possible explanation that, the phenetidin being the real source of danger, its neutralization by two acid radicals may be more complete, thus removing the danger and at the same time adding a valuable antiseptic property-the salicylic element. My experience is confined to a single case, a member of my family who must have drugs of this kind occasionally for pain, and she says that while phenacetin (which she long ago gave up, but I got her some a few days ago to see if it would not now act better than formerly) is fully as depressing as the various acetanilid mixtures, or more so; thermol is not; but thermol will not take the pain away quite as promptly, but "is more soothing." I was told of a number of cases of typhoid fever, etc. in which thermol was successfully used, but I haven't access to the records. I was also told of a case of whooping cough in which the child watcht the clock for the time to take its 221⁄2-grain tablet of thermol, in order to continue to avoid the distressing paroxysms of another child near by, not taking the thermol. But this evidence-all I know at the present time (others may know more)is too meager and indefinit upon which to base an opinion. Besides, an inventor is naturally sanguin concerning his own preparation, and his claims perhaps would better be discounted somewhat. Hence the importance of impartial testimony. It is "up to" the profession to determin the value of thermol and act according to its findings. I am glad that it is the product of an American laboratory, for we Americans have depended far too long on foreign laboratories for these synthetic chemicals. As to price, it is 75 cents per

ounce much

more expensiv than acetanilid, you see, but worth the difference if the inventor's claims are borne out by ample clinical tests.* It seems that such new things cannot and would not be conceived and achieved if it were not for some prospect of profit. The time, work, risk, initial expense for machinery, etc., are very great, and the result not always certain. But patents on processes run out in time, and then we have the really good things at a narrow margin of profit, as on sugar or salt. But copyrights on such proprietaries as antikamnia, neurilla, etc., never run out; no manufacturer except the owner of the copyright can ever make and sell a preparation under one of those names; but fortunately nothing of special scientific value is thus perpetually monopolized. They are simple mechanical mixtures, and their formulas, tho secret, are approximately known.

Since the above was written, numerous clinical reports on the use of thermol in typhoid fever and pneumonia have been submitted to me. However, I have said enuf above for purposes ct comparison of the different members of this group, and no more wou'd be appropriate here.

H. John Stewart and Finsen Rays. The distinguisht Editor of the Journal of the American Medical Association writes us as follows:

Dr. C. F. Taylor, Editor of THE MEDICAL WORLD, Philadelphia, Pa.

Dear Doctor Taylor:-I read your apology on page 96 under the title of "Beg Your Pardon." We did not bite, but you have not publisht half the journals that contained this article.

Besides those you mention, the following were caught Boston Medical and Surgical Journal, Memphis Medical Journal, Cincinnati LancetClinic, Western Medical Review, Modern Medical Science, Canadian Journal of Medicin and Surgery, St. Louis Medical Review, Denver Medical Times, Texas Medical Journal, and Western Druggist. Very truly yours, Chicago. GEORGE H. SIMMONS.

[Thanks, Dr. Simmons. As my time permitted the examination of my exchanges, I found the article in some of the above, but I did not reach all. I would not have been caught if H. John Stewart had not lied. The profession should know how to size up the institution which he sought to advertise in this dishonest way.-ED.]

Thank you, Sincerely.

As a rule, I don't like the sometimes too prevalent habit of giving presents--particularly wedding presents, which latter custom has grown into a monstrous abuse. Articles given as presents are frequently not needed, usually not what would have been chosen by the recipient, and they always place the (unfortunate) recipient under obligations, and sometimes in an awkward position. I am very sensitiv in this matter, and have often felt, if either giving or receiving must be done, that it is "more blessed to give than to receive." But there are exceptions to all rules. My old friend Dr. W. F. Waugh has evidently finisht his season of travels, for the following note comes to me from him at Chicago:

DEAR DOCTOR TAYLOR-I send you herewith a pen made from a feather from the wing of an American eagle, with which to indite your editorials. May you never write anything unworthy that free and fearless bird, bold and dauntless with lofty flight and keenest of vision.

This I accept with great appreciation.

Is it a Diploma Mill?

