others are not. If these lesions-which may produce, aggravate, or prolong diseased conditions are the result of abnormal nervous impulses from tissues primarily affected, then any measure, mechanical, medicinal, or other, that will control these impulses, will prevent or modify their formation; or if they are already developt, removing their cause will allow their restoration to the normal. If these lesions are of sufficiently long standing, tissue changes will likely have developt which will require much time for nature unaided to remove, even if the causes which resulted in the condition cease to be activ. Chronic lesions are apt to take the form of inflammatory, hypertrophic, hyperplastic, atrophic or even paretic changes of the softer tissues with resultant osseous subluxations. For these chronic lesions, at least, it would seem that mechanical measures are of first importance, tho other means may also be of service.

This idea of external measures to influence conditions is not new with osteopathy. Counter-irritants, hydrotherapy, Swedish movements and massage are all external measures, and most of their good results are reflex.

After the foregoing exposition of osteopathy it would seem superfluous to refer to the ludicrous statements made by some that osteopathy is nothing but massage. Such statements show ignorance of either osteopathy or massage, or betray a malicious desire to mislead. The masseur may by efflurage, petrissage, tapotement, vibration, and massage-a-friction reduce and remove many lesions of softer tissues, and with them the associated internal disorders. But of anatomy, physiology, pathology, diagnosis and therapeutics from an osteopathic point of view, he knows nothing. His work is all good and valuable in its particular sphere, but it has neither the sphere nor the precision of osteopathy. What the engin wiper is to the skilled mechanic the masseur is to the scientific osteopath. Massage is to osteopathy what patent medicin is to scientific medication: a shotgun prescription without positiv diagnosis or accurate prescribing. True, both osteopathy and massage are mechanical, and in that respect they are similar. Surgical operations and the reduction of fractures are also mechanical, but on that account could hardly be classed with massage. Homeopathy and allopathy are both systems of medicin, yet one is the antithesis of the other.

The theoretical side of osteopathy may be attractiv, but have clinical results verified these theories? Has bedside experience demonstrated the efficiency of this system? I cannot here quote from medical authorities to prove my statement when I say that clinical experience has demonstrated these theories to be

true. Medical authorities having had no practical experience pro nor con to offer, can be no authority on the merits of osteopathy. With theoretical evidence from medical authorities, and with clinical evidence from more than one thousand practising osteopaths of average intelligence confirming these theories, I submit that it remains for its opponents to show by practical experiment and not by ridicule that these results cannot be obtained osteopathically.

But we are often told that osteopathy may be all right in hysteria, hypochondriasis and other nervous disorders. Truly, no greater compliment could be paid to osteopathy than to say it is successful in treating disorders of that great center of life, the nervous system. To say that buckeyes, raw potatoes and rabbits' feet also cure these and other conditions relieved by osteopathy is no argument. Sugar pills and hypodermic injections of distilled water also have some reputation as therapeutic agents. The influence of suggestion is not confined alone to osteopathy, and it remains to be demonstrated that a D. O. has greater powers of suggestion than an M. D. În the hands of the M. D., who by tradition and common consent is the reputed healer of disease, it would seem that suggestion would be more effectiv. Only after repeated failures by the anointed has brought doubt and discouragement to the patient, do the majority of them consult an osteopath. No, this raw potato and rabbit's foot dodge will not do; if any system has a corner on suggestion it is the medical, so we must look elsewhere for an explanation of whatever results may be obtained by osteopaths.

But we osteopaths are accused of claiming too much for osteopathy. Perhaps we do, but having repeatedly proven its merits, our judgment on the subject should be of more value than that of those who have not done so. To all such I can but reply in the words of Newton, who, when ridiculed concerning his theory of gravitation, said: "Sir, I have investigated these things; you have not."

Tho all the common diseases, both acute and chronic, both infectious and non-infectious, have been treated osteopathically with the most encouraging results, it does not claim to be a cure-all. If it possesses but one-half the truth claimed for it by those who know most of the subject, it would still demand consideration by every physician and would rank as the greatest contribution to therapeutics, for no other has so wide a sphere of usefulness.

