The Medical World The knowledge that a man can use is the only real knowledge; the only knowledge that has The Medical World chest, in which the patient demands and In accordance with the usual policy of THE WORLD, to consider the diseases most apt to be prevalent at the time of the issuance of the journal, the next great subject to be taken up will be the affections to be classed under the general head of cold weather diseases. Bronchitis, catarrhal troubles of the air passages, pneumonia, grip, etc., will all be considered in this connection. Perhaps one of the most troublesome complaints the doctor has to encounter is the common cold in the head or on the expects speedy relief, and yet does not consider himself sufficiently ill to observe the ordinary precautions of avoidance of exposure and strict attention to hygiene. It seems impossible to impress on the mind. of the average patient the absolute necessity of nursing a cold, not so much for fear of the direct consequences of neglect as for the purpose of avoiding probable ultimate weakening of the system and the forming of a predisposition to attacks of more formidable affections, such as pneumonia and phthisis, quinsy or diphtheria. Take, for example, a cold in the head. It is considered of no consequence save from the inconvenience caused by the constant flow of mucus. The sufferer doses himself with sufficient quinin to make his head ring, takes a Dover powder to open every pore in the body, further assists the good work by copious libations of hot lemonade with whisky in it, goes to sleep wrapped in blankets sufficient to serve for an Arctic voyage. The natural procedure of kicking these off is also duly followed, and the next day the patient, still under the influence of his home medication, his entire system in excellent trim to take" anything, goes on the street and about his business, wondering at night why he has taken "more cold.” 66 Practically the same modus operandi is followed when finally a physician is consulted. Too many think that the mere visiting of a doctor's office ought to bring healing in its train, and too often such matters as the close following of directions are thought of trifling moment. The same negligence of precautions against further exposure follow, and, as a consequence, has arisen the popular idea that "the doctor does not live who can cure a cold in the head. It must run its course." The natural conclusion comes that right here is opportunity for some of that much deprecated "education of the laity." Do not let the patient go away with the shadowy idea that hygienic directions are so much "abracadabra" for the purpose of impressing, but make him feel that they are as much part of the medical treatment as are the pills and potions he takes, and, tho not so tangible, are still as necessary to effect cure. You may be told sometime that these are "things everyone knows," but reply with the statement that they are also things that everyone neglects; that if people would just put into operation such bits of information that the doctors are all the time giving them, there would soon be no need of doctors, since there would be no disease but old age, and there is no remedy for that. to some difficult case-the solution of the problem afforded by which, may, in its turn, be of the greatest assistance to you in some future complication. Help, like mercy, "blesses both him who gives and him who receives." Therefore, do not hesitate because the notes you have to send seem trifling or of little worth. It is just on the everyday things that help is needed. One may have but one case of Hodgkin's disease in fifty years of practice, but a hundred cases of sore throat in a season. Let us hear by what simple means you conquer the simple things, how you diagnose and how prevent complications, It may be a case of pneumonia or only of "the snuffles," but still let us have your experiences, great and small. There cannot help but be something in the interchange of ideas that will be of benefit to you. Be brief, and entertaining if you will, but above all else be practical. Public Health. Ever since the outbreak of infectious disease among our soldiers, together with the probability of the wide spreading of its ravages and the rendering unhealthy certain tracts of country heretofore regarded as most salubrious, public interest has been generally awakened to the need of measures being taken, not only by the medical profession, but by the government, to search out the reasons for certain outbreaks of disease, and wherever possible, enjoin means to preserve and maintain public health.. It is in such lines as this that the effieiency of symposiums among the practi- The Necessity for a Cabinet Department of tioners of our profession is apt to be most highly developed-the sending of notes upon matters apparently so slight that they are overlooked in our text-books, not considered in our lectures. The wide scope of practice is given in all the numerous works sent forth weekly by publishing houses thruout the country; it is the minuter details, the finishing touches, that can only be obtained thru experience. We may learn as well by the experiences of others as by our own, and thru our own experiences we may become the best of teachers. The opportunity for such a good work is afforded by THE MEDICAL WORLD, which monthly throws its columns open for the interchange of thought and experience. Still the degree of good done must, in some fashion, depend upon those who reap the benefit, since those who are helpt should help in their turn. The little point that seems unimportant, tho unusual, to you, may be just what is needed to solve the perplexities of some brother practitioner-may prove the key Recent communications in regard to the special causes operating to produce the camp fevers, and a generally mistaken idea as to the scope of