What seems to be a diploma mill has its "Correspondence Department," to which all letters must be sent, in a town in Michigan. Answers to inquiries sent to this Michigan town are mailed from a town in Pennsylvania. But the "Main Office," and the " College" itself

are in Oklahoma. Here are two clippings from their catalog:

"Last and greatest of all: To do for the preachers what their theological schools have not done, viz.: Make them physicians of the physical needs of the body as well as of the soul. To prepare them for this two-fold work. What minister has not realized the great need of being able to do this? As the world grows older more and more do we realize we cannot improve on the Christ plan. He sent His disciples out to heal the sick and preach His gospel. The minister of Christ today is not prepared for his work until he can cure the sick. Of course, not in the miraculous way in which the Apostles healed; but by using means and knowledge every one has, after being taught how to apply it. Who is so well prepared to administer to the needs of the body as he who thoroly understands and is deeply interested in the needs of the soul? The preacher already possesses a great deal of knowledge that will make him a successful practitioner. The preacher has studied the soul, and the doctor the body, whereas the two are inseparably connected and a knowledge of both is necessary to properly administer to the needs of either."

"To the school teachers, let us say, here is a chance for you to make from two thousand to five thousand dollars per year. It will far surpass in remuneration the salary of a teacher."

Comment is unnecessary. This is tempting bait for preachers and school teachers. What a grand thing it is for the health of the people that most states now require a medical examination before granting a license to practise medicin.

Do your medical friends take THE WORLD? If not, don't you think it is because they don't realize what it is doing for the profession? Won't you show them this number, and say that such a publication deserves the support of every medical man?

At the recent meeting of the American Public Health Association held at Washington, the committee on vital statistics reported that effectiv cooperation had been instituted between that Association, the Conference of State Boards of Health, the American Medical Association, the United States Census Bureau, and the United States Public Health and Marine-Hospital Service for the improvement of the vital statistics of this country. Among the objects sought are the extension of adequate methods of registration, the use of uniform and comparable tables and rates in bulletins and reports, and the improvement of the international classification of causes of death. A pamphlet on "Statistical Treatment of Causes of Death" has been issued by the United States Census Bureau, requests for which should be addrest to Mr. W. A. King, Chief Statistician for Vital Statistics, Census Bureau. It has special reference to the difficulties encountered in compiling deaths returned from several causes, and asks for the cooperation of the profession in framing a thoroly satisfactory method of procedure in such cases.

The impression growing among the profession that early hemoptysis in a given case of tuberculosis is a favorable sign, is explained when we remember that hemoptysis is alarming to the patient and he hastens to the doctor for treatment. Thus he is a more favorable case just because he has earlier care and treatment, and not from any favorable indication as regards the case itself.

A Kiss.

"A kiss is a peculiar proposition. Of no use to one, yet absolute bliss to two. The small boy gets it for nothing, the young man has to steal it, and the old man has to buy it. The baby's right, the lover's privilege, the hypocrite's mask. To a young girl, faith; to a married woman, hope; and to an old maid charity.". Stolen.

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 certainly misunderstand them. Generally, also, e downright fact may be told in a plain way; and we want downright facts at present more than anything else.-RUSKIN. REFLECT COMPARE RECORD

READ

Charges for Telephone Advice. Dear DR. TAYLOR:-In THE MEDICAL WORLD for March, the question is raised, what should be charged for telephone consultations. The question is a pertinent one and should receive consideration. While theoretically a telephone consultation should be paid for as an ordinary consultation, there are cases where we ask for reports over the phone and give some advice or directions, and yet we do not wish to make a charge. Let me illustrate :

Some time ago a farmer called me up and told me that his boy, whom I had ushered into the world some four weeks earlier, had a bad cough. It was late, the weather stormy, the distance considerable. So I ordered some simple remedy and was told the next morning the baby was better. I charged fifty cents for my advice, which was cheerfully paid.

Another time a lady called me up, whom I have been treating off and on for years, and gave me all the symptoms of what she called "the grip." I sent her some medicin and charged a dollar, my usual office fee.

Again, a man is ill with typhoid fever. I can see him only once a day, as he lives far away and the roads, just now, are not exactly like boulevards. He has a phone in the house and I frequently ask for reports and give directions over the phone. Of these talks or consultations I do not keep track, and shall make no charge.

I think these three instances will illustrate what seems to me a fair use of the phone and a fair mode of receiving returns for telephone advice. H. Y. ACHARD, M.D.

Roselle, Ill.

