GEORGE W. BOSKOWITZ, M. D., Editor.

JOHN W. FYFE, M. D., Associate Editor.

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Contributions, Exchanges, Books for Review and all other communications should be addressed to "The Eclectic Review," 242 West 73rd Street, New York City, N. Y. Original Articles of interest to the profession are solicited. All rejected manuscripts will be returned to writers. No anonymous letters or discourteous communications will be printed. The editor is not responsible for the views of contributors.

VOL. XVIII.

NEW YORK, JANUARY 15, 1914.

No. 1

Hints and Winnowings.

Medical Practice of the Future is to be based upon the principles now governing Specific Medication. One has but to observe the present trend of medical thought in order to become convinced. that this statement is already an assured fact. There is hardly an issue of the leading old school journals that does not contain one or more articles suggesting progress along this line. Physicians of all schools are beginning to realize that Specific Medication enables one to obtain better success in the treatment of the sick than has ever been secured through the means of any other system of therapeutics.

Specific Medication may not be an easy practice for those who are pleased to believe in a definite treatment arranged by some "authority" according to the name of the disease, for in the practice of this system of therapeutics each case is a study in itself and must be thoroughly worked out and divided into its component parts. This requires one to think hard and quickly, but when one becomes accustomed to such study it affords much pleasure and profit.

Even the Journal of the American Medical Association, in replying to a correspondent, recognizes the principles upon which Specific Medication is founded, when it says:

'What is the best There is nothing

"A letter received by the Journal reads: treatment for diabetes mellitus?' That is all. unique about the letter or the question; it is a sample of queries that come every few days, and illustrates the fact that some men are still treating names. There is a popular notion that a definite treatment has been laid down to correspond to every disease; one has but to apply the treatment prescribed in the textbook. The idea is crude and fallacious that when the diagnosis is made the treatment is easy, the fallacy arising from the fact that diagnostic analysis is not carried far enough and names alone suffice without a determina

tion of the pathologic condition in all its details. Our present querist appears satisfied with the name 'diabetes,' qualified, to be sure, by the adjective 'mellitus.' A little reflection should indicate that this name includes a number of different conditions, the presence or absence of which must decide the plan of treatment to be adopted. Thus, diabetes patients differ much in their tolerance of carbohydrates. Some have acidosis and are threatened with coma; others are in no immediate danger. Before deciding on the treatment for any disease the actual conditions requiring relief must be determined, and then the appropriate remedy prescribed. In the case of diabetes it must be determined to what extent carbohydrates can be tolerated by the individual patient, as there may be present so great a degree of acidosis that to exclude carbohydrates would be dangerous. If the danger is from intoxication by sugar in the blood, the diet must be regulated to reduce the sugar to a minimum. If acidosis threatens, the proper remedies must be chosen to avert the danger. We are taking this particular letter and the disease it specifies to emphasize a principle, for the principle applies to other diseases-to all diseases, in fact. There is no specific treatment for typhoid fever, even the diet of a typhoid patient must vary according to conditions. The same is true of pneumonia; what will benefit one pneumonia patient may injure another. Those who conduct the so-called 'practical journals,' and more particularly the readers of these journals who love so-called 'practical matter,' should note that more is required of the physician than a diagnosis of the disease by name only. If it were otherwise, doctors would not be necessary, for the majority of people can tell a case of whooping cough, of measles, of typhoid fever, and of other common diseases. The people would need merely to look in a book and see the treatment. The doctor is supposed to treat, not a name, but the individual patient and the particular conditions in that patient. There is no 'best treatment for diabetes,' but what is best for each patient must be settled first by determining the actual pathologic conditions in the individual. affected.'"

"Twilight Sleep," as an obstetric procedure, was reintroduced in this country through the lay press in such a manner as to give it a commercial aspect. In fact, it was announced in a monthly magazine with every appearance of a paid for invitation to wealthy pregnant women to go to Freiburg for delivery. The article even stated that women delivered by the "twilight" method gave birth to healthier babies-that the children were better looking, grew faster and were stronger. This nonsense in itself branded the whole article as an advertisement of the Freiburg hospital.

Were it not for the dangerous character of the "twilight" treatment, especially when attempted by a physician neither fully in

structed nor aided by competent assistants, it might fail to interest the general practitioner, but the trouble is likely to come from physicians who are not properly prepared for the work yielding to the demands of their pregnant patients.

The unprofessional manner in which the German hospital allowed (or caused) its work to be announced in this country no doubt delayed investigation by our physicians, but the subject has recently received considerable attention from some of the most prominent American obstetricians, as is shown by a series of articles published in the December issue of the Medical Times.

Dr. J. B. De Lee, professor of obstetrics in the Northwestern University, Chicago, in giving his experience with the "twilight sleep," says:

“The drugs used in producing the twilight sleep carry inherent dangers which have not been completely eliminated, even in Freiburg. The general re-employment of the method-discarded ten years ago and again seven years ago—will result in the repetition of the bad experience of those times. Practiced by specialistically trained obstetricians, in a specially equipped maternity hospital, with an abundance of trained assistants and nurses, the dangers to mother and child may be reduced to bring them to a point where one may well consider the advantages and disadvantages to more nearly balance each other. Even under these circumstances one will have to reckon with a certain toll of infants' deaths and injured mothers. For general use-especially in the home-the drugs are contra-indicated."

