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tioned, have not fallen off, and it is true, without the shadow of a doubt, that cocain, pure or in combination, can be purchast in 65 percent of the drug stores of Philadelphia without a prescription. With this condition existing in the face of a recent law, what little difficulty can there be in procuring morphin, with no special law against it?
With regard to Dr. Livingston's treatment for morphin addiction, principally the use of ergot hypodermically, I have had no experience, but would not be disappointed if I failed to cure a large percentage of patients. While not altogether new, I have never seen claims quite as strong made for it. In the absence of experience, I shall not condemn it, but viewing it in the light of my experience with other remedies, it appears too easy to be reliable. The tendency of ergot to form abscesses is certainly great, and on this score it would be likely to be objectionable.
Physicians who essay the treatment of opium addiction will not progress very far before the discovery is made that it is the patient who must be treated, and not the disease. So many of the profession seem to act on the principle that all that is needed to cure drug addiction is some formula, or fixt treatment, that has cured other patients, and that all that is required of them is to see that the remedy is administered according to the directions given. It is therefore not surprising that physicians will continue to report failure after failure, even tho they use the same remedies other successful practicians use. Dr. Callahan (page 51, February WORLD) appears to be in difficulty regarding patients of this class under his care. He has used the ergot treatment without success; he says "I have Dr. Albright's book, and have tried his remedies without the slightest avail;" he has used hyoscin and failed, and now asks in apparent despair, as did Jeremiah of old, "Is there no balm in Gilead?"
Dr. Callahan should be imprest with the truth that books and remedies will not cure opium addiction. The colors of a celebrated artist were mixt "with brains," according to the reputed words of the artist himself, and so, indeed, must disease be treated. He says he has used my remedies, as tho I prescribed fixt formulae for all cases. I mention. in the book he refers to, perhaps thirty remedies, and he should not forget that the entire materia medica is at his command, just as it is at ours, and if we cure a large percentage of patients, is it not apparent that the method and not the remedy is most important?
Dr. Wilcox, of Clifton, Ariz., reported a remarkable cure some time ago. A professional man was consuming upwards of 100 grains of morphin, in addition to unknown quantities
of cocain and whiskey, each day. After a struggle with his patient, meeting indications as they appeared, he had the satisfaction of restoring his patient to his family, his business, and standing in society. Dr. Wilcox possibly used the same remedies that Dr. Callahan condemns, yet the results are quite the opposit. Within two months, while in New York City, I called on a physician whom I had the pleasure of curing over two years ago. His fine appearance, activ life and apparent perfect health told me, before he uttered a word, that he was permanently cured. Regarding hyoscin, which Dr. Callahan also condemns, I will simply say that it is a fine remedy when properly used. Professor Hare has advocated its use for this trouble during the past year, as have also many others of more or less prominence.
After these criticisms, made in no unkind spirit, however, it would be unjust not to offer any suggestions as to how some of the more prominent symptoms attending the withdrawal of opium can be relieved or avoided. Bridges are easily destroyed, but not so conveniently built.
Abstinence symptoms are referable to one or all of three points: the brain, heart or stomach.
It has long been known that as the craving for opium increases, the action of the heart becomes weaker, and it was supposed that the latter depended upon the former. Recent observations convince me that such is not the case, but that the reverse is true.
The brain, so long accustomed to periodical stimulation, is the first to cause disturbance when its customary stimulus is withdrawn. These disturbances produce the various nervous phenomena, including the pains and cramps not usually referred to nerve center disturbance. With these the cardiac action becomes weaker and the stomach often rebels.
The gastric rebellion is always due to hyperacidity, causing pyrosis to an extraordinary extent in some cases, and between the three vulnerable points, the patient is ready to collapse.
As a dose of opium relieves these symptoms, so beginning at the other end, attention to these organs will relieve the craving.
Nitro-glycerin is perhaps our best remedy for the disturbances due to the brain and nerve centers, producing a period of calm and comparativ ease; to some a sense similar to that of morphin euphoria.
For the heart, spartein, digitalin, strychnin, caffein and hydrastin are the best remedies. Giving these remedies according to indication, in an effort to keep the heart's action as near the normal rhythm and volume as possible, will do much toward alleviating the craving for opium. For the hyperacidity of the stomach
but one remedy is suggested: bicarbonate of soda, 60 grains every two to three hours, or as required. The wonderful relief patients experience from this simple remedy is amazing. Hot baths before retiring conduce toward sleep, but they must be hot. Galvanism, negativ pole to forehead and positiv pole to back of neck, using four to eight cells for ten minutes, is excellent as a sleep producer. Fluid extract of coca, half dram doses, will assist in dispelling restlessness.
As remedies which seem to exert some specific action on the combined disturbances, physostigmin salicylate, hyoscin and cannabin may be employed. Dr. Mattison recommends fluid extract of cannabis indica in large doses for Trional for insomnia. J. D. ALBRIGHT, M.D. 900 North 48th St., Philadelphia.
