herders on western prairies. Life in the open air in a country as free from dampness and sudden changes as possible is often very beneficial.

For chronic rheumatism tincture of poke root and iodide of potassium are beneficial in more cases than any other two remedies of which I have any knowledge.

Is everybody satisfied that the Switzerland woman (page 130) really did have her stomach removed? Could not those doctors have mistaken the womb for the stomach? If the report of this case prove a correct one, may we not in the near future look for a boom in this special line of surgery, as we have had on the appendix, ovaries, etc.?

If Representative Parker of Ohio (page 130) gets his bill passed, and the law can be enforced, it may do great good for the coming race. But people now-adays have an idea they know their own business on the subject of marriage, and will not tolerate any legal interference. It would be very difficult to enforce the law if passed, and a law that cannot be enforced should be repealed. Let us first as physicians strive to teach the people that none but the healthy should marry, and then a law may do some good. But notwithstanding all our efforts, and even should the stern hand of the law intervene, there will always be marriages among the weak and diseased. We will always have among us the maimed, the halt, the lame and blind, the weak and the diseased.

Kendrick, Miss. C. KENDRICK, M.D.

There seems to be no doubt that the entire stomach was removed in the case referred to. The detailed report of the operation shows that clearly.

If the weak, diseased, criminal, etc., will marry, would it not be a blessing to all concerned if they knew how to avoid bringing their kind as a charge upon the community? The marrying among the defective classes does no harm-indeed it may do good in some ways, as regards both the individual and community. But it is procreating among them that is objectionable and some of them will procreate without marrying. There is a problem here that few men have the moral courage to admit, because it calls condemnation from the narrow and the

blind, who cannot or will not see the highest and truest interests of humanity.-ED.]

Experience No. 2.

INCONTINence of URINE.-ACONITE FOR

RHEUMATISM.-GASTRALGIA.

Editor MEDICAL WORLD:-In the spring of 1873, a young man from a neighboring town fifty miles away, called on me and stated that he had been afflicted with kidney disease, and that he had been having incontinence of urine for the past five years. He was much distressed on account of it, as he was debarred from society, and wanted relief. Upon examination I found paralysis of the sphincter muscle. I ordered gtts. v of Hall's sol. of strychnia three times a day, to be increased if necessary. In a week or two he reported himself as entirely cured.

During the summer of 1884, another young man called at my office making the same complaint. He had sought advice freely and had travelled extensively on account of his condition, but without avail.

Upon careful examination I found that he had inflammation of the neck of the bladder; and as soon as a small amount of urine accumulated it would be forcibly expelled. He was much depressed on account of his condition.

I gave him the following mixture: potassium acetate, potassium bromide, aa one ounce, atropia sulph. one half grain; water and syrup, aa two ounces. He was ordered to take one teaspoonful well diluted three times a day. The acetate was given to correct the acidity and to increase the amount of urine; the bromide to numb the sensibility of the mucous membrane, and the atropia to control the sphincter.

Knowing the disagreeable nature of the prescription I stated to him that he had a remedy that would no doubt cure him, but that I did not believe he would take it. I asked him to report in a few days. I did not see him again for three months. He saw me in my buggy one day, and running to me asked me whether I recognized him. I said no. He said: "I am the man to whom you gave that bad prescription, and I want to tell you

about it. I took it for five days without any perceptible relief, but on the evening of the fifth day my disease left me all at once, and I have been well ever since, and I want to thank you for it."

In 1874, I was called to see a young lady who had inflammatory rheumatism. She had high fever along with inflammation of several joints, and was suffering terribly. Along with other remedies I ordered three drops of tincture of aconite every two hours. But her friends thought that was rather slow treatment and they increased it up to ten drops. After giving her two or three doses they became alarmed at its effects and very properly and promptly sent for me. They were very much alarmed and said she would be dead by the time I would get to the house. I must confess that I was badly demoralized when I saw her condition. Her pulse was about 25, and very irregular. She had a cyanotic hue of a very marked character. Her respirations were only five or six to the minute, and she was laboring very hard to get her breath. And oh, what a sweat! The perspiration was running off her like rain drops. I gave her large quantities of brandy and other stimulants and brought her out all right. The rheumatism was nowhere to be found. It had left her "quicker than a cat." Thereafter I labeled aconite, quick cure for rheumatism." But I But I must confess that I have never cared to repeat the experiment. It was shockingly successful and "did the business" with a vengeance.

