Collectible Contract vs. Uncollectible Accounts. He I regard the medical contract plan as the only plan which will provide the service of a physician in every case where service of this nature is needed among our industrial workers. treats everyone alike, because everyone pays alike, but if the arrangement were the way many physicians would have it, then each physician would attend those who were known to be "good pay" and let those suffer who never had anything with which to pay. My very first work as a practician of medicin was along the very line that Dr. McDonald suggests. The company had no physician at that time, and the miners, or a large majority of them, selected me. I got all the practise of the mine, but owing to the fact that the company would assume no responsibility in collecting for me, I only got about one-third of what I earned, until finally I had to adopt the rule of "no pay, no treatment." In the instances of which Dr. McDonald speaks, the operators are to blame. They should see to it that their physicians are competent, sober, industrious and always on the job, and give them clearly to understand that whenever they fail in any of these particulars their services will be no longer needed. Feeding in Typhoid. Before closing this letter I wish in particular to commend the ideas of Dr. John J. Reycraft, on feeding in typhoid, to all. He is hitting the nail squarely on the head. Only a very few of us seem to have adopted this plan of feeding until very recently, and it is a shame, too. But the time will come when not only the medical profession, but the laity as well, will be forced to accept the everlasting truth that starvation cannot aid the human economy in throwing off disease. The medical profession accepted this fact years ago as one of the fundamental principles in the treatment of tuberculosis and blood diseases, and it seems strange that it should be so slow in applying this same principle in a case where it is even more clearly indicated. Worthington, W. Va. GEO. L. HOWELL, M.D. [The title "Iniquitous Contract Practise" was put on by the editor, Dr. McDonald merely writing the letter. In the case described by Dr. McDonald the title is justified. Therefore Dr. Howell should not attribute any seeming animosity in the headline to his state neighbor. In fact, no animosity is intended. The effort is merely to help right a wrong.-ED.] the fetal head. After delivering the placenta, I lookt over the neck of the fetus, thinking that the head may have never been formed, showing that it was not decapitated during delivery. I made a second uterin examination of patient and was astonisht to find the fetal head. Consequently I tried to deliver same. (Right here I want to say it was no easy task, especially with short fingers and the head being well lubricated.) I had to resort to my placental forceps, which made the delivery easy, finding no putrefaction what [We have not been able to discover a parallel case in literature. It evidently is unique. We should be pleased to hear from our readers who have had any similar experiences to the above writer's.-ED.] Supernumerary Digits on a Newborn Child. EDITOR MEDICAL WORLD:-In May of the past year a negro midwife of more than the usual intelligence delivered a negro girl of an illegitimate child so much out of the usual that she called my attention to the matter, and I was able to see and obtain the following facts, viz: The mother was in her sixteenth year, of slight build, weighing but one hundred pounds. All during her pregnancy she workt out and no one suspected her condition. She laced very tightly and "carried the baby high" during gestation. The presentation was a breech and was so delivered, with the toes of the child over its shoulders. After delivery the left foot showed a tendency to assume the same position until the midwife tied it down. The child is a male, weighs eight pounds, has six fingers perfectly formed on each hand, and six perfect toes on each foot. D. C. MAIN. Welaka, Fla. Gasoline for Ivy Poisoning. EDITOR MEDICAL WORLD:-In the September issue of your journal, under "Current Medical Thought," sweet spirit of niter is recommended for poison-ivy poisoning. I think gasoline beats it-use it straight. EDITOR MEDICAL WORLD:-THE WORLD brings us in touch often with the rail-fence, the mud-road, "hogand-hominy" country doctor, with the trials and tribulations of that overworkt and underpaid practician. God bless him, wherever he is, be it facing a blizzard on a bleak Dakota prairie, climbing a long, lonesome path with his horse and saddle bags in the Ozark Mountains, or following by flashes of lightning a dim trail across a cactus desert in the "wild and wooly" on a "night a child might understand the de'il had business on his hand." So we must take off our hats to the man in the trenches and behind the