have it to-day is the result of thousands of co-workers for ages past. In early times they did not associate very freely, medical books were few, and medical magazines had not made their appearance. All these means and methods of association have grown wonderfully in the last half century, with the best possible results to the science of medicine; and consequently to the people whom it

serves.

These thoughts are suggested by the coming meeting of the American Medical Association in Denver on the 7th of June; also by the fact that May is the month in which more State medical societies meet than any other month in the year.

There is something sublime in the meeting of men for the up-building of the science of medicine, by the mutual exchange of thought and experiences. No private proprietorship is sought nor desired. Each gives freely and each is free to take. He who has most to give is the most distinguished; hence the competition is not to get the most, but to give the most. How different from the commercial world! Yet some people tell us that we "must change human nature" before such a standard could apply in the commercial world. In the military world the bravest and most self-sacrificing are the most distinguished, and deservedly so. But in the commercial world it is the most selfish and avaricious who are the most distinguished. Why this difference in standard? Cannot commercialism be lifted to a higher level? If milionaireism were looked down upon as "piggish," gifted, active and enterprising men would not become less active and enterprising, but they would find nobler objects for their activities than the amassing of private gain. The ethics of the medical profession are sound, and worthy of adoption in the commercial world. What a change would follow!

Association is important in our professional work. No one should neglect it. Attend all the medical meetings you can. Give all you can from your store of experience, but at the same time be willing to learn from others. Owing to the heavy tax placed upon transportation by the railroads (read Mr. Cowles' book reviewed in another column), many physicians cannot attend these associations as freely as they wish. To these the printed page is the best substitute. We We strive to make the pages of this magazine practically a medical association (on paper) with monthly meetings in your office.

ORIGINAL COMMUNICATIONS

Short stories on the treatment of diseases and experience with new remedies are solicited from the profession for this department; also difficult cases for diagnosis and treat

ment.

Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors.;

Copy must be received on or before the twelfth of the month for publication in the next month. Unused manuscript cannot be returned.

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than anything else.-RUSKIN. REFLECT. RECORD.

READ.

COMPARE.

Editor MEDICAL WORLD:-There is a good deal in the question of spelling reform, and my sympathies are strongly with the editorial on that topic in the April WORLD. But the extent to which these reforms are to be carried affords a field for argument. I have long since ceased the use of the diphthongs in the midst of words, but when they begin a word, as oedema, oesophagus, etc., it is an objection to omit the "o," because it takes the word out of its place in the index; and unless one is posted, he will hardly look for these words under the e's. As to the final "e" in the names of alkaloids, as aconitine, it serves to distinguish them from the extracts and glucosides, and is therefore a valuable letter, whose omission would lead to confusion.

Dr. Dumm, on page 152, has given some very apt illustrations of the dangers of the old method of dosage, by uncertain preparations in large, infrequent doses. How much better to give the active principle, in a dose too small to harm any one, and repeat it every fifteen to sixty minutes, until the desired effect is secured. No matter what is the susceptibility of the patient, too much cannot be administered in this manner if the nurse has been told what effects are expected, whose advent is the signal to stop the medicine. Used in this way, Dr Dumm need not hesitate to avail himself of the powerful aid of aconite to relieve fever, dissipate congestion, unlock vaso-motor spasm loosen the excretions in his next case of rheumatism.

Dr. Dalton (page 156) certainly did well with his case, but he does not give us near enough information about it. Was cerebro

spinal meningitis in the town? Had the boy dilatation of the pupils or other evidence of the effusion? Had he the peculiar eruptions on the skin that are present in this affection? From what data are given I would not venture a diagnosis further than that of tetaniform convulsions. Nor does he tell us whether the boy recovered completely or incompletely, or what became of the paralysis. Why did he give ether hypodermatically when he could have used it, or, better, chloroform, by inhalation. And why use a potassium salt when this metal is itself a cause of convulsions? Were there any examinations made of the urine before, during, or after, the attack? Was the patient neurotic, by inheritance or individually? These and other questions should be answered to complete the record, for we cannot afford to lose a possible cure of a possible case of cerebro-spinal fever. Cures are too srce for that.

There is so much good sense in Dr. Oppermann's letter (page 157) that I would like to have the power to enforce it. It would be a most valuable thing if physicians were to report every week the cases they treat. Suppose we were to note in such a report a case of cerebro-spinal fever, cholera, smallpox yellow fever, dengue, influenza, anthrax, trichinosis, arsenic or lead poisoning, or any of the unusual diseases would we not immediately recall if we had in our own practice a case that might possibly be of the same nature? Just note how many cases suddenly turn up when any of these are announced, as was the case when D. D. Stewart discovered lead in the Philadelphia buns a few years ago.