Objections to the Automobile Answered. Editor MEDICAL WORLD:-There is a number of unfounded assumptions in an article entitled "Automobiles not Popular," on page 68, February WORLD. The title itself should be qualified, because automobiles are popular with those who own, or desire to own, and operate them. To non-owners it is largely a case of "sour grapes." Every argument for restricting their use by unusual and often vicious laws, rules and regulations had gray whiskers before the foundations of the pyramids were laid. They were used by the ancients against the horse and in favor of the ox and ass. But four or five years ago they did service against the bicycle. Horse cranks swore publicly that they would take pleasure in smashing all the wheels they could run over, and hinted that they would delight in murdering the riders. But the bicycle enthusiast went on his way rejoicing, and secured a long list of court decisions that are of inestimable benefit to the users of the autocar.
ed so often against the horse that a mere allusion to it is all that is required.
It is the horse that is dangerous on the crowded streets. The auto never rears, kicks and plunges at the sight of an unfamiliar object, or a familiar object in an unfamiliar place. It never goes into a panic and leaves death and destruction in its wake because the wind has blown a piece of paper against it. It does not plunge off grades and into rivers because a rabbit crost its path. It does not smash, kill and cripple all ahead of it because of some noise that would not startle a sheep. Who that has been much on the road has not had life and limb placed in jeopardy by the antics of a nervous or crazy horse? Who has not had difficulty to escape with his rig when pursued by a runaway team? Every village surgeon has reduced more fractures and dislocations, and drest more lacerations, contusions and other injuries caused by horses than from all other causes combined.
To say that an automobile is a "luxury" is irrelevant and immaterial. The word is ambiguous. A watch may be a luxury to a plow boy, but it is a necessity to a railway man. A machine that will enable a physician to visit two patients while he could call on but one before, cannot be disposed of by calling it a "luxury." The horse is a luxury to that imaginary old lady who "takes her usual ride of a summer evening." Why should she monopolize the road? Perhaps there are other old ladies who cannot manage that foolish and dangerous animal called a horse, but who can handle a runabout with safety and pleasure. There is a fallacious assumption implied but not exprest, and that is that nothing but horses and horse drawn vehicles has any natural rights on the roads a question that has been decid
As to reckless driving: We have all seen a lumber wagon drawn by horses driven at a speed that endangered all vehicles and pedestrians on the road. We have seen drunken drivers race their horses two and three rigs abreast, and with no regard for what happened to be ahead of them. We have had our light buggies and cutters crowded off grades into deep mud or snow drifts by "read hogs" with heavy wagons or sleighs. We certainly should have rules and regulations, but so far as possible, they should apply to all users of vehicles alike, whether their carriages are drawn by horses, propelled by human muscles, or driven by motors. J. A. MULNIX, M. D.
Malaria or Autointoxication? Editor MEDICAL WORLD:-During our sojourn in the South I have taken pains to ascertain the views of physicians in regard to malaria and its dependence upon infection thru the mosquito. Naturally there is quite a variance of opinion. But I have been surprised to find what a large proportion accept the mosquito theory. Many, old and young in the profession, agree not only that the mosquito causes the disease, but that it occurs in no other way. Others, as worthy of respect, deny this, and while admitting that the pestiferous insect conveys infection, claim that this is not the only means by which it is imparted to human beings.
Little of our "knowledge" is absolute; most of our beliefs are based on analogies, the balance of testimony, weighing of probabilities, even excluding the influence of superstition, and the tendency to view facts thru the tinted glass of preconceived opinion. If we analyze
the beliefs of physicians, we will very often find that they are based on a single notable case, whose features are strongly imprest on the memory. When an impression is once formed in this manner, every subsequent experience that goes to confirm it is received at its full face value, while all that antagonize it are minimized, or explained away. In this manner we find many physicians who will stoutly affirm that the unbroken experience of a lifetime confirms their view, while others, who have had perfectly identical experiences, will have formed diametrically opposit opinions.
There is a tendency in those who practise in the malarial belt to see this malady underlying very many affections which in other sections would not be so regarded. There is much reason in this, for a malarial taint may tincture any disease the patient may have, and quinin will then exert a curativ influence it does not manifest in non-malarial subjects. But this generalization has its disadvantages. A person may be ill, even showing periodicity in the symptoms, and yet not be malarial. The probability here is fallacious, the similarity illusory.
