a patient's stomach with a superabundance of highly nitrogenous food. It does sometimes help toward recovery, but just as surely it sometimes does harm.

The patient should be told about what and how much is best for him. One with some temperature and a not good appetite would better eat five or six small, easily-digested meals, than to follow the usual custom of three meals a day. As the fever leaves and appetite and digestion improve, he can return to the usual three meals. Remember always that individuals differ greatly as to the quantity of food they can take and assimilate. What is a surplus for one is not half enuf for another.

Probably fewer people need advice with regard to the amount of water they drink than on any other subject, and yet within the past year I found a man who had read that it would fatten one to drink lots of water, and he was trying to drink two gallons each day! Some do not drink enuf water. Few take the pains to investigate as to the quality of the water they get.

The drinking of beer, wine and distilled liquors is greatly abused by tuberculous invalids. One brief rule will apply with great benefit to forty-nine out of fifty of these cases. It is, don't touch any alcoholic drinks-not a drop. Many physicians still prescribe these things for their consumptiv clientele, but like opium in this condition, alcohol has little possible good for much possible harm. The harm is sure and positiv if the liquor is drank in any considerable amount, and no one is more prone to drink to excess than the sick man away from home. Forbid it.

Pure air is one of the best of things for the consumptiv, and yet believe me, people go to extremes in getting pure air. I do not mean that it is possible to get too much of it, or that it is possible for the air to be too pure. I mean that in what the patient fancies is necessary in order to procure pure air, he goes to extremes in the way of exposure and fatigue. One of the advantages of the Colorado climate is the clear weather that makes possible so many hours of out-door life. But it is not necessary to be climbing mountains or riding horseback all the waking hours. It is in this that many make wreck of their chances of recovery. And it is in this that many physicians give bad advice. Dr. Erskine, in the May number of THE MEDICAL WORLD, tells of physicians advising patients weakened by disease and with afternoon temperature, "to ride thirty-five or forty miles every day and to climb mountains and inflate that consolidated lung."

Such advice is all wrong. Such a course is almost sure to lead to cavitation of the lung

and to dilation of the heart with attendant evils. In no other condition with fever is exercise ever ordered. Will some one give a rational reason for doing it with tuberculous fever?

Of course there are conditions in tuberculosis when some exercise is proper. When the lung is healed, the fever gone and strength returned, even mountain climbing may be indulged in. The limits of this paper will not allow further discussion of the subject of rest and exercise in tuberculosis; but let me emphasize this point: The patient with fever should be told to rest; to live all possible in the open air, and to take as little exercise as possible. He can lie on a couch under a tree, on a veranda, or in a room even, if it has a free circulation. free circulation of air in a room requires doors or windows on opposit sides with a constant current. This free circulation should exist in room or tent at night also. The bed can be at one side and screens can be used to protect, if necessary, from a too strong draft.

room.

A

One who is quite feeble, with a weak circulation, should not dress and undress in such a There should be, in cold weather, a warm adjoining room in which to prepare for bed; or the caretaker may put the patient to bed before a fire with the room warm, and then throw open doors and windows. The room so opened will, during our clear winter nights, become very cold. The patient should wear a warm night dress with plenty of light, warm bedclothes, and a night-cap if more comfortable with it.

To sum up regarding fresh air: The patient should live in fresh, free air, but he should do it with comfort; and there should be no exposure or over-exertion to tax his vital forces.

The trouble about this advice is that so many do not know how little they can do without over-exerting themselves-how little they can bear without taxing their vital forces. ' Even physician patients, with the first appearance of returning health, will fancy their old vigor has returned and will work or walk beyond their strength. Other patients say they feel better in a hotel office over a hot stove and will stay there unless watcht. Or they think it can do no harm to go into a crowded theater, church or lecture hall, or that it will not hurt them to go to a ball "just this once." The tuberculous subject should do none of these things.

This leads to one more word of advice: When you have decided where to send your patient, select some physician at that place and instruct the patient to report to that physician immediately upon arrival, and to be obedient to his instructions thruout his sojourn in the locality. If the family doctor knows no

cor

physician at the desired point, he can respond with the postmaster or mayor of the town regarding men of ability and standing, or he can refer to Polk's Directory and select some one who is a member of state and national medical societies. It is very important to place the patient under the care of a good local physician. To do otherwise is like sending a ship thru a rocky, perilous channel without a pilot.

