smooth words and large promises, that they can obtain much in exchange for very little, without toil or risk. Only three years ago it was mining stocks that were to make every one rich. There had been real discoveries of large and valuable ore deposits in Alaska, Canada, and the United States. Some poor prospectors had be come millionaires in a month. Legitimate investments by large capitalists in properties which their experts had investigated returned big dividends. There were and are good mines in the Yukon, the Cobalt and the Tonopah, Goldfield and Bullfrog regions. These limited few were made the basis of a gigantic campaign appealing to the "get-rich-quick" instinct. Men in Chicago, Boston, and New York, who never had seen a mine, bought a worthless piece of rocky soil or an abandoned hole in the ground somewhere in the same county where there was a real mine. Millions of neatly engraved certificates of stock were run off the presses, expensiv page advertisements in the country's leading newspapers were paid for, and column after column of glittering promises of fortunes to be made drew hardearned money from the pockets of millions of people in moderate circumstances, of which they never again will see a penny. In In that matter the North American was not sinless. The early advertisements were plausibly worded. view of real discoveries, their offerings were not absurdities. But after we had printed some of them, and more and more came seeking publicity, with more and more Aladdin-like promises, we instituted an investigation, which resulted in our canceling every contract, rejecting every new one submitted, and denouncing the entire swindling campaign. This story of the fleecing of the people by the mine swindlers, with the aid of conscienceless newspapers, was only a repetition, in substantially all details, of the schemes workt after the real and rich discoveries of oil in Texas, Kansas, Oklahoma, and California. Still earlier were the town lot booms in the West and South. Some were legitimate and, after severe suffering due to the crazy speculation, recovered and began a sound, natural, legitimate growth. Examples of these are the thriving cities of Seattle, Los Angeles, and Birmingham. But for each of these there were a score, flamingly advertised as future metropolises, where the rotting stakes still mark avenues and boulevards in cornfields miles away from the dead and squalid crossroads town-acre land once more, but which then sold at front foot prices equal to those obtainable for centrally situated property in this city of 1,500,000 people. Middlesboro, where $20,000,000 of English money was sunk, the Three Rivers, of which Tom Lawson appropri ately enuf was the presiding genius, were types of such boom towns. But the western prairies and the southern hills are dotted with their like. The latest example of this long-pedigreed plan to extract small sums from a host of people by promises, that while deceptiv are kept skillfully on the safe side of the law, is the extensiv sale of farm lands. Some of these tracts offered on easy terms at cheap prices per acre are in California, some in southern Texas, a few in Georgia near the Florida line; most of them, however, in Florida. Some of these suspiciously generous and benevolent offers, to exploit which the promoters are purchasing page advertisements in the newspapers, may have merit. But none we have seen has so imprest us. We may not have rejected the advertisements of all these schemes. We may not have seen them all. We have refused to print those that have been offered to us. And these include most that we have seen printed in other newspapers. And the reason is that not one, so far as we have investigated, carries even presumptiv evidence of sound ness. news Most of the advertisements we barred from the North American have appeared in other Philadelphia papers, so that the people of this city and the vicinity are more or less familiar with the character of the appeals. They are dextrously worded in the main-a mixture of attractiv truths, vague pretenses and guarantees. deception concealed by smooth words that can be read with two meanings, and generalities as large and gaudy as a circus poster. Here, for example, is a pleasing specimen of the literature in question: You can build here a bungalow and in a few You must not think that just because you cannot raise them with profit. If a In Florida nature works for man, and man does not have to slave like he does in the North and the West. Now, all these statements are literally true. man with ample means desires to escape the rigors of the northern climate, buys a suitable tract of Florida land-taking care that it is not cypress swamp or pine barrens, with no soil save sand, and sees to it that he is near a railroad station and can make fair arrangements for consignments; solves the difficult problem of labor in a beautiful state where the hookworm or some other cause has bred only too many of the shiftless, ignorant, and incompetent among those to whom the stranger must look for help-he may set out his orange and other trees, pray against the coming of one of the freezes that happen every ten