THE PRACTICAL APPLICATION OF ELECTRICITY AS A THERAPEUTIC AGENT. CONSTIPATION, HEADACHE.

BY J. R. ETTER, M.D.

EDITORIAL NOTE.-This is the tenth of DrEtter's series of short, practical articles Each article complete in itself, the entire series when complete, will form a regular vademecum on "The Practical Application of Electricity as a Therapeutic Agent. This series of papers will probably be continued through the present year, and will give the technique of application minus the theory.

Constipation-In cases of chronic constipation, there is nothing that will act with the certainty that the sinusoidal current will. In treating those cases, I place one of the pads under the back of the patient and, with the other pad, go in a circular motion around over the abdomen in the direction of the colon. The current should be as strong as the patient will bear it, and it is well to reverse the current once or twice during each sitting. Of course, in cases of long standing and where they have been taking much medicine to get their bowels to move, we could not wait for the current itself to give them the desired actions from the beginning, but must necessarily use some medication until the current has had time to get its effect. After a few treatments, you will observe that there will be a peristaltic movement set up in the bowels, and it will not be long until there will be regular action without the medicine -that is, the medicine can be gradually diminished almost from the beginning of the treatment. In this class of cases alone, electricity is worth all its cost for time and money spent, by both the physician and the patient. In this class of work I have not found the steady galvanic of any great benefit, but, on the other hand, the faradic has answered the purpose fairly well, set

ting up peristaltic action, but not to the extent the sinusoidal does. In many cases where there is a torpid condition of the rectum, I use an electrode, passing it several inches up the rectum, with the other pad on the back as above described. One thing should always be remembered in using electricity, and that is that the electrodes should at all times be held firmly on the patient, otherwise severe shocks will occur.

Headache There is no remedy, in cases of ordinary headache, that is of equal benefit to electricity. These cases are of almost daily occurrence in the physician's office, and he is often taxed to give them relief, many times re rting to the coal-tar preparations, which is so liable to cause the patient to form a habit for them. Electricity, if properly used, will relieve those cases within a minute or two, and that is what your patient wants. They not only relieve temporarily, as do the coal tar preparations, but the relief is more permanent. There is a knack in treating headaches with electricity. I have found the sinusoidal current the most beneficial as a curative agent, but the faradic current is also of great advantage, especially if from a high tension. coil.

One of the hands should be placed on the cervical region, then the operator should grasp the other electrode in one of his hands and place the other hand on the forehead so that the entire palm of the hand is in contact with the forehead. By using this method, the operator is enabled to control the current so minutely that it will not shock the patient, as the current can be increased or decreased in proportion to the tightness with which he grasps the electrode in his hand. Of course, as in all other cases where electricity is used, the patient will gradually bear more and more current after the beginning, so the machine should be in handy reach in order

It was my good fortune to receive a large number of inquiries following my articles in the SUMMARY last year. Among these, several questions were repeated so frequently that I have thought it best to answer them in these columns somewhat more fully than I could have done in the private correspondence. How may I equip a small laboratory in my office and do my own work—that is, the more simple and valuable analyses which should be completed with rapidity and ease and which would be most likely to aid me in my everyday labors? Such apparently was the great question in the minds of the readers, and such I made a brave attempt to answer.

Honey does not tempt cold flies: ambition does not stir to action, discouraged men. We are all fairly well informed as to the great truths which Pasteur, Koch, Virchow and others have given to medicine, but apparently these have been denied to the man who needs them most-the family doctor. While there has not been a tendency upon the part of medical authors to confuse, the old practitioner has been perplexed nevertheless not so much by virtue of the complexity of tests but from their multiplicity. Various attempts have been made to simplify these things, and now at last we are beginning to accomplish some good. I have been a close student of the situation for several years, and am pleased to announce my belief that the practitioner is coming into his own. For into his own

he must come.