guns. He has no time to be ultrascientific. Often he is rough, but he is always ready, and THE WORLD keeps us in contact with him. And so I wish a happy New Year to the plain, oldfashioned down-the-creek, calomel-and-rhubarb X and X country doctor. May he not vanish with the wild pigeon and the great auk. HENRY E. W. BARNES, M.D. 1141⁄2 E. 4th St., Santa Ana, Cal. Dr. W. Wilson states that it is absolutely essential, in the treatment of chronic catarrh, that the general health be perfected. Many patients will recover upon adopting a wholesome, open-air mode of life, with abstention from tobacco, alcohol, etc. Calomel on alternate evenings, with magnesium sulfate in the morning, should be employed to relieve portal congestion. Local treatment consists of simple lavage, which, however, must be persisted with. teaspoonful of the following powder, added to a pint (500 c.c.) of tepid water, forms an efficient preparation for the lavage: R Powdered boric acid, Sodium bicarbonate, Sodium chlorid, equal parts. One Add a little crystalline menthol, mix well, and grind. A ball syringe should be employed in the douching, but great gentleness is necessary. If the head is bent somewhat forward and the patient performs rapid, sharp expirations thru the mouth, there will be little danger of the solution entering the sinuses. On no account, however, should a swallowing movement be made. Where there is a tendency to dryness and Treatment of Dyspnea in Pulmonary A. Robin refers to the dyspnea sometimes appearing in tuberculosis without apparent cause, at other times after fatigue or excessiv eating, or, again, at the menstrual period. The temperature rises somewhat, expectoration is abundant, and the sputum is often streakt with blood. Percussion causes a little pain at the site of the disease focus, and auscultation reveals an area of blowing respiration with fine or moist râles. The patient, if constipated, should be given 5 to 8 drams of castor oil. Leeches may be applied to the base of the thorax on the affected side. Next day a mustard foot-bath should be taken. Revulsion should be effected over the focus itself by means of mustard poulticing, dry cupping, or even small blisters two inches square. The following should be ordered: MONTHLY CLINIC Please notice that our CLINIC department is not used to "boost" proprietary remedies, almanac fashion. THE MEDICAL WORLD has no interests other than to give to the medical profession the greatest amount of honest service possible. It has absolutely no interests in any proprietary preparation nor any medical supply house. Only such queries will be publisht as are likely to interest and instruct many others as well as the one asking help. No charge is made for this service to our subscribers. However, those who wish an immediate and personal reply by mail may obtain the same by inclosing two dollars to the Editor of this department, DR. A. L. RUSSELL, MIDWAY, WASHINGTON Co., PA. This is really a consultation in the interest of the patient, and should be charged to the patient-two dollars being a very moderate consultation fee. The Doctor agrees to give full, careful and immediate attention to such consultations. We reserve the right to publish in this department any such consultations that may be interesting and helpful to our readers. Name and address will be withheld if requested; but anonymous communications will receive no attention. Come freely for help, but read up as fully as you can before coming to us. [The fee bill publisht on pages 23 to 25 of the January WORLD gives great latitude to the doctor in making his charges. It is not a rigid price list, as the Sherman act was aimed to prevent. The antitrust act was intended to abolish monopolies that made the general public pay excessiv prices and which could not be avoided. Since hospitals are plentiful and can be establisht by any community no monopoly is likely to occur in that line. The schedule of prices referred to is not a fixt price, but a fluctuating one, varying according to circumstances, and is only an approximate standard for making charges.—ED.] Medical Men at the San Francisco Fair. EDITOR MEDICAL WORLD:-Is there to be any display or demonstrations by the medical profession at the Exposition at San Francisco in 1915? If so, what? It seems to me that it would be very helpful for the medical profession to have a department or building there on the order of a post-graduate school, where all doctors might attend while at the fair and learn a great deal that would be helpful to them. Boydsville, Ark. W. P. CUSTER, M.D. [Many national specialist and general medical bodies will meet on the Pacific Coast while the fair is being held. You can attend the San Francisco post-graduate schools while there, these being always in session. No separate medical building is planned for the fair grounds.