a. m.: Chill; temp. 103.5; pulse 95; pain severe; righ side of belly tense.

Went there with counsel at 2.30 p. m., as I had advised operation, to which family demurred. We found: Temp. 99; pulse 80; only diffuse soreness; patient discharged the 18th. No recurrence since.

Feb. 11, '99, was called to see Mrs. M. She had complained about some pain and soreness in right lower quadrant for three. days previous. Right leg numb after walking. Severe pain at or near McBurney's point; more so on pressure, then when releasing pressure. Sick at stomach; temp. 98.4; pulse 80.

Treatment: Injection of decinormal salt solution. Oil of wintergreen 10 percent in oliv oil, locally. Internally 10 grs. salicylate, with echa folta and peppermint every 4 hours. Fowler's position; no food.

Feb. 12th: Little pain, only diffuse soreness; no tension in muscles; temp. 98.6; pulse 80; no vomiting; a little ringing in

ears.

Feb. 14th: Temp. and pulse normal; no pain; only a little diffuse soreness. Bowels move freely. Stopt salicylates, continued echafolta, allowed feeding.

Feb. 15th Patient apparently well; only diffuse tenderness over right side of belly. Complimented myself as to results of salicylates.

Was recalled Feb. 20th; patient had chill at 9 a. m.; severe pain in lower right side, not localized; temp. 98; pulse 85; a little weak and irritable; vomits.

Feb. 21st: Had counsel; decided on operation. Nothing definit; pain easier; diffuse soreness from liver down to below umbilicus; temp. 98.3; pulse 78; no vomiting.

Feb. 22d: Dr. Gregor, of Watertown, N. Y., operated; red injection around colon and appendix; end of appendix free in cavity; swollen in lower end; bloodless.

Case I lookt like operation; case 2 seemed never to be dangerously ill. Both had salicylates. Comments are not necessary. P. H. VON ZIEROLSHOFEN.

Croghan, N. Y.

P. S.-On page 103, March WORLD, do you not mean sodium nitrite in place of nitrate? [Yes.-Ed.]

EDITOR MEDICAL WORLD:-Inclosed find $3 check for four years' subscription to the Doctor's Friend, viz., THE MEDICAL WORLD.

My bank account is much larger than it would have been without THE MEDICAL WORLD, and its other features make it invaluable to me. Your Monthly Talks show the right spirit, whether they meet the approval of all men or whether they do not. Yours very truly, Patten, Me. E. J. FARNHAM.

Mine Practise in West Virginia. EDITOR MEDICAL WORLD:-Perhaps a description of the work of a West Virginia mine doctor (and there are many of them in this state) will prove of interest to the readers of THE WORLD.

First, understand that the conditions and fees may vary some in different sections of the state, as some one may come along later with an entirely different story in reply to this letter. I am going to tell of the work as I know it.

The company which I have in mind collects from each single man employed 50 cents per month; and from each married man $1. At some places it is 40 and 50 cents respectivly. This amount (less 7 percent for collection (?)-maybe it's for giving the doctor the work) is paid to the doctor about a month later by the company's check. As the doctor has no list of the number of men employed, the company has it all its own way; and he may go on treating a man after he has been discharged or has quit working for the company, unless he accidentally discovers the fact.

For this sum the doctor is expected to go whenever any of the miners or their families call him; treat them, visitors included, furnish all medicins and dressings, pull teeth, and attend obstetric cases-and there is no race suicide among the miners. It is for him to go, whether he thinks it really necessary or not; and occasionally he is called upon to give first aid to some mule or horse hurt in the mines. Fortunately, the state has establisht four hospitals, situated at points convenient to the mining section, to care for all laboring men who may get injured while at work, and this relieves the mine doctor of considerable work, tho he has usually to accompany the patient to the hospital, paying his own expenses and sometimes that of the patient as well.

The superintendent, store manager, and bookkeepers usually favor the doctor with their patronage, tho the chances are that they may forget to charge themselves with the usual monthly assessments.

The advantages are: To the men, a guaranty of first-class medical attention when needed (for the company doctor will average in ability with other practicians), and by the co-operativ method of paying, which is no hardship to any one. I hardly fail to see, tho, just why men who are making from $45 (day laborers earn about this lower amount) to $100 and sometimes more, should not pay a regular fee as does his

neighbor, a farmer, whose earnings are often less, unless it is that it gives them more money to spend at the company store. Their house rent is not a very large item, for the company houses are usually good ones and none of them rent for more than $7 per month-most of them for less.

