[Doctor, we are sorry to say that both are correct. Both methods have high authority, so it is a matter of taste, or of choice, between the two. We wish some one could decide, once for all, so we might have uniformity; but no one can do this, so usage will have to finally decide it. Where classical ideas and habits of thought are prevalent, as in some of the universities, there the Italian method is likely to be prevalent; elsewhere, the English method is preferred. We decidedly prefer the English method, and we think that it is destined to prevail. ED.]

A Form for Statement of Accounts. Editor MEDICAL WORLD:-Observing the various forms of statements, etc., from members of the family, I would present the one in use by myself. Noting the one presented in the August WORLD is mild, and the one in September WORLD is exceedingly strong, I believe this one to be just about between the

two.

I also inclose a case record card, as compiled

by myself, which speaks for itself as to its convenience. One can carry same in pocket, and as we are not infallible, important questions sometimes may be forgotten. It answers as acute or chronic records, impresses the patient that you are not neglectful, then with the symptoms underlined on the card, they afford ample time when returning to the office for further consideration for diagnosis. I have them for sale; they are they are not copyrighted, as I believe we should all stand with an open heart to one another. I can furnish them to the family as reasonable as they could have the composition (type-setting) done alone.

I am in most hearty sympathy with your attitude toward those who swindle the people (and the profession). They outrage justice, and are a foul disgrace. I trust they may be transported to Hades, to his Satanic Majesty, that they may deal with the old fellow who rules there, in place of fastening themselves upon honorable professional men.

HERMAN H. LAHKE, M.D.

1542 Linn Street, Cincinnati, Ohio. [We suggest that those who are interested send a postage stamp for a sample of the case record cards, and terms, and if the terms are too high, you can have some printed for your use by your own printer. The bill form follows.-ED.]

Meningitis.-Clay in Inflammations. Editor MEDICAL WORLD:-In THE WORLD for September I note an article in which the writer urges clay poultices frequently applied to the head and spine for the relief of menin gitis. I shall try it It is simple and humane. I believe in clay. But before I speak of clay I wish to relate my experience in the Indian Territory with meningitis. It was in the midst of an epidemic. It seems that every one stricken with it died.

A good old woman, part Indian, said to me, "Dock, are you curing any of them?" "No not one, so far." "Well, you'd jis as well follow my treatment then, they won't no more'n die no how."

I said, "What is your treatment ?"

She said, "Put fifteen drops of tr. belladonna in one tumbler of water; put fifteen drops of tr. aconite in another glass of water; give a teaspoonful of one, one hour, and the other the next hour, and so on."

I tried it. In such an emergency I would try anything. I treated eight more cases; six recovered but one relapst, leaving five cures out of eight cases. Gentlemen, when your cases are all dying, don't fail to try the old woman's remedy. A man would rather live unscientifically than to die very scientifically.

Now about the power of clay as a poultice. A few years ago I was called six miles into the country to see a very old man. He had been riding on the hounds of a wagon and dragged his leg over a stump five days previous to my visit. I found the leg broken, very black and swollen, with signs of gangrene. I thought of antiphlogistine (which is Colorado clay perfumed and ground), but it would have taken several dollars to buy that kind of clay. So I told them to send out to the hills and get a half bushel of clay. Directed them to keep leg in clay mortar for 36 to 48 hours.

I noticed a peculiar grin on some of the faces of their wise old neighbors. I reflected about it a moment, as I was a new doctor in that community. However, I turned and drove home.

After I was gone one of them askt my name. A wag replied, "that's Dr. Henry Clay, sir; he treats altogether with clay.' I am told these fellows, wise or otherwise, had considerable merriment over the clay doctor.

But when I returned thirty-six hours later all had changed. In place of a solid swollen leg I found the clay had pulled out the inflammatory exudate, the swelling had disappeared, circulation was establisht, and the limb was receiving its nourishment. The tissues of that limb were soft and flexible like the other limb. I put on a splint and the man made a perfect recovery. With a leg rapidly becoming gan

grenous in an old man, amputation would in all probability have proven fatal.

After this the clay doctor was the big man in that neck of the woods That was in the Indian Territory. I have used clay in pneumonia. I shall use it in meningitis.

I have applied a clay mortar (previously boiled and cooled) to pull out old inflammatory exudates in an old ulcerated leg. Thus you establish the circulation and nourishment

to the parts. Then any antiseptic will heal the ARTHUR C. BELL, A.M., M.D.

ulcer

Dallas, Texas.