-ED.] Hyperidrosis. EDITOR MEDICAL WORLD:-I have a case I wish to report: Ten years ago this winter a boy, 4 years old, was brought to my office for sweating of the wrist and back of the hand. Every winter since, he has commenced in September and sweats until spring. He is worse this winter than ever before. He is 14 years old and the picture of health, does not complain of anything and is never sick. He goes to school and sweats so profusely that at times his desk is wet and his coat sleeve is as wet as tho it were laid in a bucket of water for three inches up the sleeve. His mother did his wrist up in absorbent cotton and at noon the cotton and coat sleeve were dripping with water. He came to my house three nights ago to show me how bad it was, and my wife used my handkerchief on his wrist to mop the sweat away, and in twelve minutes the handkerchief was soakt. The sweating is only on back of right hand and three inches above the wrist. The father and mother are in good health; no history of syphilis or tuberculosis. Give me some cause and treatment for the above. I would be glad to hear if any of the readers of THE WORLD have had similar cases and would like to hear from them. C. L. WILSON. Ewing, Ind. [The condition is known as hyperidrosis, idrosis, ephidrosis, sudatoria or polyidrosis-a universal or localized sweating independent of the usual physiologic causes. It may be symptomatic or idiopathic; generalized or localized. In your case it is localized, and seems to be idiopathic, as you make no mention of tuberculosis or rheumatism, and these are the diseases in which it is symptomatic. The physiologic cause is some disturbance of innervation of the sweat-controlling apparatus. It may be that passiv congestion plays a part in your case. Lowered tone of the general health acts as a predisposing cause, and it is often observed in those of neurotic heredity or tendencies. It is hardly likely that you will be able to work out a satisfactory physiologic hypothesis in this case, but you can proceed to treat it empirically, with every prospect of success. Local applications of value in all cases are tannic acid; zinc sulfate; alum; from 1 dram to an ounce in a pint of water; or, if the parts are not excoriated, in equal parts of alcohol and water. Immerse the hand in the medicated bath for from ten minutes to an hour, twice daily; dry, and powder with boric acid to which 2% salicylic acid has been added. Another very efficient bath is made of 1 part of commercial formaldehyde solution to 50 to 100 parts of water; used in the same manner; and followed by the same dusting powder. Another very good one is made by adding enuf crystals of potassium permanganate to water to make it a very deep purple color, and continue as with other baths.-ED.] Epilepsy. EDITOR MEDICAL WORLD:-I would like if you, or some of your well-qualified lieutenants, would give us your latest and most advanced opinions on epilepsy, with the most modern treatment. W. H. MOORHOUSE, B.A. M.D. 249 Queen's Ave., London, Ontario, Can. [The space at our disposal precludes a discussion of our opinions, or the most advanced opinions of the profession, on epilepsy. There is nothing new, of moment. You would do better to purchase a text on the subject, such as "Epilepsy," Spratling, publisht by W. B. Saunders Co., Philadelphia, Pa., at $4, containing 504 pages. As to treatment: The newer things include the chlorid-free diet, on the hypothesis that the cerebro-spinal fluid of epileptics contains an ex cess of chlorids, and that this diet reduces the excess. Netter has shown that calcium salts have a special sedativ action on the cerebral cortex, as contrasted to the sodium salts, which are stimulant. Calcium salts are therefore to be substituted for sodium salts in treatment, in addition to the chlorid-free diet. It has been noted that a certain proportion of epileptics are subjects of thyroid deficiency, and that such patients are remarkably benefited by thyroid therapy. The crotalin (rattlesnake venom) treatment of epilepsy is the latest, and is attracting wide attention. The explanation is offered that crotalin contains at least two activ principles, one, a peptone, which acts in a paralyzing way on nerve tissue; and the other, a globulin, which diminishes the coagulability of the blood. It is known that there is increast coagulability of the blood preceding an attack in an epileptic subject.-ED.] American Red Cross Society. DEAR DR. TAYLOR:-Will you please give me the address of the Red Cross Society. I desire to enlist in that organization. Kittrell, N. C. F. O. SWINDELL, M.D. [Address Headquarters of the American Red Cross, at Washington, D. C.