logical impulse is necessary to the genesis of the false trend. Now, this false trend, especially in relation to the supra-physical, constitutes the rule, not the exception. It is not surprising, therefore, that there is plenty of superstition in medicin-it would be surprising if there were not. I am therefore capable of a degree of tolerance for those who have, as I am convinced, absorbed an undue faith in drug efficacy. Without a historical review of the successiv phases of drug superstition, let it suffice to say that the principal errors of the present depend on the fallacies that drugs are the carriers, or generators of vitality, and that therefore they cure by cosseting rather than by inimical perturbation. Coincident with this conviction is a host of evil possibilities which I cannot enumerate here, but which will readily suggest themselves to the thoughtful. But I find I am extending this little article too far-I must cut it off. I still insist that it is the highest duty of the doctor to permit his patient to recover; and that the principal means to this end consist in "giving nature a chance." Cleves, Ohio.

W. C. COOPER, M.D.

Proprietaries.-The Importance of Knowing the Results of Treatment.

Editor MEDICAL WORLD:-Regarding advertised proprietaries, let me suggest that perhaps the principal objection to at least a great many of them is this: the patient reads the prescription and easily remembers the name of the remedy (or gets a copy if he desires); then continues to purchase without prescription at the drug store, and to advise the remedy to friends without end.

The remedy is this: Let the doctor himself dispense, not in original packages, those proprietaries the composition and physiological action of which he knows, and which, perhaps with additions of his own, he considers indicated in the case in hand. In this way the credit for results obtained, and the profit of

refilling (when indicated) go to the doctor, where they belong; and the patient does not unwittingly contract drug habits, nor damage himself and others in other ways.

Another subject: Would not much permanent good accrue to the profession if the editors of medical journals would, from time to time, say every six to twelve months, ask for the experiences of his readers with methods recommended during the same period preceding, and then briefly publish these results? For example: Some time ago an article by Dr. Galbraith in the Journal A. M. A. recommending large doses of quinin in pneumonia attracted considerable attention. Now, during six months many readers try the method. Would not the collectiv testimony of a great number of these be of great value? The same course could be followed by any and all of our journals in regard to those things recommended which they consider of the greatest importance. Why not take the lead, Dr. Taylor? Omaha, Neb.

A. F. BURKARD.

[In student days we noticed the fact that in clinical teaching the professor would diagnose the case and prescribe the treatment with great care (and presumable ability), but we students never saw nor heard of the patient afterward. We were often annoyed by this incompleteness of teaching. In order to estimate the value of any treatment it is necessary to know the results. Most of the articles We which we publish deal with results. would be very glad to carry out Dr. Burkard's suggestion if our readers will only give us the results.-ED.]

The Comstock.

Dr. H. D. C. Phelps, of Oswego, N. Y., writes: "The Comstock agency has removed offices from here to Syracuse, N. Y., and other points. Has no standing here in that line."

Wonder if any more doctors are being taken in by them. We think that the doctors got too wise for them (thru THE WORLD), and that they are now devoting their attention chiefly to small merchants.

M

FROM

190

AUGUST, 1906]

He Found a Tartar. A Scheme for Cheap Drugs.

Editor MEDICAL WORLD:-While frauds and attempts to bleed doctors by all sorts of schemes and by many kinds of people have been getting due attention at your hands and also the hands of the family, I thought that to report one little experience I have had in the last year might not be without interest. Last fall a nicely dressed, smiling and very affable gentleman appeared at my office on one of my off days (I suppose every doctor has a day occasionally when he is not in good humor, and therefore pretty crusty). After passing compliments he announced that he represented a certain firm of manufacturing chemists that would not sell to the drug trade at all, but was catering entirely to the medical profession; that they had fallen upon a scheme whereby they were enabled and desired to supply the medical profession with everything they might want at greatly reduced prices. I told him that was very nice indeed, and askt for his "scheme"; whereupon he produced a contract blank, to be signed by the contracting physician, in which the physician bound himself to buy all of his supplies from this company until he had purchased from them to the amount of $200, and in consideration of the doctor buying all of his supplies, etc., the company bound themselves to sell to the doctor at jobbers' prices, or at prices which equaled a discount of 40 percent below prices charged by other chemical and pharmaceutical manufacturing establishments, like P. D. & Co. and others of like character. grew very eloquent in showing how nice it would be for the doctor to get from them for $120 what he would have to pay to others $200 for. It would be so nice to have all these things and $80 still in the doctor's pocket. He was also very careful to show me a list of names of physicians all over the country, many of whom I knew, who he said had lately signed this contract.

