lasts 5 to 10 minutes. To-day she went into a clonic spasm and her father and brothers held her. She could not strike; she at once went into a tonic spasm, and a bad one, too.

Now I have given her all the various treatments I know of. H. v. c. before menstrual period; dicrotalin for her nervous system, thinking that might help, but to no avail. Now, can you suggest from what I have stated, anything that would be of benefit to her? DR. L. M. FRIEDRICH.

Hobart, Ind.

[If the attacks are only in evidence at the menstrual period, the way to a diagnosis is pointed out. The irritation and congestion about the pelvis incident to the flow is evidently the cause of the attacks, and if a cure be brought about, it must be by making the molimen a normal one. It is a possibility that you have an epilepsy to deal with, or the attacks may be hysteric in nature.

We suggest that you make sure that the bowel functions are properly performed at all times, and the only way we know that you can make sure is by the nightly administration of a laxativ like Drysdale's aperient pill, cascara sagrada, or phenolphthalein. For three nights before the appearance of the flow we suggest a hot sitz bath of twenty minutes' duration, with due caution about passing immediately from the bath to bed. At the same time, on retiring, we would use a glycerin and iodin vaginal depletiv suppository or vaginal tampon.

Examin the os uteri and see if a uterin sound will pass freely-which is not likely. If it does not, dilate and curet. Curetment is to be followed by swabbing out the uterus with Churchill's tincture of iodin, and the curetment may have to be_repeated several times.

Iron, manganese and strychnin should be used in full dosage over a length of time. Bulkley's uterin tonic pill every quarter to one hour at about the beginning of the period, has helpt similar cases.-ED.]

Neurasthenia.

DEAR DOCTOR TAYLOR:-I wish you would write an article in THE WORLD on neurasthenia and its treatment. I've had it for four years. My appetite and digestion are good. Insomnia is the only symptom that bothers me. Veronal is the only hypnotic I take; I take 5 grains twice a week, but I find that 10 grains act better. I'm uneasy, afraid I'll form a drug habit. I'm 62 years old, have head noises some; I weigh 195 lbs. What kind of physical culture do you think would help me most? I've been practising thirty-four years, so I hate to give up just now. Joshua, Texas.

J. T. SELMAN, M.D.

[Neurasthenia is too large a subject to take up in THE WORLD, for it would occupy many columns, and most readers prefer searching textbooks devoted to neurology, anyway. Without further details, it would not be possible for us to make any suggestions of value for the treatment of your case. As to the insomnia, we think you need not fear to take 10 grains of the drug as often as you need it, as that is not an excessiv dose. You are in no danger of forming a habit as long as you only require it twice a week. Drug habits are formed when the dose is regularly increast, and the drug is used regularly and daily.

At your age you should not attempt any violent exercise. All you require is regular, mild, muscular activity. Walking, riding, etc., cover the ground.

Oleoresin black pepper.

4 grains

grain

grain

grain

44

Solution iron chlorid, q. s. to make 1 pill. Antimalarial "minnie balls" frequently miss the mark, so we believe 'tis better to use doublebarrel shotgun" doses hereabouts. In one year there have been five cases of typical yellow chills within one mile of my office. These in addition to numerous cases of other manifestations of pernicious malaria.

Thanking you in advance for your attention. North Emporia, Va. HU. B. MAHOOD. [There is nothing incompatible in either of the prescriptions, but about 2 grains of quinin is as much as is generally used in a dram mixture. There would be no harm in adding not only a little more alcohol, but also a little more acidthe latter to improve the solution of the quinin. Immense doses of quinin are used in pernicious malarial fever, as much as 90 grains at a dose being nothing unusual for some practicians.-ED.]

Spastic Paraplegia or Friedreich's Ataxia.

EDITOR MEDICAL WORLD:-Will you kindly give me assistance in diagnosis and treatment of the case, history of which is written on inclosed sheet? I have diagnosed it spastic paraplegia, and treated it by massage, electricity and general tonics. I have described the condition as nearly as possible to do so.

The condition has been diagnosed many different things, and some by good physicians, too. White, male, aged 14 months. Weight at birth, 7 pounds. Present weight, 20 pounds. Mother and father perfectly healthy. Birth of this child took fourteen hours, terminated after injection of pituitrin and traction by hand.

