NON-DRUG THERAPY.

BY HENRY BIXBY HEMENWAY, A.M., M.D.

Many physicians might more properly be called "physickers." They imagine that they must find some drug to give to every patient, and that their duty ends with the writing of a prescription, or with the doping out of some pills. As a rule such men are by no means accurate in their knowledge of the action of the drugs which they prescribe, and not seldom they become therapeutic nihilists because their patients are not cured. They do not realize that cheap drugs are very expensive, because they are inert or uncertain.

Drugs have their proper place in the cure of disease, but they cannot accomplish all that is desired. Often, very often, the cure may be effected better without their use.

Some years ago the writer was consulted relative to a case of most obstinate dysmenorrhea and occasional menorrhagia. She had taken a great deal of medicine under the orders of several physicians but with only temporary relief. Being a young woman of modest disposition, she at first refused to permit of an examination, and could not understand why I did not follow the example of her former attendants and prescribe without a vaginal investigation. I simply told her that if she wanted that kind of treatment that she had better go to those who practice in that manner. The next day I was sent for again, and found that the uterus was prolapsed, retroverted and bound down in the pelvis in such a manner as to obstruct the intrauterine circulation. The patient was put in the kneechest position, and the womb replaced. She was instructed as to the taking of the kneechest position, but no further prescription. was made. Two or three years afterward, the next time that I saw her, she reported

that she had taken no more medicine, and from the day that the womb was replaced she had no more trouble. She had lost her nervousness and had gained in flesh.

One point relative to the knee-chest position is frequently overlooked. To be effective, air must enter the vagina. If the patient assumes an erect position after her devotions, the air frequently rushes out so rapidly that the womb falls back to its abnormal position. There is nothing to hold it in the normal place. After the knee-chest position the patient should be instructed to turn first onto her side and then onto her back, straightening out. After resting in that position for a few minutes she may be permitted safely to arise.

Many cases of pelvic disorders, caused by abnormal positions, are relieved by daily exercises like scrubbing the floor. While taking the exercise there should be no band or belt around the waist; neither should a corset be worn. The effect of this exercise is like that of the knee-chest, but more tonic. It is especially indicated in delicate girls and women. It must be remembered, however, that the effect of carrying a pail of water is exactly the reverse in such persons. In carrying the heavy weight the abdominal muscles are set, and crowd the abdominal organs into the pelvis.

Another case: A man had a most obstinate rheumatic pain on the right side of his lumbar region. No treatment was satisfactory. Why should the pain be thus located? He did no heavy work, being engaged in the office entirely. On visiting him while at his desk it was noticed that he sat in a fine office chair, with nearly solid back. On each side of this back there was an opening at the height of his loins. The chair was in front of a window. When the patient was writing, his back was squarely toward the window, but much of his time was spent talking with customers. When

thus engaged he turned in his swivel chair so that the right quarter was towards the window. By erecting a protection from the cold draft the rheumatic pain was banished.

Among our most common disorders are those of digestion. Heartburn may be relieved by an alkaline dose, and gas may be thrown off by the effects of a hot carminative, but these drugs give but temporary relief. Digestion may be aided by a diastase, or possibly by pepsin, but the case is not cured. Perhaps the trouble is in the kind of food eaten. Far more likely the fault is in the manner of eating. Remember that starchy food must be thoroughly masticated, not to make it fine, but to get it mixed with the saliva. In nine cases out of ten, among adults, the dyspepsia is amylaceous. One case, which had been diagnosticated as recurrent appendicitis by several physicians, proved to be the result of amylaceous dyspepsia, which was caused in each instance by the eating of crackers and milk. The starchy crackers being soaked in the milk were not masticated, so that little saliva was in the stomach to digest them. By eliminating that combination from the dietary and explaining why, the trouble was removed. Before appendicitis became fashionable this patient had acquired a mild morphine habit as the result of the treatment which she had received for her stomach trouble.