I sincerely trust that Dr. Humphrey (page 158) will think better of his determination to leave us, for two good reasons. First, the editor of a modern medical journal would be derelict in his duty were he not to gi-e fair and full examination to new ideas in our beloved science and art of medicine, even if these ideas appear preposterous in the light of current opinion. No more ridiculous idea was ever sprung on the profession than vaccination, as Jenner's contemporaries saw it, and yet what a boon it has proved! The animal products have enough proof in their favor to compel their being taken on probation. The effects of thyroid extract upon myxedema, and of splenic extract on exophthalmos, of testicular extract in sexual debility, and of nuclein in affections where an increase of the leucocytes is beneficial,

are too well attested to be doubted. And the success of these compels us to admit that benefit is legitimately to be expected from other animal extracts.

The second reason is that as Dr. Humphrey has reason to doubt the efficacy of antitoxin and tuberculin, it is his duty to give us those reasons. There are two classes of observers; the optimist, who takes the statement for granted before he has tried it, and the pessimist who does not believe a thing until he cannot help it. We need good, sturdy doubters to show the weak points in our theories, and keep us from falling into error by too easy acceptance of what may prove to be false.

Whenever a new remedy is brought out there are many who quickly report great things of it; but we who realize the powers of suggestive therapeutics wait for the sober second thought, and th more of a pessimist a man is, the more is his good opinion valued. Dr. Humphrey is lacking in his duty if, believing there is a mistake in the published statements as to the efficiency of the animal extracts, he does not give us his reasons for that belief. And I believe that I voice the universal sentiment of the WORLD readers and its editor when I say that an honest expression of opinion is just as highly valued, if not as welcome, when it is against the claims for a remedy as when it tells us of its success.

I must take issue with Dr. Kidder (page 162) as to the cause of typhoid fever. His explanation does not explain. If the accumulation of toxic matter develops the typhoid bacillus, does it cause its spontaneous generation, or simply develop it from a pre-existent bacillus? If the former, he is going back to an exploded hypothesis; if the latter, he contradicts himself. thousand or more who contracted typhoid fever at Plymouth, Pa., were not more laden with toxic matter from overwork than others, but they were proved to have drank of water infected by the typhoid bacillus. Moreover, it was only those who drank the polluted water who were at first infected, while others living alongside them and subject to the same conditions, but drinking water from another source, were not affected till later, when new foci of infection had been developed. The effort has been repeatedly made, especially in France, to attribute typhoid fever to non-specific causes. Evidence was adduced to show that soldiers who made long marches were seized with it, and it was even

proposed to substitute the term fatigue fever for typhoid. But all that was shown was that prolonged fatigue was followed in some instances out of many by a fever of the typhoid type; and even so, the very obvious explanation that the fatigue simply rendered these men specially liable to typhoid, whose germs they had received from an unknown source, was ignored. The presence of living beings presupposes the existence of their ancestors; and from that proposition there is no escape.

I regret also that I cannot agree with the statement that the "sina qua non in the prevention and arrest of that dread disease is mercury." But if he has been treating typhoid with mercury for forty-five years it is not likely such youngsters as I can convert him. No physician over forty years of age, who practiced when Harvey announced the circulation of the blood, accepted that discovery. It is hard for an old dog to learn new tricks. To young men belongs the incentive, the inestimable privilege of introducing and advocating new in as and new theories.

WILLIAM F. WAUGH, M. D. 103 State St., Chicago, Ill.

Hysteria.

Editor MEDICAL WORLD:-I once practiced at a place where I had quite a lot of hysteria. A very large percentage of my practice was among hysterical people. So often did I have these cases, and so fully did I expect them, that I was slow to be convinced that a patient was really suffering. I remember being called in haste some miles in the country to see a lady (25 years old, mother of one child) who was suffering with acute congestion of the brain. Pardon me,

A very

but I thought she must have hysteria. I used my usual remedies, but she failed to "round to," and I began to realize what I had to deal with. I told the family she would die, and asked for help. bright young man was called to consult with me and after he had finished his examination we went out in the yard to exchange ideas, and one of the first words from him was hysteria. I told him that was my first opinion, but I had changed it. He could not agree with me, so we decided to wait, and we did wait until she died, about three o'clock that morning. This lady died with all the symptoms of hysterical mania, and I fully believed she had hysteria until the circulation told me different. My brother

practitioners, do not cover up your mistakes. Tell them. It will do us good.

