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His death was lamented by Cotton Mather in the following poetical effort:

His pen did once meat from the eater fetch,
And now he's gone beyond the eater's reach;
His body once so thin was next to none.
From hence he's to unbodied spirits flown;
Once his rare skill did all diseases heal,
And he does nothing now uneasy feel;
He to his paradise is joyful come,

And waits with joy to see his Day of Doom." His gravestone, bearing the following epitaph, still stands in the Malden burying ground:

"Here lyes buried ye body of that faithful servant of Jesus Christ, ye reverand Mr. Michael Wigglesworth, pastour of ye Church of Christ at Maulden, who finished his work and enterd upon an eternal sabbath of rest on ye Lord's Day, June ye 10, 1705. in ye 74 year of his age.

Here lyes in silent grave below,

Maulden's physician of soul and bɔdy two.” Even in their dual capacity, these ministerphysicians had a hard struggle to obtain a living, having to take their pay in anything they could get-cordwood, codfish, grain and such like produce. The records show that they were very poorly paid. A physician's fees were only 6 pence a visit at Hadley and Northampton in 1730, and 8 pence at about Revolutionary times. Tooth-drawing cost 8 pence extra. One independent New Haven doctor charged a shilling a visit, and got it.

A good idea of the physicians' fees in England a little earlier than this may be obtained from the funeral bill of John Dudley, who died at London in 1580. He was a brother of the Thomas Dudley who came to New England. To Dr. Astlow for his attendance during his sickness

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The total of his funeral expenses was about 310 pounds. From this it will be seen that only about 25 pounds were for medical attendance, including the 10 shillings that went to the "poore" man that made the epitaph.

The small fees of the olden time led the physicians to adopt all kinds of expedients to help them to get a living; most of them compounded their own medicines and sold them to their patients; this may account for some of the mammoth doses of those days. Others were innkeepers, schoolmasters and storekeepers; one was a butcher, and this in more ways than one.

A noted physician was Dr. Nathaniel Ames of Dedham. He was doctor, innkeeper, and also wrote almanacs. In 1725 he began the publication of his almanacs, and continued to do so for thirty-nine years. His house of entertainment was at the sign of the Sun, eleven miles from Boston.

Even the quack soon found his way to this new land. "Runnagate chyrugeons" and "physickemongers" they were called. In 1631 Nicholas Knapp was fined and whipped at Boston for pretending to cure the scurvy with a "water of noe worth" and which he sold "att a very deare rate." The same treatment might possibly be used with advantage on some of their nineteenth century descendants.

With the doctors making and selling their own medicines, and the people preparing many at home, there was no room left for the apothecary, and we find none at all until 1761, when Thomas Hanasyd Peck of Boston advertises "plain buttons, black thread, cards, lace and small bowstrings, verdegrees, copperas, men's and boys' felt hats, castor and logwood." I have found one advertisement of that time which may be that of an apothecary, in the Boston Post-Boy of September 8, 1760:

JOHN LORING.

At his shop near the Great Trees. A fresh
and General Assortment of Medicines,
both Clinical and Galenical. Spices of all
sorts; likewise Redwood Logwood, Allum,
Copperas, Brimstone, etc. N.B.-True
Lockyer's Pills Bateman's Drops, Stough-
ton and Duffey's Elixir, etc., etc.

Through this conglomeration of doctoring, preaching, butchering and tavern keeping a great deal of the science of medicine in this country has passed in its evolution down to the present time. Looking back at that little handful of resolute men who first obtained a foothold on the rock shores of New England, we can only be amazed at what has taken place since then. We should also be very thankful, too, for it was through the struggles and trials and efforts of our Puritan forefathers that many of the comforts and blessings we now enjoy have been produced. Some of them foresaw the future of this country in their day, and were glad. I can find no better closing than the prophetic words of Edward Johnson, in the Wonder Working Providence of Zion's Saviour in New England, 1654: "The Lord Christ intends to achieve greater matters by this little handful than the world is aware of." 743 Inglehart street.

MEDICAL HEMORRHAGE.

The following is an extract from a paper published in the Lancet by Dr. F. J. Smith:

He divides medical hemorrhages into (1) those with some severe, perhaps even necessarily fatal, constitutional or general dyscrasia or diathesis; and (2) those without such concomitant.