Mother nurst child for first three months, then until nine months fed on Mellin's food, at which time it weighed but 15 pounds. We then changed it to cows' milk, and in the five months it has gained 5 pounds.

Present condition: Color slightly anemic, well nourisht, never sick, no fever, etc.

At nine months of age it was noticed child could not hold its head up and had no control over action of hands and arms. All movements were of spastic nature; try to grab articles, but could not control action of hands and arms. This

condition continued and at present time, child 14 months old, weight 20 pounds, eats and sleeps well. Eyes normal. Hearing good. Action of kidneys and bowels good. Sweats very much at night, especially about the head. Can't hold head up. Can't walk. Has no use of legs and spine. Movements of arms spastic, hands in crampt position most of the time. Notices music, flowers or anything, same as any child of 14 months. Can't speak any words, but seems to understand when talkt to.

Tries to grasp articles in hand and will move arms and hands, and if it strike article will hold it and shake it about. But all movements are irregular and of spastic nature.

Treatment has been massage and general

Add the chlorid of lime to the water, shake well and then set aside for a week, then decant the clear liquid and to it add the borax solution.

For use, saturate the spot with solution a, apply a blotter to take up the excess of the liquid, then apply solution b. When the stain has disappeared, apply the blotter and wet the spot with clean water; finally dry between two sheets of blotting paper.

A good single solution which will answer for erasure of many inks is prepared by mixing citric acid and alum in equal parts. The powder is spread well over the spot and rubbed in with the fingers. A drop or so of water is then added, and also rubbed in. A final rinsing off with water, and then drying of the paper completes the process.-En.]

on for appendicitis a year ago, in which fistula developt in February last. Was reoperated on in April of this year, when gut was closed and drainage left in cavity, as there was considerable pus at time of last operation. In six weeks' time the fistula was open, and draining fecal matter as much as ever.

Has been treated with Beck's paste, alcohol and iodin half and half. Patient went to Asheville, N. C., first of last July, where he was treated by packing with iodoform gauze twice a day for three months with some benefit, gaining fifteen pounds during his stay there, but the opening is still there, discharging as much as ever. Any assistance you or any of the brethren can give me will be greatly appreciated. There is no specific trouble. W. M. TURNAGE.

Hollywood, Miss.

[Such cases are always discouraging. Of course, only an operation will result in a cure, but the chances are nearly all against a successful operation. It is useless to try paste, packing, iodin, or anything else. If he could maintain the improvement indicated by the gain in weight at Asheville, there might be hopes of success by another operation. Unless his physical condition can be improved and toned up there would not likely be any use in suggesting another operation. We are sorry that we cannot offer greater encouragement. Why not first try to cure the tuberculosis by hygienic, dietetic and tuberculin or calcium creosote treatment? Send him to a climatic resort for tubercular patients.-ED.]

MEDICAL FRAUDS.

Remedies for Indigestion Must Be Properly Prepared and Sold While Fresh.

The Service and Regulatory Announcements of the Bureau of Chemistry, U. S. Department of Agriculture, Washington, D. C., state that examination of a number of products which purport to contain certain enzymes or ferments supposed to be useful in promoting digestion shows that these contain little, if any, of these activ agents. Further investigation shows that the manufacturers frequently have employed a sufficient quantity of pepsin, diastase, pancreatin, trypsin, or similar material, but in many cases no attempt has been made to determin whether the material used is really activ. In certain cases, manufacturers have combined pepsin and trypsin, which tend to negativ each other, and in other cases they have used pepsin in alkalin media, which destroy its activity, and have combined trypsin with acid Under substances which are not suited to it. certain methods of preparing the remedies, heat is applied to a degree that may destroy the activity of the pepsin or other enzymes. Similarly, many of these substances which owe their properties to the action of enzymes are put up in too strong alcoholic solutions or in other ways which lessen their effectivness.

The great trouble with many of these preparations, however, is that they do not keep well, and while activ at first, after a time lose their digestiv activity. The Department of Agriculture therefore warns manufacturers that preparations claiming to contain digestiv enzymes should be put up in such a way that they will have suffered little, if any, loss of activity when sold to the consumer.

