given. By such an examination, if pus, blood, mucus, or inspissated fecal material is present, it can be seen; whereas if an injection has been taken and the rectum thoroly cleaned out before the physician examins it, the substances may be entirely removed, and the condition causing them may be overlookt."

My method is thoroly clean out the bowel with a warm normal salt solution, then place the patient on an operating chair in the Sim's or lithotomy position, then I next try to get as strong a light as possible. I use a student's lamp with light condenser and head mirror, such as used for examining the nose and throat; this, I find gives a very satisfactory light. With my light properly adjusted, I note the external appearance of the rectum and anus to determin whether there are fissures, external openings of fistulas, pruritus, whether the pigment is normal or not, whether there is protrusion, excoriation, redness, dryness or moisture of the anal margin, etc. Then, after examining the external parts, I introduce into the rectum an O'Neill's speculum which has been previously anointed with vaselin, and proceed to examin the inside of the rectum. I note the color of the mucous membrane, size and color of tumors, if any are present. I examin carefully for ulceration and internal openings of fistulas, stricture, etc. If there is protrusion in answer to the straining down of the patient, there is (excluding external piles) one of three things: first, internal hemorrhoids; second, prolapsus of the gut; third, polypi. If internal hemorrhoids, they can be felt as well as seen. If prolapsus or protrusion, it is likely to exist all around the anus. It has not the color of hemorrhoids, does not evi dence the same sensation to the sense of touch as internal hemorrhoids; it is soft and velvety, giving the sensation of a wet bladder prest together with the fingers. If it is a polypus, altho the protrusion may look very much like a pile, it will be found that it has a pedicae." -Mathews.

Treatment:-For convenience, the treatment of internal hemorrhoids has been divided into preventiv, palliativ, and curativ.

By preventiv treatment we mean the removal of the predisposing causes before the development of hemorrhoids has taken place; the regulation of the bowels where constipation exists; wherever there is a predisposition to rectal trouble, the patient should avoid in discretion in diet, excessiv drinking of liquors, or dissipation of any kind, heavy lifting, or sitting long at stool. If there is present such diseased conditions as syphilis, stone in the bladder, prostatitis, stricture of the urethra, cystitis, and uterin displacements, the same should be treated, not only to overcome the

effects of the disease, but for the fact that reflexes arise from them and predispose to hemorrhoidal development.

Palliativ treatment is one that will relieve the acute inflammatory exacerbations, but not be curativ. The surgeon and possibly the specialist will tell you that the physician who resorts to palliativ treatment is unscientific, and that he is not a conservativ physician. There are, however, circumstances, diseased conditions, complications, etc., where the palliativ or harmless methods should take the place of the clamp and cautery or other radical measures. In the general practise of medicin, the country physician is frequently called upon to treat internal piles, and as a general rule he is at a loss to know just what method to use or what course to pursue. The cases coming under his observation are usually among the farming or laboring classes, who cannot well afford to lose the time or possibly their financial conditions will not permit them entering a hospital for surgical treatment. Many lack the moral courage to submit to surgical methods, while others who are nervous and easily frightened, resort to palliativ means or accept "quack" treatments rather than submit to a radical operation. People who are afflicted usually like a treatment which will give them the least pain and annoyance, and are slow to accept that which has much the appearance of surgery.

"Some say that palliation of hemorrhoids is unscientific and only done for sordid motivs; that radical removal is the only method of treatment. Aside from the fact that operation is often contra indicated, the patient has some right himself to choose whether he will be operated on, or treated by palliativ means for conditions in which life is not endangered. The fact that the larger majority of those who suffer from rectal diseases in the United States to-day are treated by irregular practicians is due to the inability or refusal of the general surgeon to apply palliativ measures properly." -Tuttle.

