of the infant. It is never wise, when it is possible to employ any of the mother's milk (poor quality or quantity excepted) to dispense with it entirely and suddenly; even if but one or two nursings daily can be furnisht, it may be very valuable. Before the age of ten months, if the milk become deficient in either quantity or quality, the physician should make a diligent study of the mother as regards her physical condition and personal habits, in order that he may be positiv that the deficiency is irremediable before ordering the babe weaned. Chemical analysis is the only scientific and accurate method of determining the food value of mother's milk, yet the expense of the procedure renders it imperativ in many instances that we employ less scientific measures. First, then, if a babe is growing at a normal rate, we assume that it is getting sufficient nourishment. If it is not growing normally, or if diarrhea or vomiting is persistent after other assignable causes have been eliminated, we assume that the milk is either insufficient in quantity or deficient in quality. If a child is unwilling to cease nursing after a proper length of time at the breast, or if it relinquish the nipple with a wail of dissatisfaction, the milk is likely insufficient.

Nurs

The health of the mother is always to be considered as much as that of the babe. ing longer than ten or twelve months puts a drain on the system to which few women should be subjected. The popular belief that a woman will not became pregnant while nursing has no foundation in fact, and should be explained to every mother who persists in nursing her infant for an unduly long time. Some women in whom the molimen appears while nursing, notice that the baby sickens each month when the flow appears. women should feed the baby artificially during the continuance of each flow, and usually the milk again becomes fit for use in a few hours after cessation of the flow. Should pregnancy occur, the mother should wean the infant at once, regardless of age, since no woman has the strength to nourish two bodies in this manner, and either the fetus or the infant would suffer in nutrition.

Such

Advice upon this matter is strictly in the province of the family physician; and he should realize this and act accordingly.

Simple Continued Fever.

There is a fever, common in the Southern States and occasionally observed in the northern sections, which is neither typhoid nor para-typhoid. It continues for two weeks to three months, and no lesion has yet been discovered. Cases coming to autopsy reveal nothing beyond a state of lowered vitality of

all tissues, and the deaths are rare indeed. While the fever generally has a slight morning remission and evening rise, it is seldom observed over 103° F. There is a slightly coated tongue, possibly slight gastro-intestinal derangement, malaise, etc.; but there is nothing essential but the fever. Quinin eliminates malarial origin, and the large percentage of recoveries removes the question of tuberculosis. Not many cases give a history of any affection preceding from which infection might have arisen-as in pneumonia or pleurisy which sometimes leaves a local focus of infection which manifests itself by mild constitutional symptoms of septicemia. The disease has been studied by DaCosta, John Guiteras, Cain, Baumgarten, Goodhart, and Hale White, who respectivly labelled it "protracted simple continued fever," "thermic fever," "atypical continued fever of Nashville," "simple continued fever," "innominate fever," and "inexplicable fever." The name, simple continued fever is probably the best, and now has a recognized place in our text-books on medicin.

The diagnosis is an important point, since it is necessary to save the patients from being subjected to the hardships of typhoid fever treatment, when the exigencies of the case do not require it. Fortunately the Widal test admits of elimination of typhoid fever from consideration; remittent and intermittent fever may be set aside by proper therapeutic tests; miliary tuberculosis can usually be detected when carefully searcht for; and the fever sometimes attending chlorosis, hysteria, or nervous disorders ought not to baffle long, any practician of ordinary ability.

The treatment is entirely symptomatic, and merely includes tonic and supportiv measures. If practicians would study their cases closer, there would be fewer cases of "walking typhoid," "para-typhoid," etc., reported.

Reflex Cough.

Reflex cough is one of the symptoms most frequently misinterpreted by the careless and superficial diagnostician. Even after cursory examination has failed to reveal anything wrong with the bronchial tubes or respiratory apparatus, after divers expectorants, sedativ and stimulating, have failed to relieve, still the misguided medication is persisted in until digestion becomes deranged, and the after condition of the patient is worse than the first. Surely there is no excuse for this variety of malpractise at least there is no excuse for failure to suspect the true origin and for neglect in attempting to search it out. In the summer season, especially, when a patient presents a history of an intractable cough,

which may be simply an annoyance, or which may be violent and distressing, and which is not accompanied by any evidence whatever of coryza, asthmatic attack, or bronchitis, it is high time for the practician to examin other parts of the body beside the thorax.