Safety for the phthisical patient, his restoration to health, depends upon careful painstaking management of every detail of his daily life; and the greater the care and pains taken, the greater will be the success.

Boulder, Colo. L. P. BARBOUR, M.D.

Is $5. Per Capita Per Year a Reasonable Average for Medical Attendance? Editor MEDICAL WORLD:-Inclosed find one dollar to pay for your valuable journal for 1904. Pardon delay in remitting, and be assured it is not due to lack of appreciation of your efforts in behalf of the profession. Your crusade against proprietary medicin journals, whose existence is made possible by the patronage of the profession they seek to rob, places THE WORLD in a class almost alone, in the work it is doing, and should win for its Editor a place high among the benefactors of the world.

I used to be a subscriber to the Medical Brief, but becoming disgusted with its editorial endorsement of every proprietary nostrum advertised in it from cover to cover, I dropt it like a "hot tater;" but now and then I receive a sample copy which reminds me that I once aided and abetted in propagating a professional stench by sending the Brief a few of my hardearned dollars. If it is true that this unholy thing is now being offered for sale to the laity by newsdealers or others, it is not fit to occupy a place in any physician's office, even in the waste basket. But thanks to such men as the Editor of THE WORLD and a few lay magazines and papers, the dawn of a better day is approaching, and let us hope the time is not far distant when secret nostrums will no longer be used by profession or laity.

I have just received a sample copy of Everybody's Magazine, publisht by the Ridgway-Thayer Co., of New York. This magazine, The Ladies' Home Journal, and a few others of the better class, not only decline secret medicin advs., but they are doing a good work in teaching medical common sense. the June number of Everybody's Magazine is an article on consumption worth many times the subscription price of the magazine, and I am acquainted with several doctors who would profit by reading this kind of literature, pro

In

vided they can be brought to the point of disbelieving some things taught them by their grandmothers several decades ago. Our learned (?) profession must learn to act different before it can hope to preach the true gospel, and then it must learn to practise what it preaches. So long as physicians give their testimony for, and often in consideration of a few sample bottles of, Dr. Cureall's Elixir of Life, or Get Rich Quick & Co.'s Specific, we may expect the less enlightened laity to follow our lead, and be led to ruin in many cases by consuming the various proprietary nostrums containing alcohol, morphin, cocain, etc., in disguise.

Altho we may differ widely in religion and politics with some degree of consistency, I see absolutely no reason why the great majority of medical men cannot agree upon truths too apparent to admit of doubt, and of vital importance to the profession.

If seventy-five percent of the physicians in the United States would do their whole duty to themselves and their profession there would not be a secret nostrum for sale in this country two years from today; and instead of living from hand to mouth, receiving less pay than the man with the trowel, or saw and square, or even pick and shovel, as the great majority of physicians do, we could live in ease and comfort, as the doctor must to do his best. I don't think I am getting the cart before the horse when I say as a rule, almost without exception, the best paid doctor is the best doctor; in other words, professional success depends very largely upon the doctor's income.

The profession is over-crowded with quacks, secret nostrum vendors and free dispensaries; eliminate these and compel all who are able, to pay physicians even as well as they do grocerymen, etc., and there will be room for all who are qualified and have a legal and moral right to practise medicin.

The law of the survival of the fittest does not hold good in the practise of medicin; the shrewd quack with his catching advertisements can put a scientific physician out of business, and pocket more good money in a month than the former would in a year. Is it right to allow these sharks to go about over the country, taking sick people's money and at the same time robbing them of the few days or weeks when their disease was in its incipiency and might have been cured by one qualified and equipt to render the very best service? I contend that a physician whose armamentarium consists only of an office desk, medicin case and prescription book is necessarily to a considerable extent practising quack methods, tho it is nearly always the case that one so poorly equipt is giving his patrons considerably more than they are paying for.