In the case of preparations which are liable to

deterioration within a few months, the department suggests that each lot should be dated, and that sales after a certain fixt time should be prevented. The stocks of ready-made digestiv medicins which the druggists keep on their shelves from year to year to meet an occasional demand and turn a ready penny are therefore to be condemned and shunned by the public as their utility as digestants is most probably entirely destroyed by age.

Dr. Jiroch Company.

For some years the Dr. Jiroch Company, 533 South Wabash Avenue, Chicago, has been conducting a mailorder medical concern. On June 24, 1914, the federal authorities declared the concern fraudulent and denied it the use of the mails. The attorney for the Dr. Jiroch Company was Fletcher Dobyns, of Chicago, the same man who appeared in behalf of a similar fraud operated from Detroit, the "Interstate Remedy Company." The Jiroch fakery also introduced, thru its attorney, a physician, who attempted to justify the methods of this concern. This physician was Dr. Nathaniel H. Adams, of Chicago, member of the Chicago Medical Society and, thru this membership, Fellow of the American Medical Association.

The methods of the Dr. Jiroch Company were investigated some time ago by the Journal, and much of the matter that follows was written nearly two years ago. Other matters prevented the completion of the "story" and it was filed away.

As in all such cases, the physician whose name gives the title to this fraud has been but a mere stool-pigeon. At the time of the Journal's investigation the real men behind the scheme seem to have been Melville W. Johnson, Garrett, Ind., president; A. G. Hagerty, secretary; Thos. R. Bradford, treasurer; F. W. Jiroch, medical director.

Jiroch was a student at the Harvey Medical College at Chicago at the time this low-grade institution went out of existence. He then seems to have gone over to Jenner Medical College, Chicago, by which school he was graduated in 1906, receiving a license to practise, from the State of Illinois, the same year. The practical man of affairs in the Dr. Jiroch Company seems to have been Thomas R. Bradford, who, it is said, was formerly with a somewhat similar fake concern, the "Blair Remedy Company," of Chicago. Bradford, apparently, is an old hand at mailorder medical frauds. In 1904 Thomas R. Bradford was operating a business in Cincinnati under the name of "Bradford & Company." The scheme was an attempt to sell an alleged cure for "lost vitality, sexual debility," etc., and was put out of business by_the federal authorities in December, 1904.

The Dr. Jiroch Company obtained its victims thru advertisements placed in the cheaper weeklies and daily papers. In addition, the concern bought or

rented "sucker lists" either from letter brokers or from concerns in a similar disreputable business. An enormous amount of circularizing was done, much of it in a haphazard way; the member of the Journal staff, who has corresponded under assumed names with various medical frauds, was richly favored with Jiroch "bait," altho he had never written to the concern, showing that these names had been purchased or rented.

While, in what follows, Jiroch's name is used as tho he was the one individual responsible, it should be borne in mind that he was but the "hired man" of the concern. Nevertheless all letters were signed (in facsimile) with Jiroch's name and the victim was led to believe that Jiroch gave personal and individual attention to each case.

The prospectiv victims were sent circular letters, printed in imitation of typewriting. With each letter was a brilliantly colored "certificate"_that_ was alleged to entitle the holder to a "Special Free Proof Treatment and Diagnosis." Not all the "certificates" were the same; they varied in color and in the series of questions askt. Some were sent to those supposed to be suffering from "female trouble," others to those presumably deaf, still others to those whose ailments were of a general or indefinit nature. whatever kind of "certificate" was sent they all offered the "Special Free Proof Treatment and Diagnosis."

But

Those who answered the advertisements or who sent in the "certificates" received a "free proof treatment" consisting of two small boxes of tablets, one kind pink, sugar coated and ovoid in shape, varying in number from four to six; the other white or very

faintly pinkish, sugar coated and cylinder shaped, varying in number from seven to fourteen. By the same mail a circular letter came giving directions as to the use of the "free treatment.' This "letter" also was prepared in imitation of typewriting and the name of the individual to whom it was sent was filled in by means of a typewriter. All of the "proof treatments" seem to have been identical irrespectiv of the age or sex of the persons to whom they were sent or whether the recipients were suffering from consumption, rheumatism or malaria.

