We have the only Master Clinical Thermometer in the city. We test every Clinical Thermometer which bears my name. We are therefore enabled to furnish an absolutely accurate Clinical Thermometer at a low price, and we know that they are correct within specifications. "Reliance" Clinical Thermometers, guaranteed within 1-5 of 1°. .$.65 1.00 PAUL WEISS, OPTIGIAN 1606 CURTIS STREET DENVER, COLO. Reed Publishing & DENVER, COLO. We can offer you something better, both in quality and price, than is possible elsewhere-no matter where you are located. Let us prove this to you MOUNT AIRY SANATORIUM E. TWELFTH AVE. AND VERMONT ST. DENVER, COLO. OFFERS SUPERIOR EQUIPMENT AND ADVANTAGES TO CASES OF GENERAL INVALIDISM, NERVOUS AND Cerebral Exhaustion, Drug and Alcohol Addiction. Separate modern dwellings for men and women; electric light, city water, six suites with open grates, one short block from the Fairmount car direct from the Union Depot. For terms, illustrated circular and references, address DR. J. ELVIN COURTNEY, Academy of Medicine Building, Denver, Colo. Sanatorium Telephone, York 849; Office Tel., Main 1579.1 PUBLISHED BY THE COLORADO STATE MEDICAL SOCIETY VOL. III. DENVER, MARCH, 1906. No. 3 EDITORIAL COMMENT COPYING AND REFILLING. Medical literature during the past score of years has been replete with articles written by members of the profession on the evil of substitution, but in the opinion of the writer copying and refilling constitute a thousand fold greater evil than substitution. When a druggist substitutes he tries to give the patient "something just as good," and it is a safe guess that the remedy substituted is in the same pharmaceutical class as the one prescribed. An honest druggist will not substitute and it is the business of the physician to see that his prescriptions do not go to the shop of any who belong to the opposite class. physician because his medicine did no good. In all cases it is better to instruct the druggist not to copy or refill and then each patient will get the remedy suitable to his condition. Some years ago the writer discovered that he was treating a great many more patients than his office register showed and he was forced to have printed on his prescriptions, "this prescription is the property of the undersigned and must not be copied or refilled." Since then the honest druggists who appreciate his trade have been very careful to carry out this instruction and he is also pleased to note the fact that a great many physicians have adopted much the same plan. The Supreme Court has decided that an architect who receipts "for professional services" can protect his work and his client cannot build two houses on the same plans, while the architect who receipts for "plans and specifications" forfeits his right to ownership, therefore the patient who pays for professional services does not own the prescription. All druggists copy and refill unless ordered not to do so by the one writing the prescription. Some diseases may reSome diseases may require the same medicine indefinitely, but in the vast majority of cases the remedy of to-day will not be suitable for next week or next month as the disease progresses toward recovery the pathology must change and hence the therapeutics should change also-besides the necessity for a change to suit the changed pathology of the case there is another reason why prescriptions should not be refilled and copied. The empty bottle or box is often passed to the neighbor in a spirit of charity in the hope that the A CASE FOR THE STATE BOARD. neighbor may be relieved of a supposedly similar condition. What follows? If the neighbor gets relief the doctor gets no credit and the neighbor is saved the necessity of calling a physician. If the neighbor gets no relief he will not call the same Protect your patients (and others who imagine they have the same disease) by protecting your prescriptions, and you will find that every druggist who is a gentleman will be pleased to carry out your wishes. If you know of any who are not gentlemen, don't allow your prescriptions to go to their store. On the editor's table lies a circular which loudly proclaims the fact that a new drug store has been opened in Denver that fills a long felt want because the proprietors have their own prescriptions "for all ailments" and that money will be refunded if their "bottled health" is not satisfactory. The circular ends with this invitation: "You state your ailment and we'll provide the cure." If the State Board of Medical Examiners has an attorney his opinion would be of interest to the profession. If the scheme is legal it will prove a great boon to the profession of Denver, for once the case is diagnosed the patient need not trouble the physician any further but go at once to be cured. The editor of COLORADO MEDICINE has several heretofore incurable cases which he will be pleased to furnish with a correct diagnosis and