the cases recovered on your treatment in much less than twenty-four days? Then they were not typhoid, for typhoid untreated, which your management practically is, or with the old fashioned expectant treatment, runs a course of twenty-eight days. Some doctors call every fever, "typhoid"; and every acute chest trouble, pneumonia." With lax methods of diagnosis, it is easy to report wonderful results. It is all right for you to advocate better nourishment in typhoid, but we can't accept your statistics until you give us very convincing proof as to your diagnosis.-ED.]

66

Influenza.

Editor MEDICAL WORLD:-I wish that you or some of THE WORLD Subscribers would write a good paper on the treatment of influenza. This disease appears to have come to stay, and I think a good paper and some discussion on this subject would be in season. For the purpose of starting the subject, I write the following: I give an outline of my mode of treat.ment of influenza, not because I think it superior to other methods, for while it has served me well in most cases, I am sorry to say that it has failed in many. The treatment of influenza has in my hands been unsatisfactory in a large number of cases; whether it is due to my method of treatment, or to the treacherous nature of the disease, you will probably be able to judge.

In the first three or four days, when the fever runs high and there are considerable rheumatic pains, I have found nothing better than a good sweat. To this end I give Dover's powder together with plenty of hot lemonade. The Dover's powder ameliorates the muscular pains, and together with the lemonade, starts a profuse perspiration and an increased flow of urin. At the same time I usually give the U. S. P. cathartic comp., or small doses of calomel, enuf to give one or two stools during 24 hours, but not any more, as purging will only weaken the patient and not accomplish any good. Depression of all the vital functions seems to be more markt in this disease than in any other; and for this reason I never give any of the coal tar products in this disease except in a few cases, and then always in combination with quinin and strychnin or caffein. A favorit capsule with me is acetanilid gr. 3, quinin sulf. gr. 12, and strych. sulf. gr. 8. In mentioning the coal tar remedies, I think that I have noticed a more markt and longer continued mental depression where these drugs have been given freely during the early stage of the disease. When there is great weakness from the beginning, I give quinin sulf. gr. 2 and strych. sulf. gr every 6 hours, together. with the Dover's powder. After the febril

stage, and when there is a good deal of bronchial irritation, I give such remedies as amm. carb., or spr. amm. aromat., syr. ipecac and squills or fl. ext. white pine, with the addition of a little codein. When there is no appetite, which there seldom is, I give a bitter tonic, such as nux vom., gentian, cinchona, etc., and a little good whiskey before or during meals. I never recommend stimulation until late in the disease. As a general tonic, which I use in a good many cases, especially where there are bronchial symptoms, is syr. hypophosphites comp. (Fellows). In some cases there is a good deal of mental depression during convalescence; here I prescribe valerianate of zinc or valerianate of iron, as the case may indicate, in conjunction with a bitter tonic. There seems to be a disagreeable sensitivness to cold in this disease long after the patient considers himself well, and relapses are frequently due to that cause; therefore I always recommend a good deal of precaution in going out after being sick.

It

It is in the cases of digestiv and mental depression that I have met most defeats. is mostly in cases past middle life, tho it is not always so. Last winter I had a case who after apparently a common attack of "la grippe " lost all appetite; when he forced himself to eat a little he would either vomit or get severe pains in stomach and bowels. Bowels were either costiv or relaxt. Two experienced physicians saw the case with me, but we could find nothing the matter with him with the exception of the above symptoms. Many things were tried, both in the way of medicin and foods, but to no avail. He died in eight weeks apparently of starvation, after he got over the first stage of influenza. Another committed suicide, due to melancholic insanity following "la grippe." Another case, that of a young man 20 years old, became partly insane during the first stage of the disease, but finally recovered in six weeks. What can I do to prevent or overcome the great mental and physical depression, which is nearly always associated with this treacherous disease?

Mr. Editor, I hope I have not tired you out completely with this long letter; but if I have, I can only say that you can congratulate yourself that I have not sent you the other three articles I have written for THE WORLD during the last year, but consigned them to the waste basket myself. C. P. HORN, M.D.