Case of Strychnin Poisoning. Editor MEDICAL WORLD:-A boy came running into my office saying that his father had swallowed some tablets and had spasms.

I at once suspected strychnin poisoning. Went to house with chloroform and chloral in my bag. Arriving at the house I found near the bed a bottle containing about 500 tab. trit. of strychnin sulf. gr., by Wyeth & Bro. The wife said that her husband was drunk, and while she was absent from the house he had taken a number of these tablets.

The patient was 48 years old, strong and well built; a habitual drinker. My entrance into the room brought on a convulsion. I learned that he had taken the drug about two hours before I arrived; that he had not eaten that day (it was then 1 p. m.).

The tetanic convulsions affected nearly every muscle of the body. The limbs were tossed about and were very rigid; the head was thrown forward and then backward; the entire body was very rigid. Opisthotonos was developing gradually. Pulse was 200, temperature 100.5°. The least noise brought on a convulsion, as did also the pricking of the hypodermic needle. These convulsions lasted about 30 seconds, and then all muscles became relaxt, only to become rigid again at the next convulsion. The abdominal muscles were hard, as well as those of the chest. Eyeballs did not stare. Patient was entirely conscious thruout attack. Was unable to tell just how much strychnin was taken.

Treatment.-Stomach pump brought up almost nothing; hence washt out stomach. (This did little or no good, as in two hours almost all the drug was absorbed). Stopt stomach washing at once and gave hypo. of apomorphin

gr. which caused vomiting inside of six minutes. Every act at vomiting brought on a convulsion. During convulsions I gave inhalations of chloroform which of course instantly aborted spasms. Between the convulsions I gave morphin sulf. 4 gr., hypo. every twenty minutes for three doses. I then gave per mouth (after vomiting stopt) twenty grains of

426

The Strychnin Habit and Its Treatment. Doctor, did you ever stop to think how many "strychnin fiends," if I may so call them, you have made of your patients?

Many physicians will give a patient who is suffering from some slight disorder and temporary weakness a prescription for strychnin. Usually this is all the patient needs, and after a short time he feels all right, with the exception that he feels weak and "run down" without the medicin he has been taking; he, therefore, keeps on taking it without the doctor's order or knowledge. Soon he is a confirmed habitue, and cannot get along without it. He naturally goes to it, as the morphin and cocain fiends do their beloved drugs. Of course the strychnin habit is not as pernicious a habit as the two just mentioned, but there comes a stage when poisoning sets in, his jaws feel stiff, he can't sleep, his sexual desire becomes extremely great, and he has a "smothery feeling" in his chest, with other kindred symptoms. He soons finds out it is this potent poison that is causing these disagreeable symptoms, and he cuts down the drug for a while. As soon as the superfluous strychnin is eliminated, then there is a craving for more, and he starts in again. He keeps on again until he is overcome by the poison, or borders on the verge of insanity or neurasthenia. In the advanced form of the trouble there are constant twitchings of various muscles, producing a condition resembling chorea. There is also a great emaciation present, possibly resulting from the insomnia and diarrhea.

Patients soon find out the advantages of the hypodermic syringe, and will usually employ it; others will "eat" it, in the form of tablets or sugar of milk triturations which some "good" (?) druggist will put up for them.

The treatment is simply to withdraw the drug suddenly, and give fifteen grains sodium bromid t. i. d., p. c., and one one-hundredthgrain doses of trinitrin between meals. For the "eaters" give a one-grain tablet of quinin sul

fate in lieu of the bitter strychnin. The quinin will not form a drug habit; of that you may be sure.

Prophylaxis is, for physicians to try and use less of the drug than they do. Some men seem to think that strychnin is the "universal panacea," judging from the way they prescribe it. When I was a drug clerk, nearly every other prescription that I put up contained strychnin; often times for short periods every prescription would contain the drug, and many of them from the "biggest doctors" in Denver. Understand, I am not condemning strychnin, which is a useful drug and oft-times a life saver. I am only cautioning about its careless use.

I would like to hear from the "familee" what drug habits they've come across. I've seen opium (morphin), atropin, codein, cocain, digtalin, cannabis indica, bromid, chloral, chloroform, arsenic, hyoscin, and trinitrin fiends. DR. F. AMMON.

Lawson, Colo.

Poisoning by Wine of Colchicum. Editor MEDICAL WORLD:-On the 23d of last February four Indian boys, pupils of the Hoopa Valley Indian Boarding School, drank sixteen ounces of the wine of colchicum root. Early in the morning of that date two of the boys entered the school dispensary and stole the drug, which was mistaken for port wine, as afterwards developt. It was carefully secreted until after the boys had eaten their breakfasts, when they were joined by two other of their schoolmates, and the four went into an unoccupied building within the school campus, where the bottle containing the wine was passed around in regular order until the last drop was drained from it.

