but as a tonic laxative, one or two three times a day, more or less, as needed to produce what might be called a natural movement of the bowels. After taking it awhile the dose can gradually be diminished and finally left off, being no longer needed. If the headache comes in the time of scanty urine, relief will likely be had by giving phenacetine or acetanalid, but in such case, after getting the headache thus under control, combine with the acetanalid or the phenacetine about an equal amount of salol, and give of this in moderate doses for some time longer. If the headache is of the neuralgic type and comes cn in the spells of profuse diuresis, give the salol alone.

The trouble with your patient is that she is loaded with urates. What she needs is to get rid of them. To do this they must be excreted. Do not make the mistake that is usually made in thinking that when you have given something to cause the urates to quit appearing in the urine that you have thereby gotten rid of them. The probabilities are that you have simply precipitated them into the tissues. And while by this your patient may get some relief, it will not be permanent.

The matter of diet is very important. But until you have, by elimination, in a measure relieved the system, you will find the regulation of the diet rather difficult. For the patient will probably not be able to digest readily the food that would be best suited to her needs. But as rapidly as you can, direct her diet along the line of the grain foods, and of milk, taking care to see that in doing so she has plenty of proteids. Have her use the whole wheat flour, containing the full amount of gluten; also breakfast foods of various kinds from grain (granola, granose, etc.). Have her gradually discontinue the use of tea, coffee, meats, meat soups and eggs; also tobacco should she be accustomed to using it. If she does not use it, her rooms should be kept free from the smoke of it. These changes are radical and should not be attempted too abruptly, but gradually while the process of elimination advances. Read my article in the March WORLD. Get and study Haig's work on "Uric Acid a Factor in the Causation of Disease." But in the meantime do not charge all the seeming vagaries of this article to Haig, as that would be unfair to him. I would be pleased to hear from you again regarding this case.

Fraternally, E. CHALLEN SCOTT, M. D..
Maxwell, Iowa, April 4, 1898.

[Not only to prove our "great tolerance" do we present the above correspondence, but for the value of Dr. Scott's studies along the line indicated. These ideas cannot be presented too often nor too strongly, and their application, with details, to actual cases, as above, is of special value. However, the diagnosis, hysteria, remains unshaken; and the advice given to read up on this subject, applies. In this connection the following, which was crowded out of April issue, will be of interest:

One of our subscribers asks some questions concerning the treatment of hysteria. This indicates that some do not make past issues of THE WORLD as useful as they should, and thus much usefulness is lost. Bound volumes of THE WORLD should be conveniently at hand. By means of our Bindvery one can have bound volumes of WORLD. Regarding hysteria, take the 1897 volume and refer as follows:

ers

May issue, pages 201, 202 and 203.
June issue, pages 221, 222 and 223.
August issue, page 338.

September issue, page 373, first column.

If you will read these articles again, we will venture that you will value the practical information that they contain more highly than the price of THE WORLD for a number of years.-ED.]

Uric Acid Diathesis.

More details as to Dr. Scott's treatment are given in the following correspondence:

SYCAMORE, O., March 28, 1898.

Dr. E. C. SCOTT; Dear Doctor:- I have become quite interested in your articles in WORLD for November, 1897, pages 464, 465 and 466, and for March, 1898, pages 93 and 94. I have made use of these remedies and believe them to be good; but I find in giving the acid phos. dil., that it disorders digestion, especially where we have a weak stomach, as is usually the case in tuberculosis. I also have the same difficulty with the ammon. salicylate.

I cannot find a vehicle for it that will disguise its taste.

Perhaps you may be able to tell me how to overcome these difficulties. Would be glad for whatever information you may be able to give along this line, either by letter or thru THE WORLD.

MAXWELL, IOWA, March 30, 1898. DR. A. L. WALTON, Sycamore, Ohio; Dear Doctor:-Yours of 30th inst. just received. I am glad to hear from you. In giving In giving acid phos. dil. in these cases, it should be given before meals and well diluted with water, and followed after meals by the salicylate. The dose must be regulated to suit the condition of the patient.

In most cases you will find this an excellent stomach tonic, but in some cases it causes distress in the stomach; this I believe to be due to the precipitation of urates into the walls of the stomach. If the acid is followed soon after by a dose of salicylate, the distress is usually either avoided or soon releived. If in this way and by careful regulating the dose you are still unable to give the acid, then resort must be had to something else.

In such cases try separately some of the following: Lime-water, lithia, calcium sulfide, calcium sulfo-carbolate, mercurial preparations, phenacetine, acetanalid, or acid fruits, all of which, tho differing widely in their general charisteristics, appear to have this in common: that they lessen the excretion of urates, presumably by precipitating them out of the blood into the tissues.

