prevalence of malaria,
The Ills of the Menopause. saying that our sailors when on the coast of All authorities tell us that there should Africa could go ashore with impunity between be no symptoms at the menopause, except sunrise and sunset, but let them spend a perhaps a little nervousness different from single night ashore and they were sure to take what one would expect at any other down with malaria in a few days. The dear time of life. That is, that under the old man went to his grave without knowing same conditions, the same symptoms would anything about mosquito infection. The eco present. But the conditions never were the nomic and health possibilities of this discovery same ; the woman who for 30 years has been we will leave to the reader's imagination. accustomed to a certain systemic habit, does
The third notable achievement also affects not yield it easily; she insists on treatment; the tropics and subtropics. The awful anemia and physicians generally side with the woman, that bleaches the faces browned by southern and accord it. suns was supposed to result from relaxation The experienced practician generally has due to the climate, or to improper nutrition. but little trouble with his uncomplicated Many a southern brother (and sister) has been cases in diagnosis and treatment, but a younger branded as lazy, shiftless, stupid, but we find and less experienced man is very apt to make that this was thru no fault of theirs. We find many errors in handling his first few cases. that numerous little parasites have been suck- One of the first mistakes is timidity in asking ing their blood as fast as the best nutrition questions relating to this subject of a woman could make it; and hence ambition, energy, who “looks too young for that." Let him and general health were undermined. Put remember that there are recorded cases octhose little blood suckers into our intestins curring in women of twenty-nine, even in and we too would become pale, languid and temperate climes. Let him also remember lazy ; and our southern brethren who are free that there are recorded cases in which the from these little vampires are as full of spunk, menstrual molimen persisted until the eightieth ginger, talent and energy as the best of us in
year. Most medical schools are very remiss the north. We refer, of course, to uncin- in teaching upon this subject They take up ariasis, or the hook worm disease. Only a all their time in teaching the rare and technibeginning has been made to rout it out, and cal points of surgery, and leave the student to restore our long suffering and long blamed work out his own salvation with the problems southern people. An important move along of puberty and the menopause. this line is described in the July issue of the The experienced practician realizes that he Review of Reviews, under the head of “ The will have to combat at the least consideration, Porto Rican Government's fight with Anemia.” all the multitudiform symptoms with which Before the Porto Rican legislature adjourned puberty is ushered in, and in a patient who has last April, it provided for the appointment of been debilitated by age and probably frequent a commission (and an appropriation to cover child-bearing. Such a man knows that he will expenses) to study the causes, and if possible meet digestiv disturbances, nervous disorders, to suggest a means of eradication of the terrible uterin troubles, vertigo, faintness, flushes, cold anemia which affects a majority of the rural hands and feet, constipation, or diarrhea, palpopulation of the island. How is that for pitation of the heart, vicarious hemorrhages, progress and public enterprise in our new sudden and severe sweatings, loss of memory, island possession? Of course we know that changes in disposition and character, irritathe cause is the hook worm, and the commis- bility of temper, hysteria, melancholia, pelvic sion has establisht camps for the free treatment and lumbar pains, pruritis, leucorrhea, colics, of the disease, to which the rural poor flock plethora, anemia, etc., and indeed he someand get relief. The astonishing statement is times gets the most of them in one patient. made that 90 percent of those living outside of The flushing is the most common complaint, the large cities are infested with the parasite ! and next in order of frequency are the disturbThe work goes encouragingly on, and this is ances of the alimentary canal. only a start at what must be done to restore It is very easy to “settle” the line of treatthese numerous victims in all the tropics and ment by saying that you must “ treat the consubtropics to health and economic efficiency. ditions just as you would at any other age;"
but the conditions never were the same at any Dear Doctor TAYLOR :-I enjoyed the June number of The
When you are confronted with World, I wish every doctor would subscribe for it, not for one year but as long as they practise. I have been a subscribe any other symptoms common to the meno1886, and let me tell you I cannot do without it. Your journal gives information that is right to the point, and on so many good
pause, go at it with the understanding that you points. Thanking you again I am, fraternally,
are apt to find about the hardest proposition Newkiik, 0, T.