Why can we not lay aside professional, jealousy and by mutual agreement present a Solid front to our enemies, the quack, secret medicin vendor, and, worse than all, the dead beat who goes from one physician to another, year after year, never paying a cent for services faithfully rendered? There is a remedy for this rodent ulcer which is gnawing at the very vitals of our professional existence, and if we fail to apply it, a very large percent of physicians now living are destined to fill paupers' graves; while $165,000,000 are spent annually for secret nostrums, dead beats are robbing the profession of uncounted millions. Take for example the county in which I live, with a population of a little more than 25,000 people and 25 physicians in activ practise. If equally divided, each physician in the county would have a clientele of 1,000. Now confine the drug stores to their legitimate business, and compel all who are able, to pay their medical accounts, and the average would not be less than $5. for each individual per annum, or an annual income of $5,000 for each physician in the county. But let us see what we have. There is but one doctor in this county who claims an annual income of $5,000 from his practise; the others get from $500 to $2,000. We will say 24 of the 25 average $1,500 each, or a total of $36,000 a year; add $5,000 to this and we have a grand total of $41,000 paid to the physicians of this county annually, whereas, at $5. each, as it should be, the 25 doctors would receive an average of $5,000 each, or a total of $125,000. In other words, we are losing $84,000 every year of money that we are justly entitled to. Where does it go, and whose fault is it that we fail to get what is justly due us? Think, brother.

For the encouragement of the Editor I must say I endorse his political views. I am a democrat, but not to the extent of "following demagogs to perdition." J. L. EDWARDS, M.D.

Brownsville, Tenn.

[The Doctor's figures are interesting. Apply the same basis of calculation to our total population of 80,000,000, and the annual income of the medical profession would be $400,000,000. In "The Physician as an Economic Factor," March WORLD, 1902, page 128, I estimated the total annual income to the profession to be $217,000,000. When we think of all the poor people, and particularly of the poor negroes in Dr. Edwards' own county (they must have been in his count), $5. per capita every year for medical services seems to me pretty high. True, all the protracted cases, surgery, obstetrics, chronics, etc., go in to help make up the total and determin the average, but still it seems high. So many individuals need no service at all, year after year;

and if they did, so many would not be able to pay their $5. quota. However, if the wealth of this great country were distributed on a more just basis than it is, $5. per capita for medical services could well be afforded, and it would be a good investment; but when we think of the great wealth of the few, and the poverty of the many, and that poor people are even more liable to get sick than those provided with every comfort, we see the difficulty of establishing such a high average, with any prospect of getting it. This would be an interesting question for discussion.-Ed.]

Packing the Auditory Canal.-Collection Agencies.

Editor MEDICAL WORLD:-Your criticism of my paper publisht in the June WORLD, page 233, is duly appreciated; but I do not think the point is well taken. Packing the external auditory canal indiscriminately would indeed be very bad practise, and no well-informed man would do so; but to pack the ear with a soothing remedy such as I recommended for the relief of pain, before there is any discharge to "dam back" certainly can do no harm, and often affords a great amount of relief to the poor sufferer. It was, if you and the readers of THE WORLD and Dr. Gleason will note carefully, only at this stage, before there is any discharge, that the measure is recommended. The pain almost always ceases as soon as the discharge appears, and then, of course, the remedy would be discontinued.

Anent the question of collecting agencies, I thought perhaps my experience might be worth relating. My first time to "monkey" with any of them was about fifteen years ago. A friend suggested that I send some bad accounts I had to R. G. Dun & Co. I wrote them for terms, etc. They required fifty cents in advance, to cover the cost of correspondence. I sent it and a list of accounts. After some six months or more, I received a letter from an attorney in my county site asking for some information concerning some of the claims, and saying that he had been employed to collect them. That has been more than fourteen years ago. I have never heard any more from the matter in any way. So I sent good money after bad, and it never brought any back.

Next, the United Protectiv Association, with headquarters at Topeka, Kansas, got my name and wrote me, wanting to "collect my outlawed notes and accounts." The terms on which they proposed to do so were that I should sign a contract to pay them $15 membership fee, to be paid out of the first money collected from the claims sent to them, and after this I was to pay them a certain small percent of all

amounts collected on these claims. I was only to send them a statement of the claim. I held possession of my notes, and all money collected was to be paid to me, and I was to remit their fee. They further agreed that if they had not collected ten times the amount of the membership fee in twelve months, they would continue their efforts free of charge until they had done so. I signed the contract and sent it to them with a good number of claims. That has been ten years ago, and I have never received a penny thru their service, and have not heard from them for several years. So I am not out anything except a few postage stamps and a little of my very precious time; nor have I received anything in return except a little experience.