years or so, and after living on his other resources for a term of years, he may by good management obtain an excellent return upon his original investment and have the pleasure of living in a climate that is delightful-in the winter. But to the northern farmer boy who, by unceasing industry, has laid aside a few hundred dollars, the picture of the flowery land where perpetual sunshine draws unending riches without exacting heart-breaking toil, such advertisements mean a chance for the home of his dreams with the girl of his choice in a land of flowers. The small merchant and the clerk who have struggled against ill-health read between the lines the promise of wealth, as well as health, in exchange for their savings and a little wholesome, strengthening work. Why, even the Everglades is a name of charm to all such small investors. And one of these companies actually is endeavoring to sell farms in that marsh covered with water and saw-grass. Most assuredly worth quoting are some of the features of this Everglades proposal: We are now offering this land for sale at We will not permit any man to locate upon wet prairie now-when we deliver it to you it But it is not represented that this tract is not a "wet prairie" at present. It is only "estimated" that it may be drained thirty months hence. But concerning this water-covered marsh of 46,000 acres it also is "estimated" that "when we have delivered our land and permitted settlers to move upon it, it is estimated that there will be every convenience in the world for their comfort, including telefones, free mail delivery, railroads, and waterways right at their very doors. To compare with this hopefulness we can cite only this portion of the promise of a company that sees in a southern Texas county. instead of Florida, the new Eden: The cost of living amounts to practically nothing at all. Your first move upon arriving should be to prepare and plant a small plot of ground in vegetables. In less than three months' time you will have an ample supply for your table, and in the meantime, while waiting for your table truck to grow, your neighbors will supply The with vegetables at very little cost. you rivers abound in fish, while the woods are alive with quail, squirrel, and all sorts of small game. This means that you will have no meat bills to pay. All there is left for you to purchase are such staples as sugar, coffee, tea, and spices. Now, let it be noted that these schemes do not appear to have the sanction of the railroads which offer inducements to good settlers to colonize desirable tracts along their lines. Nor are they put forth, apparently with the approval of the honorable and enterprising men who compose the trades bodies of the attractiv and thriving communities of Florida and Texas. These advertisements come from the tall buildings in Chicago. To readers of the North American who do not feel inclined to draw their own conclusions, we desire simply to remark that one of the best means of obtaining a safe income from one's savings and provide for one's family is to purchase thru a reputable financial house a good hond-some such bonds are in denominations as low as $50. But if the reader be bent upon a farming venture, there is much land at low prices, fairly fertile and close to markets, in southern New Jersey, where an investment will bring smaller returns in climate and dreams, but more in things tangible, than purchases in some parts of Florida and Texas. Dr. Charles S. Grabin, of Wakefield, Neb., writes: "Your Business Talks saved me $10 the other day-was not taken in. Let the good work go on." ORIGINAL COMMUNICATIONS Short articles of practical help to the profession are solicited for this department. Articles accepted must be contributed to this journal only, The editors are not responsible for views expressed by contributors. Copy must be received on or before the twelfth of the month, for publication in the issue for the next month. We decline responsibility for the safety of unused manuscript. It can usually be returned if request and postage for return. are received with manuscript; but we cannot agree to always do so. Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will cer tainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than anything else.RUSKIN. EDITOR MEDICAL WORLD:-I will give Brother O. Manasco my treatment for pellagra. The treatment consists first of all in the interdiction of unsound maize as an article of food and the prohibition of alcohol as a beverage. With respect to medicinal treatment, Lombroso recommends large doses of arsenic. Wurzel confirms the value of arsenic and also advises the use of quinin and strychnin in large doses; for the nervous symptoms, massage, electricity and salt water baths are of service. The patches of erythema should be kept moist and supple with oily ointments to which cocaine, carbolic acid, salicylic acid or chloral may be added to control the itching. The prophylaxis of the disease includes education of the people in the infected area about the danger of fermented maize as an article of food. Maize should only be harvested when ripe and should only be stored in dry, well-ventilated