He

About this time I askt him if he was thru with his speech, and if so to please let me have the floor a little while. In about two minutes I had told him that in my opinion his offer to sell me goods at jobbers' prices carried with it the fact that he would sell me jobbers' goods, which consisted of goods bought up by his firm (and not manufactured by them) and relabeled to make them look new -goods of bankrupt drug firms and small dealers who wisht for various reasons to go out of business; goods that had been on their shelves twenty years or more, and therefore utterly worthless. In this connection I told him I would wait and confer later on with men on his list whom I knew, and find out how much they were delighted with the transaction after they had used jobbers' medicins on their patients for a year or two. I proceeded to tell him in no uncertain terms what I thought of people who would thus

309

traffic in the lives and health of people, and informed him that he couldn't humbug me in any such way. It did not take him long to get enuf of that kind of discourse, and decide to take his grip and hunt another " easy." D. C. SUMMERS, M.D.

Elm Springs, Ark.

Medicins Should be Reliable, and Reasonable in Price.

Editor MEDICAL WORLD:-It has been my pleasure to read the advice of THE MEDICAL WORLD, especially in regard to schemes and swindles offered by various concerns, and I have learned to look to it for advice on matters of this kind where the interest of our profession is at stake.

One thing more I would like the Editor and family to discuss is: The reliability and quality of drugs and pharmaceuticals put up by the different manufacturing pharmacists. For instance: I have paid one manufacturing pharmacist $1.50 per pt. for fl. ext. of cascara sagrada, and another comes along and offers to sell us the same thing for 75 cents; and so on down the line for fl. extracts, elixirs, syrups, and everything. We have only one means of testing most of them (therapeutically), and that is by no means a satisfactory way; in fact it is not our business to be experimenting with medicin on our patients to learn their therapeutic strength. Now, how are we to know which is our friend? One man says the cheap article is no good; the other says the high priced article is no better than his; that it is extortion on the part of the pharmacist. We are beat one way sure; we are buying inferior medicin from one man, or paying the other too much.

A comparison of prices may be found by looking thru the catalogs of Parke, Davis & Co., Sharpe & Dohme, Jno. T. Milliken, Meyer Bros. Drug Co., H. K. Mulford & Co., Traux Green & Co., and others; also compare discounts.

We want the best products at the best prices. I think I am speaking for a large majority of doctors, who will greatly appreciate something on this subject.

Dilolo, Ark. DR. DANIEL MCCALL.

[This is an important matter to the doctor who supplies medicins to his patients-and the number of doctors who do this is constantly increasing. But we cannot ask a very frank discussion of this subject, for fear we will seem to be advertising certain houses that some contributors may wish to "boost" -of course honestly and conscientiously. The goods of pharmaceutical houses that have establisht a good reputation may be depended upon, for a reputation is too valuable to be jeopardized by carelessness. It is important that doctors get reliable medicins; and it is also important that they should not pay extortionate prices for them.-ED.]

Shock.

Editor MEDICAL WORLD:-In your editorial on the "Treatment of Shock" (February number) you quote Hare as to physiology of condition : "Shock consists primarily in an overstimulation of the inhibitory apparatus governing the heart and respiration, immediately followed by exhaustion of inhibition, so that the pulse and breathing become rapid and shallow instead of slow, and depression of the vasomotor center, so that a serious fall of arterial pressure ensues."

The experiments of Dr. G. W. Crile, New York, on animals to determin the physiology of shock seem to show that the most important factor in the case, the fall of blood pressure, is not cardiac in origin, because by eliminating the action of the cardio-inhibitory apparatus by the injection of atropin or previous division of the vagi, the fall of blood pressure occurred on injury to the spermatic plexus similar to that without the use of atropin. The fall was due to the dilatation of the splanchnic vessels, the blood collecting in the great splanchnic veins. He showed that the rapid action of the heart which occurs in severe shock is not due to commencing failure and exhaustion of that organ, but to an insufficient quantity of blood to work upon.

