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certified milk. It is pointed out that expensive equipment is not necessary so much as a careful and unremitting attention to details.

In 1907 the American Association of American Milk Commission was organized. The methods and standards for the production and distribution of certified milk adopted by this association at its 1912 meeting are given in the appendix to the bulletin.

CATHARSIS.

Dr. Chas. F. Denny says that he gives aloes and castara to stimulate the upper portion of the alimentary canal; also podophyllin in combination with hyoscyamus or belladonna; also combinations of aloin, nux vomica strychnine and belladonna,

combinations, etc. His favorite hepatic stimulants are sodium phosphate, sodium glycocholate, taraxicum, calomel and potassium iodide.

To unload accumulations in the colon he gives high injections of glycerin, normal salt solutions, also oil injections (olive oil, cottonseed oil, linseed oil) retained and followed by one of the preceding enemas. Calomel he usually gives in 1/10 grain doses with sodium bicarbonate, repeating every half hour until one grain is taken. At times larger doses-from two to three grains are given until six grains are used. The laxative salines are given when he desires to promote exosmosis and magnesium and magnesium citrate are used. Usually these are administered upon rising in the morning, followed by a glass of hot or cold water. Occasionally a dose is given at bedtime.

To children he administers such laxatives as castor oil, olive oil. Flaxseed is useful in foods; some breakfast foods contain flaxseed.

In habitual constipation he tries to avoid the use of cathartics and enemas, and endeavors to increase the normal peristalsis and overcome atony by proper diet, exercise, massage and free water drinking. Sometimes he resorts to absolute or gradual withdrawal of medicinal measures. unload the bowel quickly he first clears the lower bowel by an enema, then gives either three or four ounces of castor oil, one or two drops of croton oil or 1/20 grain of

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OSTEOPATHIC RECOGNITION.

Within twelve years osteopathy in some form has been recognized in practically all the States. The following twenty States have separate boards: Connecticut, Arkansas, Michigan, Minnesota, Utah, Tennessee, New Mexico, Montana, Idaho, Missouri, South Dakota, Louisiana, Georgia, North Dakota, Nebraska, Florida, Califor nia, New Hampshire, Pennsylvania, and Kansas. The following eleven have an osteopathic member of the State examining board: Iowa, Wisconsin, Kentucky, Indiana, New York, Oklahoma, Oregon, Texas, Utah, Washington, Massachusetts. In the following nine States osteopaths are examined and registered as osteopaths by the State board of examiners: South Carolina, Wyoming, Ohio, West Virginia, Delaware, North Carolina, New Jersey, Colorado, Virginia. There are no specific regulătions regarding osteopathy in the District of Columbia and the following seven States: Alabama, Arizona, Illinois, Maine, Mississippi, Nevada and Rhode Island. In Maryland osteopaths are exempt from the operation of the medical practice act. In fifteen States osteopathy is declared to be practice of medicine, and in twenty-one States it is declared not to be

THREE POINTS WORTH REMEMBERING.

Every case of prostatitis is not necessarily due to gonorrhea, or even to any urethral infection. The infection may come from the rectum, particularly in cases of severe hemorrhoids.

A chronic prostatitis or seminal vesiculitis may be the cause not only of arthritis, lumbago, general "rheumatism" and endocarditis, but may also cause a general toxemia.

The Wessermann test might be negative in the blood and positive in the cerebrospinal fluid. And some now demand that no case of syphilis should be pronounced cured until the reaction of the cerebrospinal fluid was demonstrated to be negative.-Critic and Guide.

DRINKING AT MEALS.

"I recently read," writes a subscriber, "that it is good to drink plenty of water with the meal, provided one does not wash down the food. I have always heard that it was not good to drink with meals, especially cold water. I should like to know your opinion."

Recent experiments performed by a number of careful observers seem to indicate that food is better digested when a certain amount of fluid is taken with the meal than when it is not. This has been tried by scores of individuals observing their ability to work, their symptoms and digestive powers, and everything of that kind, over quite long periods of time, and I think there was not an exception to the observation that the use of fluid with the meals seems to be beneficial. Ex.