Three of the boys were between the ages of sixteen and twenty, and the fourth about twenty-four. From one of the youngest I learned that the drug was drunk between the hours of eight and nine in the morning of the 23d; that, so far as he was able to judge, they each drank about the same quantity; that neither of them experienced any uneasiness or discomfort up to about one o'clock in the afternoon; that within half an hour after eating lunch at noon all four vomited very freely, from which they obtained a degree of relief; that the three younger vomited only three times more during the entire afternoon, and that by six or seven o'clock in the evening they had been completely relieved; that the oldest young man continued to vomit at intervals of from one-half to an hour until six in the evening, when the severity of the symptoms was increast, so much so that the young man

himself, as well as his associates, became alarmed, and I was sent for.

I saw the patient first at 7.30 p.m. of the 23d, and it did not take long for me to decide the character of the case I had to deal with, notwithstanding the young man guarded his secret so well that I was unable to ascertain anything that would give me a clue to the origin of the trouble. His pulse was very weak and thready, his breathing rapid and shallow, and a cold, clammy perspiration was on the surface, all indicating a considerable degree of prostration. Every effort to get at the cause of the trouble being in vain I began meeting the indications with such remedies as I considered applicable. I gave him sulfate of strychnin and nitro-glycerin hypodermically and succeeded in giving some relief thereby, the action of the heart becoming more regular and its volume increast.

Patient

seemed to breathe deeper also. After I had administered the fourth heart stimulant hypodermically I left the care of the case in the hands of a competent nurse for the night and retired, with instructions that I should be called if my patient got worse.

I was sent for at three the following morning, the messenger saying that my patient was thought to be dying. When I entered the room it did appear to me that the end was not far away, but I decided to change the treatment and remain with him until morning. I procured two ounces of alcohol and began giving him teaspoonful doses every half hour, and contrary to my expectations the young man began to improve from the first dose. After the fourth teaspoonful had been given he went to sleep and slept about two hours. He awoke feeling much better and called for a glass of milk. I allowed him to have four ounces of sweet milk with lime water, which was retained. I continued the alcohol at longer intervals thru the entire day, and by 5 o'clock p.m. of the 24th, patient sat up and was able to take as much nourishment as I allowed him to have.

At four o'clock in the afternoon of the 24th I was called away, about six miles from my office, and did not return until nearly nine that evening. I was surprised and vext to find that the relativs of my patient had taken him to his home out on the reservation, about five miles from the school. The removal was accomplisht over the protest of the nurse, and in their rush and anxiety to get him away before my return, the medicin was forgotten and the treatment ended at the time of their departure from the school. If I had returned before dark I should have followed and forced his relativs to return the young man where he could have had proper care. At six o'clock

in the morning of the 25th a messenger arrived at the school to report to the Indian agent that the young man had died at three o'clock that morning. This report did not surprise me at all, but, as I informed the relativs afterwards, there was absolutely no necessity for this young man dying; if the treatment had been continued he would have gone on to complete recovery.

I

There are at least two points worthy of consideration in the cases here reported: 1. The quantity of the drug taken at one time. 2. The length of time it remained inoperativ in the stomach. Prof. H. C. Wood states in his excellent work on therapeutics that death has been produced by two drams and a half of the wine of the root, and that recovery has taken place after an ounce was taken. In these four cases four ounces each was taken. account for the drug remaining inoperativ for so great length of time to two causes: In the first place the boys had eaten a very hearty breakfast almost immediately before the wine was imbibed, and secondly, the drug is very slow of absorption. There are two important features connected with the case that ended fatally that I cannot account for satisfactorily to myself: 1. The fact that four boys drank almost the same quantity of the wine, three recovered with very little gastric disturbance, while the fourth and oldest one died from the effects of the drug. 2. There was an entire absence of purging in all four cases, which is usually one of the most prominent symptoms, according to recognized authority. J. S. LINDLEY, M.D.

Hoopa, California.

Locations.