To the doctor: He is sure of his pay from a class who, as a rule, are classed as poor pay; and he is insured a fixt income, varying only as the number of men employed vary. He is also insured a large practise, the very thing most physicians are working hard to obtain, tho every call is a loss to the mine doctor. The miners have very little knowledge of prevention of disease, depending on the doctor to cure them after they get sick. The work is usually convenient, so there are no long, cold rides, tho he is expected to attend any man who lives close enuf to the mines to come to his work every day, and I have known them to come as far as three miles.

The disadvantages to the men are not many, the principal one being that they feel compelled to have the company physician because they are paying him, tho they may not like him, and have not the money or inclination to spend it for another physician. Much of the prejudice they may have is cultivated, as they are great faultfinders. I believe that the company doctor will give a serious case as careful consideration as tho he was getting a regular fee for every visit; because it is to his interest to get the patient out as soon as possible.

The disadvantages to the doctor are, that he is called upon to treat so many trivial ailments, both imaginary and real, that he tends to grow careless in his examinations and unfit himself for any other practise; for there is no inducement for him to improve himself. I have seen company physicians neglect to take the temperature. The social advantages, even if he had the time to use them, are very limited in a mining community. He must, of course, give them medicin when he is called, whether they need it or not, or they will soon be making complaints to the superintendent, who likes to exercise his control over the work of the physician as well as the miners.

It is nothing unusual to hear the men tell of going to the doctor to get medicin when there was nothing the matter with them, because, as they say, they were paying the doctor and they ought to get something out of it. It is considered a great joke to tell about the time "Doc" gave tablets to a man

with a broken leg, for they think medicin in tablet form does not cost much.

I believe that as a general thing the foreigners are more appreciativ of our treatment than are the Americans; but it is just as in private practise, some will not call the doctor unless he is actually needed, and others want the doctor to come every day, whether they are sick or well, to see if there is any possibility that they might be needing something.

It is my understanding that the lumber companies follow about the same plan.

Perhaps some of the WORLD readers would not like to undertake the treatment of a case of typhoid fever and furnish the medicin for 93 cents (remember, the company gets 7 percent) a month, especially if the patient lives two or three miles away, and with good prospects of more cases to follow in the same family, for the sanitary conditions are anything but ideal about many of their homes. Of course the well ones are paying whether they need a doctor or not. It is safe to say that if the doctor is getting $150 monthly, that he is earning $300 to $400 at the regular fees.

Many of the doctors are making a good thing at it. I see but little chance of any change being made, as some one will always be found ready to take up the work. If the earnings run over $300 per month the mine doctor will usually require an assistant, which will cut down his receipts.

W. Va.

[In connection with the above, it may be well to note that an article by Dr. T. L. Nutter, of Clarksburg, W. Va., upon "Experiences of a Mine Physician," appears in the March issue of the West Virginia Medical Journal (publisht at Wheeling, W. Va.). Dr. Nutter treats the subject in a manner different from the article given above; he recites difficult obstetric and surgical cases that fell to his lot while a mine physician.ED.]

"Mattie" Ache.

A MODERN FABLE BY E. CLAIR. "Mattie" Ache is a yegg. He was born in Stomachville, Homo, twenty-five years ago. Today, near the end of his Strenuous Majesty, Teddy Bear's, reign, he is the boldest buccaneer on the Border. The inhabitants all along the Esophageal Thorofare quake at the sound of his dread name; and the Leucocyte Police Force are entirely powerless to check his madness.

But Ache is to be pitied! This much is

APRIL, 1909]

every criminal's due. We are all more or less victims of our environment, in spite of the fact that we try and like to think that we are self-made. Improper Nourishment! There, the cat is out of the bag, in just two words. The people who gave Ache birth and Hades on earth, are the grab-life-by-the-throat, shake-unmercifullyand-die-young kind. They eat, at any and all times of the day and night, anything that tastes good. Their highest developed sensation is Intemperance. The grandeur of success they know not; for what man is successful who bolts his breakfast?

So, Ache the yegg, miserable, and pitied, continues to rob the Homo State of health, happiness, and success.

Moral: Obey the Laws of Nature! conceived by God, for man; and aches and pains will pass you by.

Cyanide of Mercury in Diphtheria.-A Doctor's

Income.

EDITOR MEDICAL WORLD:-On page 58 of the February WORLD you make some inquiries about the use of cyanide of mercury in diphtheria. I would like to volunteer this information: The cyanide of mercury is with the homeopaths an old and highly esteemed remedy. It is almost exclusivly used for certain cases of diphtheria, particularly those accompanied by great prostration and heart failure. This, you see, is where the cyanide comes in (action upon the heart).

The Reference handbook of Medical Sciences, edition 1893, does not mention the cyanide of mercury, except as useful but rather dangerous in syphilis.