GELSEMIUM IN LA GRIPPE.

As cold weather approaches acute coryza and la grippe will demand attention. Let the prescriber remember gelsemium in onedrop doses from the start. At first every hour, later if the physiological effect upon the eyes appears, every two or three hours. It is a good plan to give the patient a hot foot bath at bed time, and if the case is epidemic influenza keep him in bed.—Ellingwood.

RACE DEGENERACY.

Dr. J. H. Kellogg, of Battle Creek, Mich., in a paper read at the meeting of the American Public Health Association, at Colorado Springs, said:

"If race degeneracy is to be prevented it will only be accomplished by the development of a more resistant type of man-a tougher, more enduring, more rugged type, capable of wrestling successfully with the problems of the Twentieth century and the greater centuries to come."

Taking the stand that public health educational campaigns must broaden their scope in order to successfully accomplish the tremendous task that confronts them.

IRON.

What is the most agreeable manner of presenting iron in cases of anemic women and children? The particular behavior of iron in the system is not a settled fact and we must necessarily give it empirically, yet we know that clinical results are usually gratifying. Iron and ammonium citrate, according to Medical Review, is not highly constipating. It is neutral in reaction, so far as the teeth are concerned, and its taste is not bad. This solution may be disguised perfectly with any fruit flavor, especially pineapple. Children take it willingly and any doctor can prepare the medicine in his office.

NEW CURE FOR RABIES.

A patient in the St. Louis Hospital was cured of rabies by subcutaneous injections of quinine. When he arrived at the hospital he seemed to be in the last stages of the disease, and on the verge of convulsions. Favorable symptoms followed the first injection of fifteen grains, after which he was given two injections a day. Favorable results had already been obtained from injecting quinine into animals sick with rabies. -Life and Health.

Dr. Jones says that carbonate of lithia, in two to four grain doses; one dose will relieve the most aggravated case of systitis in from 20 to 30 minutes.

our next.

slagent readers may be pleased to contribute for publication

HYDROCELE,

Editor Medical Summary:

In the September number of THE SUMMARY, page 196, a subscriber asks for the best solution to use as an injection for hydrocele.

Years ago, Prof. Joseph Pancoast, after emptying the sac injected tincture iodine with good results. A patient one time told me a doctor injected coal oil into his hydrocele. I have only the patient's word for it, but rather doubt the truth of it.

Some years ago I read in a medical journal of "The Catgut Treatment of Hydrocele." Dr. Geo. W. Lawrence had used it for years with 100 per cent. cures. Shortly after reading the article I tried it in a case of a man who refused operation, and every few months I emptied the sack with a trocar. I now used the catgut ligature, and he has had no trouble since. This was about six years ago.

The method to proceed is as follows: Make sure the trouble is hydrocele. Insert a small trocar and thoroughly empty the sack. Then insert through it ten or twelve inches of No. 2 ao 3 sterile catgut. Be sure of an aseptic condition of the scrotum, trocar, catgut and hands. The gut is stiff, firm and straight and will go through the canula easily; as it passes into the sack a little manipulation is needed to coil it about and slip entirely within; remove the canula and seal the opening with colodion or oxide of zinc plaster.

There is very little or no pain. The patient can go about his business, and seldom puts on a suspensory. In three to nine weeks the hydrocele is cured. It has also been used in housemaid's knee and bursitis of the elbow.

J. WM. TRABERT, M.D. 327 N. 9th St., Lebanon, Pa.

TUBERCULOSIS-REPORT OF A CASE.

Editor Medical Summary:

I take the liberty of reporting the following case, because it was through the columns of THE MEDICAL SUMMARY that I received the impetus to do what I did. J. L. Eet, 37. To save space, the diagnosis of the case was tuberculosis, the bacilli being found by a well known pathologist. Having been suspicious for some time, the patient has been under open air treatment with raw eggs, but there was no marked improvement.