West Denmark, Wis.

[We compliment the Doctor on taking our advice given in these columns a year ago, and writing for the waste basket at home, instead of the waste basket here. How many others have done the same? Still there are some who are offended if their articles do not happen to ap

pear. Sometimes really superior articles cannot be accomodated, for various reasons; as they may not be timely, or we may have had too much of that particular subject. Some articles that come are not worth printing, even tho the subject be timely and desirable. It is the writers of these that are always the most sensitiv about their non-appearance. They write demanding their return long after they have disappeared. The way to avoid disappointment is to request return at time of sending, inclosing postage for same, if not acceptable.-ED.]

Persistent Sneezing.

Editor MEDICAL WORLD:-A well developt girl of 15 years, a domestic, was engaged in hanging out a washing of clothes late one evening in the latter part of last March, and all at once was seized with a violent sneezing, which she kept up to the hour of midnight, when I was called to see her. When I arrived, I found her having paroxysms at short intervals. The family informed me that it had been a great deal worse before I got there. Upon examination I found pulse, temperature and respiration normal, or nearly so; I also examined the nasal passages and throat, the best I could under the circumstances, being eight miles from my office without a very great supply of instruments. However, I administered a hypodermic of morphin and atropin and remained with patient till morning. She rested fairly well thru the latter part of the night, and said upon awaking that she felt better, but occasionally would sneeze. After giving some instructions and leaving some medicin for patient I returned to my office, hoping that the paroxysms of sneezing were from some local cause, and that the patient would come all right; but it was not so; four or five weeks afterward I was called to see patient again, with a similar attack to the first. I administered an anodyne, made another partial examination without any success as to cause, and prescribed for further treatment, blindly, for yet I could not tell what was the matter, and I would be very glad if some of THE WORLD'S family would give me their views on the subject. Patient kept up the sneezing for a month or more, at intervals, after my last visit, and died a raving maniac. A number of other physicians saw her, but none could tell what was the trouble. G. A. TAYLOR..

Sixty Years Ago Compared with the Present.

Editor MEDICAL WORLD:-Please find in this, one dollar to renew my subscription for 1904. The writer has seen many changes in the theory and practise of medicin in the sixty years he has been a medical observer. He thinks he gets a dollar's worth of rather sad amusement to say nothing of what else he may get-in looking over the pages of THE WORLD, in learning what a heterogeneous mass of ideas are still entertained by the rank and file of the profession in regard to the treatment of disease, notwithstanding the great increase of claimed positiv knowledge as to its cause and nature, and the recent introduction of many new and valuable remedies. Yet in this connection we should remember that the judicious physician does not prescribe for names, but for conditions.

With due appreciation of the triumphs of surgery, of the antitoxins, of the gland extracts, and sanitation, as life saving agencies, we question whether the acute diseases of the three great cavities, the head, chest and abdomen, are as successfully treated to-day as they were fifty years ago. Take pneumonia for example, with its fearful mortality, under its present treatment; any change in treatment, or no treatment, could hardly make matters worse. Formerly many pneumonic patients were bled-perhaps too often and too freely, now possibly not enuf. Blood letting has come down to us from more than a thousand years of believed experience of its utility. Were all these generations deceived as to its doing mischief, rather than good? or has disease changed in its type and character, so that blood letting is no longer useful? Judging from several recent well considered journal articles, we would seem to be slowly drifting back to the use of the lancet or leeches in the treatment of pneumonia, to unload the congested lungs and over-distended right heart (where heart failure begins, the left heart becoming secondarily affected). The abstraction of blood lightens the load and relieves the over distended right heart. It is a question whether it is not better to lighten the load first, at least before resorting to the whip and spur with digitalis and strychnin.

When I was a medical student in the forties of the last century, my worthy preceptor in a country village often used the lancet, and as my memory serves me, judiciously, from its favorable influence over disease. În my early practise I used the lancet as I thought, and think now, to the benefit of my patients, and have continued to use it as I have thought advisable from that time up to date. Quite recently I bled a hospital patient in the presence of several members of the staff, not one

of whom had ever performed phlebotomy or had ever seen it performed.