granaries. When maize is a staple article of import it should be rigorously inspected at the first port of entry and all spoiled grain rejected. Witts Springs, Ark. E. M. DIXON. Seven Cases of Pellagra. EDITOR MEDICAL WORLD:-As there is quite an interest in the lay press and medical journals, too, on the subject of pellagra and but little about it has appeared in your valuable journal, read by so very many doctors, and as I have had seven cases, some of which seemed to be benefited by treatment, I thought I would give a short article on that subject. The article by Dr. Manasco in the November issue describes very well the advanced cases of pellagra. I had four cases before diagnosing it. The first one came to me three years ago next February. She was very nervous; had insomnia, melancholia, stomatitis, diarrhea with very offensive stools; some numbness in legs and arms, and some fever, very irregular. I diagnosed her case as spinal paresis due to some intestinal autotoxemia, the nature of which I did not know. She soon developed the typical symmetrical erythema of hands and some on face. I stopt corn foods because of the diarrhea and not from any etiologic reason and prescribed a light diet as in any lienteric diarrhea. M. Sig.-3j every three or four hours, as needed, to check bowels moderately. The bowels should not be checked entirely or patient will get worse with nervous symptoms. I gave elix. glycerophos co. tonic alternately with petroleum emulsion, and castor oil and turpentine every few nights to clean out. One important thing I discovered was that, tho the patient was very nervous and had insomnia, it was an internal nervousness and despondency and was much benefited by the Morton wave static current and direct sparks. I never saw a neurasthenic or nervous patient of any other kind that enjoyed the static sparks so much and was so benefited by them. She would beg for the sparks. She gained thirty pounds and remained apparently well during summer and fall, leaving my town and returning to her former diet of cornbread, buttermilk, greens, etc., and was not heard from until February, 1908, when she returned to me with uterin hemorrhage, vaginitis, stomatitis, etc., again. She soon developt acute mania with short intervals of lucidity; was sent to the asylum and died within a few days. I treated two other advanced cases in the summer of 1908 for only a week or ten days each. Both had melancholia, diarrhea with very offensive stools, paresthesia, etc. They soon returned home and died. One other case treated that summer and fall is still living. She remained several months taking the static electricity, Morton wave current and sparks, and the medicins given the first case. She had a recurrent arthritis and fever that returned every nine days, remaining two or three days, in addition to the erythema, stomatitis, diarrhea, etc. She did not return to her former home but to another one, and has not relapst tho not in good health yet. The blood examinations made in three cases showed only a secondary anemia-in one only a slight leucocytosis, but no eosinophilia in those examined thus far. The stools in two examined showed nothing of importance. About fourteen months ago I read an article in the A. M., A. Journal from Babcock, I think, of South Carolina, and diagnosed my four cases at once. Since then I have had three other cases. The first one, seen last June, had been nervous three years with insomnia, numbness in the legs, burning of feet and hands (a symptom present in almost all the patients somewhere), but no diarrhea; instead, however, a constipation until three months ago when the offensiv diarrhea began, followed soon by the dermatitis, stomatitis, etc. Under the above mentioned static electricity and medicins he has now gained 32 pounds, perhaps to relapse in February or March. I hope not, however, because he had no symptoms of melancholia and will never eat any more corn food of any kind. We do not know the cause and it is useless perhaps to speculate; but the cause, whether bacteria, toxin or fungi, is believed to be conveyed to the alimentary canal through the corn food products, thence to the spinal and sympathetic nervous systems; in most of my cases producing nervous symptoms, burning, etc., long before the diarrhea, stomatitis and erythema. We know when one is salivated once he becomes very susceptible to the influence of mercury. One made very sick once on any article of food, that food is frequently thereafter almost a poison. Hence the importance of changing the location entirely and avoiding all corn products that perhaps the etiological factors might be better avoided. My two later cases are similar to the last mentioned in symptoms and duration, being "raised" on corn bread, but not having eaten much the last three years since sick. They are improving on the above treatment, but have not had time yet to show such gains. In conclusion, will say I am sure the modified Morton wave has been the most important factor in the improvement of my cases, the numbness and nervousness being relieved thereby. The cord is connected to the positiv side of the machine, poles are widely separated, other