A partial degree of success, with a certain amount of failures, only stimulate a man to renewed efforts, and my failures have led me to try other and better methods of treatment, whereas, otherwise I might have remained in the same old rut. If we can make use of some method of treatment which is mild, painless, simple in appearance, free from hemorrhage, with no detention from business, we have accomplisht much toward holding this class of country practise. The method I have used for several years is similar to the one described by Dr. Joseph B. Bacon of Chicago; his article appearing in the Milwaukee Medical Journal, dated March, 1893. I have made a

few slight changes in the method of using the electric needle, but as the changes are so slight I call it Bacon's Method, which I presume was original with him. Those who contemplate using this method should secure a good reliable battery. The one that I use is made by the McIntosh Battery and Optical Co., and is a thirty-six cell combined galvanic and faradic battery. Those who have had but little experience in electrolysis should have a milliamperemeter connected with their battery so as to know the strength of their current. I do not use forceps attacht to the positiv pole as advocated by Dr. Bacon, but prefer the old way of using a damp sponge attacht to the positiv pole the same as we do in removing moles, superfluous hairs, etc. To the negativ pole is attacht a needle holder (McIntosh) containing four new cambric needles. The hemorrhoid is graspt with forceps or tenaculum and held while a four percent solution of cocain is painted over the tumor; after a few minutes waiting for the anesthetic effect of the cocain, the needles are pusht into the center of the tumor, the current of from 10 to 20 Le Chlanche cells or from 5 to 10 milliamperes is turned on and the positiv pole applied by means of a wet sponge to the thigh. If you have an assistant it is better to place electrodes in position as above described and then have assistant to turn on current gradually until the proper strength is attained. Immediately there will be noticed an escape of hydrogen bubbles around the needles, and a decided blanching of the hemorrhoids. The current should be kept up until the tumor becomes whitish gray, usually requiring from two to five minutes time.

There are some points necessary to observe in using electrolysis in this class of cases:

1. "Give an enema and thoroly empty the colon before operating.

2. "Disinfect the tumor before introducing the needles, and again after operation.

"Never use this method in acutely in3. flamed hemorrhoids.

4. "Do not use over one-sixteenth of a grain of cocain, if used hypodermically.

5. "Always insert the needles into tumor before the current of electricity is turned on, and have the assistant again turn the current off before withdrawing the needles.

6. "Use a milliamperemeter for measuring the strength of current, as it is impossible to estimate the varying resistance of the tissues in different cases.

7. "The needles may be a direct source of infection in the hands of a careless operator, and they must be boiled before using.". Bacon.

I find that cocain solution brusht over the sur

face of the tumor is quite sufficient to allay all pain, and that a hypodermic of cocain is seldom necessary. No assistant is needed if you use a self-retaining speculum; the positiv pole properly prepared, adjusted, and fastened to the patient, the needles inserted, and held by one hand while with the other free hand you may turn on the current as you choose. I will freely admit that it is not as convenient or as satisfactory to do this work all alone as it is with an assistant, but physicians in the country are used to such inconveniences.

One or two applications is sufficient to effect a radical cure.

"The advantage electrolysis has over other methods is that no ulceration is produced by it, and the patient is never annoyed by the slight moisture and occasional backache which is associated with all operations which depend upon healing by granulation."-Tuttle.

This form of treatment has proven satisfactory in my hands in all the cases I have treated. While my work in this branch of practise has been limited, I cannot speak from the fulness of experience as to this form of treatment; but, so far, I am well satisfied. Grant City, Mo.

W. E. MCKINLEY.

"A Case of Malpractise, but not the Doctors'."

Editor MEDICAL WORLD:-In the case of Awde vs. Cole & Drought, damages $25,000, District Court, Fergus Falls, Minn., the doctors operated successfully for appendicitis. During the nursing the nurse (the patient's own selection) placed some hot-water bottles in the bed, which accidentally burnt the patient, causing temporary but painful injury. The plaintiff subsequently fell into the hands of a "hungry lawyer," and as the nurse had no money it was decided to sue the doctors. At the first attempt the case was thrown out of court. On the second trial the jury disagreed. On the third trial the jury found that the doctors had successfully and skilfully performed the operation, and that the nurse was the servant of the plaintiff at the time of the accident; but that the doctors were responsible for the actions of the nurse at the time of the accident, and awarded $500 damages. Judge Searle pronounced the verdict "irregular," and said he would set it aside upon application; but it is found that it will be cheaper to pay the judgment than to try the case again, even if the defendants secured

a

verdict in their favor. Of the $500 awarded the plaintiff, it is conceded that he will not have enuf to give each member of his family a drink of soda water when his expenses are paid. It is an outrageous travesty on justice that such a case should not be met

grains." 75 + 38 +380 would give 493 minims total quantity, containing the 12 grains arsenious acid. Six minims would thus contain grains of the arsenious acid, equaling 2 minims, and 22 minims would contain