Within twenty-four hours of receiving the "free treatment" the patient had inflicted on him, unaskt, a "full-size treatment." This came in a cardboard box holding four small boxes numbered respectivly, "1." "3" and "4." The boxes were labeled as fol

49 "

lows:

Box 1: "Prescription No. 16759. Directions: Take one tablet before or after the morning meal. Swallow with a little water."

Box 2: "Prescription No. 29408. Directions: Take one tablet before or after the noon meal. Swallow with a little water."

Box 3: "Prescription No. 30651. Directions: Take one tablet before or after the evening meal. Swallow with a little water."

Box 4: "No. 4039. Directions: Take one tablet at bedtime, or as often as necessary to insure about two movements of your bowels each day.".

The tablets labeled Prescription No. "16759" that came in Box 1 are white or faintly pinkish, sugar coated, cylindrical-shaped tablets, apparently identical with part of the "free proof treatment."

The tablets in the box labeled Prescription No. 29408" were large, bright yellow, sugar-coated tablets.

The tablets in Box 3-Prescription No. “30651"were brown, uncoated tablets oval in shape.

The tablets in Box 4, labeled "No 4039," were apparently identical with the pink tablets that came with the "free proof treatment."

Analysis of the "Treatment."

A complete set of the "Dr. Jiroch Treatment" was subjected to examination in the Association's laboratory, and the chemists' findings may be briefly summarized as follows:

Box 1 (R 16759): These pinkish pills were found to contain licorice root, starch, some vegetable extractiv and a trace of alkaloid, apparently strychnin. Box 2 (B 29408): These yellow pills were found to have for their chief constituents powdered licorice root and cornstarch with small quantities of vegetable extractiv.

Box 3 (R 30651): These tablets, according to the chemists, were found to consist essentially of cornstarch and extract of nux vomica. Quantitativ analysis indicated that the total alkaloidal content was equivalent to about 1/3 grain of nux vomica in each tablet.

Box 4 (B 4039): These pink pills were found to consist essentially of starch and aloes, with a trace of strychnin. No other medicinal ingredient was found.

What Were the Diagnoses Worth?

We have said that the second letter from Jiroch to his prospectiv victim gave what purported to be a "diagnosis" of the patient's case. As a matter of fact, this diagnosis, so called, was one that could have been made by the girl typists who filled it in on the imitation typewritten letters-and perhaps was. Did the person put crosses against "rheumatism," "indigestion" and "piles," Jiroch made a "diagnosis" that the person was suffering from rheumatism, indigestion and piles. This was the method by which these quacks cajoled their victims into believing that a physician had carefully studied their cases and diagnosed their ailments.

To show the worthlessness of Jiroch's "diagnoses," the Journal had "symptom blanks" sent to the company from various parts of the country and describing widely varying forms of ailments. In every instance Jiroch sent the free trial treatment and followed it up immediately with his "full-size treatment," together with a "diagnosis" letter detailing the very symptoms that had been sent in. The "fullsize treatments" that were sent were all the same, whether the supposed patient was suffering from consumption, rheumatism or Bright's disease. One letter was sent from Virginia and a cross was put against the following list of symptoms: "Spit up mucous and slime." "Pain in the back."

"Heartburn and indigestion."

"Bowels irregular and constipated."

**Weak, nervous and trembling after slight exertion.'

Back came the "diagnosis" letter, which read: "According to my diagnosis what you need to cure you completely is a thorough special treatment from the Spitting up of Mucus, Pains and Soreness Across the Back, Poor Digestion, Constipation, Nervousness, Defective Elimination and Uric Acid Conditions."

The words that we have italicized are those that had been filled in on a typewriter. The "full-size

treatment" sent in this case consisted of the four boxes containing the pills labeled respectivly: Prescription Numbers "16759," "29408," "30651" and 4039"-price, $3.

Another letter sent from a small town in ǹlinois had a cross placed against the following symptoms: "Have sick headache."

"Heart trouble."

"Stomach trouble."

"Are depressed in spirits."