In 1875, I was called to see a young married lady who was having a severe attack of gastralgia. I gave her a full dose of morphia, but thinking it a little slow concluded to assist with chloroform, internally. I gave her twenty drops in water and repeated it in twenty minutes, when she went under the anesthetic effect almost immediately. I was not expecting any such result, and was very much alarmed. Nevertheless I stayed with her, and in' a half hour was gratified to see her come out all right. I afterward reported the case to the Delaware County Medical Association, and Dr. T. B. Williams (now deceased), got up and reported a similar case. He stated that he left the patient and

returned to his office, thinking she was dead, but heard the next morning that the patient had fully recovered.

Columbus, O. S. C. DUMM, M. D.

Business Methods in the Injection Treatment of Hernia.

Editor MEDICAL WORLD: I notice that the treatment of hernia by the injection method is attracting quite considerable attention, and I wish to give my experience in this line. I want to say first, however, that I am pleased to see the growing interest in this method, as it shows an up-to-datedness which is commendable. The treatment is simple, effectual, and as compared to other methods, very cheap. The returns therefrom are good, and by its use a financially poor year can be turned into a good one. The medical profession is proverbially slow to adopt new things, and while this precaution may be excellent at times, it is true also that by so doing many golden opportunities slip thru their hands, to be grasped and taken advantage of by those who are on the lookout for such opportunities. I know personally that I have more than doubled my former income by the adoption of this so-called rupture cure business. Since I have taken hold of it I have cured over 40 cases, and have at least a dozen under treatment now. I failed in three cases, but this was due to disobedience to my instructions, and in two more where it was impossible to get a truss to retain the bowel. Umbilical cases I have thus far refused to treat, as I cannot see how the principle of creating an irritation in the canal can be applied to them. The technique of the operation has been dwelt upon by the different contributors in these columns, so that I need not mention them any further. There is but one way to do the operation right, and that is my way of doing. Sometimes I get into the canal thru the public tissue, and when they are very fat I go thru the scrotal wall with a protected needle. In women there is but one way, the former, and altho there is no inguinal canal to invaginate with the index finger, the seat of the breach is easily reached with the ordinary needle. I used a proprietary formula when I first began the treatment, but I have since

Mix. Sig. Inject from two to four minims.

The injection of the above mixture causes a slight burning sensation for a few minutes, which is followed in a short time by a feeling of soreness which lasts a few days. I repeat the injections weekly. In all my experience with this mixture I have had no sign of a bad re sult, nothing that would be in any way considered unpleasant having yet occurred to me. This formula causes a little more irritation than some others, but I am certain that it also cures quicker than some others. I have known cases to be cured in one month, or four injections, altho the rule is eight to ten or twelve. The size of the hernia has a great deal more to do with it than the length of time that it has existed. The usual antiseptic precautions should be taken as to cleansing the parts and the care of the needle. I keep my needles in an antiseptic solution of either carbolic acid or alcohol. I prefer the former. The fluid as I prepare it requires care and accuracy to compound. It is antiseptic and also aseptic.

A good business man will venture new risks to increase his possible profits, instead of sitting on his chair and weeping over the hard times. So with the doctor; he should be on the lookout for means by which he can increase his income in the special lines, when the general business is dull. I get from $25 to $75 for a cure of this affection, and I generally find that when a means of cure is offered them, they manage to scare up the cash. I notice that Dr. Souder says he does not guarantee cures, and I wish to say that when you have a treatment that is as reasonably certain of cure as this, it pays to do so, as you will get many cases, and cure them, that you could not get without the guarantee; and if you have to refund the advance payment, as I did in two cases where the truss did not answer its purpose, the extra cases that you will get will more than pay for it. It will also create an impression that you are honest and

mean what you say. I take them "No Cure, No Pay," and I know that it works. I do not accept every case, as I know about what I can expect. Not long ago I was consulted by a gentleman who had a hernia as a large as a peck measure, with a hole in the abdominal wall as large as a saucer, and as I could not guarantee him a cure he allowed that he'd stick it out a while this way. Such cases get no encouragement from me. I can safely assert that at least 90 per cent. of the cases ordinarily met with are adapted to this method, and he that is wise and has an eye to business will take it up and hustle.

Pottsville, Pa. J. D. ALBRIGHT, M.D.