J. FITZ-MATHEW, M.D. West Sound, Wash.

Dosage of Hoff's Consumption Cure. Editor MEDICAL WORLD:-Referring to the prescription reputed to have been written by Professor Dr. Adolf Hoff in Vienna for a consumptiv patient, as publisht in the "New York Journal and American" and as reprinted in your issues of June 1904 (page 246), and of July, 1904 (page 276), I would like to call attention to its dosage.

No dose is given in your reprint and I assume that the dose given in the circulars wrapt around the vials sold by Messrs. B. & S., 3d Ave., cor. 10th Street, New York City is given correctly.

They state the initial dose to be: 6 drops 1 time a day for one half week. And then 6 drops 2 times a day for one week, and they give the maximum dose to be 22 drops 2 times a day for one week. If you add up the quantities as printed, 75 +38+ 38 you get 151 minims containing 11⁄2 grains arsenious acid. Six minims of the same will contain grain of arsenious acid, equaling about 6 minims of liquor potasii arsenitis U. S. P. '90 (Fowler's solution).

Twenty-two minims would contains grain of arsenious acid, which, given 2 times daily, would equal 46 minims of Fowler's solution daily.

the

The United States Dispensatory 18th Edition, 1899, page 819, gives, however, the average dose of Fowler's solution as minims 5 2 times or 3 times daily or 10-15 minims daily.

The Italian Pharmacopeia 2d Edition, 1902, page 364 gives the maximum doses of Fowler's solution as: single dose 1⁄2 gram or 72 grains and the daily dose 12 grams or 22 grains.

The German Pharmacopeia (English translation) page 318 gives the maximum doses of Fowler's solution as: single dose grams or 6 grains. Daily dose 2 grams or 30 grains.

The original R was probably written in Vienna in the metric system and a misplaced coma (,) in the quantity of the last ingredient (water) would make the probably intended 25,000 grams look like: 2,5000 grams and equal the 38 grains as printed. These 38 grains probably ought to be read: "380

tion.

As 7 minims of Fowler's solution 2 times daily would only be 1⁄2 of the maximum daily dose as given by the German pharmacopeia it would be a perfectly safe dose.

If dispenst as printed in the "New York Journal and American" and as reprinted by your paper, the mixture would contain 50 percent more arsenious acid in its maximum daily dose as allowed by the German pharmacopeia. Would you consider this dose to be safe? And furthermore, did Prof. Hoff employ such overdose? Could you possibly obtain a statement from Prof. Hoff direct or quote the original as probably reported in one of the Vienna or Berlin medical periodicals and clear up this dangerous "mystery?" Hoping that you will print this and thus attract attention to the dosage, I am, dear sir, Yours respectfully, GUSTAVE WOLFF, Phar. D.

316 E. 87th St., N. Y. City.

The Umbrella in the Sick Room. Editor MEDICAL WORLD:-There are many little things left undone in the sick room, and never ordered to be done by the physician, that would add greatly to the comfort of the patient, as well as to his chances for recovery. As I have "rested on my oars" for several months-not having tormented you nor your readers "before the time," I hope you will allow me to relate two things that I do (if present) or have done in the sick room. Now, it is bad to be sick, worse to take a purgativ, and worst (for the patient) to have to smell the discharges from the bowels. Hence I always take an umbrella, stretch it as for ordinary use, and fan out the house well, after each movement of the bowels. If there are any among us who do not practise this, I will tell how to do it. Begin at the bed-side of the patient, and hold the umbrella in front of you, just above the floor, and jerk it toward you, as you were wont to jerk your father's old briarhook. This will remove the horribly fetid order from under the bed. Now raise the umbrella high above your head and jerk downward and rather toward yourself, with all the force you can exert. Having gone over the room in this way several times, stand at the doors and windows, and fan outward a while, and then inward. You will be surprised to see how soon you will have that room smelling 'right." I have the house fanned out in this way every hour or two, whether the "purga

tiv" calls for it or not. The room of the measles, smallpox, typhoid, or any other patient, should be fanned out every hour. Learn to do this yourself, and then teach the nurse how to do it.