True, some of the enthusiastic advocates of this system have at times promist and tried to accomplish what osteopathy nor any other system could accomplish, but have not other

practicians done likewise when intoxicated by success and unguarded by reason? Sufficient clinical experience is not yet at hand to determin the exact value of osteopathy in all conditions as compared with that of other systems. If the osteopath enters fields which for want of results he cannot maintain, like the followers of every other system have had to do, he will be compelled to recede or change his methods. In the meantime the field is open.

Homeopathy was and still seems to be necessary to show the merits of the single and similar remedy in the minimum dose. To the eclectics it was left to develop the vegetable remedies and specific indications. To osteop. athy is given the task of emphasizing macroscopic lesions as related to disease process, and to develop mechanical therapeutics, and it, like these other systems, must and will continue to exist as an independent school so long as its truth remains unknown and its workers unrecognized by the predominant school as fellow-students and physicians possessing the same high order of intelligence and purpose that they claim for themselves.

So far we have dealt chiefly with the theoretical and political aspect of osteopathy. In our next and concluding article we will consider the mechanical and practical side of the subject, illustrating it by the examination, diagnosis and treatment, both palliativ and curativ, of a condition treated so unsuccessfully by medicin-a case of chronic headache. Peoria, Ill.

W. A. HINCKLE, M.D. [To be continued.]

Dr. T. J. Ray, of Centreville, Miss., incloses the following letter as more evidence as to how antikamnia is being pusht Notice the date. Please notice also that they are still advertising in some medical journals. What does the medical profession think of this?

ST. LOUIS, U. S. A., August 2, 1904.

MR. JONES-We are pleased to inclose a sample of "Antikamnia Tablets" for Pain. A sample of something good is a "good thing" to keep about the house or for convenience, in your pocket or purse.

Antikamnia tablets will relieve all headaches, muscular pains, neuralgia, la grippe, insomnia and women's aches and ills. The inclosed booklet tells when and how many, and druggists everywhere sell them in any quantity or in our regular "Vest-PocketBoxes " as below.

Sweet Milk and Malaria. Editor MEDICAL WORLD:-I noticed in your July issue a communication entitled "Sweet Milk and its Possibility of Producing Malaria," by A. J. Hall, M.D., McKenzie, Ala. My experience in Bacteriology outside of Dr. H. F. Harris's laboratory, College of Physicians and Surgeons, Atlanta, Ga., amounts to very little; but under the able teachings of Dr. Harris I was taught that the plasmodium malariæ is injected into man thru the bite of a certain variety of mosquito known as the anopheles, this mosquito previously having sucked the blood of a malaria patient, which, having gone thru certain development within the organism of the mosquito, is then ready for re-introduction into, and renewed life in, the human blood. Sweet milk is our most nutritious food-milk from a healthy cow and the milking being cleanly done. Is there any case on record where malaria developt outside of a malarial district, and patient had not been to a malarial district? You find the anopheles mosquito only in malarial districts, and you do find sweet milk elsewhere; so there is no use "Dreaming, only Dreaming," as tongues don't always tell. McKenzie, Ala.

E. P. PRUITT.

Removal of Tapeworm.

Dr. Mitchell sends us the following letter, confirming the value of his treatment as given in June WORLD, 1903, pages 251 and 252, to which those interested are referred:

DR. GEO. MITCHELL :-I employed your tapeworm remedy, which was publisht in June WORLD, 1903, and succeeded the first time in removing a tapeworm 231⁄2 feet long. I got the head. It certainly does the work. Felton, Minn. R. W. HUFFMAN, M.D.

Liquozone.

Editor MEDICAL WORLD:-The formula for liquozone is hydrochloric acid and water. The druggists in this country serve it at the soda fountain. They call it a liquozone bracer. Coweta, I. T. F. A. WIER, M.D. [We doubt the above. See our remarks in

August WORLD, page 354, near top of first column.-ED.]

The following table is short and easily memorized, and will wonderfully aid in his reading one who does not understand the metric system. It is taken from Culbreth's Materia Medica.

I millimetre (mm or Mm)- of an inch.

I centimetre (cm or Cm(- of an inch.

1 inch-25 millimetres, or 21⁄2 centimetres.

I cubic centimetre (Cc or cc)-16.23 minims.

1 fluid ounce-29.53 Cc.

