cause anxiety, fear or irritation. The task of reforming the patient's emotional habits and restoring a normal balance and control in his cortex is both difficult and complicated. Every bodily or mental change in the patient has some direct or indirect influence which is favorable or unfavorable, but the aim should be to select such a combination of the possible favorable influences as will lead to success and at the same time prevent those which are unfavorable.

In reference to the physician's influence the writer states that much may be done to displace false and depressing ideas by encouraging those that are encouraging and tranquilizing. "This part of the treatment begins," he says, "when the patient enters the waiting-room. No pictures of the dissecting-room or sick-bed, no specimens or surgical instruments should be there; all the furniture and decorations should be suggestive of comfort and peace. It seems trite to speak of the physician's attitude toward the nervous invalid, of the need of an interested, sympathetic, patient, confident manner. Yet only a few seem to realize how the patient is influenced by it. Something like the 'insolence of office' is easily acquired in hospital and dispensary work; neurasthenics are trying patients, and the physician easily slips into an attitude of indifference or exasperation. It is difficult to exaggerate the advantage of putting the patient at his ease in the very beginning and making it easy for him to tell his troubles and their real or imaginary causes."

Valuable suggestions are offered for aiding the patient in the control of his emotions as well as his physical unrest. The patient should shun all controversies, conversations about health or disease and writings of medicine or hygiene, whether good or bad. He must absolutely cease studying his own case. The patient must treasure up pleasant things to think about and be ready to take refuge in such thoughts whenever his bad feelings are most troublesome and other diversions are impracticable. As an aid in substituting relaxation for tension the habit of breathing deep and regularly is of the utmost value. Regular breathing helps to overcome palpitation and circulatory disturbance, and is therefore conducive to tranquility of mind. It is by this process that

we learn to overcome the habit of crying in childhood, that we are cured of stagefright, and that we learn to face trying situations of all kinds. The patient should be drilled especially in correct breathing, so that when he is threatened with a disturbance he can apply the remedy.

The writer speaks of the futility of drugs in general in neurasthenia. The bromides he has found useless. Alcohol serves a useful purpose but is a dangerous remedy. He is of the opinion that opium is the best drug agency to assuage neurasthenic symptoms, but must be employed in the most judicious.

manner.

COUGH SYRUPS.

The average cough syrup is intended to soothe and allay coughing and usually its components are on the "shotgun" order, a little of everything that is "good for" cough thrown in. Very few cough mixtures are really intended to promote a cure by reason of a reconstructive process. Tar, creosote, cod liver oil, and a few other agencies may, of course, exert a benign effect upon the disease process. But the main things that we expect from a cough medicine in routine practice are sedation and relaxation. Opium in some form is the most reliable for the first action; bromides and nervines in general may have a modicum of value. Perhaps as a relaxant of the bronchial secretions we have no more useful drug than ipecac, or emetine. Opium and ipecac in combination make about the best hit-or-miss cough medicine that can be devised. We have these drugs well presented in the old-fashioned dover powder, there being enough milk sugar in the combination to steady the absorption. It may be administered in capsules or in tablet form, or if preferred, as a syrup.

324

THE PHYSICIAN AS A BUSINESS MAN.

This is an old topic, and we can't blame you, doctor, if you skip it in this instance. There are, of course, many physicians who are shrewd financiers and money grubbers. The rank and file of the profession are not prosperous financially and, sad to relate, many are rated by business men as dishonest. Doctors, above all other men, seem to have a knack of getting head-over-heels in debt. At heart they are perhaps honest and sincere, but too often they are disposed to live and buy on the prospect of future collections. All doctors think they are going to make more money next year than this, but they seldom do. Some one has aptly said that we can always divide by two the money we are going to receive.

The

far-away hills look greenest. If doctors could collect their bills in the way they should there would be less complaint along this line. Unfortunately, many of them fall into the same dilatory ruts that their undesirable patients are in and form the habit of standing off creditors.

Physicians, perhaps, have many excuses for being dilatory in financial matters. but excuses do not justify our course of conduct. It pays the physician always to make no more bills than he can promptly meet and then meet them. There is something incalculably satisfying about knowing that one's credit is good.