Dr. J. C. Applegate, professor of obstetrics in the Temple University, Philadelphia, in referring to his former use of the Freiburg treatment, in part says:

"From my personal experience with scopolamin-morphin anesthesia in obstetrics in 1906, when it was being used quite extensively in our hospitals as the anesthetic in general surgery, and again quite recently, I am forced to the conclusion that this treatment has a very limited place in obstetrics. In 1906 it was used routinely as the anesthetic in a series of cases, but finally almost wholly abandoned because of the unpleasant effects and after-effects. -mental and otherwise-on the mother or baby or both in about 75 per cent, of the cases. Since then and until recently, its use has been limited largely to the one dose, preliminary to some other anesthetic in operative obstetrics. Since the widespread notoriety given to the method, and because some expectant mothers want it, we have again been prompted to adopt it, by way of experimentation, and observe what was originally observed, viz.: That the results were very satisfactory in a small percentage of cases, with whom the labor was progressively active, when both the involun

tary and voluntary forces were vigorous and little or no resistance existed to interfere with the normal termination of the labor.

The

one dose-morphin 1/6 and scopolamin 1/100-is also valuable in dystocia, given preliminary to the administration of ether or chloroform, when the labor is soon to be terminated by instruments or section, under which circumstances the amount of ether or chloroform may be reduced one-half."

Dr. J. W. Bovee, professor of obstetrics in the George Washington University, Washington, D. C., well points out the necessity of confining the "twilight" treatment to obstetrical experts, and in part remarks:

"It has a place in obstetrics, though a very limited one. It should be used only by those who are expert first in obstetric practice and second in the physiological action of the powerful drugs. employed, especially when administered to women in labor.

"It demands careful, continuous and tedious observation on the part of the obstetrician and an isolation of the patient and attendants away from family, which latter, from the standpoint of obstetrical cleanliness, might always be advantageous. I believe, too, it endangers the welfare of the infants."

Chronic Headaches, in which the cause cannot be found and satisfactorily explained, should be carefully examined as to refraction and ocular balance. This should never be neglected.

FYFE.

Report of Meeting of Committee of the Board of Regents on Proposed Legislation.

The Regents Committee consisted of Vice-Chancellor Sexton, Dr. Vandeveer and Regent Adelbert Moot. There were present the members of the Council, the State Board of Medical Examiners and representatives from the State Eclectic Medical Society and the New York State Medical Society, the Osteopaths and the Dean of the Homeopathic Medical College. The first topic discussed was that students be admitted to the study of medicine conditioned in Chemistry, Physiology and Biology. It was recommended that Biology and Physiology should be allowed to be regarded as suitable subjects for condition. A division of sentiment was held in regard to Chemistry and some recommended that condition in this subject be permitted, by others that one year in chemistry should be required.

The second topic: An addition to the authority of the Regents to be passed by the Legislature authorizing the Board of Regents to enact changes in its rules regulating the requirements and standards regarding the preliminary requirements of students and the extent of the medical course and its character in the colleges and that these be governed by the rules of the Regents so that they can

be changed from time to time without the necessity of legislative enactment. Sentiment upon this recommendation was divided, a majority of those present being in favor of the proposition, a minority nearly as great in number against such an arrangement.

The third topic: "Unprofessional conduct" means and shall include the following acts or conduct by or on the part of a practitioner of medicine:

(a) Advertising fraudulently either in his own name or in the name of another person, firm, association or corporation in any newspaper, pamphlet, or other printed paper or document, or by writing letters or causing them to be written, wherein or whereby the medical practitioner holds himself or herself out to cure diseases or defects or for being employed by any person, firm or association or corporation so advertising or announcing.

(b) Wilfully betraying a professional secret.

(c) Habitual drunkenness or addiction to drugs.

(d) The employment of any capper, solicitor, or drummer for securing patients, or the division of fees or promise of division of fees or the payment of money to any person or persons, or of any other valuable thing in return for service in securing patients.

An addition to the law that revocation of license be authorized by the Regents of a practitioner declared insane or confined in a State hospital for the insane. A vote being taken the amendment was favorably recommended.

The chairman of the committee announced that in consideration of the requests of some of the representatives present for further allowance of time be given for more thorough consideration of the proposed changes that no definite action would be taken until a special meeting of the Regents to be held early in January. In the meantime the committee would be pleased to consider any memoranda which might be submitted for the improvement of the recommendation as above outlined, so that they might fairly represent the opinions of the medical profession.

Original Articles

Duodenal Ulcer-Its Diagnosis and Treatment With Report of a Case.

BY EARL H. KING, M.D.

Read before the Saratoga Springs Medical Society. March 28, 1914. In presenting this subject to this society tonight I am moved to call your attention most decidedly to the frequent and apparently increasing existence of various forms of so-called chronic indiges