I gram (Gm or gm)-15.4324 grains (generally considered in

prescription writing as even 15 grains).

I grain-0.0648 gram.

1 milligramme (Mg or mg)-0.01543, or of a grain.

1 litre (L)-34 fluid ounces, or 2% pints.

Editor MEDICAL WORLD:-Please credit my account $3.00 and oblige. Your exposure of the Comstock agency is worth several years' subscription to any physician. B. F. BISHOP, M.D. Garrattsville, N. Y.

QUIZ

New books as they appear, are sent to our Assistant Editor, Dr. A. L. Russell, of Midway, Washington Co., Pa., for review As the Doctor thus has all the late books for reference, and is made familiar with them by reviewing each one carefully as it reaches him, he is unusually equipt for answering queries. Therefore it has been our custom for a long time to send queries to him for reply. In fact, the Doctor made a special request that this be done, as he enjoys this work. It now occurs to us that time will be saved if you will send directly to Dr. Russell matter intended for the Quiz Department, which has grown so much under his vigorous treatment " Please notice that our

query department is not used to "boost" proprietary remedies, almanac fashion. THE MEDICAL WORLD has no interests other than to give to the medical profession the greatest amount of honest service possible. It has absolutely no interests in any proprietary preparation nor any medical supply house. Other medical editors have become, and are becoming, wealthy, by using their pages to increase the sale of preparations that they are interested in; but we prefer to render service to our subscribers that is above suspicion of personal pecuniary interest. How can a man interested in the sale of certain preparations render the best service? He is always trying to push one of his preparations in. That is commercial journalism. We prefer ethical journalism-and so does the profession, for THE MEDICAL WORLD is growing in popularity faster than ever before-and our subscribers are paying ones. They must be, for we have no medicins to " boost," nothing to sell, nothing to depend on but pure journalism; but doctors that want honest, straight journalism are willing to pay for it-they are glad of the opportunity.

Only such queries will be publisht as are likely to interest and Instruct many others as well as the one asking help. No charge has ever been made, nor will any charge be made, for this service to our subscribers. However, those who wish an immediate and personal reply by mail may obtain the same by inclosing two dollars to Dr. Russell. This is really a consultation in the interest of the patient, and should be charged to the patient-two dollars being a very moderate consultatione. The Doctor agrees to give full, careful and immediate attention to such consultations. We reserve the right to publish in this department any such consultations that may be interesting and helpful to our readers. Name and address will be withheld if requested. Come freely for help, but read up as fully as you can before coming to us.

Why So Much Tetanus from Fourth of July Wounds?

sons.

The circumstances and environment are calculated to encourage infection. The fireworks and explosivs are generally fired from the ground; the hands of the parties firing are generally more or less begrimed; dust and dirt are much in evidence; and the tetanus germ is common in certain kinds of earth and dust; and when a wound occurs, the facilities for infection are present. Wounds from explosivs are more likely to be followed by tetanus because extraneous matters are forced into the flesh, and the contusion of tissues extends further than is evident to the eye, the force following the course of tendons, and hence the wound is seldom completely opened. — ED.]

Drugless Treatment of Insomnia.

Editor MEDICAL WORLD:-I am taken with the originality of many natural methods of treatment of disease advocated thru your columns, and profited by the suggestion.

Now I would like to ask, in your experience, what is the best method of producing natural sleep in the vast army of patients troubled with insomnia?

Is there a drugless method by which we can give the nervous over-workt business man natural sleep without injuring him with drugs? Can you help me out? P. C. SCHENKELBERGER, M.D.

Montreal.

Editor MEDICAL WORLD-Now that the glorious Fourth of July is once more over and the daily papers have reported their usual number of victims, it would be interesting to have you or some one of the WORLD readers to explain why it is that so many little victims of innocent pleasure die of tetanus. never hear of such cases occurring at any other time, except as a result of fireworks accidents? I have no reason to doubt the correctness of the daily press reports as to the diagnosis, but I am puzzled to know from whence the infection. Accidents occur daily, men are wounded by the thousands in war time, but such heartrending stories of lockjaw as are reported from Fourth of July accidents very seldom or never reach our ears from these other sources. Moxahala, O.