The "stomach cough" is known and recognized in many instances by experienced mothers or "old grannies," and the practician who gives a cough mixture is pretty certain to aggravate the case, if indeed he be fortunate enuf to escape ridicule at the hands of wiser, if unlearned, therapeutists. This variety of reflex cough is toucht upon but gingerly, when at all, by the text-books; yet every practician of experience has noted it. It comes from an overloaded or improperly functionating stomach, and promptly disappears after a cathartic and ingestion of digestants, with a little judgment regarding diet. Impacted cerumen in the ear is a not infrequent origin of reflex cough, and one which will likely baffle the man who makes "snap diagnoses." The nose is the organ most frequently at fault, and it is always deserving of an examination when the suspicion of reflex cough has been aroused. Cough, without coryza, may be induced by simple, chronic or by hyperplastic rhinitis; spurs, deflections, or abnormalities of the septum; congestion of the cavernous tissue covering the vomer; adenoid growths in the pharynx; enlargement of any of the turbinated bones; or by any vasomotor disturbance in the nostrils. If, upon inspection of the nose in cases of suspected reflex cough, any alteration, malformation, or unnatural irritability of the intra-nasal spaces be discovered, they should be promptly remedied by suitable application or surgical procedure. Even when nothing can be discovered, the nose is often at fault; in which case the application of a cocain solution at suitable intervals will confirm the suspicion and establish a diagnosis in the majority of cases. Failure of the cocain should not encourage one to abandon the search in the nose when other parts have been examined.

In any event, never let yourself be led into the error of a continued erroneous diagnosis regarding a reflex cough.

The Oat Cure: A New Dietary for Use in Diabetes Mellitus.

Von Noorden, the German clinician who has done so much to revolutionize the dietary of chronic nephritis, is out with an essay advocating the "oat cure " for diabetes mellitus. He reports 100 cases treated by a strict diet of oats, with a little albumin and some butter. He does not claim to have cured all of them, but he only reports one total failure. He be

lieves that mild cases without diaceturia are aggravated by the oat cure, and his total failure belonged to this class.

His diet table when instituting treatment follows: 250 gm. oats; 100 gm. album'n; and 30 gm. butter, daily. A little black coffee or a little brandy or wine is allowed.

It has been known previous to the publication of this paper that the rigid "diabetic" diet, as outlined in the text-books of a very few years back, was not calculated to maintain the strength of the patient, and certainly was not productiv of practical results as regards cure or even improvement in any but exceptional cases. It was also recognized that a plain diet rich in carbohydrates was generally better borne by the average patient than the mixt diet containing but small proportion of carbohydrates. He is very fair hydrates. He is very fair in recalling the injurious effects following the craze for the absolute milk diet as promulgated by Winternitz; the "rice cure" of von Duhring; and the "potato cure" of Mosse; and he distinctly states his wish that such radically minded enthusiasts will not expect too much of the "oat cure. He reiterates an old axiom in medicin to the fact that all patients cannot be treated alike. Every one reading the paper (The Post-Graduate for April, 1904) will be convinced of his sincerity and of the value of the method.

It is simple, logical, and easily followed, and we advise its trial in suitable cases of diabetes. Just as to which cases are suitable for the oat diet, von Noorden is not yet prepared to state. He brings out the contra-indication mentioned above quite forcibly, and pleads for careful study of the effect on each individual case. If the profession will use this diet in the careful and conservativ spirit which characterizes the originator's efforts, it will not be long before we will be able to classify the cases as to whether or not the diet is suited to them. Certain it is that a distinct advance has been made (altho it can hardly be dignified as a discovery) and much good will result.

Readers having diabetic patients upon whom they wish to test the effect of the diet should keep a complete record of the weight and general condition of the patient, the excretion of ammonia and acetone, as well as the exact amount of glycosuria, in order that they may report their results in a manner that will be logical and convincing to those who have not been fortunate enuf to have had the management of a case. The entire "family" working upon this problem can soon turn in thousands of reports, and this mass of testimony will be convincing as regards the merits or demerits of the dietary. Von Noorden used the oats prepared by Knorr or the oat groats

of Hoenlohe, but we do not doubt that the oat meal of domestic manufacture is as fine and wholesome as any brand from across the sea.

Alopecia Areata.