Whatever the remedy used for holding back the urates, it is well to continue in a mild way the use of the salicylate in order to get the residue remaining in the blood into a freely soluble form, so that it may be by the kidneys excreted from the body.

The above remedies, including the acid, may be given in broken doses between meals, by combining with them, or following them with salicylate.

As to ammon. salicylate, I know of no way of completely disguising the taste. But quinimel (S. & H.) is as successful in this as anything I have tried. If the ammon. salicylate solution is made extemporaneously from ammon carb. and acid salicylate, it will be least unpleasant when just neutralized; this will require about five parts by weight of the ammon. carb. crystals to nine parts of acid salicylate. Solutions of ammonia salts are not very stable, being inclined to turn dark on exposure to light. So keep in a dark place, and make fresh as needed, or at least frequently. The salt of ammon. salicylate is much handier, but also much more expensive. When I am using much of the solution I make it in quantities to last me about a week, by putting the ammonia carb. and the acid salicylic into an open jar

of sufficient size to allow of effervesence, then add the requisite amount of water, stirring it gently occasionally to facilitate the chemical action. When the solution is complete I put it in a stone jug for preservation. I usually now dispense it without any attempt to disguise its taste, and I find it about as pleasant so as anyway I have been able to fix it. In the winter time the solution is unhandy because of its tendency to freeze; then I use salol. Salol is in my experience the most pleasant to take of all the salicylates, is quite efficient but rather more expensive than the above-mentioned solution.

Salol, however, melts at a temperature of about 110° F., and in the summer time, unless care be taken, it will change from a powder to a hard crystalline mass. This is one reason why I used the solution in the summer time. Where expense is no object and a liquid form is preferred, a very elegant and effective preparation is the Elixir Ferri Salicylata (Merrill). This preparation of Merrill's I use for children, even for infants, often combining with it in solution ammonium iodide, and diluting it with quinimel and water.

E. CHALLEN, Scott, M. D.

Comments on April WORLD. Editor MEDICAL WORLD:-Just how far to go in spelling reform is the question. If THE WORLD will adopt the reforms suggested in the April WORLD (page 130) and keep it up, the time is not distant when many other smaller papers will do the same. Many who favor the reforms suggested may, in writing, forget to spell the words correctly; but the printer can make the necessary corrections.

No

Fortunately, such cases as Dr. Dalton's (page 156) are comparatively rare. doubt he treated the case as well as any one could. It is one thing to tell some one else what to do, and quite another to stand by the bedside with all the responsibility resting on one's own shoulders.

I was sorry to see (page 138) Dr. Humphrey so strongly object to THE WORLD on account of articles on "antitoxin, "tuberculin," etc. I have never had much faith in some of the fashionable fads; but it occurs to me that it would be very silly for me to object to a journal that did not publish just what I want and nothing else. We, of all men, should avoid prejudice, and always keep before us this truth: that we may be

wrong and some one else right. We should study well both sides of every question. It is to this kind of spirit we are indebted for the rapid progress in medicine during the last few years. No man can attain the highest success in practice who makes up his mind that he has reached perfection in any department of medicine. No matter how ridiculous or absurd a "medical fad" may be, it is seldom without a lesson. THE WORLD is so very fair in every respect that it is difficult for me to understand how any physician can find an objection.

While on the subject of fairness, I want to say in reply to "Candid Criticism" (page 159) that I cannot help contrasting the fairness of THE WORLD with that of another medical journal on my table, which considers public questions in its pages. THE WORLD'S articles on these questions are nearly all in the back of the magazine, separate from medical matters, and may be read or not, as the reader may desire. Besides this, those who have an objection can be heard in perfect fairness. This is more than can be said of a large majority of the political papers and journals on political economy. political economy. Some of these matters are like an untried remedy, and some of them I am very much in favor of trying.

Did you read "Progress" (page 175)? For twenty-five years I have advocated this idea. I have no serious objection to the practice of an educated "eclectic" or "homeopath," but I do object to the use of the name "to trade on," as the writer very properly puts it. There is little difference in the practice of educated physicians, no matter what school they may claim. All our societies should receive educated physicians who call themselves physicians only and do not advertise an exclusive plan of practice.

Dr. Stearn's official act (marrying the couple), so closely followed by the professional act (delivering the bride of a baby, page 159), is rather unusual. But I have known something like it. A physician and preacher baptized a lady, married her, delivered her of several babies, treated her in her last illness, and preached the funeral. It is needless to say this was not all done on the same day.