After the bacilli being found and it being impossible for him to avail himself of sanitarium treatment, the best sanitarium environments were secured at home.

Seeing the formula, as recommended so highly by a Michigan doctor, as a tonic, I discontinued his medicine and placed him on the tonic advised (Dowd's comp. phos. tonic 21⁄2 ounces in glycerin to 6 ounces, one teaspoonful t. i. d. in milk).

The result was like magic. He commenced to gain in weight immediately, cough improved until to-day, were it not for the fact that we must believe what the microscope says and always regard this patient as suspicious, I would say, and he says he is a well man; his weight has increased almost to its former state.

Fresh air, raw eggs, rest and abundant nutricious food are all valuable measures, but certainly, judging from this case, we have learned a valuable lesson; phosphorous in its elementary form is a most valuable adjunct, one that should not be ignored, not only in the condition reported, but in any wasting disease.

Atlanta, Ga.

MEDICUS.

RHEUMATISM.

Editor Medical Summary:

Rheumatism is a very common complaint for men, women and children. It is so common that the average layman can tell what it is in most instances. Rheumatism affects different parts of the body in different ways, as there are different kinds of rheumatism. Any disease that can cause such pathological changes and damage to the system as rheumatism does deserves due treatment at once. If it is allowed to run on it may produce permanent injury. Almost everybody is familiar with the crooked backs, stiff joints, fingers drawn out of shape, almost useless limbs, etc., in old rheumatic cases that have neglected treatment at the right time. In order to prevent permanent injury or deformity all cases of rheumatism should be treated in the early stages, and the treatment continued until the cure is complete Acute rheumatism can be cured much quicker than chronic cases. A patient with chronic rheumatism should bear in mind that all chronic diseases require chronic treatment, or in other words, it takes longer to cure chronic diseases than acute cases. A large

majority of patients are too ready to quit treatment when they get better, or apparently well, hence the disease sooner or later returns and is as bad as before.

Rheumatism is not always the same; the patient is better, then worse at times, and occasionally apparently well. In regard to the treatment of rheumatism I will say this is fully discussed in the latest leading textbooks and medical journals. Some prefer one treatment and some another, same as in all other diseases. I am a strong believer in hypodermic medication in the treatment of rheumatism, same as for various other diseases. The main cause of rheumatism is no doubt in the blood, and when the proper remedy is injected into the circulation it has a Internal remedies, local remedies, hot air apparatus, therapeutic lamps and various other forms of treatment may be needed. All cases, of course, are not treated alike, and as a rule no one form of treatment is used exclusively, but a combination of methods as may seem needed. Rheumatism is a good specialty. It is a disease well

more direct effect.

suited for office practice. I am very much interested in rheumatism and like to treat it, when the patient is a reasonably intelligent being and will submit to proper treatment and continue it long enough and pay the bill as the treatment is given.

I think that many experienced physicians will agree with me when I say it is often harder to control the patient than the disease in many cases of rheumatism, as well as in other diseases.

J. A. BURNETT, M.D.

Hartshorne, Okla.

GOITER WITH EPILEPSY COMPLICATION.

Editor Medical Summary:

About three years ago I was called to see a young man, 17 years of age, in this city, who had a goiter about the size of a hen's egg in the front of the neck, and during the previous three weeks had some four or five epileptic fits-fell down, frothed at the mouth and remained in an insensible condition for several minutes. I could not decide whether the epilepsy or goiter was the primary cause of his trouble. Which was propter hoc and which post hoc the reader may judge for himself.

However, I was satisfied that there was a hyperemic (irritation) of the base of the brain and that the goiter treatment, per se, would not reach the trouble, that this hyperemic condition must first be removed.