-ED.] me Identifying a Plant. EDITOR MEDICAL WORLD:-I would like information regarding a plant growing wild in the woodlands of Pennsylvania. Possibly it grows in the open also; but the sample shown Above was growing in wooded shade. ground, it resembles in leaf and size sheep sorrel, and below has long, thread-like roots, a bunch of them, attacht centrally. These roots are white when drawn from the ground, but upon drying in the open air shrivel and turn brown, not unlike tobacco in appearance. The dried roots chewed have local repute as a diuretic. If I remember rightly, it is called colt's foot locally. Can a Pennsylvania reader supply information as to name, extent of habitat and medicinal use beyond that mentioned? JOHN D. KELLY, M.D. New Haven, Conn. [The only way to identify a plant is to secure a green specimen, including flower and root, if possible, and press it dry. The specimen is then fixt on cardboard by small strips of surgeon's or adhesiv plaster crossing the branches at various places and fixt to the card on either side of the branch to hold it in place. Wash soil from root and split it if fleshy, leaving one-half of the outer surface undisturbed. Do not cut off small rootlets. Spread plant out as much as possible on white blotting paper, and cover it with another sheet of blotting paper, and place under a weight. After twelve to twenty-four hours renew the paper in order that all possible moisture may be absorbed and the plant thoroly dried. The blotting paper may have to be renewed a number of times, if the branches are juicy or heavy, but persistence will secure a good specimen. Care must be exercised in handling the partially dried plant to avoid getting branches crost and tangled. Once properly dried and mounted, it may be sent to the Department of Agriculture, Washington, D. C., where it will be positivly identified by expert botanists, without charge, and information furnisht the inquirer. No one could identify a plant from the description you send.-ED.] Growing Medicinal Plants. EDITOR MEDICAL WORLD:-I notice in your last WORLD a Dr. Gregg, of Brattleboro, Vt., asking in regard to raising golden seal for profit. I have twenty acres in southeast Georgia, fourteen miles east of Waycross. Not flat, but rolling; soil a dark sandy loam twelve to sixteen inches deep. From a state analysis, 11,125 pounds of phosforic acid to acre; nitrogen, 4,460 pounds to acre; potash, 7,720 pounds to acre. Now, what other fertilizer does it need? It is cut-over land; long-leaf, hard yellow pine; subsoil is yellow, sandy clay; water, 12 to 25 feet to sheet soft water. [The United States Department of Agriculture gives the range of hydrastis as: "From southern New York and Ontario west to Minnesota and south to Georgia and Kentucky, ascending to higher altitudes as its southern limits are approacht." We should fear your land too far south. Send for Bulletin 613, "Golden Seal Under Cultivation," United States Department of Agriculture. It is free. The last quotation we have on hydrastis roots is $1 per hundred for small size, $2.50 for medium size, $5 for large size. In writing the Department, ask for bulletins on medicinal plants; they have others covering all medicinal plants under cultivation, and can give you much more detailed information than we can give. The Physicians Drug News is publisht by Physicians Drug News, Newark, N. J. It was the November, 1911, number, page 226, to which we referred. H. K. Mulford Company is growing cannabis indica successfully near Philadelphia and describes it in a circular. They would probably send you a circular on request.-ED.] Cancer and Recurrence. EDITOR MEDICAL WORLD:-The following described case has defeated a full half dozen doctors. Could you offer any suggestions that would give relief? Mrs. W. A., aged 61, married, mother of two children; always been a hard-working woman. About two years ago a swelling appeared in the right breast; about nine months later she entered a hospital and the breast was removed, the diagnosis being a cancerous growth. She made a rapid recovery and within a few weeks returned to her home and resumed her daily tasks. Some few months later she began to have pain in her right shoulder, which has increast until it is unbearable and has to be kept under the power of morphin. The pain cannot be localized; it covers all the scapular region, down over or to the spine, and up on the back of the neck; very little pain down the arm. The right arm and hand are swollen to quite an extent, it being from one to two inches farther around the right wrist than the left one. Some days the swelling is worse than others and the more the swelling the more the pain. She seems well in all other respects. Several surgeons have examined the case and cannot find anything wrong, and are at a loss to know what to do. She has never had fever, but is losing flesh. The constant pain is wearing her out and unless relieved will sooner or later end in death. We would be very much pleased to have THE WORLD help us