G. C. SNYDER, M.D.

[We are not aware that there is any special reason for more cases of tetanus following Fourth of July wounds than follow a like number of similar wounds at other times. The dreadful results following the customary method of celebrating this day have claimed the attention of medical as well as lay press, because the accidents come all on the same day. The mere fact that the deaths following the Fourth of July directly due to wounds from explosivs are in excess of the deaths following contests of armies is sufficient to attract attention. It is a fact that tetanus is more apt to follow wounds of the feet and hands than of other parts of the body, and these are the parts most frequently wounded in the use of fireworks and holiday explosivs. It is also well known that more cases occur in warm weather than at other sea

[The drugless treatment of insomnia is more of a fantasy than a fact Hypnosis; suggestion; local application of cold and hot water by means of baths, or of packs; judicious rest, or exercise in moderation, as the case may require; due consideration of the evening employment before retiring, etc., have all been commended, and have found favor in certain Each individual case must be studied, and the treatment adapted to it. There is a cause for the imsomnia, and when the cause is found and removed, the insomnia will disappear. An hour's talk with your patient should suffice to reveal wherein he has sinned or is sinning against the ordinary rules of hygiene; then correct the vicious habit. There are now numerous drugs of value in insomnia against which no harmful effect has been recorded, yet naturally the thoughtful practician would prefer a "drugless" method. If you get such a method, you will find that it will require remodelling with each patient treated, general rules of proper living excepted. See editorial on "Insomnia."-ED.]

Questions Concerning Growths on Skin.

A. L. RUSSELL, M. D.; DEAR DOCTOR :-In re your article on Growths on Skin (MEDICAL WORLD, Aug., 1904), kindly answer two questions:

(1) Hirsuties. When epilation is practised do you not find a certain irritation causing a coarseness of skin which is to the patient as objectionable in its way as the hairs?

(2) Epithelioma. I have used this method successfully in two or three cases, but your article fails to describe a minor point which in actual practise is one of the difficulties. To quote your article: "Either paste

is covered with lint and left in position 24 to 48 hours; it is then removed and poultices applied."

How do you manage to retain your dressing and poultices, and what sort of poultices do you use? It is no easy matter to fasten a dressing on a small epithelioma situated near the margin of the lip, or on the alae nasi, or on the outer canthus of the eye, or even on the cheek; and I feel sure that a supplementary note dealing with this matter would be useful to readers, as it certainly would to me. Thanking you for your useful article, and in anticipation for your further information, I am yours truly, R. S. THORNTON,

Deloraine, Man.

[Yes, it is true that certain patients suffer from this coarseness of the texture of the skin, but it is not nearly a universal rule, and I find that lady patients would rather endure it than to have the more unsightly hair.

The dressing may be held in place where a bandage is not readily applied by overlapping strips of ordinary surgeon's adhesiv plaster. I cut the strips long enuf to afford considerable attachment to the skin. By a little care, the dressing may be held neatly in place about the eye, nose, or mouth. It does not matter what is employed as a poultice, so that ordinary cleanliness is employed. Anything that is kept moist and warm will do: flaxseed meal; corn meal; hops; bran; or a mixture of any two will answer well. All of them may be kept antiseptic by addition of an appropriate amount of carbolic acid.-ED.]

Removal of Moles.

DR. A. L. RUSSELL; DEAR DOCTOR :-In the August WORLD I notice your treatment for warts, moles, corns, etc. For years I have been troubled with a mole, situated at lower edge of eyebrow. Fearing the laity might have some grounds for their belief that "if interfered with they turn to cancers," I let it alone. I have concluded now to try and remove it. There are others on my face and body, but this special one is in the way. I remember my mother had them, so they may be hereditary. This one is one-quarter inch at base, about three-eighths inch long, and is disposed to hang out over the eye. Do you use the common glacial acetic acid? Applying the acid three times daily, about how long should it take to remove it? or should I apply it more frequently? I have toucht it a few times. I notice it has turned black on top. Should the part that has turned black be removed? or shall I continue to daub it? Does it just dry up and fall out? How does it get loose at the base? Is there any other dressing to apply to heal it after removal? I am rather anxious about it, and any instructions you will give me I shall receive gratefully. I am getting to be an old man now. I graduated at St. Louis, Mo., in 1859. I have done lots of surgery, but have always been afraid to tackle that mole; but it is getting to be an eyesore J. C. FORD, M.D.

now.