end of cord is attached to a long flexible piece of metal placed next to the skin of the spine. The bare feet are placed on a metal footplate from which the shepherd's crook passes to a metal ball on the insulated staff one to three inches from the prime conductor of negativ pole making the jump spark there. The negativ side is grounded. The current passes entirely thru the patient's spine, down legs, and is set into rapid oscillations by the interruptions of the current as it passes up to the negativ side and thru to the earth. It is a modified Morton wave current and is very valuable in any form of spinal paralysis. By its use with correct hydrotherapy a case of universal lead palsy entirely helpless, involving even the recurrent laryngeal nerves was completely relieved in five weeks last spring and many other cases due to other causes benefited more slowly. I would advise physicians having pellagrins to try the above treatment and report results, as nothing else has seemingly done good. J. W. TORBETT, B.S., M.D. Marlin, Texas. Atlanta Med. College, 1895. Diseases of the Eye in Pellagra.* EDITOR MEDICAL WORLD:-In diseases of the eye in pellagra I find no differences in the symptomatology, characteristics, appearances, or complications, save only they are very prone to exhibit the same cycle, as it were, a recrudescence in early springtime and, as summer progresses, make recovery. My observations and findings have been primarily upon the rice field negro who has been inured to hardships, poorly educated and equally poorly nourished, seldom able to read, and, when he has visual disturbances, attributes it to local conditions. My patients have invariably given the history of damp meal, grits in lumps in bags which have been wet, carrying home in cotton sacks during the winter months while raining, buying the week's supply and leaving it in the sack openly exposed to vermin and dew, many times sour, and eating sour corn-bread. My attention was first directed to this disease in 1906. The patient gave me a history of rheumatic pains, general malaise, sensation of heat of the esophagus and in the regions of the kidneys, radiating to the hands and feet, noticeably the palms and soles. One child has spastic paralysis. All complain of vertigo, neuralgic pains in the posterior aspect of the neck. The dorsum of hands and feet they said were "sun burnt," skin swollen tense with burning and itching, severe stomatitis, patellar reflexes exaggerated, insomnia, anorexia, erythema, with petechia occurring at times. Also, small oval blisters, even bullae which, upon breaking down, leave indolent ulcers. The chief psychic symptoms are delusions, apathy, melancholy, disorientation with symptoms of dementia præcox. In two of my cases the tissues between the fingers cracked, extending to the metacarpal bones and exposing the ligaments. The tongue and mouth are red, inflamed and sore; gums swollen at times and present appearance of salivation. The lips swell and appear almost scarlet, crack and become denuded. The tongue has presented three varieties to me. One heavily coated with a dark streak in the centre, notcht around the edge and very red. Again, smooth and denuded of epithelium. Finally, in another instance, slack with deep fissures. Have never seen any change in the hair and nails of my patients. All have digestiv disturbances and lack of appetite. As the disease progresses the mental disturbances increase from extreme dull apathetic conditions, slowness of speech, listlessly tired, ennui, melancholy, dread of persecution, even suicidal tendencies have been exhibited. Some of these patients have informed me that these conditions have crept upon them insidiously, gradually becoming more severe each spring and summer. Three of these patients have since died. Many of them complain of pains in the eyes, one of diplopia and others of various symptoms. I examined more carefully and present the following data. I: Man, 42, negro. Had been working timber and living upon a diet of grits and corn-meal mush, crackers and cheese, all of which he stated had become molded and soured as he had no place to keep them. He was suffering from ectropion, both eyes, with slight conjunctivitis. Had markt pellagra symptoms. Iris was dilated. Very little photofobia, cornea aqueous, lens clear, vitreous slightly hazy, choroid showing marks and scars of atrophy, dark pigmented areas. The nerve head was oval suggesting myopic conditions. Arteries pale, veins thick and heavy. The other eye was normal, consensual reaction from left to right but not from right to left. I made several further attempts at examination, but patient was in a cachectic condition and refused, dying in seven days days after last attempt to review fundus. II: Child, 6 years, boy, negro. Epiphora in both eyes, a markt pellagra patient; talked incoherently all the time; had three-fifths degree of fever in the axilla. History, positiv; mouth, tongue and nares raw. Mother stated that child's eyes became sore every spring, which suggested vernal catarrh. Examined for it but it was not present. Had markt conjunctivitis, with small granulation, which resisted all