None of them, if cured, are liable to produce diseases or disease in any other part of the human system. All cases of piles and fissure can be cured. Nearly all cases of fistula can be cured. I doubt if cancer of the rectum can be cured. I doubt if syphilis of the rectum can be cured. Eczema of the anus can occasionally be cured. I now only employ two methods in the cure of piles, viz.: The ligature and hypodermic. All cases can be cured by the ligature. All soft piles can be cured by the hypodermic treatment. Hard, indurated piles had better be ligated. All cases of hemorrhoids can be treated in the office. Confinement to the house is seldom ever necessary after treatment. A patient does fully as well to be around and outdoors as he does to be confined to the bed. I recommend my patients to avoid any strenuous employment for a couple of weeks after treatment, but moderate exercise does no harm. All fissures can be cured by stretching the sphincter muscle, and by cutting through the muscle. I never cut any more in the treatment of irritable ulcer or fissure of the anus and rectum. I stretch with my fingers, and never use a dilating speculum for this purpose. In the treatment of fistula I now always use the knife. I simply cut the tissue between the fistula and the anus and rectum. There is no necessity of the backward cut. I insist upon my patient getting out doors a day or two after the treatment. Fistulous patients do not do well in being confined to the bed, or even the house. I have them come to my office daily. I find frequently that there is difficulty in curing fistulas. This, I think, depends upon the condition of the patient's system. A patient having a fistula is always below par, and requires tonic and alterative treatment. How often I have noticed a fistula, which has dragged along for months without healing after being treated, heal up in a month or six weeks if the general system has been built up and strengthened. I believe rectal specialists should direct more attention than they do to the general system in the management of their fistulous patients. Results would be better if they did. I have learned that cathartics will not, as a rule, cure chronic constipation. They may, perhaps, assist, but never cure. Diet of a proper kind is far more useful in these cases than is medicine. Exercise, if taken correctly, is useful. My treatment now for chronic constipation is massage, with faradic electricity. This treatment has proved eminently successful in my hands. I generally dilate the sphincter muscles in the treatment of constipation. I even do this if the muscles seem relaxed. Why this benefits I can hardly say, but experience has taught me that it does. I may say it is a routine practice in my hands. I may, at some future time, at more length, enter into the treatment of rectal diseases. 623 Paul Jones Building. INFLUENZA. BY CHARLES G. POLK, M. D., Pensauken, N. J. [Written for the MEDICAL BRIEF.] This malady is one of the most frequent that visits the United States. It is not ever entirely absent, sporadic cases occurring at every season of the year; and it spares neither age, sex or condition in life. It often assumes a widespread epidemic form, seizing upon a large per cent of communities and counting its victims by the thousands. It is evidently a contagious disease, being directly transmissible from one individual to another, often attacking almost a whole family at once. It presents its most violent forms amongst the aged and feeble. Every organ of the body is liable to become its seat-the brain, nervous system, pulmonary organs, stomach and intestines. Pneumonia is a frequent and often a fatal complication. The exciting and determining cause of influenza is yet undetermined, in spite of what the authorities claim to the contrary. It is, however, generally believed to be due to a definite micro-organism which we are yet unable to name, which assumes increased action under certain atmospheric conditions and simultaneously attacks a large proportion of a community. In 1890, I had at one time forty patients seriously ill with it, ten of which had broncho-pneumonia. The diagnosis is not difficult. The attack is sudden, and there is a rapid increase of the temperature, which often reaches 105° F., retaining this elevation for several days. It resembles dry dengue in its sudden invasion and the severe pain in the head it occasions, but is lacking in pains in the back and limbs which, if present at all, are less severe, and the nervous system is much more severely involved, tic douloureux being terrific in influenza. Humidity of the atmosphere seems to exert a potent influence, damp, chilly, foggy weather greatly influencing its development and spread. Temperature, especially a cold, dry atmosphere, is unfavorable to its spread, and it also diminishes its severity, fatality and resistance to medical treatment. Altitude does not exert any very decided influence for or against the origin and spread of this malady, apparently pursuing the same course on the mountain and in the valley. Therapeutics is of the first importance. How to halt its progress and overcome its numerous complications is the most important duty devolving upon the physician. To lower the high temperature and the attending nervous symptoms demands our first consideration. The coaltar products naturally attract our first consideration; but their depressing action at once suggests the necessity of great caution in their use. I always commence the treatment of every case where I encounter high temperature with a prescription containing acetanilid with salol, quinia sulph. and tincture aconite rad. (U. S. P., 1890); these, combined in suitable doses, I prescribe in capsules, giving one each three hours. The temperature is reduced, the skin becomes moist, the severe headache and other neuralgic pains are dissipated within twenty-four hours. To evacuate the bowels is an important indication, as the liver is almost always involved in this malady. A good cholagogue is suggested. I usually give the following: R Podophyllin... Pulv. Aloes. Hydrarg. Chl. Mite.. 2 grains. 12 grains. 3 grains. 3 grains. M. Ft. Pilula No. 12. Give one pill after the capsule until the bowels are evacuated. The above will nearly always abort an uncomplicated case within three days. Pneumonia is the complication most to be dreaded, and always demands our serious consideration. To meet this complication I have usually found the following as my most successful course: R Ammonii Carbonate.... Fl. Ext. Pruni Virg Syrup Glycyrrh, q. s. ad Sig.: A dessertspoonful in water after each meal. 4 scruples. I ounce. I ounce. 