His experiments showed that injury to the spermatic cord or testis produced shock; that exposure of the intestins thru abdominal incision produced in a short time a decided fall in general blood pressure and markt dilatation of the splanchnic vessels. The fall of blood pressure was increast by injury or overmuch handling of the intestins, but if previous to injury or exposure, the splanchnic arteries were tied or clampt, no fall took place, no shock resulted. In these experiments it was also shown that the specific gravity of the blood increast after shock had persisted some time. This increast specific gravity is important in its relation to shock in that it interferes with recovery.

Surgical shock is the result of the exhaustion of the vasomotor centers, the cardio-inhibitory and respiratory center being affected secondarily, and the main factor is the decided fall of blood pressure, due to the bleeding into the veins of the splanchnic area. To prove this, Crile showed that if the vasomotor centers were cocainized in a normal animal, a fall of blood pressure occurred similar to that following shock. Collapse is also due to a fall of blood pressure caused by a severe hemorrhage or inhibition of the vasomotor centers. This differs from shock in that the centers are intact.

In the treatment of shock, atropin hypodermically is advocated, as it increases blood pressure. Morphin is also useful, but should always be combined with atropin. It should be administered after operations just as the patient is recovering from the anesthetic. It

relieves pain, and pain is a factor in producing shock.

Saline transfusion should be used in all severe cases of profound shock. It restores tension and reduces the increast specific gravity of the blood. It should be given in sufficient amounts to restore pulse to normal, repeating the necessary amount if the condition returns. This may readily be done with a large hypodermic needle attacht to a fountain syringe, the needle inserted directly into the median basilic vein at the bend of the elbow pointing in the direction of the heart, and allowing the flow to proceed slowly, checking if dyspnea is produced. The solution should be hot (110° F.) and steril, adding steril salt one teaspoonful to the pint, and injecting from 1 to 3 pints at a time.

Raising the foot of the bed, bandaging the lower extremities, and compressing the abdomen to empty the overfilled splanchnic veins, are important aids.

Stimulants such as strychnin and alcohol are sure to do harm by increasing the exhaustion of the vasomotor centers.

Adrenalin acts on the walls of the bloodvessels, directly raising the blood pressure, restoring the peripheral resistance. This remedy will prove thru clinical use to be one of the most important we have to combat the fall of blood pressure in shock.

In prolonged shock, some easily digested nourishment should be given, such as white of egg or peptonoids, either by mouth if patient can swallow, or by enema. ("Shock and Collapse," Mummery, Eng.) Smithfield, Utah. R. J. SMITH, M.D.

Saw-Mill Surgery.

Editor MEDICAL WORLD:-I would like to reply to Dr. John J. Sturgus on Mill Surgery, in the June WORLD, pages 227, 228. I wish to state that the Doctor is in need of a

few text-books on surgery. A little book which was of great help to me is "A Manual of Minor Surgery and Bandaging," by Christopher Heath. Publisht by P. Blakiston's Son & Co., 1012 Walnut street, Philadelphia. Joseph D. Brayant, in his "Operative Surgery," gives good methods of preparing ligatures. I will state that catgut is pretty diffi cult to prepare perfectly aseptic. I use silver wire, which will stand boiling and is not elastic.

Concerning the "greatest trouble with the gauze adhering to the jagged cuts," I had the same experience in my work in my (paper) mills. But I discovered a good way, which I will explain: I use as dusting powders of iodoform, boric acid ãã, aristol or europhen or acetanilid aa. Occasionally these powders pure. I cover the wound with my antiseptic powder, put one layer of gauze over it; on the top of this and all around a liberal quantity of boric acid. This dressing is undisturbed for about from 3 to 6 or 8 days, accord

ing to the requirements of the case. Then I wash the surface with boiled (and cooled) water, which dissolves the boric acid, and the one layer left next to the skin is easily peeled off.

"The stitches remaining in situ": Catgut I usually remove on the sixth or eighth day, but I had cases among laborers in my railroad district where they never came back to me to remove the sutures for fear of pain. They kept on working, and later, when the sutures absorbed, pulled them out themselves. Silver sutures I remove on the sixth or seventh day. I hope this will help the Doctor till he gets the above-mentioned text-book (I will recommend another also, namely, "The American Text-Book of Surgery").

WALTER SUNBURNT, M.D.

Floriston, Cal.

Was It Appendicitis?