treatment. Cornea, aqueous, lens, and vitreous clear. Ophthalmoscopic findings: Fundus dark, black spot similar to retinitis pigmentos, only limited to about 4 mm. around nerve head and involving macula regions. There was no evidence of choroditis, nor were these dark areas in any other part of the fundus. Mother stated that child's eyes had been sore in the springtime for 3 or 4 years when his hands and feet became sun-burnt. His vision had become worse this time. From this child I recovered uncinarias upon two occasions. Child's hands, feet, arms, legs and nape of neck in horrible condition; extremely emaciated. Died in five days after my seeing him. They refused an autopsy and would not allow me to remove one of its eyes. III: Man, 36 years, negro. History: working in swamp, making shingles; living on grits and condensed milk; he termed it "stir mush." Would make enuf at night to do the next day. Sometimes it would sour in the pots, he said, but if boiled over it was fit to eat. It had given him indigestion, he stated. Both hands, arms, and legs presented distinct line of demarcation. with round ulcers, some confluent, with irregular edges and edema. Patient was painfully emaciated; complained of pains in the eye, with burning sensation and failing vision. Upon examination I found fundus visible and appearing normal; optic nerve pale, almost white, beginning nerve atrophy. Patient was to return in 14 days but was unable to do so, dying in 19 days "second" or "butts." They need meat, after the last visit. IV: Girl, 17, negress. Anemic; enlarged glands, cervical and epitrochlear. For 3 years hands and feet, and arms and legs had become denuded; were now raw with fetid ulcers on one leg almost to knee. Right eye: cornea hazy with small ulcers; iris irregularly dilated and had posterior synechia; aqueous, hazy; vitreous, muddy; fundal lesion, large hemorrhage to temporal side. Patient stated she was not aware that she was blind in that eye. Had floating bodies. Was unable to get any detail of fundus. Left eye normal. In inner canthus of both eyes small papilla which exuded watery substance upon being punctured. Patient came regularly for 4 weeks, becoming rapidly worse; had excessiv diarrhea and became almost unmanageable, refusing to eat. Died in 11 days after last week. V: Woman, 42, negress. Second year had sun-burnt hands; sore mouth; vertigo; had lost considerable flesh, and had grown melancholy with hallucinations. Iritis in right eye 3 weeks. History of damp grits; bought them because they were cheap; damaged meal. Upon examination, hands and feet desquemating in layers, shelling off, leaving shiny tense skin beneath and, in places, a raw bleeding surface. Lips and tongue denuded. Suffered from insomnia and had no memory. Ophthalmoscope gave no fundal lesions. Patient recovering. VI: Woman, 26, negress. First year mouth became sore and denuded, bright red in appearance, distinct erythema; complained of pains in the eyes, smarting and burning. Patient came every other day for 2 weeks and each morning had a film of bluish tint over the cornea of both eyes. At the end of 6 weeks she stated that her eyes gave her no further trouble. Physical condition improved; mentally slowly making progress. Ophthalmoscope shows nerve head normal, arteries very small, veins enlarged, small hemorrhages in veins to nasal side in physiological cup. This patient gave positiv history when and where she obtained the damaged meal. In presenting these histories I have refrained from repetition as much as possible, also from citing pellagra symptoms. The class of persons who I find are suffering are those who lack nitrogenous food. Many exist upon rice, grits, potatoes, and a little cheap poor grade pork termed red meat, and a variety of vegetables. In 4 out of 7 cases that I examined I found uncinaria, and anemia in all. The treatment has been supporting and nutritious. Tonics, in increasing doses of tincture of the chlorid of iron up to 30 minims, t. i. d.; Fowler's solution to the point of tolerance as high as 24 minims t. i. d.; cod liver oil, eggs, bovinine, pepto-mangam (Gude), acetate of lead and opium for diarrhea, phosforic acid and strychnin or tincture of nux vomica. Fish diet, also oatmeal, and milk in abundance. I find local applications of practically no value. These cases are from the extreme rural districts where hygienic conditions are very poor. poor. Mentally, from educational standpoint, nil. Not one gave a luetic history but all gave a record of malaria. In one family the mother had a chronic condition and the son, acute; both died. I have been informed that many negroes bought damaged meal which had been recovered from a flat, it having sunken. Some of the negroes became sick, had vertigo, abdominal pains, and intense gastric disturbances. From my observations I am of the opinion that pellagra is a trophoneurotic condition involving the entire sympathetic system, It is not an autointoxication, but secondary to the ingestion of a fungi or ferment which causes katabolic metamorphoses. A. B. CLARKE, M.D. Planterville, S. C. * [The above paper was read by Dr. Clarke at the recent Pellagra Conference at Columbia, S. C.-ED.] |