16 grains. Hot mush poultices applied on the chest have an excellent effect upon the pneumonia. If the heart becomes weak, we must support it. Tincture of digitalis and nitrite of amyl, given every three hours, are the remedies. If other complications spring up, they must be treated according to the indications they may present. ITCH. The Bulletin des Sciences Pharmacologiques recommends two remedies for the itch. Both are essentially the same, but the prescription intended for summer contains a small per cent of white wax to decrease its melting point. EDITORIAL TOO MUCH SPECIALISM. The field of human endeavor is so extensive that no one individual could ever hope to master all parts of one subject. Such a subject is the art or science of medicine. Rapid, indeed, has been the pace set in the progress of medicine within the past half century. Keeping abreast with the advance of medicine has proved to be a difficult matter for every man in the profession. It is for this reason that some have deemed it fitting and proper to select a branch of medicine to the exclusion of other practice, and by strict devotion to that particular branch, they have, individually and collectively, accomplished more for the general good of mankind than would have been done by a concerted effort to view medicine as a universality. Magnificent results have thus been obtained by subdividing the work into sections. Beneath this apparently rational scheme for the development of medicine there lies a danger which has been, as yet, but little thought of by the average physician. With all the delving into special lines of medicine, with all the development of special apparatus and special paraphernalia for the various specialists, there is a serious flaw in the system, a flaw that in some instances, operates so adversely against the interests of the patients that very often it might be said that 'twerę vastly better for humanity had there never been such a thing as a specialist in medicine or surgery. This flaw consists in the narrowness of view of the average specialist in that he fails to recognize disease conditions outside his own specialty, or, rather, refuses to see anything pathological that can not be explained by the phenomena arising from the diseases of his own line of work. In other words, some specialists forget that the human body can not be divided into segments and sections like the various parts of an edifice; they forget that an aberration in function of some remote part is accompanied by disorder of the whole organism. They want to tinker one spot and believe they can remedy the whole in that manner. Such a hiatus exists in the minds of some specialists concerning knowledge of general medicine that one could as well entrust his health to the keeping of a piano-tuner as to one of this gentry. This habit of mind undoubtedly is caused by too sudden an entry into the domain of a specialty upon medical graduation. The medical student of the present day, unless duly warned, wants to be either an abdominal surgeon or a dermatologist, or a rhinologist the day after he is graduated. We recognize the fact that no one should specialize before he has been at least ten years in active general practice. At the expiration of this time he is capable of selecting the line for which he is best adapted, and at the same time he knows enough general medicine to keep him from making mistakes as a specialist when dealing with cases that require general as well as special treatment. And another point in this connection: the "refinery" of some city specialists is absurd. An "obstetrical" specialist will not prescribe for the new-born child. He orders the services of the "pediatrist." The pediatrist is never in a hurry to order himself out of the case. The whole proposition appears to be an attempt to eliminate the general practitioner from the field of practice. There is a general tendency among specialists to belittle the work of the general man; a feeling as if to say: "If you had consulted me immediately instead of the family physician, you would have been cured by this time." The specialist should appreciate the wider experience and greater difficulty in practice of the general practitioner, and should esteem him rather than belittle him. If one were to compile the facts relating to the mistakes of the general practitioner, together with those of the specialist, the following conclusion would undoubtedly be deduced: The sum of cases is greater in which the general practitioner recognizes and relieves special disorders in his practice than is the sum of cases in which the special practitioner recognizes general disorders in his special cases. ADVERTISING UNOFFICIAL PREPARATIONS. The American Medical Association-or rather the bureau which controls the association, for it can not be supposed that the members at large had any concern in the matter beyond the perfunctory passage of any resolutions presented to them from the council chamber-has recently communicated to the medical press of the country a resolution adopted at its last annual convention, requesting them to refuse advertisements of all unofficial remedies which have not yet been passed upon by the Council on Chemistry and Pharmacy and assigned a place in its blue book. It is unnecessary to reopen at this time the whole subject of proprietary remedies and the jurisdiction of the Council on Chemistry and Pharmacy. Undoubtedly the communication referred to will carry to the society organs in the various States the expression of a more or less peremptory command, which we nevertheless venture to predict will not be any too broadly observed. For the rest, it is enough to point out that there are many and excellent reasons why the independent medical press can not and should not comply with a request of this gratuitous and unreasonable character. It might, indeed, occur to any intelligent person, as a foregone and axiomatic reply to such a propaganda, that the independent medical press, in virtue of the essential nature and quality of its function, is estopped from complying with the request. It is like asking an employer who is, as a matter of principle, contending for the open shop, to treat |