"Have twitching of the muscles."

The "diagnosis" letter to this supposititious patient read:

"According to my diagnosis what you need to cure you completely is a thorough special treatment for the Headache, Poor Circulation, Stomach trouble, Depressed Spirits, Twitching Muscles, Defective elimination, and Uric Acid Conditions."

Here again the words we have italicized had been filled in with the typewriter-and the same boxes of pills were sent. Another symptom blank the Journal had mailed from a town in Ohio with crosses against the following:

"Are troubled with catarrh."

"Have dizziness."

"Are depressed in spirits."

"Have too frequent desire to pass water." Quack Jiroch "diagnosed" this case:

"According to my diagnosis what you need to cure you is a thorough special treatment for the Catarrh, Dizziness, Depressed Spirits, Bladder Trouble, Defectiv Elimination and Uric Acid Conditions."

In this case, too, the recipient of the diagnosis got the same stock "full-size treatment" Prescription Nos. 16759, 29408, 30651 and 4039-with the usual request for a remittance of $3.

The per

From a city in Pennsylvania the Journal had a symptom blank sent in describing as well as is possible by mail a case of diabetes mellitus, son sending it in stated explicitly that he had diabetes and also put crosses against the following:

"Are losing flesh."

"Feel weak and all run down." "Have itching or burning of skin."

The

"Have boils and pimples on face and on neck.” "Have too frequent desire to pass water." Diagnosing by mail is, of course, an anomaly. scientific value of a diagnosis of ailments in persons who have never been seen and whose symptoms are described by the persons themselves is nil. Nevertheless if any conclusion at all could be reacht regarding the hypothetical case just described, it must have been that the patient was suffering from diabetes mellitus. What did Jiroch say?

"According to my diagnosis what your case requires now is a thorough special treatment for the Kidney Trouble, Itching Skin, Impure Blood, Nervousness, Headaches, Defectiv Elimination and Uric Acid Conditions."

And the treatment? The same "full-size treatment" sent to the sufferer from consumption, rheumatism. etc., that is, Boxes Nos. 1. 2, 3 and 4 (Prescriptions Nos. 16759, 29408, 30651 and 4039). Worse yet, the diabetic-in common with all others-was told: "For your case I would advise a mixt diet.'

A "mixt diet" recommended to a supposititious diabetic to whom the starches in such articles as bread, biscuits, potatoes, etc., and sugars, sirups and sweets might, in the amounts ordinarily taken, be deadly! A mixt diet, indeed!

Other diagnoses just as worthless as those detailed above could be given, but these are sufficient to make plain the worthlessness of the diagnosis and the fraudulence of the Jiroch "treatment." Yet the Jiroch concern said about Jiroch:

"I am a specialist and I do not have one remedy that cures everything. My special treatments are made up of my own private preparations perfected after years of successful practise.'

One thing will be noticed regarding the fake diagnosis. No matter what other ailments the patients were supposed to have, they were all suffering-ac cording to Jiroch-from "Defectiv Elimination and Uric Acid Conditions." Whether it was a case of consumption, kidney disease or "female trouble" every person whose case Jiroch professed to diagnose

was a sufferer from "defectiv elimination and uric acid conditions."

The Postoffice Stops the Fraud.

The matter preceding represents the investigations made by the Journal some time ago. That which foliows is taken largely from the memorandum of Assistant Attorney-General Lamar to the postmastergeneral recommending the issuance of a fraud order. Judge Lamar's report says that after a thoro review of the evidence submitted with the report of the postoffice inspectors who investigated the Dr. Jiroch Company he finds the facts to be as follows:

"The Dr. Jiroch Company and Dr. Jiroch are engaged in selling medicins thru the mails. In order to obtain the names and addresses of persons to whom they may direct their solicitations, they advertise in newspapers and magazines having a general circulation thruout the United States."