If any agent used to reduce the temperature may be considered an "antipyretic," I wish to speak of the umbrella as an antipyretic. Any one who knows how to use the umbrella can lower the temperature from 1 to 2 degrees in 20 or 30 minutes. From 11 a.m. to 9 p.m., it takes hard and fast work to bring the temperature down one, or one and a half degrees in 20 or 30 minutes; but from 9 p.m. to 5 a m. you can have your patient shivering and calling for cover in fifteen minutes.

Remove all the cover from the bed, let the patient separate the legs as widely as possible, and place his arms so they will not be in contact with the body. Take, now, a very large umbrella, and raise it a little more in front of you than perpendicularly, and begin to jerk it downward with all the force you can summon. The higher the ceiling the longer will be the strokes, and the more rapid the descent of the temperature. I have never used the umbrella for this purpose (for reducing the temperature) except in the summer months; and it takes "fast" work to reduce the temperature more than one degree, during the heat of the day, but it can be done. It is surprising how soon you can have a patient shivering, if you will strike him at midnight. It is best to put corks (country doctors prefer corn cobs) on the ends of two of the ribs of the umbrella -the two next to you-as otherwise you might stick the point of a rib in your head or face, in jerking downward. I can take an umbrella and do all I have claimed for it, and if any brother should try it and fail, let him not be too ready to throw it aside, for you must know how to handle an umbrella in a sick room before you can do "these things." For instance, my friend Moody, our village blacksmith, can take his tools and make whatsoever he wishes; while I, with the same tools, could make nothing but an "ugly face."

Hohenlinden, Miss.

A. C. GORE.

[We are always glad to hear from Dr. Gore. The seemingly little things in the sick room are big things to the patient.-ED.]

Questions for Homeopaths.

Editor MEDICAL WORLD:-It is only by speaking as we really think and feel that we get at the truth. I would like to say a few words to the brethren as to how I felt on reading the article by Dr. Bailie Brown. That such wonderful cures could be accomplisht by ferrum phos. 3x and fluoric acid 6x seems to me bordering on the impossible. I can't, from

my point of view, attribute the results to anything but suggestion and the vis med. nat. I take my dog and give him a whole bottle of ferrum phos. 3x and fluoric acid, and I see no change in him; but if I give him ten or fifteen grains of ferrum phos. he gets sick and vomits an appreciable result. Physiology is not imaginary, and the physiological effects produced by powerful drugs are not so either. How can any of these decimal potency drugs relieve a severe pain which will immediately respond to opium? and how can the same potencies relieve a severe constipation, and so on? The foundation of homeopathy is false, imaginary, indefinable, and, to my way of thinking, is a huge medical mania covered up by the overwhelming force of the vis medicatrix naturae. Any doctor can give a purely suggestiv, imaginary power to a substance, and after its exhibition claim that it "cured."

One of the most successful homeopathic physicians I ever knew gave quinin in threegrain doses, comp. cathartic pills, sulfocarb. of soda, morphin hypodermically, etc. He had to or drop from the list of successful physicians.

Will some of the homeopaths tell how they would relieve the pains of hepatic colic, sciatica, tabes, or any agonizing complaint? What chemical difference exists between a crude and a potentized drug? and can they prove, without quibble, that such potentizing can be accomplisht? ARTHUR A. COTTEW, M.D. San Diego, Cal.

Osteopathy:-Bacteriology in the Light of
Osteopathy.-The Relation of Osteopathy
to Other Therapeutic Measures.
No. 5.

The question naturally arises, even tho osteopathy may be efficient in many diseases, how can it be efficient in acute and infectious diseases? How can such measures influence disorders due to micro-organisms? The same question might be askt of drug therapeutics, for with the possible exception of quinin in malaria, we have no drug which we can say is curativ by its germicidal effect upon microorganisms in the system. Even with quinin I think there is much cause to doubt this explanation of its modus operandi in malarial affections; however, this is immaterial to the point under consideration. Many drugs are of service in infectious disorders which are known to have no direct germicidal effect. These drugs seem to act in infectious disorders as in the non infectious by so influencing the bodily activities as to assist in overcoming the abnormal condition present.

