tion. Now, the surgeon has no monopoly on trained nurses. Get your own nurse; have her there a day before the operation unless it is an urgent case, and just tell her the room you want fixed and you need worry no more about its being in proper shape for opening the abdomen and doing the most serious operation. I assume, of course, that you get a nurse you are sure is reliable. As a rule the trained nurse will fix the room far better than you could. You do not need to tell her how; she will have everything ready for you. Now you have the room, the nurse, and everything in order; now say to the family you will consult with the surgeon, and others if wanted, and if they think best to wait, you will make them share in the responsibility of waiting. Always fix this so if the surgeon thinks best not to operate it can be delayed without hurting any one's feelings. This is fair to the surgeon, and protects you against any trouble if the surgeon does not wish to abide by your diagnosis and operate. It also gives the patient the judgment of all the doctors called, and avoids the unpleasant task of operating just to save your reputation.

Sometimes the surgeon complains, justly perhaps, that he is called to operate, but when he gets there he does not wish to do so, nor does he wish to make it appear that the attending physician does not know his business. This can all be avoided if the job is well managed; and if you are ready to operate, no delay is needed. Of course, if there is no hurry and the surgeon can see the case with you and then come again to operate if it is thought best, this is all proper; but many times this cannot be so and the surgeon does not wish to make but one trip. Then be sure you are right, and get things all ready and call your help and do the work. There is no dividing the fee; you get your pay, and the other men get theirs, and you earn your money as well as any one connected with the

case.

I have an operating table which can be carried to any home, and this helps to make the room a surgical one. I remember well the last words to our class by the late Prof. Thomas F. Rochester, of Buffalo. They were as follows: "The difference between the man who succeeds and the man who fails or partially fails, is the difference between a man who gets ready for his opportunities and the man who does not." Let the general practician get ready for these jobs. I called a nurse, fixt the dining room in my own house in a few hours, and we operated on my own boy for appendicitis. If I had carted him off to a hospital I would have lost him. Your editorial is a good one, and practically says to the general practician: take care of your own patients; be something more than a signboard to tell those who come to you who to go to to get relief.

We cannot all be surgeons, nor do we want to be. I oppose the idea that everybody should dabble in surgery. We are the surgeons of emergency, and we should be ready to take care of these cases. We should know as much about the operation as the man with the knife; just where to cut, just what to cut, just what arteries are in the way, and in fact know all about it; but our fingers are not educated to do this in the most skillful way; and what is more, we cannot get them trained with the few cases we have to operate on. Romainia, the great violinist, said: "If I should stop playing one day I would know it; if I should stop for two days there are a lot of people who would know it; and if I should stop for three days any darn fool would know it." So with the surgeon; he must be at it if he expects to succeed. Then let the ones who are by nature adapted to this work, and who will work and watch the great surgical clinics, have the work for a large community and he gets expert, and is a useful man. While he is working you are working also; he can no more get along without you than you can without him. Your opinion as to whether the patient ought to be operated on may be better than the opinion of the surgeon. Surely you should put your heads together. Great surgeons have been wrong and the general practician right more than once.

Dr. Hard has certainly had a "hard time" with his consultations. I enjoy a consultation; never find a doctor who wants to injure me or hurt the patient. Why the difference? Is it because of the low condition of the profession in his town? I will advise Dr. Hard to have something to say as to who is called in consultation. Do not stand for such work as you describe. Say to the friends you have called one doctor; get two, and weigh down the opinion of such fellows, and show them up. He has the wrong feeling toward his fellows. Get together and swear off; and after this, work together. You will all have more patients and the public willing think more of all of you. Almond, N. Y. C. R. BOWEN, M.D.

Rubber Bandage for Leg Ulcers. Editor MEDICAL WORLD:-I see by a recent number of your journal that a physician has a sore leg. When I came here, just 22 years ago, there were a good many sore legs -ulcers between the knee and ankle. Now there are none. I cured them all with the Martin rubber bandage. In my limited experience I found two cases that could not tolerate the bandage. Dr. Martin found only about that many in his extensiv experience. I am surprised that so few physicians know of this method. Our text-books give it very little prominence. It is about to become a lost art. THOS. H. HAMMOND.

Oxford, Fla.

Editor MEDICAL WORLD:-Having seen, some time ago, a query asking for a means of preventing nausea after hypodermatic injection of morphin, I wish to suggest the following, having used it in my practise a good deal: When the first sign of nausea manifests itself, add 15 or 20 m. of ess. peppermint to a half tumblerful of ice water and drink at once. Repeat in a few minutes if necessary. I have never seen this fail.

