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.

3. We finish up with good, movable joints near the seat of the fracture. 4. We gain time.

First of all, let it be well understood that we refer only to simple fractures. It is not inferred that the masseur is to reduce the fracture; he is only to overcome the swelling from the effused blood and lymph, under the surgeon's directions and orders. Men like Billroth and von Bergmann were their own masseurs when it came to reducing fractures.

As soon as possible after a fracture, we begin the massage to relieve the swelling and make it easier for the surgeon to set the bone. For instance, in a case of fracture of the leg, somewhere below its middle, we have the patient resting flat on his back, the assistant holding the foot steady, and the operator starts with strokings with the full, curved palm of the hand upwards from above the seat of fracture up to the groin. The muscular spasm is now troublesome, and it is decided comfort instead of pain that the patient experiences from our work. Grad

is treated daily from the start. We begin with strokings of the inside of the thigh, afterward strokings of the leg and the foot. On the fifth day I begin the passiv movements. We must try to overcome the contraction of the quadriceps entensor, and we must from the very beginning guard against adhesion of the fragments, especially the lower one. This form of fracture affords the best illustration for practical results by massage and passiv movements. Most everyone who has treated patella fractures by the old method of the tightest bandages and complete immobilization knows how troublesome it was to get the normal flexion restored, and how the patient was compelled to suffer

How Can a Town Doctor Increase His Usefulness and Income?

EDITOR MEDICAL WORLD:-Can you suggest some ideas looking towards progress? There may be others needing similar advice. I have been in general practise twenty years. Have tried every plan I could devise legitimately to increase my usefulness to the public. I have left undone many things which appeared to shipwreck other men. Yet at 42 years of age the ordinary duties of general practise are growing little stale, night work is a burden, and long drives not enticing. I have equipt myself well; have by far the best library and instruments, and have taken more

the most excruciating pains on forced flexion. This we now fortunately do away with by our modern methods, and it is the sincere wish of the one who writes these lines that every reader of THE WORLD will at once purchase a copy of Dr. Sir William Bennett's excellent work, "Massage in Recent Fractures." By special permission of the publishers of this book we make use of four of the illustrations for this article.

KURRE W. OSTROM. 112 N. Sixteenth St., Philadelphia. [The publishers of the above mentioned book are Longmans, Green & Co., London, New York, Bombay, and Calcutta; and the price of the book is $1.75 net. The book can be easily and quickly procured by sending the order to the New York house.-Ed.]

than twice as many post-graduate courses as any doctor in my section of the state. My gross receipts amount to about $2,500 per year, having varied little in

the past three years. I fear to move to a larger city at my time of life, as I have a large family. I do not like to open a private hospital, as this town of 2,000 will probably not support one. Most of my colleagues engage in other businesses-farming, drug stores, etc., and appear to be making more clear money than I do. I went into medicin to stick to it to the end of the chapter; but I want to be progressivdon't want to feel that at 42 I have reached the limit. I have fed, clothed, and educated my family well SO far, and have accumulated all told $5,000 -starting in debt for my education.

Some men essay major surgery or some form of specialism at my time

of life- many of them failing to

better their condition. I have been fearful of such a course. I don't want to become imbued with the idea that there is a decided limit to the progress of the general practician. PROGRESSIV.

[See reply in the editorial department of this issue.-ED.]

Comments on Bodily Temperature.-The Old Doctor.-Discoverer of Surgical Anesthesia-Sulfid of Calcium for Carbuncles.— Enuresis.-Intestinal Antiseptics.

EDITOR MEDICAL WORLD:-Dr. Ernest Barton's suggestion as to thermometers, page 103, March WORLD, is a wise one. Zero should be the human temperature. There is another idea about thermometers which physicians would do well to consider. It has become very common for people who are not physicians to have and use thermometers on all occasions when there is sickness in the family. Of course, this is a harmless amusement in cases where there is very little danger; but in all serious cases, especially in continued fevers, the use of the thermometer on the patient by members of the family may cause serious trouble. Many people think the medicin is doing no good when the temperature reaches three or four degrees above normal, and they will insist on the doctor or on some one else "doing something." That many persons have died from the excitement caused by using the thermometer and by the use of antipyretics which would not have been used but for the thermometer, I have not a shadow of doubt. Some patients will have another doctor when the attending physician will not give medicin to "cool" the fever. Some relativs of the patient will give antipyretics without the advice of the physician when the thermometer shows a slight increase in the temperature. Physicians have yielded to the pressure sometimes and given such remedies against their better judgment, the pressure being greater than they could endure. In some families the wires of the telephone are kept "hot" calling up the physician every hour almost night and day, to tell him that there is a little increase in the temperature. The majority of the people cannot understand that a degree or two of temperature is not necessarily an indication that the patient is not doing well.