Rocklin, Cal.

[Doctor, simply go after it; that's all. Use the ordinary commercial glacial acetic acid, full strength. In a case like yours where the wart is fusiform in shape, you would apply the acid to the entire surface. Remember the caution to suspend operations whenever soreness is manifest. The wart darkens, and finally disappears; in some instances a crust is formed which may be pickt off so as to admit of the acid reaching the living part of the wart more quickly; but in many instances no crust is

formed and the growth simply "goes." In a few cases which we have treated it has been necessary to resume treatment for a short time after the lapse of a few months, but only in a very few. It will leave no scar. No definit time can be stated as required for removal, some consuming more than others. There is nothing to be gained by applying the acid oftener than three times a day, since the treatment must be discontinued when soreness is manifest; some skins, indeed, will not tolerate applications made more frequently than twice daily. Now, brother surgeon, work up all your nerve and tackle that mole.—ED.]

Persistent Hiccups.

Editor MEDICAL WORLD:-Male, sixty years of age, came with history of having drank a great deal, but for a year or more had not drunk any. Was taken on Sunday night; I saw him Thursday. However, another doctor had him in charge three days. Don't know what his treatment was, but he had blistered his stomach. Patient had an aggravated case of hiccups. His urin showed nothing abnormal; vomited frequently; couldn't retain much food or medicin; didn't suffer much pain, only a soreness in the chest from constant hiccuping. Had very little fever during the attack.

I gave him hypodermics of morphin and nitroglycerin; also gave him Hoffman's anodyne, chloral hydrate, and at the beginning gave him a purge, and all during the attack kept his bowels open with mild doses of salines; but was unable to control the hiccup, only temporarily; two hours at a time was the longest I was able to get them stopt. On the sixth day I washt out his stomach with warm normal saline solution and put him on dessertspoonful doses of neurosine every two hours; on the eighth day I put him on a tonic of iron, quinin and strychnin. About the third day of my treatment I put a blister on back of patient's neck. My treatment from the sixth day acted well, and patient improved rapidly.

I thought this was from a gastritis, the result of drinking; but was a little doubtful, inasmuch as he had not drunk any for about a year, and had not suffered any unpleasantness whatever. Were my diagnosis and treatment right? T. B. MCANALLY, M.D.

Buda, Texas.

[It is not likely that the gastritis could have been due to intemperate use of liquor a year before. It was doubtless a gastritis, but probably due to indiscretion in diet; however, many other factors may cause the development of hiccups. Your treatment was good, but you might have tried other remedies with earlier success. See editorial on "Persistent Hiccup" in this issue. Examin your patient carefully for high-colored urin, any evidence of uric acid diathesis, and orificial troubles, and you may be able to ward off another attack.— ED.]

Local Dropsy.-Dysmenorrhea.

Editor MEDICAL WORLD:-First I wish to say to those members of THE WORLD family who have not carefully scanned the August number, to do as I have done: Place a tab on it, reading as follows: "This number is full of good meat. Save it and digest and re-digest it in the future."

Brother A. L. Russell, Midway, Pa., keep writing your articles on Dermatology. They are worth rereading and saving. Now, Brother Editor and family,

I wish good formulae and advice on cases of local dropsical diathesis. Say, in legs below knees and no place else, and of long and short standing; also in arms and no place else; one of a year and the other of shorter standing. General health of each good. The youngest twenty years, the oldest sixty-five years. I have not, as many say, exhausted the materia medica," but have tried a few remedies, but with no lasting results.

THE WORLD, as I see it, is becoming too precious for extended, long historical explanations, unless under discussion. THE WORLD is doing good in Montgomery County, in stamping out the cure-alls."

Give us some formulae on dysmenorrheal troubles without the knife. The formula in THE WORLD for "Orange Blossom " is not complete. We find a trace of tannic acid in it, and that is not all; who can find more? A brother in the family. Dayton, O.