A typical advertisement is then presented, of which the assistant attorney-general says:

"It will be noted that the representations contained in this advertisement are calculated to lead the reader to believe, among other things, (a) that for the purposes stated Dr. Jiroch will give free to anyone suffering from any of the symptoms described and responding to the advertisement a treatment for the permanent relief of the disease from which such person is suffering; (b) that this treatment will consist of special medicins adapted to the particular disease from which the applicant is suffering; (c) that Dr. Jiroch can and will diagnose and determin the disease from which the person so responding is suffering by means of the check marks placed before the symptoms set forth in the advertisement; and (d) that he can by this method cure kidney and bladder ailments, rheumatism, stomach, liver and bowel disorders, heart trouble, nervous weakness, catarrh and all other diseases arising from impure blood, uric acid conditions, etc."

Some Diagnoses.

Then follows the statement that those who answer the advertisements receive a stock letter, one of which was put in evidence, and with the letter the so-called free proof treatment which was "the same in every case.' The advent of the second letter was described and the letter itself put in evidence and the fact noted that the person who had answered the advertisement was sent, unaskt, a "three-weeks' treatment," for which he was expected to send $3. Then the memorandum continues:

"In the investigation of this case letters were written to the Dr. Jiroch Company by the inspectors under assumed names and askt treatment for the following conditions in turn: (1) 'Severe headaches for some time and no medicin will give me any but temporary relief,' (2) 'A bad cough that I have had for quite a while-am all the time hawking and spitting,' (3) Loss of sexual power,' (4) 'Simply will not make flesh-otherwise well,' (5) "Too fat and bust lacks development,' and (6) Female troubles.' In each of these cases, except that numbered 5 above, sent the correspondence quoted the applicant was above, and the affection of the applicant was diagnosed as follows: (1) Headache, defectiv elimination and uric acid conditions; (2) cough, spitting up slime and mucus, defectiv elimination and uric acid conditions; (3) failing manhood, defectiv elimination and uric acid conditions: (4) being too thin, defectiv elimination and uric acid conditions, and (6) female trouble, defectiv elimination and uric acid conditions. In case numbered 5 the applicant was written a letter in which she was advised that the symptoms given by her were rather unusual in combination and askt to give further particulars. In reply the inspectors gave the following information: "Thirtyone years old, 5 feet 5 inches high, weight 154 pounds, not much fat on my breasts, have been fleshy ever since I was a young girl, both parents dead, father small, mother fleshy, breasts always have been flat.' Thereon the respondents sent to the writer the same letters as were sent out in the other cases, diagnosing her affection as obesity."

The Claim of Individual Treatment. The judge notes further:

"If a remittance is not received promptly in response to the letter accompanying the treatment for which a remittance of $3 is askt, other letters are sent the sufferer in which he or she is advised, among other things, that 'the treatment I sent you is exactly what you need,' that it was made up of my own private prescriptions, especially for your individual requirements,' that 'the treatment is a thoro one for every symptom and condition you describe, and designed to cure you permanently,' and

mary.

imar says:

The respondents not by this method kidney and bladder trouble, rheumatism, stomach, liver and bowel disorders, heart trouble, nervous weakness, catarrh and all other diseases arising from impure blood, uric acid conditions, etc.; but on the contrary this system is utterly impractical and any benefit resulting therefrom is due to chance.

"The postmaster at Chicago reports that the respondents receive approximately 275 pieces of firstclass mail daily."

As a result, the assistant attorney-general for the postmaster-general recommended the issuance of a fraud order which, as previously noted, was put in force June 24, 1914. Journal of the American Medical Association.

Some Signs of Danger in Labor and How to Meet Them.

Dr. J. O. Arnold, Associate Professor of Obstetrics, Temple University, Philadelphia, in the New York Med. Jour., declares that the prolonged severe pain of labor, in highly nervous women, is capable of producing most serious injuries, among which are puerperal insanity and profound neurasthenia; while postpartum bleeding, puerperal infection, failure of lactation, delayed involution, and prolonged convalescence are all made more probable by labor which leaves the nervous system rackt and prostrated, and the energies of the patient almost completely exhausted. These are some of the direct effects of unnecessarily severe suffering, while it may lead to attempts to terminate labor artificially because of this suffering, which may result in injured babies and lacerations. It is often very difficult to say when the danger point has been reacht. Each case is a study in itself, and must be handled according to its own peculiar conditions and surroundings. Much relief can be given, and the process of dilatation greatly facilitated in many cases, by the judi