The first group contains purpura, scurvy, hemophilia, leucocythemia, blood-poisoning, etc. In all the diseases of the first class the attempt should be made as far as possible to cure the tendency to bleed. The writer directs atten tion to the immediate treatment of actual hemorrhage and especially to the inquiry as to what place, if any, ergot and astringents occupy in the treatment of the condition. Modern pharmacology asserts of ergot that it (a) stimulates the vaso-motor center of the medulla and any other subsidiary centers controlling blood pressure, and thereby causes an increase in this pressure; (b) depresses the motor ganglia of the heart, bringing about a slower and less powerful pulsation; (c) acts on unstriped muscle fibers, causing their contraction and thus a diminution in the caliber of the arterioles; (d) has no effect in producing a coagulum in a blood vessel; (e) is a direct amenagogue and ecbolic; and (6) markedly increases the peristalsis of the bowel. If the bleeding be arterial, he does not see how the effect of ergot can be other than to increase it; blood pressure is increased throughout the arterial system, the damaged artery must therefore feel it equally with the others, for we have not even the suggestion that ergot can exert a selective act on on certain arteries; if it does thus feel it, then from the very fact of its damage and laceration it must be less capable than before of restraining the outflow of blood from its lacerated extremity—the stream may not be so large, but the force of the current is greater, and hence the greater liability to wash away any clot that nature has formed. It must be remembered in this connection that ergot has no tendency whatever by its presence to promote clotting at the end of the blood-vessel or in the extravasated blood. If, on the other hand, the blood comes from a vein or from capillaries, it is easy to understand why ergot might be expected to act beneficially by diminishing the flow of blood through the arterioles to the damaged spot. If the author's steps in the argument are sound, it follows that it should be determined whether the hemorrhage to be

arrested is arterial, venous or capillary before ergot is administered.

The means other than ergot at our disposal include rest, complete and absolute, both physical and mental, which must occupy the place of foremost importance.

It is the fashion to place an ice bag on the chest or abdomen when severe bleeding has taken place, but he has not seen the slightest reason for believing that it has the slightest effect in checking the hemorrhage. It hinders. sleep and rest and constantly reminds the patient of his peril, and should therefore be avoided.

He next considers styptics and astringents, and mentions particularly sulphuric acid, bis-muth, chalk, acetate of lead, perchloride of iron and tannic acid, with the vegetable preparations that contain it, such as catechu, kino, hamamelis, etc. Any of these are extremely useful if they can be applied directly to the bleeding surface; that is, in gastric or intestinal hemorrhage, but as indirect-namely, after absorption-controllers of bleeding, he believes them to be as useless or even as harmful as ergot itself. Turpentine, too, must be omitted, as from its volatility it may reach the affected area by inhalation, while iodide of potassium and purgatives are very useful adjuvants.

Cerebral hemorrhage is almost invariably arterial, consequently he believes that ergot and its allies are contraindicated; rest is strongly indicated, and possibly purgatives and iodide of potassium may be given if further treatment seems desirable.

The epistaxis of youth rarely requires more than the application of cold water to the nose or sniffing up of powdered aium; that of age should not be too hastily dealt with because it forms a sort of safety valve against intra-cranial arterial rupture. Should it be too prolonged, the local measures will again be useful. If also the patient be placed sitting upright with the feet and legs in very hot water, then plugging of the nares will be but rarely required. Pharyngeal hemorrhage rarely requires any treatment, but the cautery may be applied if necessary.

In hemorrhage from the lungs all active efforts will have but little effect. In bronchitis, in pneumonia, and the early stage of phthisis the bleeding is rare y more than slight, and will usually stop of itself if the patient be kept quiet in bed and his mind put at rest as to his

danger. Should it prove more profuse, opium must be pushed and iodide of potassium administered. In rare cases of emphysma and in the advanced stages of phthisis we feel anxious to employ more active measures. To bing the patient well under the influence of opium, with perhaps the inhalation of turpentine, is as much as can be done.

In hematemesis we are more favorably situated, and can adopt measures more actively and with greater hope because drugs can reach the bleeding spot. In the young, ulceration

into an artery is the almost invariable causation, and here the swallowing of ice or ice-cold water in small quantities, or per contra and better, hot water at 110 degrees Fahrenheit is very likely to be of use, with bismuth, chalk or strong solutions of tannin which will very rapidly cause the formations of a plugging clot. Ergot, in such cases, is of no benefit, but is worse than useless.

In the hematemesis of older people there are two probable or possible sources for free bleeding: (1) An ulcer, chronic or malignant, in which the treatment just suggested is the best; and (2) a ruptured vein or capillary oozing from a cirrhotic liver. Here, in addition to the foregoing, ergot may be useful, though free purgation is preferable.

In the hemorrhage of typhoid fever, if profuse and accompanied by collapse and subnormal temperature, morbid anatomy has shown that an artery has always been ruptured. Such cases are almost invariably fatal, but even here op.um will save some lives. He advises the

use of bismuth and liquid preparations of lead, though he doubts if they can reach the spot in time; ergot must make bad worse. Slight hemorrhage in typhoid fever, he has been led to look upon as a favorable sign, and one that does not require any active treatment beyond a little extra care in withholding food and seeing that the bowel is kept open.