The feeling which pervades the professional mind regarding the futility of treatment in cases of alopecia areata is, in many cases, as in a too numerous group of other uncured maladies, well founded. But this intractability is perpetuated by a deficiency in diagnostic ability, and a consequent carelessness or error in therapeusis which is not excused by the obstinate character of the disease. There ought to be more care exercised in making a diagnosis. Perhaps ringworm is most frequently confused with alopecia areata, but the two should be easily differentiated. Ringworm is always scaly, and even if in some cases this is slight, it is always found on close inspection; alopecia areata never presents this feature. The broken off or nibbled appearance of the hair in ringworm is not at all like the total baldness of alopecia. In ringworm the baldness is incomplete, and scattered hairs remain; in alopecia areata there is no evidence of inflammatory action, and no dilated follicles. Moreover, ringworm is contagious and more than one case is apt to occur in a family; alopecia areata is limited to the individual, and is a rarer complaint, only being contagious in cases of parasitic origin.

Dermatologists differ in their belief as to the etiology of alopecia areata, some holding that it is always parasitic in origin, and others that it is a neurotic affection. Perhaps the most likely hypothesis is that two distinct etiological factors operate: in some cases a neurotic factor, and in others a parasitic one. Such authorities as hold to the neurotic theory exclusivly, direct their chief effort to constitutional remedies; those adhering to the parasitic idea use exclusivly local measures. Since there is as yet no method of settling this dispute, the pathological germ never having been positivly isolated, it is the part of wisdom for the general practician to administer both constitutional remedies and to make local applications of antiseptics and parasiticides. It is also a fact that nearly all applications used are both stimulants and parasiticides, and hence meet the requirements of either theory. The constitutional remedy employed must be directed toward the toning of the nervous system, and the best of the class are the following:Arsenic, quinin, nux vomica, phosphorus, pilocarpin, the various iron preparations and cod liver oil. Duhring is one of the most enthusiastic exponents of the arsenic treatment. It is given in doses of 3 to 5 drops of Fowler's solution, or the solution of sodium arsenate,

three times a day, and must be continued thru an extended period. Nux vomica and iron fit in nicely with the arsenic. Pilocarpin has numerous advocates, and some advise its use hypodermically in doses of to of a grain in proximity to the affected part. Morrow, holding firmly to the opinion that the disease is parasitical in origin, believes that local measures are aided and energized by the internal administration of phosphid of zinc and strychnin; phosphorus, iron and strychnin; or phosphoric acid and strychnin.

Local measures should produce two results : An increast flow of blood to the part thru stimulation, and a positivly destructiv action against any parasite which may be present in the tissues affected. In this affection the skin will tolerate drastic measures so long as the unaffected part is not subjected to the medication. It is good practise to remove the loose hairs by grasping between the thumb and finger and pulling gently; the loose ones come out readily and those with firm attachment are not removed. In making application of the medicaments, the area included should not exceed a width of over one-half inch outside the actual area of baldness. With patients not seen oftener than once a week, it is not advisable to use the stronger remedies, but to employ some of the following: full strength of ointments of tar or sulfur; 5 to 15 percent beta-napthol ointment; oil of tar, pure or with alcohol, equal parts; equal parts of oils of cade, oliv, and turpentine, or the following prescription: sulfur, 2 drams; beta-napthol, i dram; lanolin, 2 drams; and vaselin, q. s. to make an ounce. Once a week, an area not to exceed two square inches, may be treated with strong applications of carbolic acid, chrysarobin, or tincture of iodin containing four grains of bin-iodid of mercury to the ounce. If the involved area be small, or if there be several small patches, the stronger remedies may be employed regularly. One of the best of these, as commended by Robinson, is an ointment made by incorporating 10 to 60 grains of chrysarobin to the ounce of lard or vaselin; or painting the affected areas with pure carbolic acid, as advised by Bulkley. In children, or in those with very sensitiv skin, the carbolic acid may be weakened by one to three parts of alcohol. Such applications are followed by inflammation and later by exfoliation. Stelwagon advises applying a saturated solution of chrysarobin in alcohol; and after this dries, painting over with two or three coatings of collodion. Another strong application, but one which must be watcht, is made of equal parts of oil of turpentine, tincture of capsicum, and tincture of cantharides. This often requires weakening with oliv oil. Those who

above circular letter, and also indicating that the same communication was sent to the entire list of news dealers, all over the country. Corinna, Me., is a small town, with only two doctors. Please notice that in this communication it is distinctly stated that the Brief is not confined to the medical profession, and circulation to the laity is earnestly solicited! And how about the Lawrence list of proprietaries: seng, chionia, neurilla, celerina, sanmetto, respiton, etc., etc.? Are they to be used "not only by the medical profession?" Are they to be pusht to the laity, like antikamnia? Wherever the Brief goes, the almanac advertisements of the Lawrence list go, for that is the purpose of publishing the Brief. What do doctors think about it? Many, like the above, have exprest themselves freely.