you have ever tackled. Read up on it; study Have you
read The Story of New Zealand ?" it; and do not expect help on it from any but
yourself, for you must meet an individuality many chances even when the total amount is and a disordered individuality at that; and known, to trust to the specific gravity of a that it is probably true, as she says, “ No one given specimen being the same as all the rest ever felt as I do." To our minds, the best of the day's urin. The only exact way to way to treat any of these symptoms is to treat ascertain the specific gravity of urin is to have the general symptom in its entirety and the the patient save all the urin passed in a given especially annoying symptom particularly, ex- twenty-four hours and mix it; then bring cept in the following : Be sure to exclude or- a specimen from the mixt lot. The rules ganic disease of any organ by a methodical of life insurance companies are also partly and painstaking examination. It is at least responsible for this error on the part of the annoying to lightly pass over eructations and profession, but it must be remembered that vomiting as only a little nervous disturbance these companies would rather refuse an appliand then have your luckless patient die of cant than run the risk of giving him opportugastric cancer a few months later.
nity of substituting urin from another party. Make waste and repair as nearly equal as The relations of patient and consultant are possible. Watch the secretions, excretions, vastly different than would be those of the skin, kidneys, blood, etc. Look after the same parties in the role of applicant and exalimentary tract; the condition of the heart ; aminer; in the former case the patient would the nervous system; and above all, the mental have no object in deceiving the examiner; in state. Do not expect to cure everything by the latter, he might have. Specific gravity is drugs, electricity, hydrotherapy, or the laying of value only because from it we learn the on of hands alone. You will find that talk, approximate total amount of solids voided in if there is knowledge, intelligence, and expe- twenty-four hours. Knowing the total amount rience behind it, will often do more than any passed in twenty-four hours, and having the of the other measures. And you will be busy, specific gravity of a specimen of this mixt yes, very busy ; but do it.
Use any agent or urin, it is only necessary to multiply the last measure;
use all your skill; re-read your two figures of the specific gravity by 2.33, and books; recall your experience; the subject is this gives the total amount of solids voided, worth it.
nearly enuf for all practical purposes.
It must not be forgotten that this total The Specific Gravity of Urin and Its Sig- amount of solids contains urea, chlorids, uric nificance.
acid, phosfates, sulfates, ethereal sulfates, and There is considerable misapprehension in the various other constituents. For exact scienminds of the mass of general practicians re- tific work, one generally wishes to separate and garding the actual significance of variations estimate certain of these constituent parts. from the normal as regards the specific gravity The normal amount of urea voided in twentyof urin. The hint given by teachers to the four hours is thirty-three grams, and the total effect that urin of high specific gravity may be solids vary from seventy to seventy-three suspected of containing sugar, and urin of low
grams for said periods. The chlorids make up specific gravity, when passed in abundance, of about one-fifth of the total, and the phosfates containing albumin, was only intended to assist about one-twenty-fifth of this amount. The the man of limited experience in thinking of urea is the most important constituent when the most probable abnormal ingredient, in one wishes to judge of the capacity of the kidcase actual disease was present. This has been neys for performing their functions normally. construed by superficial men to mean that The specific gravity of urin passed at a single whenever a urin of very high specific gravity is micturition, and of the total for the twenty-four found, that one should expect to find sugar; hours, depends upon the character and amount and when low specific gravity is demonstrated, of food ingested, the amount of perspiration, that albumin is likely present. This has led the rapidity of tissue waste, etc. For instance, to many mistakes at the hands of careless ex- urin may be very dilute following the ingestion aminers who are prone to presume too much of large quantities of fluid, and have as low a and to take too much for granted, rather than specific gravity as 1,012, and yet be perfectly take the time and bother of making a complete normal; or, because of copious perspiration or and exhaustiv examination.
ingestion of insufficient fluids, it may have as The fact is that entirely too much signifi- high specific gravity as 1,030, and yet be cance is attacht to the mere specific gravity of normal. It may be safely stated that a specific urin. In itself, it indicates nothing of any gravity of more than 1,030 indicates functional value. Unless we know the total amount of or organic renal trouble. In the majority of urin passed in the twenty-four hours, the spe. kidney diseases, the tendency is toward a low cific gravity of a given specimen affords no specific gravity, altho in the presence of grave information, and indeed it is taking a good disease it may be normal or high. If a pale urin is found to have specific gravity exceed- and if they do, then investigate further. The ing 1,030, the presence of sugar is suggested to man who follows every will-o'-the-wisp in the mind, but sugar may be present, and the medicin will get but little greater success than urin show a specific gravity as low as 1,010. he who hunts live meteors with a net. In albuminous urin, especially in cases con- While we admire the conservativ man, we taining one-eighth of one percent or over, the always despise the man who calls himself specific gravity is affected by the amount of “conservativ" when he is possest with albumin present. Certain drugs, as the potas- nothing but a chronic attack of old-fashioned sium salis, cause changes in the urin which laziness. As for the horde who pose as conmay be manifested by alteration in specific servativs in the endeavor to shield their abject gravity, or by a change in the amount of urin ignorance, no contempt is too great. voided.