The Religious Press and Quackery. Editor MEDICAL WORLD:-I was much pleased to see your expose of the "Heidelberg Medical Institute of St. Paul" in March WORLD. Let the good work go on. While the aforesaid fakirs are surely bad, they are probably no worse than many others of the same class whose glaring advertisements we see, not only

in the yellow journals and the dailies, but in those immensely profitable mediums for the advertisement of quack doctors, and fake appliances and medicins-the church papers. Most people are a little shy of these fakes when they see them advertised in secular papers, but many fall easy victims of the fake when they read of it in a religious paper. These ads are always so worded as to convey the idea, if indeed not so stated, that the nostrum or appliance has the personal recommendation of the editor, who is usually a D. D., and ought to be a safe man to follow. I have written several editors of church papers and they all say that their papers could not be run on a paying basis if the patent medicin ads were cut out. And they can not or will not see how a contract to run an ad that brings them such returns could be quackish or dishonest. The quack is willing to pay greatly increast rates for space in said religious papers, and the business managers of the papers run the ads for the money there is in it; refusing to admit, however, that by so doing they make themselves the channels thru which countless thousands of dollars from the poor and unsophisticated but trusting readers flow to the pockets of the fakir. Now, what is the remedy for this growing evil? I suggest a general campaign of education by the family physician. Let each member of the profession strike a decided but tactful blow at this hydra headed monster whenever opportunity offers, and in time the now gullible public will look upon these alluring fakes with the utmost indifference. Does not much of the blame for the condition complained of lie with the family doctor? Long live THE WORLD.

Kimbolton, O.

D. L. COWDEN.

[No, Doctor, the blame should not be placed upon our profession, but we could and should do much to mitigate the evil. Doctors could point out to people the objectionable advertisements in their religious papers and advise them to discontinue their patronage of such papers, and that they should write to headquarters the reason for so doing. That would doubtless do much good. If a paper, religious or any other kind, cannot exist without the patronage coming from nasty, dishonest and quackish advertisements, then such paper should cease to exist. The fact is, that if a paper has any excuse at all for existence, it will be strengthened and not weakened by an upright, courageous and honest course. THE MEDICAL WORLD refuses much advertising, and it fearlessly exposes fraud in its reading columns; and it is growing stronger every year. Patrons are not slow to recognize the value of that kind of journalism, and they will support it.-ED.]

Should Clergymen and Their Families be Treated Free of Charge?

Editor MEDICAL WORLD:-What is the custom among physicians as to preachers: Do they practise for them gratis? I have been in the profession thirty-five years and have always charged ministers of the gospel one half the usual fees. I presented my bill to a preacher a few days ago and he said he never heard of such a thing before: "A doctor wanting a preacher to pay his bills." I told him it was my custom and I expected him to pay it and he did.

The preachers get a salary just as our civil officers, clerks and all others who work for wages; and doctors work for wages. The preachers expect doctors who are members of their church to help pay their salary, and pay a little more than other members, and then do $15, $25 or $50 worth of practise for them without pay. This is more than I can see the justice in. But if it is customary among the profession I will fall in line. I have always tried to be honorable and never do any thing that would bring reproach upon the profession, and I still stand on that principle.' I know you have a very large basket for this and all such that is of no benefit to the brethren; and if you should assign this to it all O. K. But I would esteem it a great favor for you to drop me a few lines on the subject, as I want to be right.

Texas.

JIM.

[Doctor, don't ask us to "drop you a few lines." We would like to do it occasionally, but to attempt to do it for our vast army would simply kill us. But concerning the above we will do better-present it to the profession for discussion. This matter is largely one of local custom, and of custom of individual doctors. Many clergymen expect and prefer to pay their doctor bills; and many doctors make it a rule to charge clergymen just like anybody else. However, this is by no means universal-in fact, perhaps, it is almost exceptional. In most congregations there are one or more physicians, and frequently there are close personal relations between one or more of these and the pastor and his family which make ordinary business dealings difficult and undesirable. Then again, frequently there is rivalry as to what doctor will have "the honor" of attending the pastor's family, for the influence it will give. This we do not endorse. Local custom and personal preference of each physician will doubtless continue to obtain. Perhaps this would be a good question for the fraternity to exchange opinions upon.-ED.]