There is relatively little waste in many of our articles of food, and the stomach calls for a certain amount of bulk. Constipation may be caused by a lack of bulk in the intestines, so that the full effect of the peristalsis is not obtained. For this reason such articles as string beans are excellent articles of diet. One of the worst articles is mashed potatoes. Because mashed potatoes is soft and moist it is eaten without mastication, and admixture with the saliva. Consequently there is practically no digestion of it in the stomach. This result is more pronounced if the starch granules are protected by a coating of milk, cream, butter or gravy. If a child swallows a penny, or a piece of glass, give it to eat freely of mashed potatoes and keep watch of the discharges, and in due time a potato ball will be found containing the penny or glass. This shows how indigestible mashed potatoes are as cdinarily eaten. In the stomach

the potato without saliva makes the acquaintance of yeast and other fermentive germs. Then "the devil is to pay." In the place of digesting, the starch is turned into acid and gas. The acid irritates the mucous membrane and makes an inflammation. The abnormal conditions extend through the alimentary canal, and the absorbed poisons interfere with normal elimination from the body. We say that the patient has the gout, or that he has rheumatic pains and neuralgia. The real fact is that he has not sense enough to eat a potato properly. The doctor who treats such a case with drugs alone demonstrates his relationship with the quadrumana. Monkeys imitate someone else; they do not reason for themselves. Evanston, Ill.

A BRIEF METHOD FOR THE ANALYSIS OF THE STOMACH CONTENTS.

BY F. L. JACKSON, M.D.

Those who care to spend time to make an analysis of the stomach contents, will find the following method quite brief and very satisfactory: Attach a piece of white silk, two or three feet long, to a sponge, as large as can be squeezed into a mediumsized capsule. By means of a needle pass the silk through the end of the capsule from inside out. Squeeze the sponge into the capsule and put it together, so you will have the silk attached to the sponge within the capsule. When you desire the stomach contents for analysis, have the patient swallow the capsule, keeping hold of the end of the silk. In two or three minutes have him make a vomiting act, during which the sponge is drawn up. In this way you will be able to obtain from one-half to a teaspoonful of the desired contents. Then proceed as follows:

I. Test with a slip of filter paper which has been previously moistened with a one per cent. solution of conog red. A blue color shows the presence of hydrochloric acid (very delicate).

2. Make a solution of two drops of carbolic acid, one drop of the tincture of the chloride of iron and ten ccm. of water. With a clean glass rod, take up a drop of the stomach contents and mix with some of

the solution. An intense yellow shows the presence of lactic acid (1 part in 10,000).

3. Smear some cover glasses for microscopic examination.

4. Test with a slip of neutral litmus paper and save the slip for reference.

5. Mix what there is left with a small quantity of prepared chalk, and after reaction has taken place test with another slip of litmus. Hydrochloric acid is neutralized by the chalk while organic acids are not, so the difference in color between the two slips of paper will give an approximate idea of the quantity of hydrochloric acid present.

If no hydrochloric acid is present but a trace of lactic acid is found and such symptoms as a gnawing pain in the stomach, a white furred tongue, cachexcia, etc., are present, we may suspect carcinoma of the stomach. If neither hydrochloric or lactic acids are found, we may look for atrophy of the gastric glands. If hydrochloric acid is present in sufficient quantity and dyspeptic symptoms still persist, there is probably a deficiency in the absorption or the motor action of the stomach. Wheatbrook, Maine.

BUSINESS PRINCIPLES OF THE PHYSICIAN.

BY W. R. ANDREWS, M.D.

Last month we tried to show the necessity laid upon the physician of to-day for being more systematic and more insistent in the matter of regular collections from both rich and poor, and the ethics and justice of the same. The changed attitude of the public toward the physician-his perquisites and benefits a thing of the past; a change that has been slowly coming about for more than a generation-makes it necessary for him to be business-like and systematic; to collect regularly from rich and poor perhaps in proportion to their respective ability to pay; and to pay his own obligations in a like orderly manner.

To do so successfully he must adopt a few business principles. He must "book" all his cases as they occur, and he must conform to legal requirements in doing so, that he may be able to collect by due process of law whenever it may be necessary. Such a

physician soon weeds out the “dead beats" from his practice by such processes.