Why should people have hysteria? and what can be done for it? We usually find this disease is delicate women; tho some of the most marked cases I ever saw was in strong young men. We find most cases in a warm climate. The long hot summers seem to predispose to hysteria. Most of the women lead very sedentary lives, and do little actual labor. If there is no place of interest for them to go to, they pass days bent over some little patchwork or novel. The digestion is necessarily impaired; they are constipated, anemic and peevish. With all these predisposing causes, let some exciting cause come and off goes the patient into hysterical convulsions, stupor or numbness. Some imagine their heart is about to stop beating; each patient has her own special complaints. This class of patients always have my sympathy and kindest treatment. I have so often been called to the bedside of these patients, and as I look on their seemingly uncontrolable actions, I say within myself, surely you would not do this if you could help it.

Most all of these cases have an exciting cause, tho some will come on periodically. The most trifling thing will sometimes bring on an attack; sometimes it is a cross word from the husband, sometimes a sudden excitement or scare. Whenever the predisposing cause is great the exciting cause may be trifling; or the exciting cause may be great, and cause an attack in a person little predisposed to hysteria.

I will suppose that I have a case now: Have been called in haste to see Mrs. A.

As I near the house I see Mr. A. standing in the door looking for me, and about the time I get to the front gate Mr. A. comes out to meet me. He tells me his wife has another one of her nervous spells; that she had been in usual health all day and had been talking of going out shopping, but this spell had come on her suddenly. I go in and find Mrs. A. a little better. She is able now to speak to me. I have failed only a very few times to get one of these patients to talk to me. Now what caused Mrs. A. to have this attack? It is simply this. Mr. A's income is $10.00 per week. It will not do for his wife to do her work, or they will be called "poor white trash." So a washwoman, cook and nurse are to be paid out of the small income. Mrs. A. wants a new hat and there is not enough money left to pay for it. She

being in poor health any way and easy to worry, it brings on the attack. What shall I do for her? If it is the first call of this kind I will let them down easy. If it is a severe attack I give a hypodermic injection of morphine. If not, I give them ammon. tinct. valerian or bromides. I prefer the valerian. After the paroxism is fully controlled, I relieve the constipation, if any, and give some good tonic. Sometimes I use elix. quinia, iron and strychnia, teaspoonful in water every six hours. I leave a bottle of ammon. tinct. valerian at the house with instructions to take a teaspoonful in water when any of the nervous symptoms are felt, and to repeat the dose in two hours if needed. I find this will give relief to a great many. I never leave an opiate of any kind with these patients, for they easily form the drug habit. I also talk to my patients, and try to encourage them all I can. I talk to them of economy, and refer them to Mr. and Mrs. K. I speak of how they manage their affairs, and how they get along, but never hint that your patient is a poor manager or extravagant. If it is a place I care to go to, or take my wife to, I will take my little family and call on them, I tell them how my wife used to do all of her cooking and washing, and with a good machine the washing could be done in a very little time. I tell how I got up early and helped her, and that I believe the exercise really did her good, beside the money we saved put out at compound interest would buy us a nice home in fifteen or twenty years. This stimulates most of them to try it, and it does a great deal of good for them. If after you have exhausted all of your efforts to make a cure, and your patient still has her hysterical spells (or if you conclude they are having them for pure cussedness as some do), I have what I call a radical cure. I would not advise anyone to use this unless the family have implicit confidence in you, for they might think the treatment a little severe. If I know the family has confidence in me I say to Mr. A. in Mrs. A's. presence, that I have fully decided Mrs. A's stomach is at fault, and I will give her a hypodermic injection. If my theory is correct it will make her sick; but if I am mistaken it will not. And i proceed to give her an injection of apomorphine. I generally use gr. I tell them to get a basin, for if I am correct in my diagnosis Mrs. A. might get sick enough to vomit. It is only a question of a few minutes until she is vomiting. After she is

better I tell them how important it will be to empty the stomach every time she has a spell like this, and urge them to lose no time in sending for me. I have used the above treatment several times and have never known a patient to have the second attack. I cured a case of hysterical epilepsy of several years standing, with one injection of apomorphine. I had the patient under observation for two years afterward and at no time did she have a symptom of the disease. I would not advise the apomorphine treatment for the rich. Give them the palliative and tonic treatment, and if they want to send for you three times a-day, go, and do not forget to send in your bill for having saved his or her life. Ellsworth, Ill.

W. J. SALING.

Hysteria and the Uric Acid Diathesis. Editor MEDICAL WORLD:-The inclosed is a copy of a letter I have this day sent to Dr. Price. If you think it worth while you may publish it. I am well pleased with THE WORLD because of its great tolerance. I thank you for the courtesies of the past.

Yours respectfully, E. C. SCOTT. Maxwell, Iowa, April 4, 1898.