A few months ago, after the assault on such frauds by THE WORLD, I saw a very flowing advertisement of the Sprague Mercantile Agency of Chicago, praising themselves at a wonderful rate, claiming unequaled ability and facility for collecting oultawed claims. I wrote for terms, and soon as Uncle Sam could go to Chicago and back he brought me a letter, and a large lot of testimonials as to the wonders that had been accomplisht for others, and a note for $50 payable in six months, for me to sign and return to them as a retainer; also a stampt envelope for reply. I simply wrote a postal card saying to them "the whole thing is off with me." About every week since I have received something from them, but have answered nothing. They They kept sending stampt envelopes until, perhaps, they furnisht me with a dozen stamps. Then they quit putting on the stamp, but sent the envelope. Now I refuse to take them out of the postoffice, and am wondering how much longer they will continue to send them and have them returned markt "refused."

My object in writing this article is to give my conclusion. It is that if one of my customers is in my reach, that I can come nearer reaching a satisfactory settlement of my claim against him than any other man or set of men can, and that it is foolish to fool with any of these collecting agencies. Any practician who will adopt and carry out a business method will have very few claims that he will wish to submit to a collector. D. C. SUMMERS, M.D.

Elm Springs, Ark.

Orificial Surgery.—A Few Cases. Editor MEDICAL WORLD:-During the first year of my practise I was called to extract a bean from the nose of a child. Failing with the forceps, I introduced a small scoop, and pressing the convex side close to the nostril, succeeded in getting it above the bean and drew it out quite easily.

Recently I undertook to take a grain of corn from the nose of a child whose parents had tried in vain to dislodge it. They had pusht it so high and so firmly fastened it that the blowing process would not move it. The best I could do was to push it back into the pharynx, where it was swallowed and troubled the little one no more.

Foreign objects may be best taken from the ear by syringing with warm water. But since living in this cattle country in Southwest Texas, I have had a unique experience in the case of an old man who came to me with pain and roaring in his ear. After using the syringe he continued to complain. I introduced a pair of forceps and in making careful exploration came upon what seemed to be a foreign substance. Taking hold of it and pulling slightly met resistance. But so sure was I that this was the offender, I pulled slightly harder and out came a regular West Texas cow tick. The tick had taken hold of the tympanic membrane. An antiseptic, emollient dressing finisht the case.

Some years ago, while practising in Madisonville, Texas, I was called by one of the resident physicians to treat him for a rectal trouble. Just above the lower sphincter my finger impinged upon a foreign object embedded in the tissues. Improvising a speculum out of two fingers of my left hand and taking hold with forceps of the free upper end of the foreign body, I pusht it up until the lower end was disengaged, then easily withdrew it. About a week previously he remembered to have had some difficulty in swallowing a bolus of food, and inadvertently had taken into the stomach an inch long leg bone of a small chicken. After entering the esophagus and passing into the stomach it gave the countersign and was allowed to pass into the duodenum, thence to jejunum, the ileum and the colon. But failing to give the proper password its passage thru the rectum was challenged, and thus the trouble was set up, and thus it was ended.

But the singular case which has prompted the chronicling of these bits of hitherto unwritten history is the following: Only two nights ago I was aroused from slumber by an anxious voice at my door. The visitor proved to be an old man long addicted to the use of the catheter. He had broken off the rubber instrument half way the body of the penis. He told me it seemed to be glued in. So I filled a pipet with glycerin, had him lie on his back, and holding the organ erect, introduced the glycerin allowing it to gravitate downward while I proceeded to select an available extractor. With one blade of the instrument in the catheter and the other outside, I made

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? Lytle, Tex.

JOHN F. NEAL.

[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. 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 neir 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. The Illinois Central also supplies information on these topics; and all the roads allow reduced rates to home-seekers.

I do not pretend to know much about farming, but there are things I failed to comprehend. 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