Conservation is the cry of the day, and a logical cry it is; and we must not waste our time by cumbersome methods in bookkeeping any more than by pauperizing the public in needless "charity" work. Excellent original entry systems for physicians' use are now largely in vogue, doing away with the old-time day book and ledger methods. The new method requires but one-half the time of the old-time one and the accounts are more easily defended in court.

The other condition that this changed attitude of the public logically leads to is that the State should assume liability-under proper safeguards-for the treatment of those who are unable to pay the physician but who are not so destitute as to necessitate admission to the various "poor farms" and like institutions. At present most local governments recognize this class of people to the extent of assisting them in the matter of food, fuel and rent. No reason exists why the physician's services should not be included. Not at a fancy rate, but at a rate proportional to the rent charged by the landlord or the quality of the groceries he ordinarily buys.

The American people are practical and generally just. And while present officials may often turn down our efforts to generally secure compensation on this basis, if every physician in the land would take a little time two or three times a year to vigorously present the justice of our contention in the matter to such voters and charity workers as are accessible to him, in a short time there would be a change of sentiment on the part of a majority of local officials everywhere, and the minority who might still oppose our just claims can easily be relegated to private life.

As a rule, the pnysician pays his proportion of taxes in his community; his name appears in philanthropic, civic and charity subscription lists about as often as do those of other persons of his class. He pays his way in the world and perhaps already contributes more than his share to the public weal. Why should not the State pay him a reasonable sum for his services to the poor?

Mannington, W. Va.

THREE MONTHS' COLIC IN BABIES.

BY J. B. CURRY, M.D.

I have read a few articles in medical journals, the title of which was how to treat successfully three months' colic in babies. Now, it is a question in my mind whether there is really a trouble with babies that should be termed a three months' colic in babies. I am aware of the fact that there is often times trouble that exists between the mother and babe, which if not corrected will cause the baby to cry, and cry vehemently for three months or longer, if the trouble is not corrected. If the baby cries, it is a matter of fact that something hurts that baby. Doctors, as well as mothers, know that often times babies cry when nothing more than hunger is the real trouble or cause, but if you are a close observer, you can tell the difference between the cry of hunger and that of real pain. You know that, that is the only way that a baby has to complain, is by crying.

I had a case a few months ago that I want to tell you about, and if you ever have a case similar to this you just look closely into the case, and see if you can detect any wrong existing, like I tell you about in this case. I attended the mother in confinement, a primipara, a long and tedious labor. I landed the little lady about one o'clock a. m. and stayed until morning. When I left the next morning the mother and babe were getting along fine. Being several miles distance away, I did not hear from them for about two weeks, when the young father came into my office one day and said: "I have not had a good night's rest since the baby was born. It cries, cries and cries. The old women in the neighborhood say that it has the three months' colic, and I want to know if anything can be done for it, or will it just have to cry it out?" His attention had been called to it so often, and being rather a close observer of things surrounding, I said to him: "Herbert, tell me what you can about how the baby does." "Well, it cries nearly all the time, and worse just after it nurses. It draws its legs up

and will kick them out as hard as it can and cry like something was hurting it terribly. Its bowels are all right, and its kid

neys act free enough. The mother is feeling well enough, excepting the worry in trying to hush the crying baby." "Well, tell me as near as you can, the natural appearance of the tongue." "It is red," said he. (You know that most babies' tongues usually has a white coat or film on them.) "Well, what is the natural appearance of the mother's tongue?" "It is coated white," said he. Now I thought that I had the key to the trouble, and I did, it is true. Hyperacidity in the baby's stomach, and alkalinity in the mother. Now do you see what the results must naturally be? A genuine case of colic. You know the results of a little vinegar and water in a glass, when you add a little soda. See? So, I just put up this: R Matricaria Marrubrium Nepeta...

.gtt. v.

.gtt. v.

.gtt. v.

Glycerin and aqua............q.s. 3j.