Hare's Practical Therapeutics, 12th edition, does not mention this remedy at all. Abbott, in his "Treatment of the Sick," says that it is used in diphtheria; dose 1-1000 of a grain. As the remedy was first used by the homeopaths, Dr. Abbott undoubtedly obtained it from their literature; his dose corresponds to about the third decimal potency of the homeopaths.

The cyanide of mercury has saved many cases of diphtheria for many years before antitoxin was discovered. It should not be used as a routine remedy, but only according to its indications, given as follows by H. C. Allen: "Malignant diphtheria with intense redness of fauces and great difficulty of swallowing; pseudomembranous formation extends all over fauces and down throat; putrid, gangrenous diphtheria, with phagedenic ulceration; mem

157

branous croup. Great weakness; extreme prostration; cannot stand up for weakness. 'When it corresponds to the genus epidemicus, like every other remedy, is effectiv as a prophylactic."

According to John W. Clarke's Dictionary of Materia Medica, the history of this remedy is a romantic one: "When Dr. A. Villers was an infant he had diphtheria. Everything failed, and his father, Dr. Dominic Villers, was in despair. Taking counsel, his friend, Dr. Beck was struck with a likeness of the symptoms to a case of poisoning by mercuric cyanide. The drug was procured, an attenuation rapidly made and administered. The patient recovered rapidly and lived to do most brilliant work with the same remedy while practising in St. Petersburg, Russia. Dr. Villers recommends the 30th attenuation.

"In the sensational poisoning of W. C. Barrett, of New York City, in 1899, by cyanide of mercury, the victim was treated for diphtheria by his doctors before the cause of the illness was discovered."

Nash says the cyanide of mercury is indicated in the chronic sore throat of public speakers when "it hurts to speak."

Hempel describes several cases of poisoning by cyanide of mercury. On reading them one cannot fail to be impresst by the likeness of the symptoms to diphtheria

from mouth to anus.

Boiled water

gr. 1-3 3 iss ..3ivss

M. Sig. One teaspoonful every 1⁄2, 1, or 2 hours.

And now, Dr. Taylor, I wish to tell what you already know; namely, that your advice to doctors about keeping out of "getrich-quick" schemes is always timely. As fools never die out, your admonitions must continue. But doctor, why is it that doctors go into those mining and other gambling propositions again and again? Is it not because they do not find the financial remuneration in the practise of medicin they expected to find? I have read that the average income of a physician in the U. S. is $750. Can any one blame a doctor for trying to increase this income? Can you suggest something to the physicians by which they can increase their income? I should be glad, and I know others would be, to learn of some way by which the

We

income of a doctor can be increast. must not advertise, we must fight and prevent disease and so destroy the market for our knowledge. We are besieged by all sorts of outside rivals, from psycho-therapeutists down to the peddler of corn salves.

You have been telling the doctors what not to do and you must continue to tell them. Try to tell them in the future what to do in order to improve their situation.

Most doctors ought to have some side issue for an income. Something which does not detract from their practise; something which helps a doctor to take an occasional week or month for recreation; something with which to educate his children; something with which. to buy clothes for his family; something to enable him to lay up for a rainy day; something "tangible" and different from

old accounts for his widow and children. K. GREINER. Sparta, Mich.

[The first thing to do is not to throw away in some foolish speculation or socalled "investment," what you have already saved. That being secure that is, when you have learned how to keep what you have already saved (not an easy thing to do in many instances), we will venture for a moment upon how to add to a doctor's income. We would say, first, not to go outside of the profession-that is, do not try to take up another occupation "on the side." If you do this, the people will soon Your cease to consider you a doctor. side line will injure your main line far more than it will help your income. It would be incomparably better for you to develop your practise by adding a specialty to your general practise, or take up the treament of chronic and subacute diseased condi

tions and see if you can benefit such patients as much as the osteopaths, Christian scientists, and the advertising electro-therapeutists do. Study their methods, and see if you can do better than they.-ED.]

too, in force thru those long, many-jointed sentences. Why, in a single one I counted over sixty words! If Dr. Harris will revise his booklet with an eye to brevity, he will doubtless be able to place it in improved form upon the four pages of a card folder, letter size. To indicate what may be done, I have condenst his opening paragraf, retaining as many of his own terms as possible:

Mismanagement and the avoidable accidents of pregnancy make invalids of many women and eventually send them to the gynecologist. To obviate this, proper supervision and management during pregnancy and at lying-in are requisit.