Editor MEDICAL WORLD: - About six years ago, at 2 o'clock one Sunday morning, a homeopathic physician phoned me saying that he had a case of appendicitis he desired me to see. In fifteen minutes thereafter I arrived at the place and found a man, about 60 years of age, suffering great agony with pain in the region of the cecum, which presented a tumor as large as my fist. The history of the case was about this: On the Thursday afternoon previous, he was seized with severe pain in the right abdominal region, for which he applied to his physician and was relieved until Friday evening, when he had another attack which let up during the night; but on Saturday evening the trouble came on again with greater intensity. The doctor's “similias” failed to give relief and I was called. Having obtained this brief history and made as thoro an examination as possible, I askt the doctor what he had been doing. He said he had, latterly, been giving one comp. aloin tablet every two hours and a hypodermic of an eighth of a grain of morphin with atropin once in three or four hours, with fomentations on the bowels, and low enemas. I said to the doctor: "You have here an engorged and distended cecum ; the appendix may not yet be involved, but if not it soon will be, as there is considerable inflammation, and if the man is not relieved you will likely have a case requiring an operation inside of forty-eight hours. We must employ more activ remedies. The first thing to do is to evacuate the cecum as soon as possible. Administer a hypodermic of onefourth of a grain of morphin with the corresponding amount of atropin immediately, and repeat as needed, to keep down the severe distress; and administer a large tablespoonful of castor oil every three hours, and a heaping tablespoonful of phosfate of soda, dissolved in hot water, in alternation, every three hours, the fomentations to be continued and

a high rectal enema given if the bowels are not moved in six hours."

This was at 3 a.m. We saw the patient again at 9 a.m., and he was resting easy under the influence of the hypodermic; otherwise no change. He had thrown up the first dose of the oil, but it was repeated, and there had been no more vomiting. We called again at 5 p.m. Thirty minutes previous, the patient had a very copious evacuation of the bowels, filling an ordinary sized chamber nearly full, of very odorous fecal matter, and was of course completely free from pain. I said to the doctor: "Continue the oil and phosfate of soda, in the same doses for twentyfour hours, till the bowels are thoroly cleaned out. It will not do any harm."

In less than a week he was at his work, that of a carpenter, and has not had a repetition of the trouble.

Now, I contend that four-fifths of the cases of appendicitis are caused, aside from traumatism, by constipation; and should be cured by proper therapeutic means. Surgical operation should not be resorted to till this has been done. Some doctors have a mania for using the knife, especially the recent graduates. They ought to be called down and forced to take a back seat until they learn the virtue of conservativ measures and how to employ them. The fact is, the majority of the colleges devote more attention to surgery and the employment of the knife than to therapeutics, and the graduate is handicapt in his first tilt with disease for want of this knowledge. He is at a loss to understand why so many of his patients die of pneumonia, typhoid fever and other ailments. He will learn by experience, by and by, that the college did not teach him the important part-how to cure his patients with medicin instead of the knife. Understand, I do not condemn the use of the knife when it is absolutely necessary, but rather, its untimely use.

Was it appendicitis, or was it typhlitis? Is not the difference, as to results, about the same as twixt tweedledee and tweedledum? Franklin, Pa. J. R. BORLAND.

[It wasn't any -itis. It was a fecal accumulation, and it was admirably treated. -ED.]

Vibratory Anesthesia.

Editor MEDICAL WORLD:-Several years ago Dr. B. F. Ward, of Winonia, Miss., now president of the Mississippi State Board of Health, read a paper before the Mississippi State Medical Association, in which he gave the history of a number of cases where persons had gone to sleep on the railroad track and had been killed or injured without being aroused from sleep. One had an arm cut off by the cars, yet slept on for some time afterwards as sweetly as if on a "downy bed of ease." He gave the history of a case where a

dog had gone to sleep on the track and even it was not awakened by the passing train. He stated that there was not an instance on record where a person had been awakened by the cars who had gone to sleep on the track with any part of the body touching the iron railing. Persons sleeping on the track with no part of the body touching the iron railing are always awakened. Reading the history of the case given below, publisht in the Memphis (Tenn.) News-Scimitar, reminds me of Dr. Ward's article, and also of the fact that, so far as I can remember, nothing on this subject has ever been publisht in THE MEDICAL WORLD:

LOSES TWO FINGERS BUT LAD SLEEPS ON.-
RICHARD WHITNEY, AGED 12 YEARS,
HAD TO BE AWAKENED AFTER
TRAIN PASSED OVER HIM.