An instance: A lady is ill; complexion muddy, tongue heavily coated and indented by the teeth, headache, fever coming on in the morning and followed by sweating; temperature reaching 101° the second day, 102° the next. Urin scanty, stools offensiv and insufficient. She was given calomel at bedtime, followed by a saline laxativ in the morning, and after free catharsis she took sulfocarbolate tablets enuf to remove all unpleasant odor from the stools. For three days she also took fifteen grains of quinidin daily. She was by that time well. Malaria, says every last one of our doctors here. The symptoms, their periodicity, the recovery under approved anti-malarial treatment, all go to prove this. But I confess I can see nothing in this case but auto-toxemia from decomposition of retained feces and their re-absorption. Such cases are common enuf where there is no malaria. The quinidin was superfluous; clearing the bowels cured her. Each of us accepts the Case as confirming his views, and of course I am just as likely to be in the wrong as my neighbor; for we have not taken the necessary means of deciding the question, by an examination of the blood. But I fully believe that very many of the socalled malarial cases are nothing but auto-toxemia, and especially those my good friend, Dr. Brodnax, cures without quinin; and that if the term malaria were limited to cases in which the plasmodia were demonstrated, there would be far less belief in infections without the mosquito. Looseness in
diagnosis, with the use of polypharmacy, and drugs of uncertain and variable qualities, make confusion in medicin, and prevent progress, by compelling each physician to go over for himself the experimentation that numerous generations of his predecessors have made, and which should have long since been definitly settled. Every element of uncertainty eliminated, every fact solidly demonstrated, helps to make firm footing for the next. Until this truth is accepted by the profession in general, there can be no such thing as real, permanent progress in the actual work of curing
Baton Rouge, La.
W. F. WAUGH. [Dr. Waugh here suggests the importance of greater care in diagnosis, but such care was not taken in the case reported, nor does he give any other case in which such care was exercised. So that leaves us all to think just as we thought before, proving Dr. Waugh's statement concerning the formation and continuance of our beliefs, of which he, himself, is an illustration in this case. In the case given, the advocate of malaria has as strong ground for his belief as Dr. Waugh, and vice versa. Nothing is proved. Many cases are as indefinit in both pathology and therapeutics. We don't learn much in that way. Let us try our theories and use our remedies singly, with a definit aim in mind. In that way we can clear up our ideas, and aid in making therapeutics more definit.-Ed.]
Periodic Skin Troubles.
Editor MEDICAL WORLD:-Please ask "Tar Heel," page 79, February WORLD, to try arsenauro (dose three to five drops). It has cured several cases of chronic periodic skin troubles, originating in poison oak, for me. One of the cases was a girl of ten years, whose hands, neck and face would break out about March 1 with a solid mass of scabs and dry serum, and last, more or less severely, for the entire summer, never healing until frost. First year cured it
up in a few days, not using a whole vial. Commencing a week before the eruption was due the next year, there has been no return since, now about nine years. If your correspondents would sign full name they could often get direct replies which would put them a month ahead of time. BEN H. BRODNAX.
Two Useful Formulas.
Editor MEDICAL WORLD:-I see that the latest fad is the abandonment of cod liver oil. We have heard of the extract or activ principle of cod-liver oil for a number of years. I can see no reason for such a fad other than the unpleasant taste and odor of the oil, and hence its unpopularity with the petted pampered public. I try to have my clientele teach their children that medicin is not bad to take, and the doctor is only their friend, who has come to save their lives. If children are taught to disregard the taste and smell of medicins they will take anything with a pleasant smile, and if they are taught that the doctor is a necessity and is constantly working for their good, they will grow up with the respect due their good old family doctor.
Cod-liver oil, genuin, pure, fresh and rightly made, is indicated in people who catch cold easily, who are constantly chilly, who have catarrh, tonsillitis, rheumatism, colds, scrofula, eczema, dry hair, emaciation, scurvy, subnormal temperature, tuberculous tendency, rachitis, enlarged glands, anemia, pale face, sweaty feet and hands, and it is indispensable; it cannot be properly substituted. It has done as much good as any other medicin, and will be continually used as long as man is diseased. It should be used externally, internally, and eternally wherever indicated, provided the stomach is in proper condition to allow of its absorption and assimilation. If the stomach is not, the subject should be dieted until he can take it.
Here is a stable, palatable, common-sense emulsion of cod-liver oil without the admixture of hypophosphites or other digestion destroyers. I specify P. D. & Co. oil because so far it is the best I have seen.
Cod-liver oil, P. D. & Co.
Oil bitter almonds Simple syrup, to make Separate the yolks from the whites carefully, and in a large bowl stir the yolks rapidly with ten drops of oil for one minute. Then add half a teaspoonful of oil, and stir (not beat) with a spoon rapidly for another minute; next time add one teaspoonful of oil. This operation may be continued, constantly increasing the amount of oil until it is all mixt. You will
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Michigan Statute, Act 237, Public Acts of 1899, requires all persons engaging in the practise of medicin and surgery to obtain from the Board of Registration, provided for by the same Act, a certificate of registration, prescribing the conditions upon which such certificate should be granted, and forbids, under penalty, the practise of medicin or surgery without procuring such certificate. The conditions prescribed by the statute were not complied with, and the plaintiff in error in the Supreme Court of the United States was prosecuted and convicted of violating the statute. That conviction was affirmed by the Supreme Court of the State of Michigan, and was alleged as error in the Supreme Court of the United States. The grounds upon which a reversal of conviction was sought were:
1. That the Registration Act violated the Federal Constitution in giving the power to the State Board of Registration to determin whether the applicant had been legally registered under a prior State statute, and had not provided for a review of the board's determination.