In all uterine hemorrhages ergot finds its best and most correct application, on the ground, first, that such hemorrhage is almost invariably venous or capillary; and secondly, that the mass of unstriped muscle fiber in the organ is so large relatively to that in an arteriole as easily to overcome any extra arterial blood pressure.

In conclusion the author makes four propositions for discussion:

1. That most cases of medical hemorrhage cease spontaneously and are essentially not dangerous to life from loss of blood.

2. That active treatment by icebags and ergot frequently defeats its own purpose; if the bleeding ceases, it does so in spite of the

treatment.

3. That where experience of morbid anatomy or the profuseness of the blood loss makes an arterial source certain, ergot is distinctly contraindicated.

4. That complete rest, opium and iodide of potassium are our most powerful and trustworthy agents for the emergency, except in certain special cases; for example, from the stomach, where additional treatment by astringents should be applied.

THE SANITARY DISPOSITION OF GARBAGE.

Dr. Frank Donaldson discusses the sanitary disposition of garbage as follows (Med. News): No measure in the sanitation of the city is more fruitful of beneficial results than that embodied in the proper care of the streets and in the sanitary disposition of the garbage. In a great city the removal of ashes, paper and similar waste products is a comparatively simple matter, but the final disposition of garbage is not the least important and troublesome, task of the department of street cleaning. In seaport towns it is customary to tow the waste to sea and dump it far from the shore. While this practice proved efficient as far as the city itself is concerned, it rendered seashore resorts practically uninhabitable during the summer months. Moreover, the absolute loss of what

ever valuable products the garbage was capable of producing when subjected to proper treatment violated all laws of economy. These considerations led to the establishment of crematories or reduction plants, not only in New York, but in other cities, notably Philadelphia. Early attempts to get rid of garbage and at the same time to derive benefit from its destruction were not defective, but the evolution of the process and final triumph was worked out by the authorities of New York city, and it furnishes an interesting and instructive lesson.

The first efforts in this direction resulted in the building of a long brick furnace, with provision at the top for dumping in whole cartloads of rubbish, and an arrangement for maintaining a fire. Many noxious fumes were

driven off by this process, and a second fire was maintained near the entrance to the chimney or smokestack, through which all the fumes passed and were largely consumed and destroyed. Such furnaces simply destroyed the waste, and to that extent were satisfactory; but in order to extract products of commercial value from the garbage elaborate modifications were necessary.

The process as now conducted at Barren Island will perhaps be understood by following the garbage in the various processes to which it is submitted. The garbage, separated from ashes paper, tin cans and such waste material, is collected daily from each house in the city. The garbage carts make their rounds on schedule time, and each householder sets out the garbage can on the sidewalk as nearly as possible at the time the cart is expected.

The scows promptly receive the contents of the carts at the dumping stations. Thus the average exposure of the garbage is from eighteen to twenty-four hours, this time being necessary for loading and unloading each scow; after which it is cleaned and disinfected before returning for another load. The average daily amount of garbage reduced during September was nearly six hundred tons, which is considerably less than the daily capacity of the reduction plant. The receptacles are kept as clean as possible, their contents dumped into carts and conveyed in scows moored at convenient dumping places along the water front, and these are towed by steam tugs a distance of ten miles to the reduction plant at Barren Island. Here the contents of the garbage boats are carried by machinery up an inclined plane to the top of one of the buildings and dropped through chutes directly into perpendicular cooking tanks or digesters. about fifteen feet long and five feet in diameter. These number forty-eight and are steam tight. The garbage is cooked by steam, which is forced through pipes opening into the bottom of the digesters. This process is continued five hours at a temperature of about 300 degrees Fahrenheit. This not only disintegrates, but completely sterilizes the contents of the tanks.

The cooking being completed, the mass is emptied into sheet iron receiving tanks, from which it is received into bags about thirty inches square. The filled bags then are placed in presses. The presses are sufficiently large to receive nine of these bags, one above the other, with appropriate slats between. Gradual pressure is then applied, and the liquid as it is

forced out runs into a tank, and the grease contained therein, as it rises to the top, is removed and placed in barrels for transportation. This grease is used largely for wheel lubrication, but some of it is refined and finds its way into other channels. The dark liqud remaining was formerly allowed to escape into the ocean, but it is now passed into a series of condensers, the product being a substance rich in ammonia and phosphates. There remains a chemically pure and odorless water which is discharged into the bay. The solid material is then conveyed to the drying-house and placed in a masticating machine, after which it is taken to the dryers, which are horizontal, steamjacketed cylinders sixteen feet long, containing revolving shafts with arms. This drying process continues three to five hours, and when the mass, which is called tankage, has been sufficiently reduced, it is conveyed to the storage floor, where it is put into bags for use as fertilizers..