out. DR. B. C. SICKLES. Petoskey, Mich. [Urticaria is merely a symptom of autotoxemia, and is quickly relieved by a brisk saline purge. Following which, of course, abstinence from food for a few hours is advisable. Many find it necessary to use some digestiv stimulant for a few days, such as 2-dram doses of elixir lactated pepsin, 80 grains to the ounce, before meals and two hours afterward. Just as soon as similar conditions maintain, the urticaria will return. There is no treatment that will prevent your having it again, except to keep the stomachic and intestinal functions strictly up to par. In certain individuals, certain articles of food must be tabooed. If you find that any given food instigates an attack you have an idiosyncrasy against that food, and freedom from urticaria will only be purchast by total abstinence from that article of diet.-ED.] Weeping Eczema. EDITOR MEDICAL WORLD:-I have a little girl patient 2 years old, who has had eczema for eighteen months or more. The face, hands, buttocks and legs are the principal parts affected. It is of the humid character and bleeds when scratcht. Her general health has been good all along. Her parents have a good record as to health. She has been treated by several different ones; also had treatment from a hospital specialist, who told them that it would disappear when she got thru cutting teeth. I cannot say what her treatment has been, either external or internal, and there has been no decided improvement at any time. I am sure she has not had any of the preparations of arsenic, and am asking you if it would be advisable to try that on a 2 year old, and if so would you please inform me what preparation and also as to the dose and length of time it may be safe to use it? JOHN PEACH, M.D. Mitchellville, Md. [Arsenic should never be given in eczema until after external measures have failed, and especially is this the case with young children. If it be decided to give arsenic, Fowler's solution, appropriately diluted so that a convenient dosage may be arranged according to age, is a satisfactory form of medication. If you treat the child according to the following suggestions, for a few weeks, we think that you will not require arsenic : For the face, cut out a piece of chamois skin, with openings for the eyes, nose and mouth; attach tapes by which it may be secured in place. Smear the inner surface of mask liberally with oxid-of-zinc ointment, benzoinated, and apply. Have another mask ready to replace the first whenever it is soiled or becomes lax from saliva dribbling from mouth. Remove mask once every twenty-four hours; swab skin with warmed glycerin; scrape off old ointment from mask and renew; reapply as quickly as possible. The essential features of this treatment are to keep water off the skin, and to keep the skin from contact with the atmosphere and to keep up the effect of the medication continuously. We have never seen it fail, if persisted in. You will not get the first mask to fit properly about the orifices but a little experience will enable you to cut them so they will answer the purpose admirably. Large-sized powder papers, held in place by the ordinary diaper, will serve well for the dressing about the buttocks. The diaper, of course, must never be allowed to remain wet with urin a moment longer than necessary to remove it, i. e., it should be examined frequently and changed immediately when moist. The hands may be drest by making chamois mittens to cover the whole surface, and provided with tapes to fasten about the wrists. It is necessary to explain to the mother that the oxid of zinc cannot be entirely removed from the skin at each dressing, and that this is neither necessary nor desirable. There will probably be considerable explanation necessary to convince her that sufficient cleanliness is obtainable by the use of the warmed glycerin instead of water.-ED.] Asthma. DEAR DR. TAYLOR:-As I see many of your patrons come to you for help, and as I have been one for some years-since the early '80's-I come now. My daughter, aged 27, has been troubled with hay fever for several years. Last September she had an attack as usual, but in a more spasmodic form, seeming to be more of spasm of tubes in bronchi. Could not lie down for about three weeks on account of smothering and pain. Applied belladonna plasters to back and breast: resulted in blisters over sternum, which discharged a sticky, watery substance. Pain in sternal region still continues, with smothering sensation when lying down. Can get sleep only by applying a hot iron and sleeping with a high pillow. Sternal region looks red and still discharges, with pain over lower internal portion of lower lobe of right lung. No cough, but during first part of attack cought up small particle of bad character, like millet seed; none now. What I want is to remove the smoth |