The suggestion I would make along this line of thought is that some thermometers be made to register one or one and a half degrees below the right figure. For example, we have a patient whose temperature is so high that the patient or some member of the family may become alarmed about it. Sometimes the very best we can do and say will not satisfy the minds of the patient and other members of the family. Yet the doctor may know that it is best not to do anything to reduce the temperature. In such cases a false thermometer registering one or two degrees lower than the correct temperature may be used and shown to the family. In most cases this will satisfy the minds of the patient and of the family. A doctor's thermometer and watch are supposed to be correct at all times. While on the subject of thermometers and temperature, I want to say that in continued fevers (I do not say typhoid fever for I have seen only a very few cases in many years) the temperature should not, as a rule, be reduced; never unless it "runs” high or causes the patient much suffering. Dr. Williams, on page 115, makes a good point when he says he does not "doctor the patient altogether by the thermometer. In measles we do not try to keep back the eruption; in fevers we need not try to hold the temperature down to normal. normal. When we hold down the temperature without removing the cause we only prolong the course of the disease. It is sometimes necessary, as a choice between two evils, to hold down the temperature. But when we do this for any great length of time, either with water or antipyretics, we generally prolong the fever. No one knows better than I do that this is not orthodox, and the statement may be criticised severely; but criticism will not change the truth. But let us all remember that the habits and surroundings of people are different in different localities; and that diseases affect people in different localities in different manners. In the south a patient with some varieties of fever may have a temperature which our professors in colleges. in the north say is always a fatal symptom, yet we frequently cure such cases here.

All this talk about the old doctor being displaced is no more than we hear about all other professions and avocations. It is human nature to want to change. The

old preacher whom we have known for a generation or more must be laid on the shelf for a younger and more eloquent man. We need not expect nor hope for anything else. But if the old doctor does his duty and keeps up with his profession he will always get work to do; and possibly as much as he deserves.

To Dr. McIntosh, page 113, I would say that the Mississippi State Medical Association, in the year 1879, passed the following resolution by a unanimous rising

vote:

"Resolved, That it is the opinion of this Association that the evidence adduced by Dr. Marion Sims and as set forth in the paper of Dr. J. M. Taylor, read before this body, is conclusiv that Dr. Crawford W. Long, of Georgia, was the original discoverer of anesthetic use of ether in surgery.

That Dr. Long used "surgical anesthesia" at least two years and a half before any one else claims to have used it, I do not think there is a shadow of doubt in the minds of those who have read all the evidence. But Congress granted the honor to the one who first publisht the discovery; or, rather, the one who first had it publisht, for Dr. Morton tried to keep the method a secret for the revenue that was in it. Any one who will read "Anesthesia," by W. T. G. Morton, M.D., will form some idea of the trouble he had in getting Congress to recognize his claims. He will also have some idea how politics plays a part in such matters, just as it does in naming candidates in a party convention. But for Dr. Morton's dogged determination to win, he would not have succeeded. Those who are interested in the subject of who first used "surgical anesthesia" will do well to read Dr. Marion Sims' article on the subject publisht in 1877. Dr. Long lived in an obscure little town where there were no railroads, no factories, no great machinery, and, as a result, seldom had a very important surgical case. Few papers were publisht in his state, and he failed to publish his valuable discovery, tho he made it known to all his neighboring physicians. To another is awarded the honor, but such is life in many instances.

"Alas, too late oft come the laurel wreath;

A Tasso's brow was pale and cold in death Before the long grudged bays trembled above The lips that sang of glory and of love.”

Like Dr. Andrews, page 114, I am very much interested in boils and carbuncles.

I have had a personal experience which has caused me to study the subject from every standpoint. Sulfid of calcium does me no good that I can see. The same may be said of sulfid of arsenic, altho some of my patients are relieved as if by magic almost by the same medicins which prove useless in my case. On one occa

sion several years ago when I had several carbuncles on my neck I took sulfid of calcium almost every hour night and day for nearly three weeks without any perceptible benefit. But after I recovered from the carbuncles I was in better health than I had been in five years. About that time an old man whose wife I was treating told me to eat shell and all of a roasted egg every day for nine days and I would be well at the end of that time. A year or two later I saw him again, and it happened that I was suffering again with a carbuncle. He askt me if I had used his remedy and I had to confess that I had not. He insisted that I try it and, I thought I would pulverize the shell and take it in a capsule. Knowing there was sulfur and lime in the remedy I tried it. There was no difficulty about eating the shell, as it was very brittle. Since that time I have used the egg remedy several times, and it has not failed to cure me in nine days every time. If sulfid of calcium ever did me any good I do not know it, altho it benefits many others in my practise. "Simple remedies sometimes suit simple people best."

The questions and answers on enuresis are interesting to me. Only a few cases have given me trouble. One girl, about fifteen years old, after being afflicted all her life, and after trying the remedies of quite a number of physicians, was cured by sleeping on her side. Some cannot be cured without an operation. Some grown people can be cured by suggestion; and even children are much more likely to be cured when they have confidence than when they have no faith in the remedy. In this, as in all other diseases, we must treat the patient and not simply the disease by name.

Dr. Russell, on page 117, says: "No physician should employ any therapeutic measure until he has satisfactorily answered the question, 'Why am I administering this, and what action am I going to expect from it?'" This is a very wise suggestion, and one we should always follow. It would be a good idea for those