Operation is now imperativ in all cases of perforation of the bowel in typhoid fever, if it be possible to do the work before the patient becomes moribund.

Appendiceal Pus Discharged Thru Lung. Editor MEDICAL WORLD:-Reading Dr. DeVoe's article, "Was it Diaphragmatic Pleurisy?" on page 60, February WORLD, calls to mind a case that I postmortemed some fifteen years ago, and which was unique in the extreme, to me, and I have never seen anything like it reported in any of the numerous journals that I get. But I feel sure that if Doctor DeVoe had "posted" his case he would have found about the same conditions as I did.

The case was as follows: H. E., colored, male, 10 years old, was taken with abdominal pains, fever, etc. Dr. J. L. Ivion, who had been practising in the community about forty years, was called to see the boy, and attended him thru to the end. The Doctor spoke to me about the case during its progress, and said that he was satisfied that it was a case of appendicitis, or what was spoken of at that time as perityphlitic abscess. Operations for this condition were not so common then as now, especially so in country practise; and of course none was attempted in this case. The case ran along for some eight or ten days, when the boy began to cough, and within a couple of days began to cough up a dark, offensiv smelling sputum. This condition lasted only a few days when death put an end to his sufferings. The attending physician askt for and was granted the privilege of making a postmortem examination. He requested me to go out with him and make the examination, which I willingly did.

Upon opening up the body I found the following conditions: Right pleura full of dark pus, such as patient had been spitting up before death. Upon further examination, found that the pus, starting from the appendiceal abscess, had burrowed its way along up the anterior abdominal wall over the liver, thru the diaphragm into the right pleura, and had been discharging thru the lung. Inflammatory adhesions had set up all along the route, which had kept the pus walled in; the track was not more than one and a half inches wide. The course of the pus was well defined all the way, especially so where it passed over the liver, the smooth surface of which had been eroded away, giving the appearance of a very shallow canal of more than an inch in width over its outer surface next to abdominal wall.

I have often thought that I would report this case, but have never done so until now. In fact this is the first time in my seventeen years of practise that I have ever attempted to write for publication; and now, dear Editor, if you think this not of sufficient interest to occupy space in your valued journal, just chuck it into the waste basket. F. A. YOUNG. Montgomery, Tex. [Doctor, come again.-ED.]

Ergot in the Treatment of the Opium
Habit.

Editor MEDICAL WORLD:-In response to the query of Dr. Callahan in February issue, pages 51 and 52, just noted. It is certain that when the general practician deals with morphin case there must be a desire on the part of the subject to be releast from the thraldom of the drug, or there must be applied a sufficient moral and physical control to accomplish the course of treatment determined upon, in spite of the subject's determination to the contrary. The latter is much more feasible in an institution where just and rational rules are inflexibly applied. No demand should be made that has not been carefully considered beforehand; but, when made, it should be final.

The subject who does not put himself in accord with the physician, or who does not consent to be controled during the treatment, might as well be permitted to go to the devil soon as later, for that will be the termination of such a case, no matter what medical help may be given him. I ought, perhaps, to except suggestiv therapeutics, but as to its efficacy I do not know.

I have witnest the extreme torture" the Doctor refers to, but, tho it was as great a nervous strain as I ever endured, it did not suggest to me "relenting and allowing the drug." The result was that within twentyfour hours the torture and my strain were over, and the rest of the voyage to health was upon a smooth sea.

The Doctor says he employed ergot hypodermically for five days with result: "hard work to suppress abscesses" and "larger appetite for the morphin." If the Doctor had sufficiently and properly applied the ergot, having either wholly discontinued the drug to begin with or used the tapering off plan I suggest, there should have been no appetite for it at the end of five days. As to the abscesses, while I have no disposition to hurt anyone, I am not squeamish about injecting in cases that so often cover themselves from head to foot with abscesses from their reckless injections of morphin. Personally, I have not had half a dozen abscesses from ergot in about thirty thousand hypodermics.

The Doctor did well to begin with a mercurial purgativ, followed by a saline, but I much prefer the after use of the rhamnus frangula to that of salines, to keep the bowels daily activ, and only to the degree of mushy stools.

As to sleep and nutrition, both are important, and are considered in my paper on ergot in the drug habits, publisht in the January issue of The New York State Journal of Medicin. Galvanization of the cervical sympa

thetics, dry-cupping and shock, mentioned in my former letter, are, together with ergot, if all are properly applied, sufficient to secure sleep and calm nervous agitation.