During the first ten to fifteen years of my professional life, when blood letting was popular with the public and the profession, at the earnest request of patients I now and then used the lancet against my judgment as to its usefulness, but from this effusion of blood I never saw any evil results. During the fifties and early sixties of the last century, for some reason it is difficult to say what reason— blood letting became unfashionable with the profession and the public, and with the profession I largely drifted from the use of the

lancet.

It is scarcely forty years since the clinical thermometer came into general use, and yet James Currie, M.D., of Edinburgh, wrote and publisht under the date of January 1, 1790, the following account of a patient: 66 Sixteen hours after the first attack her heat at the

axilla was 103 deg. of Fahrenheit, her pulse

112 in the minute and strong, her thirst great, her tongue furred, and her skin dry. Five gallons of salt water of the temperature of 44 deg. were poured over her naked body, at five o'clock in the afternoon, and after being hastily dried with towels, she was replaced in bed. When the agitation and sobbing had subsided, her pulse was found to be at the rate of 96 strokes in the minute, and in half an hour afterwards it had fallen to 80. The heat was reduced to 98 deg. by the affusion." So the clinical thermometer was in use more than a century ago. After having been once introduced it is most surprising that so useful an instrument should have dropt out of use and out of the literature and text-books of the profession for more than half a century.

The writer practised medicin for twenty years or more without a clinical thermometer. Then the profession cultivated the sense of touch as to temperature to a high degree of perfection, as the blind and the deaf and dumb cultivate their other senses. With the thermometer, the microscope and laboratory as aids to diagnosis, it is a question whether the profession has not fallen off to its disad vantage from its former critical study and analysis of bedside symptoms of disease. A word in regard to the vaunted present in the treatment of disease compared with that of fifty years ago. We could not measure the temperature in typhoid fever with a thermometer, but we knew the patient was morbidly hot, and we cooled him then as now, with baths. We could not count the leukocytes and blood corpuscles, but we could diagnose anemia by the wan cheek and pale lip, and prescribe iron, arsenic and other remedies with the same indifferent success that attends

the treatment of anemia to-day. We knew nothing of the micro-organism of malarial fever, but we could diagnose the disease from the recurring chills, fever and sweats, and we killed the parasites then, as now, with quinin, and during my teens our country village doctor prescribed fresh air for his consumptiv patients. ALFRED MERSER, M.D.

Syracuse, N. Y.

Sphygmographic Tracings.

Editor MEDICAL WORLD:-As to preserving sphygmographic tracings, dip them into a thin solution of shellac in alcohol, Canada balsam in chloroform, or gum dammar in benzol-say one to six-kept in a long wide-mouth (12 inches wide), then lay on a piece of blotting paper, smoked side up, and in a few minutes they will be dry. The paper should be 1 x 6 inches, and smoked over a flame, as this would leave small pieces of soot small piece of burning camphor, not in the

on the paper, which would stop the movement of the tracing needle. In my opinion, the "Dudgeon sphygmograph" is the best, because the simplest in mechanism, the easiest to apply, the least likely to get out of order, and the cheapest.

CHARLES H. COCKEY, M.D.

Baltimore, Md.

Answers.

Editor MEDICAL WORLD:-It is so very seldom that I ever attempt to write anything for publication that I am a bit awkward at composition. However, I have just finisht reading the January number of your excellent journal, and I must say that it is brimful of interesting matter to the busy practician; and as I see some help is wanted for various troubles by the brethren, I venture to offer a few suggestions for some of them, the remedies having been very successful in my hands. Dr. Shirk, page 29, try the following for after pains:

Editor MEDICAL WORLD:-Tell Dr. S., (page 29 of January WORLD) that there is sure relief for after-pains in specific tincture of macrotys (Lloyd Bros. of Cincinnati, Mfrs.). In all cases it is the whole thing. Of course when there is great or persistent relaxation of the uterus, ergot must be employed. But macrotys is indicated for every case, because it tranquilizes, palliates soreness and pain, and procures rest. Dosage is practically unlimited. A teaspoonful to a goblet of water, of which solution a teaspoonful every half hour for a few doses, or every hour, answers the purpose. Why authors of text-books quoted ignore the claims of macrotys to exploit inferior claims of the opium family is inexplicable, except in the supposition that they are better acquainted with said family. That is on a par with a like overlooking of the matchless claims of Norwood's tincture of veratrum viride for puerperal convulsions. R. B. MCCALL, M.D. Hamersville, Ohio.