Here is another formula for beginning bronchitis that is useful, and can be varied as circumstances demand:

R Pulv. Doveri

Ext. aconiti rad..

Quiniae sulf., q. s. ad

M. Ft. caps. No. xij.

Sig.-One at bedtime, and p. c. until relieved.
Masonic, Cal.
F. AMMON, M.D.

Please Discuss Vomiting of Pregnancy. Editor MEDICAL WORLD:-I wrote you once before in regard to vomiting of pregnancy. I have had some very bad luck. The last case was saved by inducing labor by Bossis' dilator, but in two other cases the same procedure failed. I have been in practise forty-four years, and am still "on deck." I may say this pernicious vomiting has been my bete noir. Could you not get up a discussion in THE MEDICAL WORLD about it? I have tried every means that I have ever heard tell of, and rectal feeding nearly always. I have the greatest dread of such W. H. MACDONALD. Antigonish, Nova Scotia. [Doctors are invited to please discuss the above subject.-ED.]

cases.

In December we sent out a great many bills for subscriptions, which are now due. Many of them have been promptly paid, for which we return thanks to the prompt ones. We ask those who have not paid to kindly keep the bill before them, in front of the calendar or in some other prominent place, until it is paid. Procrastination is our and your worst enemy. Please do it now. You do not need to write a letter. Just send the remittance, in whatever way you think best, inclosing your card or printed letterhead-anything that will show who it is from, either inside or on the outside of the envelope, and we will credit you accordingly. It is less trouble and cheaper to send $3 for four years than to send $1 every year.

How to Make Coffee.

Editor MEDICAL WORLD:-I noticed in some of the back numbers of THE MEDICAL WORLD that you gave us some points on making good coffee. Now, as I have had some experience along that line, I will add my mite: In the first place, select a good brand of coffee, put up and sealed in a tin can, not in paper. Always keep it as nearly air-tight as possible. Grind just as required for use, moderately fine, but not too fine. The quantity will correspond to the strength desired. Rinse the coffee pot well with clean cold-water. Then put a little more than half the quantity of water desired in the coffee pot cold, and set it on the stove. Now add the ground coffee, allowing it to float on the water. Close the coffee pot with a close-fitting lid, and also the spout, and place it on the stove where the heat is just sufficient to bring it to the boiling point in from 20 to 30 minutes. Remove from the stove as soon as it reaches the boiling point, then add the remaining quantity of water, boiling hot, and set back on the stove where it will remain near the boiling point till ready to serve. E. K. SUTTON, M.D.

Gladesville, W. Va.

[We suggest that you show the above to your wife, and possibly to the wives of your leading patrons. Vast quantities of coffee are daily ruined by boiling. This is a shameful economic waste. The Editor rarely drinks coffee away from home because, as a rule, it is not fit to drink. Boiling drives off the delightful aroma of coffee (which comes from a delicate essential oil), and develops a bitter principle which nauseates delicate stomachs and is ruinous to the digestion. The way to enjoy coffee and at the same time escape any injurious consequences is to have it made in such a way as to preserve the aroma (as above suggested), and then add a little of it to hot milk (about one-fourth coffee and threefourths milk), and sweeten to taste. Then you have the flavor of the coffee, with the nutritiousness of the milk, and you escape injury to stomach or nerves.—ED.]

Queer Cures for the Great White Plague. Editor MEDICAL WORLD:-To bask in the heat of the Great American Desert on the one hand, and to live in roofless cabins in the depths of the largest natural cave in the world, on the other, are two of the more unique methods that have been proposed for combating the great white plague, consumption. Every tourist in the Mammoth Cave of Kentucky marvels on coming to a number of huts built far in the depths of the cave. Obviously there are no panes in the windows to these huts and there are no roofs, for the buildings, primarily, are intended simply to insure privacy, one from the other. Away back in the forties some brilliant mind conceived the idea of dry air for the consumptiv; and no drier air anywhere could be found than in the Mammoth Cave, where moisture never penetrates beyond the bounds of the subterranean river.

Further, it was learned that as bacteria need the sunlight for growth and cannot exist in perpetual gloom, residence in the cave would be curativ. In consequence, the cabins were built and people came from

all corners to try the cure. How many died as result of it is unknown; how many thought themselves cured is equally uncertain. At all events, the cure was gradually given up and the cabins alone remain.