I cordially endorse all Dr. Souder says (page 155) about taking cases on the "no cure, no pay" plan. Such plans do not accord with my idea of professional ethics. It sounds too much like quackery. Besides, it is never a good business plan if one expects

to remain long in one place. I never take any kind of case, no matter how simple, on such a plan. If a physician will do such practice he should tell the patient that such contracts are null and void unless in writing properly signed, and a proper tribunal named to sit in judgment on the case, if there is a dispute as to whether or not the patient is cured.

Sorry to note (page 142) Dr. Waugh's failure with the alcohol method of treating cancer. It is possible it might succeed in cases of different character. Would like to know also the experience of others who have ligated lateral veins on the penis. Hope Dr. Waugh and others will continue to make investigations along this line, and report progress occasionally. Physicians have many calls for treatment of non-erection, but few are willing to undergo the operation unless there is a very strong probability of a cure.

The idea advanced by the editor in his comment on my article (page 151) is the proper one. We cannot prohibit certain classes from marrying, but they should be taught that it is not right to have children when they have every reason to believe they will be forever diseased.

Kendrick, Miss.

C. KENDRICK, M. D.

The Climate of Southern California. Editor MEDICAL WORLD:-I desire to remind Dr. H. Schafer that I did not, and do not now claim to be "of San Diego, Cal." The article referred to by him was written from Banning, Cal., and stated that the writer had lived here six years. It related principally to Banning and the surrounding country and their adaptability to cases of consumption. From here (Banning) an elevation from 250 feet below the level of the sea to 10,000 feet above can be reached in a few hours. Four hours' travel with a horse will take one to the higher elevation, and two and one-half hours by the cars is all that is required to reach the lower. Banning itself is situated at an elevation of from 2,000 to 2,500 feet. The elevation at the Southern Pacific R. R. depot, which is about the centre of the village, is 2,300 feet. The land gradually slopes from the mountains on the north to those on the south, a distance of about three miles, and the elevation varies on this slope as above stated. Here, within a radius of thirty miles, any one can enjoy "a high, mountainous altitude" to its full extent, and that is the "only climate," Dr.

Shafer claims, "where consumptives can be benefited." It is possible that the Doctor is not talking "bosh" when he says this, altho I know from actual observation that some consumptives have done well at Indio, which is some twenty feet below sea level; and I also personally know some consumptives that have done and are now doing well in San Diego. San Diego has a delightful climate-warm and equable. It is an ideal place to spend one's old days in. Deemingly devoid of bustle and worry, altho not commercially dead by any means. One seeking a quiet and retired life should always feel on good terms with himself in San Diego.. I always make it a point to spend a few weeks each year there, altho it is a little too close to old ocean for me to remain long, as sea air seems always to make my throat trouble worse. It is one of the most healthy places in California.

Southern California is a diversified country, full of beautiful valleys and grand mountain scenery. Here one does not have to travel hundreds of miles and spend a small fortune to get a radical change of climate. A good horse, or even a donkey, will take one from the warm genial climate of the valley to the region of perpetual snow. Any altitude desired may be obtained-any degree of moisture, from the dry, desiccated air of the desert to the moist air of the coast. Strawberry Valley, about thirty miles from Banning, has an elevation of 6,000 feet above sea level. The temperature in summer seldom raises above 80 degrees in the shade, and the air is dry and invigorating. Many people go there from Riverside, Colton and the surrounding country during the summer months. There are one or two hotels, a store, and in summer many campers. Any one can take a tent and spend months in the open air at this place at a nominal cost. Another place is situated at the foot of the mountains, about fifteen miles from Redlands, where there is plenty of pure running mountain water, pleasant scenery and an elevation of from 4,000 to 5,000 feet. There are large, beautiful live oak trees, under which the camper may pitch his tent. The air is dry and bracing, but soft and balmy. The scenery is varied; many pleasant nooks and canyons to explore and fairly good hunting-in fact, everything to stimulate an active out-door life. This place is within fifteen miles of Banning with a good road leading to it. The writer has camped there and knows whereof he speaks. It seems to me

Dear Editor:-I like THE WORLD, with two exceptions: T. The Politics. 2. The spelling.

And you want to add some more of your "reform" in spelling and kill us by inches!! The politics are bad enough, and what "reform" you have put in, but-oh, my; you are going to add more!! That will drive the minority of your patrons crazy! i. e., the majority are already beyond further injury!!

Ye gods! why do you do this? You will inflict a torture on us all every month. Leave it to a vote and see what the "other fellows" think about it.