Here

Editor MEDICAL WORLD:-Judging from the numerous letters I have received regarding my observations in Louisiana, there has been some misapprehension, which I wish to set right. It has not imprest me that there is an opening for physicians as such in that state. Every town visited seemed fully supplied, with the possible exception of Bay St. Louis, a resort on the gulf coast east of New Orleans. there is a great concourse of residents of the southern cities, during the summer when the gulf breezes are delightful. In winter there is quite an influx of people fleeing from the northern cold, so that this pleasant place has a busy season all the year round. As well as one could judge from a two weeks' visit, there is room here for a physician who uses modern methods-and in that I may say frankly I mean the alkaloids. Wherever we went, as was inevitable, people began to ask "the old doctor" about their ailments; and after a little friendly dosing with these remedies there would be a group of patients anxiously inquir

ing where they could find a physician who would use them, since the manufacturers did not sell to the laity. This was also the case at Baton Rouge, but at Bay St. Louis there seemed to be a dearth of physicians of any and all

sorts.

There is a fine medical school in New Orleans which fills the state's quota with wellqualified men of the highest professional standing. The physicians I visited seemed fairly well-to-do, and from what I saw of their dealings with patients, the southern doctor must have been free from the financial stress so trying to the practician in the northern cities. But I did not see evidences of affluence anywhere. The office was always shabby, and the doctor never notably well dressed. Nor was his equipage modern or kept in the spick-andspan neatness of a thriving practician in the North.

The financial problems require careful handling, and in this a stranger would be very apt to fail. Half the population is colored, and what fees the doctor gets from them on which he can count with certainty are those paid when the service is rendered. I imagin that credit to this part of the community shades into the charity list. With the whites, on the other hand, the largest hearted benevolence and courtesy rules. The physician who charges The physician who charges a lady teacher or clerk full fees and insists on prompt payment is apt to get himself disliked. Unhappy is the doctor who has no means and no wealthy kin, but must live on the produce of his daily labor.

Now I am giving simply my impressicns, gathered during a seven months' residence in the state. The Louisiana doctor may be amused by this, or edified, as to how he looks to a visitor; or he may feel like correcting my crude impressions and explaining how I have erred. I would like to hear from him personally. But I am firmly of the opinion that the state does not need more doctors, but mechanics and farmers; men to do the work, to develop the great resources and till the rich fields now lying idle, and feed the hungry people with their products. Men who know how to farm can make almost any sort of arrangements with the owners of land; lease, buy, or work for wages, and with ordinary industry and forethought can be independent in a few years. Men who have a little capital and know how to manage it, can find more openings and less competition than in the North. Men who know how to "do things" get big wages there, and seem to be in demand, as even in New Orleans we heard of the difficulty in securing carpenters and other mechanics, even for four to seven dollars a day. On the other hand, young men in stores get

from twenty to forty dollars a month. proletariat in the South is unwieldy.

The

Now, I want to say a word to my brethren on the subject of changing locations. When I first graduated and surveyed the field for an opening, it seemed to me that every point that could support a physician had two already. The only place where there appeared to be an unfilled need was a mountain hamlet, where a man wrote me a doctor was badly needed; that he would be glad to introdure one, and would board him reasonably; but he spoiled it all by adding that he had a large library of medical books for sale! Relics of some poor fellow's failure to make a living, I thought, and declined.

Every place is full, but when you consider that some are morally unfit for the trust that must be given the doctor, that some dull their faculties with drink, some are lazy and do not keep up with the times, it seems as if a really good man could creep in.

Put it the other way-your wife is ill; and where will you find a real doctor? Prof. A. is the big mogul-but he pays no attention to any case that has not a $500 operation in it. B. has the consulting practise, but he blames everything on the heart, while his rivals C. and D. see only uteri and nerves respectivly in everything that comes within their ken. E is not so bad, but he is never known to advise any treatment except fifty-grain doses of quinin; while F. has his hypodermic syringe out before you have told him who is ill. Fact is, when you need a real doctor, one who can diagnose a case properly, and knows something of the action and uses of medicins, he is none too easy to find.

But such as we are, in we go all together in this great struggle for existence, and the fittest to survive survives, and the unfit are crowded out. May be that the fittest is not the best, but he possesses the Anglo-Saxon traits in greater perfection; and what these are we learn from the history of the race. Anyhow, in the struggle one man wins and the other has to starve or look for a new location. But he will probably find the same struggle anywhere, and if he allows himself to be crowded in one place he will be crowded in the next; and so the old conflict comes again.

I fear there is a great deal of false teaching extant, in copy and Sunday school books. Pick out the leader in any city, "the great surgeon," and ask his competitors who in that burg steals most patients, does most mean tricks, drives closest to the edge of the code, and it may not be the great man-but I fear you will find it is. Why? Because he has in him the traits that make for success; and success must have a firm financial foundation.