cheerfully refer to the man who can cure with his own prescriptions. NEW EDITORS. Our esteemed contemporary, The Colorado Medical Journal, is rapidly coming to the front as a leading, up-to-date journal, worthy of national recognition. The recent appointment of Dr. T. Mitchell Burns as editor-in-chief and Dr. J. N. Hall as consulting editor will insure for The Journal the best management possible. Both of these gentlemen have won their spurs by hard, conscientious work and stand at the very top of the ladder in medicine to-day. If they bring to their new positions the same painstaking accuracy and energy that has characterized their work as practitioners, The Journal will prosper and the wisdom of their selection will have been demonstrated. We have no fears for the ethical standing of The Journal. IF BARNUM CAME TO EARTH AGAIN. If the famous old showman were to be re-incarnated he could find the nucleus of a good side show right here in Denver. The visitor to our city will probably never forget "All kinds of shoe laces," but when it comes to variety of wares, old "shoe laces" must yield the palm to a certain member of the State Board of Medical examiners. In his office are four windows and on each window a sign, the letters of which are only limited in size by the size of the pane, as follows: No. 1.-"Dr. Blank," Diseases of Wo men. No. 2.-"Dr. Blank," Nose, Throat and Chest. No. 3.-"Dr. Blank," X-Ray and Electricity. No. 4. "Dr. Blank," General Practice. In the interest of professional modesty we are glad he didn't have any more windows, but he would have saved a lot of paint had he used but one sign, viz.: "Diseases of the skin and everything inside." PROSPERITY. When the crusade was started to secure advertisements for COLORADO MEDICINE it was well on in November, and as most advertisers make their contracts early in the season for the next year's display, the editor received many letters reading: "Our allowance for advertising has been exhausted, but we thank you, etc., etc." In spite of the lateness, however, we were fortunate in catching some who still had money left and who kindly helped our new enterprise along. February and this issue have added to the roll of honor, and we still have some good "prospects" that will "pan out" later. Mention COLORADO MEDICINE when writing to any of our advertisers. We have also succeeded, after two months' hard work, in having COLORADO MEDICINE entered as second-class matter in the post-office at Denver, and thereby effected a saving of thirteen dollars per month on postage. ORIGINAL PAPERS NERVOUS DYSPEPSIA. By HOWELL T. PERSHING, M. D., By nervous dyspepsia I mean the functional disturbances of digestion, whether gastric or intestinal, which are caused by exhaustion of the nervous system. It might, therefore, well be called the indigestion which complicates neurasthenia. The usual history is sustantially this: A young adult of neurotic inheritance is subject to prolonged mental strain, through overwork, anxiety, or the repetition of many small annoyances. He begins to be mentally weary and to suffer from many disagreeable sensations, especially in the head, spine and abdomen. The abdominal distress is often associated with some distension and the gases of the alimentary canal are often discharged in excess both by belching and through the bowel. A diagnosis of “stomach trouble" is made and a vigorous attempt to cure it is begun. Diet is restricted, often by cutting out the most necessary and most easily digested proteids and substituting indigestible porridges, vegetables and fruits, or perhaps more rationally by restricting starch and sugar and giving meat. An old-time practitioner will very probably give pepsin and hydrochloric acid; a recent graduate will be more comprehensive and give all the digestive ferments, with a few extra enzymes, at once. A strictly up-to-date physician may give a test meal, wash out the stomach, which he finds to be 5 centimeters too low, and tell the patient of more defects in his digestive apparatus than he had had ever dreamed of. The patient now realizes that his illness is far more serious than he had supposed and that it is only by the exercise of great care that he can recover. On sitting down to a meal he thinks anxiously of what will disagree with him; after the meal he closely studies his sensations to see what has disagreed, and is greatly alarmed to find that even the permitted foods cause distress. He now studies his tongue, his pulse, his urine, his stools, and draws conclusions as to the cause of his bad feelings. He talks of his sufferings to his friends, each of whom condemns some food which the others allow, at the same time advising him to try another doctor, or to leave regular physicians altogether. In his distraction he undertakes systematic study of foods and digestion so as to have an independent opinion of his own case. He worries more and more, eats and sleeps