Almost as curious a cure is that which is being conducted as a charity on the borders of the Great American Desert, at Indio, California. Travelers on the Southern Pacific from the east recall Indio for its date palms, a mysterious grove that has stood here from time immemorial in what otherwise is the heart of the desert. After riding for well onto two days thru sandy wastes, the site of this luxuriant grove is one to set the heart throbbing with delight. To the layman a jaunt in Indio, however, is not at all the pleasant one that might be expected-if he is enuf of a layman to fear contagion from consumption. I recall one tenderfoot's experience in the little city out in the desert. The train left him at the hotel, alias restaurant, depot, and lunch room. He breakfasted with some Chicago friends passing thru on the second section of the express, which ran five minutes behind the first, and then, bidding these good-by, went out to explore the town. The depot, with its fine sunny verandas, sprinkled with chairs, and with the windows to the guest rooms opening as doors upon them,

called; each upon a wooden platform, and facing the center plaza, in which an open summer house liberally equipped with books and magazines and a flagstaff, stood. At one end of this plaza was a cottage of adobe, the home of the general superintendent, and before it a woman sat, quilting. Everywhere consumptivs were lounging about, sitting for the most part. Two of them were fixing a gun, to go hunting, One leaned on a stick and pondered. Ennui seemed to make them brood, and, brooding, feel so much the

worse.

Already the tenderfoot was annoyed at his situation. It is a rather indelicate thing to mention, but these consumptivs emitted phlegm when and where they chose, and the desert wind bore this in every direction. If there were such a thing as contagion, it must be in this air, most certainly. As in the consumptiv hospitals in the Middle West, each tent had a cup to expectorate in, but few of them seemed to use it. At each tent was a gasoline lamp, he noticed, for reading outdoors in the night-time. Inside was a double iron bedstead, white painted, and the bed nicely made, an iron cot, and over the wooden floor a little rug, on which stood a table, covered over with oilcloth. On this, letters, papers and the like were littered, while

seemed the ideal place for a sick man to stop. You could sit there, overlooking those four long, oiled, railway tracks and the row of neat, two-roomed, square cottages of the railway employees just across in the bare desert, yet shaded by ancient cottonwoods, all day. It seemed so good to see trees again; he would have liked to sit there all day, just to watch them waving. Folks came and went to and from one general store, and the grocery and the other general store among the poplars, disappearing and reappearing behind the date palms. Some passed on into a narrow side street, where there was a post office in the grocery, but no farther, for after that was only the desert. In fact, it seemed as tho all Indio could be viewed from here, the prospect extending down to the mammoth oil tank from which the railway drew its fuel.

But he had not come for perspectivs, or for a "laze" cure, but to see the famous consumption philanthropy of Indio. They directed him down the railway track, where he would find the camp-and he did. In a field of very dry, long grass-itself an oddity west of the desert-set to form a hollow square, were perhaps thirty white tents-"single tents," as they are

below two soap boxes contained additional properties of the inmates. It was very sunny here, so sunny, in fact, as to be torrid. He was glad to accept hospitality and step into a tent. For the moment he forgot all about germs. The patients, the host told him, pay a dollar a week without board, or three dollars a week with food, the meals being served in a general mess tent. Tents here are all about the same size, twelve feet by fourteen. The "Company," as the philanthropy is termed, furnish bedding and the like, chairs, stove, and things to wash in, together with a lamp. The "Company," as matter of fact, is a private individual who owns the camp, operating it as a sort of charity, which must, however, meet its expenses, but leave no profit. Any one can come here who will, and occasionally patients are given opportunity to earn their board by doing work about the premises.

It is the absolute lack of novelty or anything to do that makes the camp life boring, however. At halfpast seven they breakfast: mush and milk and eggs and coffee. At twelve noon, there is dinner: soup, a little meat, potatoes, but no dessert. Then at five there is supper. Sundays the program is the

same. For recreation: well, now and then the men go hunting after quail and ducks; and the women try to find pastime in work. Altogether there are twentyfive people in camp, so that several of the women are occupied with cooking. Others, however, board at the hotel.

No, they admit they never yet saw any one who was cured by living out here in what is almost as bad as Death Valley, but it causes every one to rally. Men have been brought here on a stretcher; in fact had to be given sleeping powders to get them here, and they are now very much better. While this was being told, the speaker unconsciously kept ejecting sputum, which the sun dried immediately and the wind wafted toward the newcomer. He remembered contagion, and almost fainted from fright then and there. He concocted an excuse to his host and walkt fast as he could out into the desert, scarce daring to breathe the impregnated air. Out there he sank in the grass, almost faint, and dazed. Then the spell went off, and for the rest of the day he wandered about, taking good care not to breathe deep lest he inhale some of the bacilli which he felt must be all over the town. He feared to eat at the tavern, because he had heard some of them stopt there. He feared to eat what was

plan of it himself. He bought a hundred and fourteen acres out here at a hundred dollars per acre and started an outdoor camp for consumptivs. The place was put in charge of a general foreman and a great ranch opened in connection with it, where barley, alfalfa, cantaloupes, and the like were to be raised for its support. Sick men, however, cannot work well, and it was found hard to keep up the farming. As a result, today the camp is maintained very largely by the Nelson contribution. While not absolutely free, it is sufficently so to admit any comer. There are no cures, so folks come and go-benefited, however, usually all.