Editor MEDICAL WORLD:-In reply to Dr. Shirk's appeal for a sure relief of after-pains, "one that does not depress" (page 29, Jan. issue), will recommend Merrell's helonias cordial given in dram doses, two hours apart until relieved, then three times daily. Should this not give ready relief, 10 grs. of chloral for

a dose or two has not failed me in a practise of 14 years. I usually give a dram dose of fl. ext. of ergot at the end of the third stage of labor. Also leave as a routine 4 to 10 grs. of calomel to give at bedtime following labor, and as a result have very rarely any call for combating septic fevers. Have patient take helonias cordial, t. i. d., thru lying-in period. Pilot Oak, Ky.

BERRY BOWEN.

Editor MEDICAL WORLD:-Gastro-intestinal trouble, page 33, January WORLD, signed "Medicin. Tell the Doctor to use sol. acetozone, P. D. & Co., grains vijss to pint of water. Prepare as directed for typhoid fever. I prescribe one pint daily in divided doses in similar cases of fermentiv, and in acute or chronic diarrheas. The other treatment about as you have indicated. I formerly used listerine and hydrogen dioxid, but find the acetozone much the best. Hutchinson, Kan.

Nocturnal Emissions.

S. M. C.

Editor MEDICAL WORLD:-In reply to the brother from W. Va., relativ to castration for nocturnal emissions (page 36), will say no; but cure him by giving him 1 to 3 gr. of santonin, say at 9 a. m., 3 p. m., and one hour before bedtime. Give him gr. hydrobromate of hyoscin, preferably the hypo. tabs., for the morphinism. I don't think you'll be disappointed. W. A. R. Mo.

Cold Feet, Consultations, Etc. Editor MEDICAL WORLD:-For "cold feet" of anybody any time; greasing them with camphorated oil is a splendid preventiv.

I have practised medicin twenty years and never have askt or permitted help from a consultant that benefited the patient or promoted pleasant professional relations. "Consultation" theoretically is right, but practically it does nothing but make trouble. If I can not handle a case to suit either myself or the patient and his friends, I withdraw from the field and let some other physician have a chance to get some glory out of it if he can. When I am called in as consultant I have as little to do with the patient and his friends as possible, and if I can give the attending physician any hints which he can use to help the patient, I do so in his office, or at least away from the patient's knowledge. I do not treat his case.

Definit alkaloidal treatment by dispensing physicians is a certain feature of the near future. These activ principles of drugs should be dispenst in the form of thin soluble tablets which will not roll all over the table in dispensing as

"granules" do, and each vial should be definitly and fully labeled with directions for special use. There is no factory now in existence which puts out satisfactory products of this nature.

One of my homeopathic friends once told me that homeopathy consisted essentially in giving a medicin which would increase the disease a little in order that Nature would be stimulated to greater antagonizing efforts in restoring health. "You can jump farther if you go back and take a run," as he put it.

"Surgical" cleanliness is impossible in ordinary country obstetrical work. If a doctor will wash his hands thoroly with McClintock's germicidal soap and fill the spaces under the nails with this soap in place of the usual dirt found there, he will have as much freedom from septic troubles in his cases as any hospital in the land can show. A. D. HARD, M.D. Marshall, Minn.

Answers.

Editor MEDICAL WORLD:-It is surprising to me that none of the valuable text-books you quote in the January WORLD with reference to the treatment of after-pains mention viburnum opulus. This remedy, the fluid extract (P. D. & Co.), in conjunction with a little tincture gelsemium or cimicifuga (whichever indicated) has always successfully combated this annoying condition. Dr. Shirk can use the remedy after acquainting himself with its therapeutic indications.