The second point regards the subject of the concluding paragraf of his booklet: "Sexual Intercourse." Possibly there are cases justifying that paragraf; but in a practise of upwards of thirty years I am pleased to be able to state that I have never had my attention called to one. And, furthermore, as a matter of personal conduct, I am pleased to be able to state that I have invariably abstained from sexual relation from the first indication of pregnancy in my wife, viz., first suspension of menstruation, until a proper interval after her delivery. For such reasons, his concluding paragraf appears to me quite uncalled for. Indeed, in view of the hurtful consequences of sexual intercourse in pregnancy thru maternal impression upon the child in utero, to say nothing of the hurtful effect upon the woman thru such a monstrous subversion of Nature's universal order, it appears quite inconceivable that a sane, intelligent human being, created a "little lower than the angels," could perpetrate an act placing him below the ox and the ass, below the cat and the dog. What is the sentiment of the family upon this subject?

New Haven, Conn.

J. D. KELLY, M.D.

to which you refer is the inferior hemorrhoidal branch of the pudic, with possibly a part of the fourth sacral. We know of no landmark by which you could accurately reach these nerves beyond the detailed description given in all large works on anatomy. We may say, in addition, that we have no confidence in your being able to induce a degree of anesthesia sufficient for this purpose by any ordinary cocain injection. Rapid dilation of the sphincter is a powerful means of resuscitation in patients so profoundly anesthetized by a general anesthetic that their very lives are endangered; thus showing that this region is the very last in the entire organism to resist the action of the most powerful anesthetics. -ED.]

That Massachusetts Bill.

EDITOR MEDICAL WORLD:-When I read in the March number the bill presented to the Massachusetts legislature to regulate the dispensing of medicins by physicians, I thought of a remark of a good old doctor in St. Louis (now dead), who did not believe in second marriages, and who had an invitation to the wedding of a physician taking his second wife. The old doctor was busy at a surgical operation when the other came into the room. "Good morning, Dr. S.," said the old doctor, "I see from a little card I have in my pocket that all the fools are not dead yet.' In addition I felt like adding in regard to the above bill: Nor do they all live adjacent to Mason and Dixon's line (I live near).

Another idea struck me when I read it. 'Twas this: In the pathology of tumors, there are what are denominated rests; that is, vestiges of epithelial cells or tissue strayed from their proper place, and years afterward come forth as malignant growths, fitted only for the destruction of the body. Certainly such a bill as this can only belong to that long ago history of Massachusetts, when she dealt so unmercifully with socalled witches and the Quakers. If it is designed to benefit the pharmacist, the druggists of the state should hold a meeting and pass a sweeping resolution to the legislature, not to protect them from their enemies, but to save them from their friends.

In our town we have no fight with our druggist. The drug store fills a needed want, and we could not get along well without it. The druggist is one of our people, and in perfect accord with the work of the

physician, and we have no fight to make with him. J. P. ANDREWS.

Marionville, Mo.

Physician's Right to Dispense. DEAR DR. TAYLOR:-Relativ to the proposed law on page 96, March WORLD, I would like to ask how they intend to remedy the injury such an act, relativ to physicians dispensing their own remedies, would incur upon the people and physicians in inland towns? If such a law should be passed here in Wisconsin, I should be compelled to discontinue practise. I am 8 miles from the nearest drug store on the east, 16 west, 18 north, and 12 south.

I carry about a $500 stock of medicins to accommodate these people. Doctors all over the United States by thousands are situated in a like manner. If I had to prescribe for my patients and send them to the towns around to get the prescriptions filled, they would soon say no use to make two trips; better go to the doctor where the drug store is in the first place, thus saving time and trouble. D. F. BOTH WELL.

Kingston, Wis.

[We publisht this bill to show what threatens doctors in all parts of the country. Certain interests would like to make it unlawful for doctors to dispense their own medicins. These interests will get such laws passed in all the states if they can. It is the business of the doctors to see that this is not done. We wish to simply put you on your guard.—ED.]

Carriage Lantern and Heater Combined.

EDITOR MEDICAL WORLD:-While the family are interested in driving lamps, I wish to explain how I have been making my lantern serve me both as a driving lamp and carriage heater. After practising two years with nothing but an ordinary lantern to furnish light on dark nights and heat on cold days, I decided to make a box in which to carry it. I took light half inch boards and made a rather tight box 131⁄2 inches deep, with glass front, and just large enuf to let my lantern set in. On the inside of the box, behind and at the sides, I fitted a piece of bright tin to act as a reflector. I cut a square hole in bottom of buggy bed just in front of seat and just large enuf to let my lantern go thru, then fastened box to bed under hole by four screws put thru bottom of bed into box. I had to spread the reaches a little to make room for the box between them; and put a cross piece in