the commission of inquiry appointed by the President, leads to the thought that the best way to cope with matters of this type is by the establishment in the Cabinet of a department of public health, the secretary of which should be a man of great experience in hygiene, competent to conduct investiga tion into all outbreaks of disease and to recommend a remedy for them. Surely the hundreds of deaths that have occurred thru the unhygienic conditions prevalent in our camps are as important to our government and as far-reaching in the effect upon our nation as the outbreak of an Indian tribe upon our borders. Where the savage foe slays tens, typhoid and malaria slay hundrede. Or, take the other hand, where the prosperity of the country may be increased by hundreds of thousands of dollars thru the labors of a department of agriculture, it is decreased by millions thru the preventable deaths occurring from infectious and contagious diseases. It seems of far more importance to know the causes of the spread of malaria, typhoid and tuberculosis, to say nothing of venereal diseases, than to trace up tuberculosis in cattle or the yellows in peach trees and the blight in the vine. Such a department would embrace in its scope the generalization and nationalization of medical laws of practice, the investigation of local outbreaks of disease, the matter of social purity so far as it could be dealt with by the government, the establishing of pure water supply for communities, incidentally the regulating of hours of labor, and all matters of public hygiene. The measure is one better worth advocating and pushing than some others that have agitated the public mind, and should be taken up with enthusiasm while interest concerning the health of the soldier is still active. Doctors and Charity. Physicians in this city and elsewhere are being freely circularized on behalf of the Red Cross Society. There is an instinctive tendency, whenever anything is wanted by any body for charitable purposes of any kind, to appeal on general principlesfirst, last and always-to the medical profession. Is this because doctors usually are the most charitable of people? They are, as a rule, not only subscribers to every charitable measure, but, outside of this, give their time and skill daily to the poor, directly, by personal attendance. They also indirectly contribute to charity thru the pauperizing of the public by hospitals, who, by entering into competition with the physician, lower his income by treating cases which, under other circumstances, would pay a physician's fee. Since the medical profession, more than any other, gives so largely to charity by free attendance, it should not be called on for pecuniary aid. This department of province of the other callings, the memcharitable work should be peculiarly the bers of which are not, by circumstances, placed in a position of constantly contributing time and labor. The Patenting of Foreign Medical Produc tions. The recent controversy concerning the granting of a patent upon the manufacture of antitoxin has by no means died out, and is now being generally taken up by the profession and considered at society meetings, etc. At a recent meeting of the Missouri Valley Medical Society resolutions condemnatory of the action of Prof. Behring were passed. The pith of the action of the society, however, lay in the resolutions reprobating the laxity of our patent laws, bestowing upon foreigners special privileges and monopolies they would be unable to secure in their native lands. The key to the position lies right here. If Prof. Behring and his agents choose to prostitute themselves for gain, it is not the business of the profession to interfere, altho they may deplore such ill-judged action. The point to assail is the clause in the patent laws that permits them to oppress the American public. Why not inaugurate a movement to change the patent laws so that foreign medicines cannot be patented here? It may, it is true, take some time to bring this about, but if each individual interested in the reform will consistently and persistently advocate the measure, and actively follow up their representatives in Congress concerning the matter, it can be brought about. The justice of the reform is obvious and it can THE MEDICAL WORLD. favor of the foreigner as against the Amer ican. article of great value in the Therapeutic Gazette. He gives, among other data, the following directions: not be believed that even the greasing of itching palms with pecuniary salve has been carried to such extent as to cause so palpable a violation natural justice in, Let the patient stand erect in a wellventilated room or wherever there is pure air. Then place the hands upon the hips and take long, deep inspirations and slow expirations, beginning at the bottom of the chest and filling up the lungs, if the expression may be allowed. In these exercises the rhythm can be varied according to this schedule: Let each medical society pass resolutions along this line and every individual physician and citizen use whatever modicum of luence they can command, and a reform in this direction will soon be evident. Respiratory Gymnastics. The treatment of phthisis will always be of interest to the profession so long as the "great white plague" numbers its annual victims by the thousand and so long as no specific has been discovered to meet its indications. In this line a great advance has been made thru recognition of the effect of thoro ventilation of lung tissue upon any chronic pulmonary complaint. Allied to this idea has always been the recommendation of walking under favorable conditions to the consumptive patient, since all exercises that bring the lower limbs into violent action are calculated to benefit the circulation and respiration. This idea is carried further, however, and to its logical conclusion, in the development and training of the lungs and of certain respiratory muscles thru and by local respiratory exercises. Care must be taken to interdict exercises of all kinds in the acute stages of the disease, such as the febrile stages, acute inflammation, or hemorrhage. The patient must be in one of the more favorable remissions before the gymnastics are inaugurated, and at first great care must be used to guard against over-exertion, a very probable thing, owing to the natural enthusiasm of the average phthisical patient. Only slight results must be expected at first, and improvement so gradual that it can only be surely established by comparison with the condition at some rather distant period. The physical treatment of phthisis has been very fully discussed by Dr. Otis in an 1. Slow and long expiration and inspiration. 