M. G. PRICE, M. D., Mosheim, Tenn.:

DEAR DOCTOR:-I have just read your query in the April number of THE MEDICAL WORLD (pages 164 and 165), and the editor's comments thereon, and I fear that you will feel that you have not been much helped, but that you have been rebuked, by the editor. Of course, as he says, it is easy to diagnose your case as hysteria. But how much does that help? What more do you know about it after you have called it hysteria than you did before?

What is hysteria? What causes it? What can be done for it? You will find the treatment of hysteria according to the generally approved plan very unsatisfactory.

I dare to guess that this case has already been diagnosed as hysteria and been treated accordingly. And doubtless with apparent success at the time, but that afterwards "she went all to pieces again." I have no fault to find with the diagnosis of hysteria, but to me it explains nothing.

What is the relation in this case between eclampsia, the miscarriages, and the hysteria? I believe they are related by having one chief factor as a common cause. And that factor is uric acid. I never had a real typical case of eclampsia, but I have had a few that

seeemed to me to threaten it quite hard. In such cases I think the general experience has been that the urine is scanty, with heavy deposits of urates. In my last case of this kind the threatening symptoms came on about half ar hour after delivery. She had been having swollen hands and feet, with difficulty of vision, before confinement; but I had not seen her before. I think I probably I think I probably avoided a spasm in this case by giving nitroglycerine promptly. I examined her urine and found it to contain a large amount of albumen. I immediately put her on treatment to hold back and to dissolve out the urates after the plan described in the article, "The Ailments of March," in THE MEDICAL WORLD for March, 1898. She began immediately to improve, and altho the albumenuria continued in a marked degree for eight or ten weeks, she eventually completely recovered.

On July 11, 1896, I was called to see a woman supposed to be in confinement. I found her having much pain, but no evidence of contraction. Her urine was about the color of strong coffee and quite scanty. She gave a history of having had a miscarriage about a year before, after which she had spells of involuntary jerking. She said her health had not been good since, and that she had been especially poorly for some months just previous to the time that I was called. I found her ankles quite swollen, tho her urine contained no albumen. I put her immediately on treatment after the plan referred to above. She promptly became more comfortable; the urine became freer, but continued about as dark for several days; the pains quieted down, and she was not delivered until a week later, July 18. The labor was natural. I continued the medication for a week or two longer, and she came out feeling quite well.

Another case, Mrs. W., a primapara, was delivered Aug. 21, 1891, with instruments, of a healthy boy at term. Jan. 7, 1893, she miscarried at about the third month. Jan. 20, 1894 she again miscarried, and again June 5, 1895, and yet again on Nov. 23, 1896, each time at about the third month. During this time of repeated miscarriages I had treated her with various uterine tonics and alteratives, and had recommended curettment to her, but she had not consented to the latter. In the early spring of 1897 she complained of feeling very miserable, of aching all over at times, loss of appetite, urine scanty and high-colored at times, then

again clear and profuse. She had no albumenuria. I put her at this time on the before-mentioned treatment for the control and the elimination of urates. She began shortly to improve. I continued the treatment in a mild way for two or three months. She got to feeling quite well, and on Nov. 18, 1897, was delivered of a son at term. She has been feeling well ever since.

In cases of severe uric-acid-emia, when the blood is alkaline, the urates are dissolved out of the tissues, into the blood, making it thick; the general circulation is defective; the secretions are deficient; the urine is scanty and loaded with urates. The food in the digestive tract ferments, generating acids that are taken up into the blood.

The blood lowers in its alkalinity; the urates diminsh in the urine, doubtless being held back in the tissues; the circulation improves; the urine from being scanty and high-colored soon becomes clear and abundant.

The patient feels much relieved by the change, but is apt to be quite sore in spots. This soreness, I think, is due to precipitation of urates at these points. If this precipitation takes place along the sheath of a mixed nerve it will likely cause cramp and pain. If along a sensory nerve it will be neuralgia with no motor disturbance. But if it is in the motor centre or along the motor root of the nerve we may expect motor disturbances without pain. I have seen typical cases of each of these classes of nerve disturbance. If the precipitation of urates at these points is the true cause of the nerve disturbance, then the remedy would be to stop the precipitation and to promote the absorption of urates at these same points.

If you recall to mind how readily urates are precipitated by cold and redissolved by heat, it will probably occur to you that the application of heat at these points might give relief; and in this I think you will not be disappointed. Apply persistently as great a degree of heat as is bearable along the tract and at the root of the nerve supplying the part affected. This is for immediate and for local relief. For general and permanent relief control and eliminate the urates after the plan before outlined. For the constipation give tablets or pills of the following: Aloin

Ext. bellad.
Cascarin

Strych. sulph.

1

.gr. 5 gr. .gr.

Direct that they be taken not as a physic,