disgrace to be old in years, but it is shamelui The lesson is plain. Not only should less for any man, young or old, to allow himself to significance be attacht to the mere specific employ obsolete methods in his therapy. gravity alone, but greater care should be taken
Keep up. to follow out the lines of investigation which the specific gravity may indicate, and to make
Epistaxis. certain that you have the specific gravity of Nose-bleed is sufficiently common to attract the entire twenty-four hours' urin before using the special attention of practicians toward the specific gravity as a basis of either diag- prompt and efficient measures for its relief. It nosis or prognosis.
has well been said to take place “ as a symp
tom, as a disease, and as a physiological proKeep Up.
Altho familiar as a physiological Keep up with the times; with the advance process, it is far from rare as a pathological in medicin. Medicin is making rapid strides one, and frequently the error is made of labelthese days. The graduate of ten years ago ing it physiological when it is pathological. who has not been a vigorous reader is now an Gross external lesions, or the history of trauold man in medicin. Many treatments of matism, may allow one to make a “snap" proven value, and now employed thruout the diagnosis, but the hemorrhage will often arise world, have been brought forward in the last without assignable cause. It is such cases ten years. Numerous new remedies of unique which demand an examination and an attempt value and therapy have risen, and have been at diagnosis and therapy. In children, for accorded a permanent place within that time. instance, cuts or abrasions of the interior of It would not have taken much time and but the nares are common, and hemorrhage frelittle study to have followed them as they quently follows the introduction of a foreign came out and were favorably mentioned in the body. The habit of “picking " the nose, and medical journals; but the man who now the removal of crusts may also give origin to attempts taking up their investigation will find hemorrhage, and not only are the children a herculean task before him. The moral is guilty of this. Occupations involving the plain : If you did not begin ten years ago, habitual inhalation of dust, or of acrid fumes, begin today. Do not allow yourself to retro- may give rise to nasal hemorrhage. The local grade further. There is competition enuf in hyperemia due to an acute attack of cold; the medicin without allowing one's “armor to overacting heart of the athlete or laborer; the rust” or his blade to become dulled. This various malformations of the septa; the prescompetition is keen enuf among the most ence of a polypus, are all common causes in brilliant and the best equipt, and it is fiercer producing the symptom. Constitutional causes and deadlier the lower down one permits him- are frequently at the basis of the symptom. self to be pusht in this treadmill work of ours. The onset of typhoid or the various exanthe
We do not mean to urge any to“ keep up” matous fevers; undue exposure to the sun; to the extent of becoming an enthusiast over congestiv conditions of the mucous membrane every new drug or method he sees mentioned, due to insufficiency of the right side of the rushing to use it frequently or in cases where heart; the cyanosis incident to portal obstruche can produce no actual indication for its tion or Bright's disease ; alcoholism; plethora; employment, and thus failing to remember or
severe and prolonged mental effort; extremes of to employ some well known and reliable agent. atmospheric pressure, as the sudden ascent of Nor do we mean to have any one infer, that we high mountains or the descent into a caisson ; sanction all the favorable reports one may find ingestion of such drugs as phosphorus, and in certain medical journals; but let one who chloralamid in full dosage ; any of these may reads of something before unknown to him, cause severe hemorrhage. study it enuf to see if its claims appear While the hemorrhage is rarely fatal, it is rational and well founded in common sense ; frequently alarming to patient and friends,
and may often be a serious drain on the vital such a thing again, and to discourage all kinds resources of a patient weakened by other of speculation. Such things are fraud traps to disease. It is therefore the part of wisdom to doctors—because doctors are so be prepared to meet emergencies of this sort understand that dentists are just as bad. Docwithout the full complement of appliancestors, get your eyes open. Learn to say no ! which we would choose had we our choice and After you earn and collect your money, learn abundance of warning. It is little things that to keep it and get the good of it. prove the worth of the "all-around" practician; and little emergencies, most of all.