Even as the home team appeals from the umpire to the bleachers, so have many of us, I fear, appealed from the councils of medicine to the ignorance of our lay clientage. But now that has passed; the farmer as well as the school teacher has come to

realize that certain analyses are necessary to prove that his kidneys are being urinated away; the mother of the street urchin as well as the mamma of the boulevard pet well appreciates the fact that certain bacteriological studies must be completed before all hope is denied her offspring. And so in our appeal, no matter with what sincerity it is presented, we meet only faces of stone.

Shall the practitioner do his own laboratory work? Yes and no. I would answer "yes" in some cases, but "no" in others. For the more difficult investigations, the specialist should be called in, but for the more simple bits of work, the practitioner may equip himself with profit both to himself and his patients.

Location of the Laboratory.-Osler has made reference to the small laboratory in the physician's office as a mighty factor by which we may combat quackery. In its modern meaning it is more-much more. It is a stepping stone to individual success. The laboratory aids have come to stay and cannot be ignored in any branch of medicine.

The laboratory furniture may consist of a single table and a slop jar-it may consist of even less. One of our most famous oldtime chemists had for his equipment a saucer, two tumblers and a candle. Vacant spaces in the mental equipment can neither be neutralized nor overcome by purchasing expensive apparatus. In my book, "Laboratory Methods, with Special Reference to the Needs of the General Practitioner," I have laid considerable emphasis upon the location of the laboratory table on the light side of the room-preferably upon the south, providing the windows are frosted to avoid bright sunlight. I have also worked at north windows, although trees and cther buildings should be at some distance from these, else there will not be sufficient light upon cloudy days.

I have repeatedly called attention to the value of a shelf table built solidly against the wall, i. e., a wide board supported upon brackets at a convenient height to serve as a bench. At one end of this should be built a sink, even though the physician is denied city water power. A slop jar should be placed under the outlet.

In Regard to Equipment.-Step by step

we go a long way. Buy a dozen test tubes, an alcohol lamp, some nitric acid and some Haines' sugar test solution. Clean up one of your glass funnels, add some filter paper and a urinary hydrometer, and you are then ready for the more simple uranalysis. Study as you perform the tests, and gradually enlarge the scope of your labors. You will quickly become interested and finally quite proficient at this work.

From this Avoid the

In the same way clean up your stomach tube and try your hand at an analysis of the gastric juice after a test meal. point, work into the subject. selections of apparatus (sets) offered for sale by jobbers. They are rarely satisfactory to your needs. They contain articles of equipment for which you will have no use and fail to include others which will serve you well. The prices are usually excessive.

Moliere has claimed that it is possible to make compromises with heaven. It is quite unnecessary to buy large quantities of highpriced apparatus. Excellent wash glasses, pans, etc., may be obtained from ten-cent stores. To many actual instances of this kind I have called attention in my book.

Selection of Tests.-It is much better for the physician to become skilled in uranalysis alone than to do half well several lines of work. Viewed from the standpoint of the general practitioner, I would venture that the perfection of technic in one line of work should be realized before attempting to become familiar with another. That is to say, if the physician becomes somewhat skilled in the simple urine tests, he may then attempt with profit some of the stomach analyses, etc.

Urine Tests.-The physician should be prepared to carry out the simple tests for albumin, glucose, diacetic acid, indican, bilirubin, urobilinogen and other similar morbid products in the urine. He should be able to determine the reaction of the urine and to accurately estimate its degree of acidity. He should be able to make the typhoid tests, determine the specific gravity and by the aid of the microscope, identify pus, blood, crystals and

casts.

Blood Tests.-He should be able to make the blood counts and to determine from a study of spreads whether there is a leuko

cytosis (infectious), a leukemia or one of the various forms of anemia.

Gastric Tests. From the simple tests for acids and from the microscopic search for sarcines, lactic acid bacilli, tissue fragments, blood, pus, etc., he should gain much information in regard to the probability of cancer, ulcer, neuroses, etc.

Bacteriological Tests. He need only make smears of the suspicious material and search for gonococci, tubercle bacilli and pus germs.