So far so good. Then, again, he was glad to beat a retreat to his hotel porch, better to watch the long trains of celery and oil and citrus fruits go by, or the longer trains of tourist sleepers. At eight the fires at the tents of the consumptivs burnt bright against the gorgeous desert sunset, but they did not tempt. He knew when he had enuf.

Another interesting cure, or better, "fake," was recorded in Cincinnati not over twenty years ago. A street fakir would take his place on a corner, attract a crowd, and then tell of the thousands who had incipient consumption and did not know it. He had

sold in the stores, because the invalids lingered about them.

He found consolation in the desert, searching the sand for the thousands of old, pearly clam shells, and other tiny spiral shells, the remains of a primeval ocean. He noticed a road leading out thru the town and he followed it, only to find two or three other consumptiv tents located apart from the camp. A wagon like a gypsy's wagon was drawn up by the roadside, its inmates perhaps sick. There were some neat frame cottages here, with hammocks and cots on the porches, where the inmates sleep the year round, for there is less than three inches of rain a year out here, so one can sleep securely. It would have been pleasant to rest here, only wherever you wandered you heard the hacking cough that betokened the great white plague. Only by wandering into the desert, among the low brush (for there are no cacti here), did he seem to find security at all.

He felt dissatisfied at the amount of information to hand regarding the camp, and he must return to it once again. People who live here in Indio reassured him that it really wasn't contagious. He tackled the first person that he met for particulars. The place, he learned now, was founded by N. O. Nelson, the St. Louis capitalist and philanthropist, who workt out the

here a clear, colorless liquid into which, if such a person breathed, the germs would make their appearance. He would induce some one in the crowd to come in and breathe. No germs appeared, the liquid was colorless. Then he threw it out and refilled the vial, and tried a second man. This time, however, unbeknown to the crowd he substituted lime water for pure distilled water, as he had at first. Again he induced some one to breathe, and the lime water filled with particles, as it always does when one breathes into it. The carbonic acid gas of the breath combines with the lime, forming carbonate of lime, which, being insoluble in water, is precipitated. The poor victim would turn white with fright at this sudden discovery that he had consumption. Then the fakir produced his "cure"-one dollar per bottle. To demonstrate its efficiency he poured a few drops in the vial and the liquid resumed its former clearness. Of course the "cure" was nothing more or less than dilute hydrochloric acid, which redissolved the carbonate of lime, and cost him not over a dime, wholesale; but victims invariably bought, to wipe these first germs from their system." FELIX J. KOCH. Cincinnati, Ohio.

Having never before heard of the "cave

cure" for consumption, we wrote for further information, asking for the exact date and further details. The following came from the Trustee of the Cave:

The stone cabins were erected in the Cave about 1842. Sixteen people tried this fancied consumption cure under the belief that the pure air and even temperature of 54° would prove to be the long sought remedy. One of them died in the Cave. None of them were benefited by their stay there. More advanced knowledge seems to have establisht the fact that pure air and an even temperature are of no avail in the treatment of consumption without the assistance of sunshine, which is apparently a sine qua non element of the proper treatment of the malady.

The Editor being acquainted personally with Mr. N. O. Nelson, and having heard an interesting account of Indio from Mr. Nelson's own lips, he was unwilling to publish the above statements about Indio without Mr. Nelson's knowledge and consent. the author's suggestion the manuscript was submitted to Mr. Nelson, who returned it with the following reply:

At

MY DEAR DOCTOR :-Answering yours, I suggest that Mr. Koch's stay at the camp was too brief to give him a fair knowledge. He evidently means to be fair and tells nothing but what he thought could be true. He falls into the not uncommon error of generalizing from quite insufficient data. Such, for instance, as the American traveler writing a book on Ireland after passing thru it on the daylight train from Queenstown to Dublin; or the Englishman writing his impressions of America after spending a few days in the center of New York and Boston.

Quite to my surprise, nearly all people visiting or staying in that desert valley soon find a fascination in the great mountain ranges close at hand on both sides, in the clumps and thickets of mesquite trees, many of them large enuf to cut a full cord of wood, in the arrow weed and sage brush and grease wood that in some places cover half the ground and in other places cover it with a solid growth, and in the magnificent sunrises and sunsets over the mountains at the ends of the valley, say forty miles away, and the 14,000-feet high San Jacinto and Gray Back peaks, which always carry their snow. A considerable portion of the patients I have found personally to get interested in these things and regard them quite beautiful and attractiv.