The relation of such a factory to the health of the community in which it is located is naturally determined by the cleanliness of the building and the machinery, the condition of the garbage water, and the manner in which it is disposed of, and the character and amount of odor which escapes. The sanitary condition of the building and machinery is such that little more odor is noticeable than that which naturally arises from a large kitchen. This is accomplished by preventing the escape of unpleasant gases in the cooking process. These gases are drawn through condensers, and after being thoroughly washed are discharged into the bay after being diluted 50 to 100 times in salt water. The grease is conveyed through close pipes and promptly barreled, and the dark, foul-smelling liquid from which it is drawn off is in its turn condensed and finally escapes as chemically pure liquid. Moreover, it has been demonstrated by this plant that as a mercantile enterprise the results are most satisfactory.

In making these assertions regarding the absence of objections to the presence in a neighborhood of a reduction plant like the one described, the writer is cognizant of the fact that many complaints are made about the odors which at times annoy the inhabitants of the shores of Long Island, and which have been and still are attributed to the reduction plant. Undoubtedly as the plant was originally set, much of the odor complained of came from the cooking garbage, but the method as

conducted to-day is practically free from these charges. When we consider what a menace to public health putrefying garbage in the streets and alleyways of a large city and along neighboring shores is, the great importance of its prompt collection and sanitary disposition can hardly be exaggerated.

At the present time the question of garbage disposition seems to be satisfactorily answered

by the success of the Barren Island plant. It is a significant fact that the death rate of New York city has been less than at any time in its history. No one can affirm that the clean streets and prompt disposition of the garbage has been the only factor in producing this result, but undoubtedly it claims its fair share of the credit. Why should not a similar system be introduced in Chicago?

TREATMENT OF BRONCHIAL ASTHMA.

He

The Boston Medical and Surgical Journal (Therap. Gaz.) contains an article by Frederick I. Knight devoted to this subject. After discussing the various views of the pathology of asthma, he considers its treatment. thinks the simplest remedies, and those attended with the quickest relief, if relief comes at all from them, are those which are taken by inhalation. They all act more or less by exciting secretion, and most of them by relaxing spasm also. Nitrate of potassium, stramonium, belladonna, hyoscyamus and arsenic are found in variable numbers and proportion in most of the powders and cigarettes in the market. One drug or one combination affects one, and another another, and only trial will decide which is best for any particular case.

If no relief comes from inhalations, the milder internal remedies may be tried. Phenacetine and other remedies of its class may give relief. Strong coffee or alcoholic drinks may suffice. If necessary, less simple measures, such as the inhalation of ethyl iodide or amyl nitrite, or the internal use of nitroglycerin may be employed. The latter drug is very efficient in the relief both of spasm and hyperemia. A large proportion of cases recover quickly on the combined use of potassium iodide and nitroglycerin. Unfortunately the system soon becomes tolerant of the latter, and the doses have to be constantly increased.

If still more powerful measures are called for, then those agents must be used which profoundly diminish the irritability of the nervous system. The hypodermic injection of morphine and atropine is one of the best, and will usually give relief though the writer has seen a case which always resisted morphine, yield readily to the inhalation of chloroform. The use of chloral, which often gives speedy relief, is to be avoided if possible on account of the depressing after-effects.

He next discusses the treatment of patients in the intervals, the treatment of the underlying

conditions which, singly or combined, cause the attacks.

The first factor is the condition of the lungs and bronchi. A previous inflammatory condition exists in many according to some authorities in a very large majority of cases. In some there is physical evidence of a chronic bronchitis. In these cases especially potassium iodide gives marked relief either as an absorbent or as an alkali, increasing and thinning the bronchial secretion. Sometimes, no doubt, the relief comes from its action on enlarged glands which compress the vagus.

Potassum iodide should be given in doses of from five to sixty grains, if needed, for a thorough trial, unless contraindicated. The syrup of hydriodic acid is sometimes useful, but is not so efficacious as potassium iodide, and needs to be given in larger doses than those usually prescribed. The dose should be from a dessertspoonful to a tablespoonful. In case of derangement of the stomach the writer has found the sodium iodide and strontium iodide better borne, and more acceptable to the patient.

All of the iodides should be given largely diluted, ten or fifteen minutes before meals. The continued use of the nitrites, either alone or with an iodide, when indicated, is of great benefit. Nitroglycerin may be used but the nitrite of sodium in one or two grain doses. has a more lasting effect.

In case of emphysema, strychnine is useful; also expiration into rarefied air.

The second factor is pressure on or hyperesthesia of the vagus nerve. Potassium iodide may act favorably on enlarged glands which press on the vagus; the same is true of arsenic, which is also a good nerve tonic and is said to act favorably on the bronchial mucous membrane. Other nerve tonics are indicated, especially quinine, which in large doses may even abort a paroxysm.

The removal of the direct irritant is possible

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