M. Sig.-Five drops every two hours. Now for the mother I put up the follow

M. Sig. A teaspoonful every hour until baby quits crying and will sleep.

It worked like a charm. It was a specific for their troubles. So, when you have a case of suspected three months' colic, you just look closely into the true conditions existing between the mother and the baby, and I venture the assertion that nine times out of ten you will find a case likened unto this one, or vice versa. I met the young father a few days afterward, and asked him how the baby was getting along, and he said, "You certainly did do the work for the baby. My wife had taken only a few doses of her medicine until the baby could nurse and go off to sleep, and it slept well all night the first night."

The great and noble John M. Scudder, M.D., who has long since passed away, tells us in his "Specific Diagnosis and Specific Medication," that the tongue indications, if we understand how to read them, will tell us a great deal, which will enable us to treat our patients more successfully. A tongue coated white denotes hyperacidity, and a condition existing in the system that sodium sulphite will correct. A red tongue

denotes an excess of alkalies in the system, therefore an acid is indicated.

Now, doctor, the tongue does not tell us everything that we should see indications in, but certainly it does tell us a great deal. Keep away your opiates, your soothing syrups, your paragoric, and give the indicated remedy and your little patient will soon get easy, and the mother and father will give you endless praise. Here it is in a nut shell, doctor: Know your remedy, that is what it will do, learn to read the indications correctly, and you will be able to relieve your patient every time. Don't give the trouble a long and hard name, and puzzle the father and mother with a great lot of different kinds of medicines to be given. I have learned years ago in my practice that babies need only the indicated remedy when sick, and but very little of that to get well. You see, this baby only got 5/32 of one drop of the combined remedies, hoarhound, chamemile and catnip.

Austin, Ark.

RECIPROCITY.

BY GEORGE L. SERVOSS, M.D.

Much has been said recently relative to reciprocity, as applied to doctors, or those desiring to move from one State to another. With but few exceptions, we find that the various commonwealths of the Union are recognizing the credentials of others. In one or two of these exceptions every candidate for license is obliged to undergo an examination, regardless of his previous record or capabilities. In one or two others, while the credentials, in so far as the candidate's medical status may be concerned, are accepted, still he is asked if he has proper academic education or training, and if not he is not allowed to enter their professional ranks. All this regardless of the fact that he may be able to show that he has carried on a successful practice, in many instances reaching over long periods of time.

It is well that the young and inexperienced should be put through the test of an examination, but not so the older men who

have shown their capabilities in a practical way. Nor should the school, either medical or academic, be a basis upon which to base the consideration of man's ability, as it is a well-known fact that some of our greatest men in medicine have graduated from inferior schools. Flexner is a living example of the fact that one's alma mater has but little to do with the subsequent work of any man. Flexner's own brother said that the school from which the doctor graduated was of a very inferior sort, but in spite of this we find that the latter has done as much to advance the science of medicine as has any graduate from those schools which have invariably ranked much higher. It is possible that Flexner would not be licensed in at least one or two States, regardless of the fact that he has shown his marked value, both to humanity and the medical profession.

Not long since we were told that it was necessary, if one desired a license in one particular State, to hold a membership in a certain secret order. One candidate going before the examining board of that State joined the order, and succeeded in coping with every test, despite the fact that he had not "crammed" for the examinations, or that he was above the general average. Others, said to be much better prepared than himself, were "plucked." It was said that the latter did not belong to the secret order.

There are a certain few doctors who fight reciprocity because of selfish reasons. These men, as a rule, were licensed long before the examinations were required, and again relicensed with each succeeding passage of a law requiring higher qualifications, and that without any examinations. They are usually of the weaker class, the sort fearful of any sort of competition, and what is still worse, they are frequently high up in the medical organizations, and they employ the latter to keep capable physicians out of their communities. Only recently, in one State where reciprocity was about to be allowed, or rather had been asked for by the broad-minded physicians thereof, one of the leading officials of the medical association said openly that the doctors should make no move toward such an end, but should leave the matter wholly in the hands of the people. If the latter wanted any