Dr. Crittenden (page 16) can warm up those cold feet with tincture capsicum three drams, alcohol three ounces, applied after a hot foot bath every night for a week. This is also excellent for chilblains.

In writing of the remedies manufactured by the Abbott Co., Dr. Robinson did not mention one of their most valuable products. At least, I regard it as such, namely, iodized calcium. In croup it is the "real thing." Give one-third of a grain in one teaspoonful of hot water every ten minutes to a suffocating child, and the effect is wonderful. Have been using it this winter with markt success in tonsillitis also.

Dr. Hovorka (page 28) might try my remedies for his weeping eczema. I have a similar case in a man who is an operator (telegraph) during the winter, but in the summer time is a race horse trainer and rider. Just as soon as he begins this wind-splitting occupation he becomes affected precisely as Dr. H. My treatment is Donovan's solution, five drops in water after meals, and unguentine applied locally, with attention to secretions. It has always relieved him in a very short time, and

every summer he sends for a little of the medicins.

For an all around application for ordinary eczema nothing compares with a prescription given in your valuable publication by Dr. Stetson, of Maine, and publisht on page 327 of the August, 1902, WORLD. It has proved of so much value to me that I have often thought you should publish the formula once a year, like you do the sulfocarbolate-bismuth-nutmeg summer complaint remedy which is so valuable.

Now, Dr. Taylor, use your blue pencil on this as you choose; but I have sponged so much valuable information from THE WORLD that I feel inclined to offer the few suggestions above to your mighty family of readers; whether or not they ever hear of them remains with you.

I inclose a fee bill adopted by the Carroll County, Ill., doctors, and is, I believe, generally adhered to.

GLENN E. MERSHON, M. D.
Barnes, St. Louis, 1901

Mt. Carroll, Ill. [The formula from August, 1902, WORLD, above referred to, for eczema is very simple. Here it is:

Fee Bill of the Carroll County (Illinois) Medical Society, Adopted Dec. 9, 1902.

Officers-J. Hallar, President, Lanark ; F. H. Snow, Vice-President, Chadwick; H. S. Metcalf, Secretary and Treasurer, Mt. Carroll.

Physicians of Carroll County-R. C. Burton, Savanna; A. D. Hunter, Savanna; G. W. Johnson, Savanna; J. D. Lyness, Savanna; L. H. Maloney, Savanna; W. W. McGrath, Savanna; J. B. Schreiter, Savanna; S. P. Colehour, Jr., Mt. Carroll; D. M. Greeley, Mt. Carroll; H. J Hughes, Mt. Carroll; G. E. Mershon, Mt. Carroll; H. S. Metcalf, Mt. Carroll: R. B. Rice, Mt. Carroll; N. Rinedollar, Mt. Carroll; R. P. Wales, Mt. Carroll; R. H. Wood, Mt Carroll; J. Haller, Lanark; T. I. Packard, Lanark; H. W. Wales, Lanark; A. H. Wales, Lanark; W. H. Durkee, Thomson; F. E. Melugin, Thompson; W. H. Miller, Chadwick; F H. Snow, Chadwick; R. C. Miller, Shannon; J. E. Porter, Shannon; A. E. Auringer, Milledgeville; R. McPherson, Milledgeville; J. D. Overholser, Milledgeville; J. A. Wright, Fairhaven; C. W. McPherson, Hazelhurst.

.

$1.00 $1.50 to 2.00

Visit in city, 6 a. m. to 9 p. m. Visit in city, 9. p. m. to 6 a. m. For each additional person prescribed for where more than one member of family is sick at same time. .50 to 1.00 Rising at night and advice or prescription, 1.00 to 2.00 Visiting contagious diseases .2.00 to 5.00 plus mileage Visit in country (Day). 1.00 plus mileage

Visit in country (Night) Same as day plus 50 percent Office prescriptions .50 to 2.00 Consultation 5.00 plus mileage