less, falls far below his normal weight and is obviously a very sick man. I shall not attempt to prove the truth of my statements in regard to this type of disease, but having studied and treated a large number of such cases, and having myself committed all the sins which I now condemn, I shall state the opinions to which my experience has led me. my tone is dogmatic I hope it will be pardoned for the sake of clearness and brevity. If This form of disease is very conumon, the cases probably outnumbering all those of organic disease of the stomach and small intestine. The origin of the disease is not in errors of diet or in the digestive organs at all, but in exhaustion of the brain; therefore, systems of diet and remedies directly addressed to the digestive organs are futile unless the nervous system is at the same time rested, soothed and strengthened. In the prevailing methods of treatment the rules of diet, the remedies for indigestion, the use of the stomach tube and the self-observation involved add to the patient's load of anxiety, suggest and develop new symptoms and increase the symptoms of indigestion, thus giving at false confirmation to a wrong diagnosis. Then the consumption of food is likely to be so reduced that starvation becomes a most efficient cause of further nervous exhaustion, aggravating the symptoms of indigestion. Caught in this vicious circle, it is no wonder that the poor patient, fearing permanent loss of health, perhaps insanity, goes from one physician to another until he begins to adopt some of the innumerable fads which cranks or swindlers have devised for him, such as making a meal of nuts and raisins alone, eating raw oats and raw wheat, drinking olive oil, going without breakfast, abstaining from food altogether, etc., etc. One of my patients, a chemist, in despair over previous failures, had determined to make a radical cure by calculating the exact amount of each kind of food for each meal according to its value in calories; and he not only tried to regulate each of his own meals by this calculation but to make his wife and daughter do the same. This led to his examination by a neurologist, not to say by an alienist. What should be done for a patient of this class? In the first place the diagnosis should be complete as well as accurate. A careful inquiry as to previous illness and as to the onset of the present symptoms will reveal the neurotic predisposition, the origin of the disease in mental stress and the other signs of neurasthenia. Organic disease of the digestive organs can be excluded by the history, together with such physical examination as will neither distress nor alarm the patient. It is with reluctance that I advise against the use of any means of accurate diagnosis, but the possibilities of examination are so nearly infinite that we must always exclude many in choosing those which we consider best; and in these cases the test-meal and stomach tube are unnecessary and practically certain to do harm unless skilfully guarded by reassurances. If on external exami nation the stomach is found distended by gas and its lower border an inch or two below the normal level, no great stress need be laid upon the fact; it may be taken for granted that both the muscular tone and the chemic processes of the digestive tube will vary, from the normal without any serious harm being done. The diagnosis having been made, we should fix in mind the one absolutely essential object of treatment: that the tired brain must be rested, soothed, invigorated and restored to its normal equilibrium. It is a problem in applied psychology. The patient must be taught serenity, repose, relaxation, courage. This is a great task, whose execution I have considered with more detail than would now be proper, in papers read before this Society and before the Neurological Section of the American Medical Association.* All habits of self observation must be broken, all advertisements pertaining to disease habitually shunned. If the patient has any popular books on health the physician should get possession of them and see for himself that they get into the furnace: the ash-heap is not a safe place for them. The tendency to fads must be restrained by all the sweet reasonableness the physician can command. As to diet, only the grosser errors should be corrected. In general, meat, eggs, fish and poultry are most desirable, while breadstuffs, potatoes, vegetables and fruit may well be moderately restricted. The most essential thing is that the patient should eat a generous quantity of food without fear. Let him be assured that even if he does occasionally overeat or partake of some food that is really unwholesome, the bad result will be tem *Pershing-The Treatment of Neurasthenia, Colorado Medicine, 1903, Medical News, 1903. The Treatment of Emotional Disturbances, J. A. M. A., Jan. 30, 1904. Defects of Will in Medical Practice, J. A. M. A., Oct. 28, 1905. |