Syphilitic Tests.-He need not attempt to carry out the complex serum tests; but should be able to determine the presence of the germ of syphilis by aid of the ink method, such as I recommended several years ago. This can be completed within six minutes in the office of the physician, and is very easy of application. If any reader of THE SUMMARY is not acquainted with this method, I would be pleased to give him details, providing he enclose return postage.

Poison Tests.-Morphine, strychnine, phenol, arsenic and other common poisons may easily be identified by the practitioner. He need not attempt medico-legal work.

Fecal Analyses.-The physician need not. turn up his nose here. A complete scientific investigation is rarely necessary; but he should be able to identify by the aid of his microscope, pus cells, blood and ova of parasites.

Exudates.-Pleural, peritoneal and lumbar exudates such as are obtained by aspiration, are easily examined and often give diagnostic evidence when subjected to the chemical, microscopic and bacteriologic examinations.

Water Analyses.-The physician should not attempt to solve the more weighty questions in sanitation; but may determine with ease and accuracy whether or not a water is really fit for drinking purposes.

Milk. By an estimation of the amount of fat and other constituents, the physician may quickly and accurately determine whether the milk of the mother or the cow is suited to the babe. He may easily prove the presence of added preservatives and of disease.

A diagnosis is of complex makeup, and may be likened to a chain. Some of its links are forged at the bedside from a his

tory or from a physical examination. Others must be perfected in the mind of the intelligent and painstaking physician using his theoretical studies and his experience as material. Still others of no less importance are completed in the little back room of the office-the rural medical laboratory-and these may often be likened to swivels they permit the chain to turn but not to break when attempting to cast the anchor.

109 E. Court St., Paris, Ill.

THE BETTER CLASS OF COUGH REME-
DIES AND THEIR COMPARATIVE
VALUE, WITH CLIN-
CAL REPORTS.

BY C. W. CANAN, B.S., M.D., Ph.D.

The formulas for cough mixtures change somewhat from year to year, yet pinus alba comp. seems to be the most universal base. To this is added tar, syrup of tolu, syrup wild cherry, syrup squills, senega, and a host of other agents of less value than the above. That there is but little medicinal value in wild cherry, white pine, tolu, etc., beyond their pleasant taste, is conceded by our most competent observers. The number of cough mixtures on the market are legion. They can be found in lozenges, elixirs, emulsions, syrups, tablets, pellets, and wafers, but only few of them. have actual therapeutical value.

Take the average cough syrup as found in the shops and it is no more than a palatable, stomach distressing agent because of the sugar it contains, having little or no merit. The lozenges and wafers are little more than candy variously flavored to suit the taste of the fastidious public.

Chloroform is frequently added to cough mixtures, and has some merit, but because of its insolubility but little can be added without danger of getting an overdose in the bottom of the bottle.

Occasionally the writer has found sulphuric ether added to these mixtures, and they are dangerous because of its tendency to depress the heart action.

The newest additions are terpin hydrate, heroin, dionin, lactucarium and the mono

bromates of champhor; these are agents of merit and have done much to put the old syrup. shot-gun prescriptions out of commission.

In using terpin hyrdate large quantities of alcohol are necessary for its solution. The N. F. formula for elixir terpin hydrate calls for 13 fluid ounces of alcohol in a 32 ounce mixture. The superiority of glycerin as a base or menstrum, over the sugarladen syrup is so apparent that the additional cost is not considered in the majority of cases.

v active practitioners have the time to compound their cough mixtures, therefofe the author has spent considerable time in testing those of the better class that appealed to him as being worthy that he might be able to draw certain conclusions as to their value and field of usefulness.

In cases that demand a powerful depressing agent, nitrate of sanguinarine and tartar emetic will be found useful. They are both soluble in warm water and can be given in small doses until the cough becomes free and easy.

Terpin hydrate is also a valuable cough remedy when used with care and can be administered either in elixir or tablet form.

In the dry cough of bronchitis, asthma, etc., lobelia is of great utility. In spasmodic, nervous cough gelsemium, herion, dionin and veronal are all useful, if used with care. As to stimulant expectorant in

chronic bronchitis the author has used grindelia with most excellent results.