Dr. C. F. TAYLOR; Dear Doctor:-THE WORLD has so many short, practical articles from the rank and file of the profession (just the kind the busy doctor needs); and you and Dr. A. L. Russell give us such valuable assistance when we write you about our puzzling cases; and above all, your pages are so free from boosting proprietary remedies, that your journal easily stands on a high plane as a pure, clean, and valuable magazine. The stand that you have taken against "almanacism," in so-called medical journals (like the Brief), is certainly commendable. Keep on Dr. Taylor, the medical profession will certainly appreciate the good you are doing for the profession.

I wish some of the WORLD family would tell me where Dr. Lawrence got the rabbit's foot that he works on doctors to make them pay him to advertise his remedies. Well, it does look like "some of the people can be fooled all the time."

As I always expect to read THE WORLD, I inclose check for $3.00 for four years. Newstead, Ky.

B. A. CANDLE, M. D..

The Records Show that Doctors are
Speculators.

The Kansas City papers publish several columns concerning the Rialto Grain and Securities Co. fraud. Examination of the records show that there was only one resident of Kansas City who was an "investor," and he was a doctor! The papers give his name and address, but we will not do so. Further on in the report (Kansas City Star, Aug. 20) occurs the significant sentence: Many doctors seem to have been bitten." Then follow the names of some of them. A Kentucky brother wrote us not long ago, "What doctor would be fool enuf to send money to schemers for speculation ?" Let the above be a reply. Yes, there are lots of them; but we are trying to open the eyes of doctors, so they will not do such foolish things. When you get such things as the following, don't bite:

In advertising for business the company made liberal use of circular letters. One of these letters told its readers that the royal road to wealth was speculation. Another circular contained what purported to be a copy of a personal letter written to a man in New Orleans and supposed to have been written by "Mr.

Whitlock." The first paragraph of this letter is as follows:

In the course of my whole career as a speculator and observer of wheat conditions, I have never seen such a chance as now exists to make big money. I don't mean to double or triple your money, but to make at least $5,000 on every $500 and possibly double or triple that.

Following this there are what purport to be reports on the wheat conditions all over the world. These are used to show that wheat is a good thing to speculate upon.- Kansas City Times, Aug. 20.

A doctor who sent $25 soon received $35 in return after a short time. Thus encouraged, he sent more money, which did not return. And thus it goes. Better earn your money; and then you would better keep it, and get the good of it yourself, instead of turning it over to some schemer to enjoy.

Eight Great Secrets of Success.

A man with a mania for answering advertisements has had some interesting experiences. He learned that by sending $1. to a Yankee he could get a cure for drunkenness. And he did. It was to "take the pledge and keep it."

Then he sent fifty cents to find out how to raise turnips successfully. He found out: "Just take hold of the tops and lift."

Being young, he wisht to marry, and sent thirty-four one cent stamps to a Chicago firm for information as to how to make an impression. When the answer came it read, "Sit down on a pan of dough."

Next advertisement he answered read "How to double your money in six months." He was told to convert his money into bills, fold them, and thus double his money.

Next he sent for twelve useful household articles and got a package of needles.

He was slow to learn, so he sent $1. to find out "how to get rich." "Work hard and never spend a cent." That stopt him.

But his brother wrote to find out how to write without pen and ink. He was told to use a leadpencil.

He paid $1. to learn how to live without work, and was told on a postal card: "Fish for easy marks, as we do."

German Orthography.

The German language, as written at present, is in about the state of confusion in the matter of spelling that has long characterized our own tongue. We are glad to learn, therefore, that an attempt to secure uniformity, so far as medical language is concerned, will be made at the next general meeting of the editors of German medical journals--New York Medical Journal, September 10, 1904.

So you see," there are others." But those "others" (and this applies to the French, too) recognize the fault, and are trying to correct it. How about ourselves?

Where hot packs fail to bring relief in acute inflammation of the kidneys, pilocarpin will often aid admirably.

A crystal of chloral in a cavity of an aching tooth and held in by a pledget of cotton moistened with clove oil relieves like magic.

In angina pectoris, after giving nitrite of amyl by inhalation, it is good practise to apply a mustard plaster to the precordial region.

Arsenic is beneficial in that form of diarrhea characterized by an uncontrollable desire to evacuate the bowels immediately after taking any food.