Let the Doctor remember that morphin has not been a food or real support to the subject, and that the chief support needed, beside warm fluid, easily digested foods, once in three hours, is the remedy which counteracts the effect of morphin on the circulation: ergot.

As to his case of inflammatory adhesion, I wish the Doctor would apply galvanism, using a large positiv electrode under the back, and a mass of clay paste over the inflamed mass, and extending beyond it, as the positiv electrode, and give daily a current of 25 or 30 milliamperes for an hour or more at a time. After removing the metal conductor (pliable sheet lead or tin-foil) from the clay, the latter should be left in position until it is entirely dry. ALFRED T. LIVINGSTON.

Jamestown, N. Y.

Treatment of the Morphin Habit by Gradual Reduction.

Editor MEDICAL WORLD:-The subject of the treatment of morphin addiction makes its appearance in the pages of THE WORLD quite frequently, and we are pleased to see that the Editor "stands pat" for its treatment by gradual withdrawal of the drug. This is the only rational method. The writer of this was once so unfortunate as to contract the "habit" and speaks from dear experience in regard to methods of cure. And first let me protest against the term "morphin habit." It is more than a habit. It cannot be dropt at the will of the individual as mere "habits" can. When long used, morphin produces an irresistible impulse to its further use, and an "irresistible impulse" constitutes a mania. This mania requires treatment and attention as certainly as any mania. Any practician undertaking the care of one addicted to morphin should always bear in mind that his patient is subject to a mania and not to a mere habit. The cause of this mania is a more or less long continued use of morphin. This use of morphin produces certain physical symptoms, and also some other mental symptoms besides the mania. To remove the cause is the first step in the treatment of any and all mental and physical conditions. Removal of the morphin is the first and great object then in this condition.

For the sake of brevity we will not discuss the treatment of symptoms, tho it must not be forgotten that this is very important.

There are occasional advocates of the removal of morphin by the substitution of some other drug, as cocain, heroin, soda bromid, etc. The writer had sad experience in this line. It

Or,

is like casting out Satan with Beelzebub. to use another simile, it is jumping out of the frying pan into the fire. Do not for a moment entertain substitution of any drug as a method of withdrawing morphin.

And

The way to withdraw is to withdraw. yet we must not withdraw in a way that will destroy the patient. Sudden withdrawal of morphin often does this. Levinstein himself reports deaths by this method. A death due to the withdrawal of morphin is, I am sure from my own experience and from what I have seen, absolutely unnecessary. But deaths will occur if the drug is suddenly withdrawn. And in every case of withdrawal suddenly there will be intense nervous agony and physical pain.

The same may be said of rapid withdrawal. There are probably not so many deaths when from five to eight days are used in withdrawing the drug, as when it is suddenly and all at once withdrawn, but the suffering is probably just as severe. Only strong men who have not used the drug long, and who must save time, should attempt either of these methods.

Slow withdrawal is the only practical method in the vast majority of cases. And the "adap

tiv slow withdrawal is the true rational method. By "adaptiv" slow withdrawal we mean taking away a little now and then, according to the condition of the patient. No hard and fast rules, no machine methods. The amount of the drug is reduced today, for instance, to as little as the patient can be fairly comfortable with. Never is it reduced to where there is serious discomfort. The patient is kept on this until he is wholly comfortable on this amount, when another slight reduction is made. Good food, baths, tonics, electricity, all possible adjuncts are used to build up the patient. If he should have an attack of intercurrent disease, as grip for instance, no attempt is made to reduce until the patient has recovered. Then forward with the reduction again as rapidly as the patient is prepared for it, and no more rapidly. By this plan morphin can be withdrawn in from fifty to one hundred days. It was in an institution practising this method that the writer finally obtained release from the fetters of this fearful drug. And that release came with very little suffering. No intense nervousness, no diarrhea, nothing severe. I can say truthfully that I did not suffer as much while under treatment as I did almost any month of the year preceding treatment. Only one who has used morphin knows what the suffering of the advanced stage of morphino-mania is. From the time the amount began to be reduced I began to feel better.

One more point. Many unfortunate victims of the drug hesitate to attempt to get free be