É. P. CLEMENS, M.D. [Localized swelling is due to renal or cardiac disease, or to local conditions, such as venous obstruction, feeble heart, pressure in the lymphatics, malnutrition in the capillaries supplying the part, some depraved condition of the blood, or an individual predisposition to this affection. We could not advise you what to do in either of your cases; you will find a different treatment necessary in each. It will first be necessary to ascertain the cause, then treat it appropriately. No one could do this except after a personal examination. We could only suggest that in event of your being unable to find the locally acting cause, that you keep the patient upon diuretics; elevate the limb, and insist upon rest in bed. Another plan might be of service: the application of an elastic bandage, either of flannel or rubber. The latter admits of the patient following his customary vocation, and often the bandage need only be applied for a few days to cause a complete disappearance of the trouble.

Dysmenorrhea, likewise, arises from a multiplicity of causes. It would not be possible to outline treatment applicable in all cases, except upon general principles. The local causes of dysmenorrhea are an important factor, and vary with individuals. They are imperfect development of the uterus, atresia of the cervix, displacements of the uterus, inflammation of the tubes, ovaries, pelvic connectiv tissue, and of the endometrium. The origin of the trouble may be constitutional; in which event the treatment consists in change in environment and attention to the diet, bowels, and toward the general health, rather than in the employment of local measures. Dysmenorrhea due to flexions or to stenosis of the cervix requires dilation and perhaps curetment. Endometritis requires local depletion and often curetment. Hyoscin, chloral, and the bromids, given before the expected periods, have given good results in many cases. It will be much

more satisfactory to examin a given case and then make a full report of the exact condition; then we will be in a position to advise the treatment for that case.-ED.]

Asks Help Too Soon.

Editor MEDICAL WORLD:-Lady of 46 years has been confined twelve times; the last time six years ago. Ten years ago feet began to feel cold and clammy; never been warm since to the touch except as bathed or rubbed. Five years back she began to have what she called weak or nervous spells and slight perspiration every two or three days, and coldness extended to knees and hands, and from then to present time has grown worse gradually until now she is in bed with the following symptoms: respiration normal, pulse 78 and a little feeble; slight pain in bladder at times; some days does not void any urin, and at best does not void exceeding 8 or 10 ounces; specific gravity 1,016; no albumin or precipitates. From one to three times in twenty-four hours she takes spells of sweating and saturates all clothing and the part of bed on which she lies. The least bit of air or draft produces a severe toothache, or neuralgia all over entire body that is exposed to it. Appetite is as good as expected of one to be in bed all of the time. Tongue coated at times and liver a little sluggish, but tongue cleans off with a brisk purgativ. Sometimes there are some eructations of gas, and on eating heartily suffers

some pain in stomach for about an hour or two.

I am giving elixir lactopeptin for indigestion, solution acetate potassium, camphorated tr. of opium, spirits nitre and water aã for kidneys and bladder. Shall begin picrotoxin at once for sweating. Am now giving strychnin sulfate grain four times a day, and nitroglycerin to three times a day. This case has just fallen into my hands, and I have not had time to tell what my treatment will do; but am very desirous of giving relief and ask for help. OKLAHOMA.

[You should have tried your own ideas of treatment before asking others for help. We are always willing to aid every subscriber, but one may cripple his self-reliance and dwarf his independence by seeking aid too early in any given case. We opine that your patient enjoys staying in bed, and we would suggest vigorous treatment. If the picrotoxin fails to check the excessiv perspiration, we suggest the use of agaricin, of a grain two hours before the expected paroxysm and a like dose one hour before; not over three such doses to be given daily. You must also get that skin accustomed to a little more exposure, and probably the best method would be to give sponge baths in bed twice a day, beginning with warm water, and gradually reducing the temperature day by day until really cold water is being used. As the temperature approaches cold, or if an honest chill follows the contact with the sponge, follow with brisk friction, or give a little whiskey twenty minutes before the bath. Put her on vaso-motor stimulants, and bathe the feet in warm mustard water once or twice daily, as an adjuvant to restoring the circulation. Have her drink several quarts of water each day, no matter what diuretics you see fit to employ. We believe hygienic measures will do more for her than drugging. See that there is no uterin complication. If you find an enlarged and tender uterus, try depletion by glycerin tampons or suppositories. Remember that at her time of life the menopause is generally about to become a considerable factor, and govern yourself accordingly. The rest cure of S. Weir Mitchell would fit her case admirably.-ED.]