DURANGO, COLO., May 21.-Richard Whitney, a 12-
year old boy, certainly deserves a medal for being a sound
sleeper. A train passed over him on a bridge where he
was sleeping and cut two fingers from his right hand with-
out awakening him.

The lad had been herding sheep and sought a shady spot on the Farmington railroad bridge underneath the tracks to sleep. He threw his right hand partially over one of the rails to keep from falling while he slumbered.

So soundly did young Whitney sleep that the rumbling of an approaching freight on the bridge failed to awaken him. The engineer saw the boy's hand on the rail, but could not stop the train until the last car had passed over the bridge.

When the train crew went back to investigate they were astounded to find Whitney still asleep, altho he was minus the two last fingers on his right hand. The boy's mother was notified and accompanied the boy to Aztec, where the company physician drest his hand.

Some inventor who knows nothing about medicin will some time no doubt invent a machine suggested by Dr. Ward, by which a refreshing sleep can be induced, and which is perfectly harmless, and under which any surgical operation can be performed without pain. Vibratory anesthesia, if perfected (and I confidently believe it can be done), will be a blessing to humanity no less than the discovery of surgical anesthesia by Crawford W. Long, Wells, Simpson, Morton & Co. Kendrick, Miss. C. KENDRICK.

Iron for Rheumatism.

Editor MEDICAL WORLD:-I wish to thank the many members of the family who replied thru the journal and who wrote me personally suggesting treatment for my case of eczema.

As a rule, I have no confidence in so-called specifics; yet several years of exceptional success in treating acute articular rheumatism with the British Pharmacopeia preparation of tincture perchlorid of iron, known as the "Edinburgh, or Dublin preparation," and quoted in the U. S. Pharmacopeia of 1873, impels me to call attention to it. Fifteen to twenty drops are given every four hours (one drop for each year of the patient's age). I watch for heart symptoms about the fifth day, and meet them by application of strong mustard embrocations over the heart, and by the internal administration of nitro-glycerin and strychnin. I have succeeded in many cases

where the salicylates had failed. The duration is generally ten days, or less. After the symptoms subside, I continue looking after all the secretions, and build the patients up with a tonic.

The formula and method of preparation of this excellent rheumatic remedy is as follows: Take of red oxid (subcarbonate) of iron 6 ounces; muriatic acid (commercial), 1 pint (imperial measure); rectified spirit, 3 pints; add the oxid to the acid in a glass vessel; digest with gentle heat and agitation for a day, or till most of the oxid is dissolved; then add the spirit and filter. This is the Edinburgh formula. The Dublin method is : Take of iron wine, 8 ounces; muriatic acid 1 quart; nitric acid 18 fluid ounces; distilled water 1 pint; rectified spirit 14 pints. Dilute the muriatic acid with the water and add the iron; apply gentle heat till solution is effected; add the nitric acid in successiv small portions, and evaporate slowly till the solution measures 1 pint. Blend this with the spirit, allow to stand twelve hours, and draw off the clear fluid. Either is good, but I prefer the Edinburgh formula. Do not allow the pharmacist to tender a substitute or to take any short cuts. F. O. NASH, M.D.

Hollister, Cal.

[The idea of using iron in this strength is new to us. The doctor quotes voluminously from old authorities and from his extended experience in substantiation of the claims of the remedy. From his own mention, it does not prevent "heart complications," indeed, Would he says they are to "be expected."

it not, then, be a good idea to combine the salicylates, alkalies, and perhaps colchicum? Any remedy, new or old, so highly commended, is worthy of trial in acute articular rheumatism.-ED.]

"Diuretic that Will Not Depress the Heart."

Editor MEDICAL WORLD:-For fear of imposing upon your well-known good nature and spirit of fairness, I have for several months supprest the desire to write, which comes to me forcibly with each number of THE WORLD on reading the therapeutic measures therein contained.

Recently a brother askt for a diuretic that would not depress the heart. You advised a heart stimulant with the diuretic. This is not like some of the "to hell with Nature" combinations, but it is a step in that direction; and it reminds me: A professional horse trainer visited our town, and among other exhibitions he drove a spirited horse thru the streets at a lively pace without lines, guiding him by motions and the voice. Comments were various, but the old stage driver shook his head. "No good," said he. "No chance to lick and hold on."

Now there is your treatment in a nutshell: Ply the whip in order to pull on the bits. You know that such treatment will worry