2. Inspiration and expiration long and quick. 3. Slow and long inspiration, and long and quick expiration. 4. Long and quick inspiration and slow and long expiration. 5. Short inspiration and long expiration. 6. Long inspiration and short expiration. 7. Short inspiration and expiration. 8. Inspiration by two or three stages or jerks and expiration long. 9. Inspiration long and expiration by stages or jerks. 10. Inspiration and expiration by stages or jerks. Breathing through the nose only should be enjoined in all these exercises. Often regular breathing alone without the modulations scheduled above will increase the lung capacity, observation having proven that voluntarily taking a number of free, deep breaths at intervals thru the day will in a comparatively short time increase the circumference of the chest two or three inches. In connection with the deep breathing, various movements of the arm may be made that will further increase the beneficial effect. Among these may be enumerated the following :— 1. Slowly raising the arms to a horizontal position and then over the head until the hands meet, inspiring slowly and deeply while performing the movement, and expiring while lowering the arms in reverse order to the raising. 2. Raising the arms and carrying them back and down, describing a movement of circumduction. 3. Standing erect and straightening up, and finally raising upon the toes, deeply inspiring during the movement. 4. Extending the arms in a horizontal position, and carrying one of the legs back so as to afford a large base of support to the body. 5. Lying on the back horizontally on the floor or table and raising the arms backward and over the head while inspiring. If lying upon a narrow table the arms can describe a circle about the head. 6. Exercises with wands or dumb-bells of light weight, which yet demand rather more exertion than the free-hand movements. One can readily perceive the benefit to be obtained from these, particularly in those where the supplementary respiratory muscles of the chest are brought into action. Too much dependence must not be placed upon such general therapeutic measures to the extent of the ignoring of drug medication, but on the other hand it would be well to break from the other extreme of depending too entirely upon treatment by drugs without recognition of the helpful aids to be found in general therapeusis. The fact that health must be earned and cannot be bought is particularly true in connection with the above. Typhoid Fever in Our Hospitals. In continuance of the article in the October WORLD concerning the treatment of typhoid fever among the soldiers in the Philadelphia hospitals, the following aftermath is presented. It will be noticed that certain institutions are not represented. Of these, certain hospitals consistently refuse typhoid cases, making an exception for the first time in their history in favor of the soldiers. Such give no report, as they can scarcely be said to have a treatment for the disease, merely treating "in accordance with such accepted ideas, as may meet the views of the visiting physi cians." It may be stated, en passant, however, that even among these there is a great preponderance of opinion in favor of some form of hydrotherapy, combined with a reaching toward intestinal antisepsis. It must be said that courteous response was the rule wherever inquiry was made, and generally there appeared a desire to afford any and all information possible for the benefit of the profession, this even in the instances where the physicians in charge of the cases were preparing elaborate articles based upon their observations. Some natural distaste to being forestalled could have been understood and excused, but to the credit of the profession be it said that in no instance did the desire for personal glorification or any other motive seem to stand in the way of a willingness to oblige, save in one exception, so notable as to markedly emphasize the rule and to gain for itself unenviable distinction. The Protestant Episcopal Hospital. The visiting physician of the Protestant Episcopal Hospital, Dr. Elliston J. Morris, of 128 South Eighteenth street, Philadelphia, refuses all information as to the treatment used at this institution, and does not desire it to be represented in any shape in this discussion of methods. Jefferson College Hospital. Seldom has a clearer, more concise and more reasonable treatment been outlined for typhoid fever than that given by Dr. Solomon Solis Cohen, as indicating the general principles employed at the Jefferson Hospital. Premising the statement that he has adopted no "routine" since "routines are bad," as not only the disease but the patient must be treated, his idiosyncrasies, temperament, reactional powers and surroundings all forming important factors, Dr. Solis Cohen declares himself unhesitatingly in favor of some form of hydrotherapy, altho placing himself on record as against the extreme views now expressed in favor of the Brand treatment. This he nevertheless considers the best of |