Ichthyol. In treatment, if foreign body be present, its immediate removal is imperativ. The recum
This is one of the most interesting drugs, bent position, with the arms extended above
and yet it is not in such common use as its the head, favors cessation of the flow. Insuf
virtues warrant. It is prepared from an oil flation of hot water, or if ice be convenient, of
which is obtained by the destructiv distillation iced water, will often check even profuse hem
of fossilized fish found in the Tyrolese Moun
tains. orrhage. Digital compression of the facial
No one has yet given any rationale of artery or of the nares themselves, will often
its action, yet Hare declares it “the best prove efficient in checking the flow. Ice ap
external treatment of erysipelas that we have." plied to nose, forehead, or base of the skull, In employing it in erysipelas, the skin is well will frequently be all that is required. Except
washt, and then anointed with the following the ice, every practician may always have at
prescription hand the means of putting any of the above
. 20 drops measures into execution, and the nasal hemor- Lard or vaseline. rhage which will not yield to some of them is and is then covered with lint upon which the worthy our deep consideration. In the way of same ointment has been spread. It is also drugs, insufflation of powered alum, tannic acid,
valuable as an inunction in acute rheumatism, or to percent solutions of the same may be used.
and the same prescription is serviceable. In Zinc sulfate, copper sulfate, or lead acetate may chronic skin diseases characterized by atony be applied by syringe or on pledgets of cotton, and induration of the deeper layers of the skin, in strength of 30 grains to the ounce. Supra- it is of markt benefit. Properly rubbed in, in renal extract in solution may be applied on
cases of acute sprains, its effect is almost pledgets of cotton to the bleeding area, and it magical. In fissured nipples, accompanied by may also be given internally. Ulcerated or
induration, an ointment containing one part of abraded spots may be toucht with a 15 percent ichthyol to four of lanolin will give prompt solution of chromic acid, carefully avoiding the relief; it must be carefully wiped off the sound membrane. Internally, ergot, oil of nipple before each nursing, as the “tarry ” erigeron, dilute sulfuric or nitric acids, tinc
odor will frequently cause the child to refuse ture of opium, or adrenalin chlorid may be the breast. Agnew esteemed it highly in cases given.
of lymphatic enlargement. A word of warning should be given as to the use of cocain solution locally. There is danger EDITOR MEDICAL WORLD:- I inclose draft for of absorption of enuf to cause toxic effect, and three dollars to continue my subscription. I notice in
THE WORLD a few letters from subscribers who are the secondary hyperemia may provoke a worse
inclined to pat themselves on the back for the length hemorrhage than the primary one. It is better of time they have taken THE WORLD. Now if you not used.
will refer to your subscription books you will discover that I am not far from the head of the list. I do not
remember just what year I first became a reader of Another “ Innocent Caught.
your very valuable magazine, but from the first number An Ark. brother renews his subscription
received to the present time I never for a moment
felt like discontinuing my subscription. I thank you and says that he was induced to send $20 to
for your kindness in continuing to send the journal for the Grain Co. for speculativ purposes.
two months since the expiration of my subscription.
I shall continue to take THE WORLD as long as I He got a receipt for the money, but since then
shall read medical journals and it continues to stand he has been unable to get any word of any up for what is just and right as it has done in the past. kind from the company. He says: “They Belle Plaine, Iowa.
(We traced the doctor's subscription back to 1888, won't answer my letters, return my cash, nor
and the subscription clerks were too busy to hunt up have me know what became of it, further than older sets of books. It would be interesting, some. that they got it.” He asks if I have any sug
time, to hunt up our oldest sets of books and see who
among those who started out with us are still with us. gestions to offer. He might write to the Post
No friends are so good as the old ones-faithful, tried Office Department in Washington, giving the and true. We appreciate such letters as the above, facts and claiming that the company is a fraud.
more than words can tell. They make us feel that
we have not lived in vain.-ED.] This might put an inspector on their track. But my chief suggestion is to never, never do Have you read “ The Story of New Zealand?"