2. That inasmuch as the Federal Constitution forbade the deprivation of life, liberty, and property without the observance of due process of law, and as no special provision was made by the Registration Act for granting a hearing. to applicants for registration, the Act violated the provision of the Federal Constitution regarding the observance of due process of law.
3. That the prohibition of the practise of medicin and surgery by unlicenst persons
violated the Federal Constitution and makes the law ex post facto. Upon these contentions the Supreme Court of the United States said: "The power of a State to make reasonable provisions for determining the qualifications of those engaging in the practise of medicin, and punishing those who attempt to engage therein in defiance of such statutory provisions, is not open to question.
"It is objected in the present case that the board of registration is given authority to exercise judicial powers without any appeal from its decision, inasmuch as it may refuse a certificate of registration if it shall find that no sufficient proof is presented that the applicant had been 'legally registered under act No. 167 of 1883.' That, it is contended, is the determination of a legal question which no tribunal other than a regularly organized court can be empowered to decide. The decision of the State Supreme Court is conclusiv that the act does not conflict with the State Constitution, and we know of no provision in the Federal Constitution which forbids a State from granting to a tribunal, whether called a court or a board of registration, the final determination of a legal question. Indeed, it not infrequently happens that a full discharge of their duties compels boards, or officers of a purely ministerial character, to consider and determin questions of a legal nature. Due process is not necessarily judicial process.
"Neither is the right of appeal essential to due process of law. In nearly every State are statutes giving, in criminal cases of a minor nature, a single trial, without any right of review. For nearly a century trials under the Federal practise for even the gravest offenses ended in the trial court, except in cases where two judges were present and certified a question of law to this court. In civil cases a common rule is that the amount in controversy limits the entire litigation to one court, yet there were never any serious questions that in these cases due process of law was granted.
"But while the statute makes in terms no provision for a review of the proceedings of the board, yet it is not true that such proceedings are beyond investigation in the courts. An application for mandamus to compel this board to register the petitioner was entertained, and altho the application was denied, yet the denial was based, not upon a want of jurisdiction in the court, but upon the merits.
"It is further insisted that it is essential to a judicial or quasi-judicial proceeding that it should give a person accused or interested the benefit of a hearing, and that there is in this statute no special provision for notice, or hearing, or authority to summon witnesses or to compel them to testify. The statute provides
for semi-annual meetings at specified times at the State Capital, but the plaintiff in error did not appear at any of these meetings or there present an application for registration or showing of his right thereto; he simply sent to the secretary of the board a certified copy of his registration under the prior statute, and his diploma from the Independent Medical College of Chicago, Illinois. The latter was returned, with a notice from the board that it had denied the application for registration. When a statute fixes the time and place of meeting of any board or tribunal, no special notice to parties interested is required. The statute is itself sufficient notice. If plaintiff in error had applied at any meeting for a hearing, the board would have been compelled to grant it; and if on such hearing his offer of or demand for testimony had been refused, the question might have been fairly presented to the State Courts to what extent the action of the board had deprived him of his rights.
"He seems to assume that the proceedings before the board were in themselves of a criminal nature, and that the State by such proceedings were endeavoring to convict him of an offense in the practise of his profession. But this is a mistake. The State was simply seeking to ascertain who ought to be permitted to practise without having his right so to do establisht by the action of the board. The proceedings of the board to determin his qualifications are no more criminal than examinations of applicants to teach or practise law; and if the provisions for testing such qualifications are reasonable in their nature, a party must comply with them, and has no right to practise his profession in defiance thereof.
"It is further insisted that having once engaged in the practise, and having been licenst so to do, he had a right to continue in such practise, and that this statute was in the nature of an ex post facto law. The statute does not attempt to punish him for any past offense, and in the most extreme view can only be considered as requiring continuing evidence of his qualifications as a physician or surgeon.
"We fail to see anything in the statute which brings it within the inhibitions of the Federal Constitution, and, therefore, the judgment of the Supreme Court of Michigan is affirmed."
Reetz v. Michigan 23 Sup. Ct. Rep. 390. [The opponents of State medical laws have, several times in these columns and many times in the columns of other medical publications, contended that such legislation was contrary to the United States Constitution, and that if the question were properly brought before the United States Supreme Court, such laws would be declared out of harmony with that instrument, and, therefore, null and void. The above,