How can you have the nerve to inflict this torture such a terrible, terrible pain on each one of your patient readers!?!? Let the English language alone. You may dabble in "pollerticks" as much as you wish, but, oh, oh, oh-now this!!

Please use stronger paper on the mailing cover of THE WORLD, for each month it comes to me torn off and in a dilapidated condition. Come down off "your high perch," and attend this minor detail which is more important than "silver," etc., since if I were to miss one number of THE WORLD, more damage would result than if "school" were spelled "skule," or "scool," etc., etc., because the loss would be irreparable since there is more medical wisdom in one number of THE WORLD than all the rest of the journals put together.

But you "reformers" always skip about on the frothy future and lose sight of the weightier bottom to which gravitate our daily affairs. In revenge I will give you some "figgers of speach." Your phantom ships sail over the billowy ocean of imagination, but you grate your keels on the smut of the bottom when your mainsails are tense with the howling of the tempest of protest! (This is a stunner!) Air castles on water!! You sail on the bosom of buoyant hope-a salt sea made briny with the tears of a vain spent life! (Are you still alive? I claim first blood!) But I will hold my hand!! But beware!! This shows what deviltry I am capa

[The above brilliant letter was one of the rarest treats of the season. I will say that this is the only vote against simplified spelling that we have received, and we give it the first place the position of honor-in the discussion o- this subject this month. Many earnest letters have come in favor, a few of which, as samples, appear below. As to wrappers, they are plenty strong enough to carry all right if they are not tampered with. But THE WORLD has always been unfortunate in being too attractive to those who get access to it in transit. In repeated instances deliveries are delayed, uncertain, and when they do arrive the wrapper is torn off and the magazine shows signs of having been used. We urgently request that subscribers will let us know of such trouble, when we will immediately send another copy. We would rather send a dozen than for a subscriber to miss one. We keep a liberal reserve for this purpose. One day I saw one of our clerks sell several copies of THE WORLD to our mail carrier. Upon inquiry I found that he wanted them for some clerks at the post office. I immediately ordered his money returned and told him that he could have as many WORLDS as he wanted for those interested at the post office free of charge, my object being to facilitate delivery to our subscribers; but those along the road cannot be reached in that way. So we will have to ask you to notify us, when we will gladly duplicate missing or worn copies. Don't be afraid of annoying us. It is a pleasure to supply THE WORLD to you. When you pay for it you ought to get it, and in good condition. So we will send good-naturedly as many times as may be necessary to accomplish the result. As to spelling, our answer to the doctor follows immediately below.-Ed.]

Philadelphia, April 8, 1898.

Dear Doctor Wassweiler:-Yours of April 6th at hand and read with great interest. It is the first protest we have received against the proposed improved spelling. By examining our subscription books we find that you are a new member of our family, having joined only last January. So perhaps you are not yet accustomed to our "gait." However, the brilliancy of your letter shows

that you will soon catch up with us, and that you naturally belong with us. You can't be a fogy, altho you may think you want to be. Your letter shows that you have too much "go" in you for that.

Turn to the front part of Webster's Unabridged Dictionary and try to read some articles of one to three centuries ago in the best English then known. As you make this effort you will pity those that had no better written language. So will those who follow us, a few centuries hence, pity us for our very unreasonable orthography. Think how you would like it if conservatives a few centuries ago had succeeded in keeping our language as it then was. Make this same application to ourselves as viewed by those who will live a few centuries hence.

I have just received a letter from the Funk & Wagnalls Co., saying that upwards of fifty publications are now using the simplified spelling, among the newspapers being the Burlington Hawkeye, Yankee Blade, and the San Francisco Star. When as many as fifty publications have joined the "forward movement," to which class do you wish to belong? The "Forwards" or the I will leave it to you to supply name for the other kind.

Do you want to condemn your posterity for all time to spell tho with an unnecessary "ugh"?

After thinking about the above please let me hear from you further upon this subject. I am sincerely in earnest about this matter, and trust that it will receive the serious thought of others.

Very sincerely;

C. F. TAYLOR.

Elk Mound, Wis., April 11, 1898. My Dear Doctor Taylor:-Yours of the 8th at hand. I am a new subscriber, but an old reader of THE WORLD. It gave me great pleasure to hear from you personally. I hope I have not taken too much of your valuable time.

As to reforms, I am quite cynical. I think the world very, very wicked, and people grasping and harsh, even to the level of beasts-in fact, the beast is an improvement on most of them.

Our Church and Christianity has become a farce, our National Government has declined most fearfully. Our homes and schools are not what they used to be. In the face of all this, why try reform? Some years ago I was an enthusiast in everything,