Therefore, I told his father to shave the hair off the back of the head from the occipital proturberance level with the ears and down the neck, then gave him a canthos plaster to cover the back of the head; gave explicit directions how to apply the plaster and how to treat the blistered part; but he let the plaster remain too long,, which resulted in the disorganized cuticle coming off, and the result was a very sore head.

But the boy had no more epileptic attacks, and by the use of specific remedies, the goiter disappeared in six months.

Authors state that goiter and epilepsy may be coincident, but is rather unusual. I do not believe a cure in this case could have been accomplished without the blister. J. R. BORLAND, M.D.

Franklin, Pa.

THE INDICATED REMEDY.

Editor Medical Summary:

Having just read the September number of THE SUMMARY, I feel prompted to offer a few helpful hints to my medical brethren who seem to be in need of them. The first is the best treatment for rheumatism. Some seventeen years ago, after being afflicted off and on for years with this disease, I was forced to make a special study of its causes. The ordinary remedies were exhausted. Even a change of climate, electricity, vapor baths, etc., gave but temporary relief. Being a great student of evolution I concluded that there must of course be a cause adequate to the production of the disease, which was but its natural effect. I sought that cause diligently and was rewarded. For from the day I began to avoid the cause to this, I have been free from the disease. And whenever I can get my patients to follow my directions they never complain any more of rheumatism. I simply avoid the food combinations that produce uric acid in the system. A man with the rheumatic diathesis should not eat meat with fruit or sweet foods, i. e.. at the same meal. He should never use sugar on sour applesauce, cranberries, strawberries or other similar sour fruits. He should eat only one kind of meat at the same meal, and that with vegetables and bread only. His His diet should be in the main cereals and an egg or two for breakfast, meat and vegetables for dinner and fruit for supper. The whole wheat flour and corn bread should be used in preference to bread made from white flour at all meals. He should drink from two to five pints of water a day on an empty stomach. A little coffee at the beginning of the meal is usually harmless, but much fluid of any kind should not be taken on the stomach until the food is digested, say from two to four hours after eating.

Of course, other precautions should be observed, such as reasonable exercise, bodily cleanliness, avoiding undue exposure, going with wet feet, the excessive use of narcotics or liquors, etc. In this as in all other diseases, an ounce of prevention is worth a hundred pounds of cure.

On "Practical Eugenics," it seems to us that the editor deals more with effects than

with causes. The sterilization of certain classes of undesirables is advocated. This seems to be the popular fad just now. But a deeper study of the causes that produce these classes proves that they are multiplying from three to five times as fast as our population. Where will we end then of we keep up this practice of vasectomy of a few generations The majority will have to be sterilized. Then would the gods smile on us in derision, when we would no longer be "the heirs of all the ages in the foremost files of time," as the poet says. Would it not be infinitely wiser to apply the same good science and sense to the matter of human breeding that we do to the production of our domestic animals? As Burbank suggests, are not babies of more value than pigs and poodle dogs? To produce a fine breed of stock we must observe the laws of breeding, of nutrition, of environment, etc. But our authorities assure us that fully one-third of the people in our great cities do not get enough to eat. They say that for healthy living the average family needs $1200 to $1500 a year, while about three-fourths of the families of our country get only $500 a year. When we think of the unhygienic environment, the woeful lack of education, etc., of these millions, what better can we expect than the rapid multiplication of all classes of abnormalities. The only reasonable remedy is the removal of the cause, i.e., the profit system, which logically Lreeds idle millionaire parasites by the thousand and paupers, imbeciles and dehumanized dependents by the million. This would also solve the "dead beat" problem and prevent most of such heart-rending, soul and body wrecking catastrophes as the one recorded in "A Tragedy of Womanhood."

Let the nation own all the trusts and operate them in the interest of all the people as their work shall appear in evidence, giving all an equal economic apportunity. Then will our civilized cannibalism, which produces most of the diseases of our body politic, pass away. Aurophobia, i e.. gold madness, is our national disease. We have too long placed mammon before man. We must reverse this procedure-give every man a chance to work and the full social product of his labor, instead of one

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