Can osteopathy accomplish these results? If so, how? Consideration of a few of the establisht facts concerning micro-organisms is nec

essary to understand how osteopathy or any other therapeutic measures can be of service in infectious diseases:

1. What are the conditions which permit of the introduction and development of microorganisms within the body?

2. How do micro-organisms so introduced produce disease processes?

3. By what means does the body combat these deleterious influences?

4. What are the indications for treatment? (1) That the healthy body possesses a certain degree of immunity to most infectious diseases is well establisht. Roux and Yersin found that in the throats of many healthy individuals may be found the Klebs Loeffler bacillus in large numbers. The cholera bacillus and the bacillus of tetanus had been found in the alimentary tract of the healthy. The bacillus of tuberculosis has been found in the lymphatic glands when no tubercle was present. Any cause which lowers the vital resistance of a part predisposes that part to infection. This has also been demonstrated and is a generally accepted fact. Lack of vital resistance then is the condition which permits infection to take place. To reap a plentiful harvest of infection both seed and a favorable soil are necessary.

(2) Micro-organisms cause disease by their presence and by their toxins, tho principally by the latter.

(3) To combat these deleterious effects the system by phagocytosis and by the anti-bodies -bactericidal, lysogenic, agglutinating and anti-toxic substances-destroys or renders inactiv the bacteria and neutralizes their toxins. By increast elimination the by-products and toxins are thrown out of the system. That bacteria are also destroyed by an excess of their own toxins or by-products is probably true also, but as the body takes no direct part in this process it need not be considered here. (4) As phagocytosis, the production of the anti-bodies, and elimination are vital processes, it naturally follows that any method of increasing the vital activity will favor the curativ process and is an indicated treatment. Treatment that will assist the restoration of the affected tissues to their normal condition and thereby increase their vital resistance is also indicated.

How may these indications be met osteopathically? As previously shown, pathological changes in tissue, whether infectious or non-infectious, are associated with certain primary or secondary lesions accessible from the surface of the body, and that these lesions produce, aggravate, or prolong this condition. Thus by removing as nearly as possible these external lesions, associated with the areas of low vital resistance which predisposes to infec

tion, prophylaxis will be promoted. If the infection has actually taken place and is activ, the removal of these lesions will help to restore the normal vitality and immunity to the affected part, thereby rendering the soil unfavorable and removing one of the essential conditions to infection. This restoration of the normal will promote phagocytosis and the production of the anti bodies-and the system will elaborate its own antitoxin instead of receiving it from without. The processes of elimination are also kept activ by such treatment. The removal of lesions as they develop will prevent or modify any complications which may tend to arise during the course of the infection. By mechanical stimulation and inhibition the various bodily functions may be regulated and complications controled, should the removal of lesions not prevent their occurrence or control them.

Such treatment is indicated and is effectiv in infectious as in non-infectious diseases. The employment of these osteopathic methods of treating disease by no means excludes the usefulness of dietetic, hygienic, antiseptic and other measures which clinical experience has demonstrated to be of service, and unless it can be shown by clinical experiment that they are incompatible, we may rationally conclude that judicious medical treatment may be effectivly used in connection therewith. In this last assertion I am aware that my views are opposed to those of many of the foremost exponents of osteopathy.

In our foregoing articles we have shown that every pathological condition of the human body has its primary or secondary lesion or cause at some point or points accessible from the surface of the body, and that the removal of such lesions is an important factor in the removal of the diseased condition.. These lesions which usually take the form of local vaso-motor changes, muscular and ligamentous contractions or relaxations, and bony subluxations, can be removed by external manipulations and mechanical measures properly applied. It has also been shown that mechanical stimulation and inhibition of nerves and nerve centers is possible, and that such stimulation and inhibition when induced from the surface of the body affects internal and other tissues supplied from the same center. From these facts, previously shown to be correct, we submit that our original proposition is true, and that every pathological condition of a curable nature may be favorably influenced by mechanical measures which are a part of osteopathy.

It by no means follows that these good results may not be obtained by other and better measures. Many of them undoubtedly are;