Lactucarium comp, is also a convenient and useful cough remedy when the cough is due to irritation in the upper air passages.

There are a number of elixirs on the market, sold under proprietory names, containing one or more of these later products; these if properly selected have their field of usefulness, but to prescribe them promiscuously because they are called cough remedies is a big mistake. You must acquaint yourself with the formula first and then you can judge where it will suit the case in hand. The nature and cause of cough determines the remedy or class of remedies to be used. Some forms of cough require a simple expectorant others a stimulant expectorant, others a simple sedative, while others a depressant sedative.

There is yet another class of cough remedies, tonic expectorants. These are generally found in the form of emulsions. There are many of them, especially those of cod liver oil. Sometimes this agent is made up in the form of an elixir or wine. These have their value in treating coughs of long standing when associated with emaciation. Cotton seed oil and petroleum are made into emulsions for the same purpose.

As a tonic expectorant and tissue builders in chronic cough and run-down condition of the system, with loss of flesh, the author has found petroleum emulsion (Angier's) decidedly beneficial.

Especially was this true in patients suffering from chronic bronchitis, pluropneumonia with adhesions, pleuritis with effusion, chronic phthisis and many other conditions with dry cough and emaciation.

We append a few clinical reports in which this emulsion was prescribed:

Case I-Annie E., age 12 years, family history tubercular, contracted la grippe, very ill. When this subsided she was left very weak, nervous and had a harrassing cough. There was complete loss of taste and smell. During acute stage aconite, quinine and phenacetine was given to control temperature, reduce arterial tension and control headache and muscular pain. During the stage of prostration cactus to sustain heart, dionin for nerve prostration and cough. Cascara, aloin and nux as a tonic and to correct constipation. Symptoms improved except cough and weakness, having lost 15 pounds in weight. She was now placed upon petroleum emulsion and the cactus continued. Improvement was slow at first, but by the end of the second week there was a decided change for the better. Cough was free and easy, decided gain in strength and vitality. Later she began to gain in weight and made a good

recovery.

Case II-Catherine C., age 7 years, contracted whooping cough. Paroxysms were unusually severe, vomiting so persistently, in spite of the usual remedies, that nutrition and strength fell far below par. As a complication pneumonia developed. Life despaired of for two weeks. Crisis of pneumonia past, but resolution

was very slow, in spite of inunctions, iodine and tonics internally. Reduced in flesh, very weak and a harsh dry cough; she was placed upon strych. gr. 1-16 t.i.d., and petroleum emulsion four times daily; also counter irritants over diseased lung. By end of first month she was able to walk about house, cough much improved and gaining strength. Improvement was uninterrupted and she made a good recovery.

Case III-Mrs. Jennie F., domestic, age 30; family history tubercular; contracted la grippe two years ago, from which she never fully recovered. When she came under the author's care she was greatly emaciated, anemic, and had a troublesome dry cough. Dullness over apices of both lungs and in right infra-clavicular space; was also suffering from indigestion. Analysis of sputum revealed tubercular bacilli. We prescribed beechwood creosote in glycerin alternated with elix. lic. pepsin and After one week we were compelled to withdraw the creosote, because the stomach refused to digest it. We substituted petroleum emulsion and pepsin and nux was continued. This treatment was slow in results at first, but after the first month the cough improved, patient gained in strength and weight. While not cured, she is able to take plenty of out-door exercise, eats with a relish, sleeps well and cough gives but little trouble. Orkney Springs, Va.

nux.

HOW ONE DOCTOR SUCCEEDED, WHICH IS THE STORY OF HOW EVERY DOCTOR MAY.

BY HENRY W. CHAMPLIN, M.D.

A home, wife and baby, horse and carriage, and auto, all acquired and paid for in five years, is the record of this doctor. The choice of location was not particularly fortunate; though a county seat, it was a small one, with no howling demand for a new M. D. Doctors were and had been practicing there with all kinds of success, from zero up. This recent fledgling had nothing especially in his favor, and nothing against him but his newness, which is about an even thing for and against.

But "Excelsior" was his only thought. Located in an humble way conveniently