There does not seem to be as much chance for ennui there as in either a hospital or a sanitarium or the heart of a city. There are the neighbors in the camp itself, the reading pavilion, the six or eight transcontinental passenger trains each day at the station, which is only 100 yards away, the bustle of train crews and section hands pertaining to a division point of the Southern Pacific Railroad, the station hotel and train dining room and large platform, the two stores, pool room, and restaurant, the large old grove of palms and cottonwood, one-fourth of a mile long, fairly good roads leading out anywhere, the always bright, fine weather. I have been surprised at how little signs of lonesomeness there were, considering their being away from home. Ennui has never once occurred to me as being present.

Then, he did not seem to learn that we have six milking cows, with always an abundance of milk and some to sell, always fresh meat and eggs, and always plenty. There are only two rules applied to patients in the camp, and these I have always enforced myself when there, and continually caution the superintendent to see enforced when I am not there. The first and most emphatic rule is to carry a pocket spittoon, never spit on the ground, and to throw the spittoon into the vault, which is to one side, where it is burned out daily. The other is to keep the tents open and clean, and use no patent medicins. These rules cannot be absolutely enforced. I doubt if they are anywhere. That there is nothing like the liability to con

tagion from sputum in the camp that there is in trains or hotels or cities, I feel quite sure.

I have always received tuberculosis patients of every description in every stage and whether complicated with other diseases or not. I started it as much as anything as a haven for the unfortunates who had gotten out to California, and who were either stranded or could not afford the sanatoria, all of which are very high priced. I undertook it and planned it by the advice of the most prominent physicians in Los Angeles. The first winter I started it and stayed with it myself for five months, taking the patients as they came; none died and some got well. The first man I took there had tuberculosis in a very serious stage. He is entirely recovered and is practising law in a distant city. I have been there other seasons, two months or more at a time. I have seen a number get able to do a full day's work on the railroad or on my ranch. One in particular I remember, who came from the Los Angeles Hospital, barely able to walk. He workt for us at full pay for a year or more after he got well. My detailed record of last year's patients, 70 plus, showed 7 deaths, a large number recovered or greatly improved.

Mr. Koch could not have gotten the information in the camp, neither from the manager nor any one else, that no one was cured. It is perfectly known that the lungs can be healed, tho the lost tissues cannot be restored. I have compared, at various times, the reports of the Phipps Institute and the Illinois experimental camp at Ottawa, and the Redlands, Cal., camp, and I find the death rate in all of them is more than twice what it is in my camp. The rainfall in Indio is from to inch a year, and not three inches, as Mr. Koch thought.

I am satisfied Mr. Koch means no harm; he simply didn't stay long enuf, and his first impression of the desert or the camp scared him too quickly back to the station hotel. Yours very cordially,

N. O. NELSON.

A Doctor Writes to His Church Paper. SMYRNA, TENN., Dec. 6th, 1906. The Christian Observer, Louisville, Ky.: DEAR SIRS:-Some time since I wrote to you concerning advertisements of patent medicins in your paper. If you will indulge me just a little while, I would like to say a little more concerning them. I must say that your issue of Nov. 28th contains more advertisements for what on their face show to be frauds than one would expect to find in a paper supposed to be for the good of the human family, not only spiritually but physically. I hope you will take the time to read the little book, "The Great American Fraud," which I send by this mail. But for fear your time is too much occupied, I mark some paragraphs dealing especially with preparations advertised in your paper. I do not propose to say anything concerning them myself, tho I have made some study along this line, but submit the evidence of Samuel Hopkins Adams, backt by such a periodical as Collier's Weekly. I believe if you are sincere in your work and are not blinded by the dollars received for the advertisements, that you will see the justice of my appeal to discontinue at least some of the very objectionable ads now carried by you. This little book was written with nothing more in view than to give plain facts, and such I believe it does. Of course, one subscription does not amount to much, but I will wait until a new year to see if some of these contracts are not cancelled; and if not, I will have to discontinue my subscription. Hoping you may see this great question in its proper light, I am,

Very truly yours,

J. S. LOWRY (M.D.)

[This is a good example to follow. See notice of and how to get "The Great American Fraud," on page 461, November WORLD. -ED.]

"Of the dozens of periodicals I receive every month, THE MEDICAL WORLD is the only one I never fail to read, and I frequently find items therein to report to the European medical profession, of which I have the honor to be a representativ."- Dr. Zwigtman, Niles, Mich.