[Not being acquainted with the first ingredient mentioned in the formula, I wrote inquiring about it to Messrs. Merck & Co., of New York, one of the leading houses in the world for drugs of all kinds, both rare and ordinary, and they replied that they neither make not handle it, nor could they refer me to any probable source of supply. I then wrote to Messrs. Lehn & Fink, of New York, making the same inquiry. They reply that they "carry Cupri Sulfo Tannate in stock, being worth 25 cents per oz. It is a brown powder, a combination of sulphate of copper and tannic acid." I enter into this in detail, so that readers will be able to supply themselves without bothering the writer of the article. The aqueous extract of thuja is doubtless meant instead of "thuga;" the latter cannot be found in Gould's medical dictionary, nor in the dispensatory.-Ed.] Business Methods in the Injection Treatment of Hernia.

A REPLY TO THE PRECEDING ARTICLE.

Editor MEDICAL WORLD:-Accept my thanks for your kindness in submitting to me Dr. Albright's letter in which he differs somewhat from my opinion as expressed in February WORLD, and granting the privilege of commenting on

same.

I am pleased that Dr. Albright has expressed views contrary to mine for it presents an opportunity to discuss the subject from more than one standpoint, which is the only proper way to consider any question of such importance. Then, too, I see the necessity of more clearly

and fully explaining my reasons for taking the stand I have.

I heartily endorse the majority of his remarks, and the formula named by him may prove to be the best known, tho I have not had time to test its virtue.

The point on which we differ most is the advisability of treating hernia on the plan of "no cure, no pay." To some physicians this question may appear of minor importance, but I think it should be well considered; besides it has a tendency to establish a precedent that may eventally lead patients to demand that all ailments be treated on a like basis.

There is not a doubt but that more people will be induced to take treatment under such a guarantee, and that it will prove far more remunerative at the outset, but, in my opinion, not in the end. At first everything is smooth sailing; patients are delighted with the results and have implicit confidence in the assurance that they are permanently cured. They willingly pay the amount agreed upon; but as time passes and the truss is removed, many of them will return with the information that the rupture has come down, or that they feel a weakness in those parts.

cure.

There may be a difference of opinion as to the definition of the word According to one of the best recognized authorities, it is briefly as follows: "To entirely eliminate the trouble and remove all disposition to its recurrence." If that be correct, and it is the physician's intention to deal honorably with his patient, yet adopts the plan of "no cure, no pay," is it not reasonable for the patient to expect to be permanently cured and able to dispense with a truss or light support for an indefinite length of time without evidence of the hernia returning, unless due to carelessness on the part of the patient, or by accident? If that is not accomplished, I am of the opinion that the physician has failed and should receive no compensation.

If human bodies were like a pile of bricks, all of the same quality and dimensions, we could state definitely what could be accomplished with each individual; but such is not the case. The question arises, how can one account for the large number of healthy people

I

breaking down after a surgical operation, when the operator is not at fault? know of a healthy lady who has, on five different occasions, undergone the cutting operation for hernia, and in each instance the rupture returned either in the line of the incision, or near by. If such patients (and a physician can not always detect them in advance) were to be treated under an agreement of the kind mentioned, they are impressed with the thought that they will be permanently cured and able to lay the truss aside. Then, should the rupture return, or it even be found necessary to wear only a light support, it is only natural for them to become dissatisfied-to not recommend the treatment. And tho they may not request the money paid for treatment to be refunded, are indifferent to the benefit already derived.

On the other hand, if people are not led to expect impossibilities, and receive an equal degree of benefit, they will forever be grateful to the physician and cannot too highly recommend the injection treatment.

My experience has proven that the opening and canal in all cases, or practically so, of reducible hernia, can be entirely closed and the patient apparently or practically cured. A large percentage of the cases will not be able to dispense entirely with a light support of some kind; by wearing one, the hernia is not likely to return, and future treatment may not be necessary. Not until the proportion is known of those who remain permanently cured after discontinuing treatment and dispensing with a truss, will it justify a general practitioner in following the plan of "no cure, no pay." He may in time injure himself more thru patients who afterward become dissatisfied, than were he to adopt the method used in the treatment of other affections. Besides, he will not be able to secure a sufficient number of patients to pay him to take the risks. As soon as it becomes known that you can cure rupture, it will not be necessary to promise impossibilities, or run the risk of having to refund the money, or have a dissatisfied patient.

The question arises, when does a physician's responsibility end under the agreement "no cure, no pay"? As an