The man whose credit is good never wants credit. That is something to ponder over. Credit is usually like all other virtues-an abstract thing which we are seldom called upon to use.

We believe that much of the financial stress experienced by medical men might be avoided if they would practice a rigid. economy and live within their incomes. Dispensing doctors often buy lavishly because of the siren song of the retail man. While the doctor must read and advance himself if he would succeed, yet he often buys absurd medical books that are good only for (costly) ornamentation.

There is one sort of debt which should be assumed by the doctor who is struggling to make ends meet. After locating in a community where future prospects seem fairly good he should purchase a home and start payments thereon. He will then have

an end to which he can work in earnest. The doctor who invests in a piece of real estate, be it ever so small, will start to acquire business sense and will not fritter his money away on things that give him no adequate return.

THE CRYING BABY.

There is, of course, no such a thing, per se, as "three months' colic." It is, however, a well known fact that many babies the first few days of their lives start their parents in on a troublous life, and this may persist several weeks, and even until dentition. Most of the remedies directed toward the alleviation of so-called three-months'colic are unavailing. In a goodly per cent. of cases of crying babies the youngsters are healthy, are fairly well nourished and may grow lustily. When the baby does not thrive and gain in weight, the untoward condition should be sought out and remedied. In the great majority of cases of this class the trouble is due to wrong habits engendered during the first few days. and then, unfortunately, perpetuated for days and weeks thereafter. These nearly always relate to improper feeding. The more common trouble is feeding too often, or "every time he cries." Usually the rest and sleep of such a child is all out of adjustment. The stomach of the new-born babe is a small and delicate affair, and what goes into it, and when and how, are matters of vital importance. Nearly everything depends upon the way the babe is started out. Improper methods of feeding can in a few days' time engender habits which cannot be broken up for weeks or months. It would be well to instruct every mother as to the capacity of her infant's stomach, which is is follows:

At birth, one ounce.
Two weeks, two ounces.

Three months, four and one-half ounces
Six months, six ounces.
One year, nine ounces.

An application of oil of wintergreen is useful when removing adhesive plaster.

Zinc ointment is useful in bed-sores. First cleanse with alcohol.

Articles contributed for the

DRUG CONCENTRATIONS.

BY GEORGE L. SERVOSS, M.D.

Time out of mind, the question of standardization of plant drug products has been uppermost in the minds of those of the medical profession. There has been a season for this. Until within recent years, so to speak, but few, if any, plant drug products were standardized. With the recognition of the alkaloidal contents of certain of this class of drugs, the finished products thereof were made standard through having therein a certain known percentage of the alkaloids thereof. In so far as alkaloidcarrying plants were concerned this gave the physician a better medium, to a great extent, although even such standardization did not solve the question, wholly. Although such products were standard when first prepared, it was only a question of time until deterioration, either through climatic conditions, evaporation, or some other natural reason, such articles showed more or less change. Those plants carrying no such demonstrable active principles could not be so standardized, although an effort was made, through physiologic tests, to place upon the market products of comparatively the same strength. These, like the ones carrying known and demonstrable alkaloids, were likewise susceptible to the elements and did not retain their standard qualities indefinitely. As with the plant products carrying alkaloids, it was possible to standardize some of those made from plants carrying resinoids and glucosides. In many instances, however, it was practically an impossibility to give any exact standard to those carrying mixed glucosides.

With the segregation and isolation of the alkaloids the standardization of the products from plants carrying them became a a matter of great ease, in that the isolated

alkaloids themselves, minus other drug contents, were employed. The same was true of many of the glucosides and resinoids. This solved the problem in so far as products from plants carrying known active principles might be concerned.

But there are numerous drugs of this sort which have no demonstrable active principle contents and which seldom give us either fluid extracts or tincture of absolutely known strength, either at the time of manufacture, or thereafter. While such drugs, or rather drug products, have been employed with more or less satisfactory results, many of us have preferred the drug in its natural condition and unmanufactured in preference to the products thereof. This preference has not been because of any exact knowledge as to the active contents thereof, but simply because of the fact that the individual doses thereof might be better regulated.

To-day we find that many of the plant drugs, carrying no known alkaloid, or other demonstrable active content, have been reduced to their simplest form possible, through concentration. This does not necessarily mean there is any absolute standard of strength in such finished products, but it does mean that much extraneous matter is eliminated through such concentration and that we are given products of higher activity than are others of the same drugs. The dirt and any possible inhibiting contents of the drugs considered, have been removed, so that those portions of the drug retained possess practically all of the therapeutically active portions of the plant. These concentrations are superior to the old-time galenic products from the same plants. The latter not only contain the active portions of the plants, but in addition carry other plant contents which may interfere, and seriously, with the activity thereof.

Not only are such products more cleanly

and usually more active than are the other preparations from the plants, but in ad dition, being reduced to their simplest possible forms the matter of dosage is more easily established. It is a matter of comparative ease, through physiologic tests to determine the comparative dose between the concentrations and the whole plants themselves. This also establishes practically an absolute dosage, in that these concentrations are, as a rule, physiologically tested by the manufacturers prior to being offered to the doctor.

There is another feature in favor of the concentrations, that being the amount of the drug required for the individual dose and the form in which it is administered. The old-time galenic required considerable amounts of fluids to be administered. These were very frequently ill-tasting and ill-smelling, at times nausient and not infrequently even emetic in effect. Because of the latter fact, were the patient to vomit immediately after the exhibition of a medicine the doctor was at a loss to know whether or not any of it were retained. Because of this fact, through loss of the remedy in such manner, results which should have obtained were very frequently not forthcoming. Under the older system of dosage it was thought proper to exhibit such amounts as would produce full physiologic effects with each individual dose, and the patient was overwhelmed by the drug. This was not only true with the products with intermediate principles, but of all other galenics. With the discovery of isolation of the alkaloids, resinoids and glucosides the dosimetric system of small amounts and frequent applications thereof, to either physiologic or therapeutic effect, was adopted and it was found that there was less distress, or other things undesirable, exhibited by the patient. Drugs which had hitherto produced nausea, vomiting or idiosyncrasy, were found admissable of application without the production of any such results. With the adoption of the concentrations of drugs carrying no monstrable active principles the same system of dosage was adopted, and with results which were eminently satisfactory. It was found that, instead of administering large amounts of fluids, the concentrates could not be exhibited in small pills, tab

re

lets or granules, and that they were swallowed without leaving any unpleasant aftertaste to worry the patient.

When the alkaloids, glucosides and resinoids were first offered in their isolated forms there were certain doctors who said that, owing to such segregation from other contents of the plants, such products would not give the whole effect, as obtained from entire plant products. With the concentrations they will have no such fault to find, in that aside from the dirt and inhibiting portions of the plants so treated, the whole thereof, in so far as therapeutic effects may be concerned, are retained.

In spite of the fact that no real active principle is demonstrable in these concentrations, they are to all intents and purposes standard in every way, in that they are reduced to their simplest possible forms and through physiologic tests are given a determination of dosage as compared with the whole plants from which they are obtained. Unlike the fluid extracts and tinctures, these concentrations are not subject to change due to atmospheric, climatic or light effects. There is no fluid to evaporate, consequently no precipitate to contend with, with the result that the remaining fluid is undeterminable as to activity without further assay. Like the alkaloids, glucosides and resinoids, the concentrates are unchangeable, if properly manufactured and may be kept on hand indefinitely and with an assurance that they will be at all times active.

Gardnerville, Nevada.

CLIMATE AS A FACTOR IN THE TREATMENT OF TUBERCULOSIS.

BY S. F. WALKER, M.D.

In the October, 1913, number of THE SUMMARY there is an editorial on sending consumptives away that contains much advice that eastern physicians would do well to heed.

The time was, a few years ago, when the subject of tuberculosis could find light employment by which he could make his way, but in later years people have become so afraid of contracting the disease that many will not trade at a store where a clerk has the appearance of being a sick man, so that

nowadays all of this class of sufferers should be supplied with all the funds necessary to keep them.

I wish to make some remarks in regard to the results of climate, as I judge from what I read in current medical literature that a very large portion of the medical profession are of the same opinion as the editor, and this opinion is based on experience and observation, but if those physicians could put in two or three years of experience and observation in the right part of the Southwest, they would change their opinions, for, beyond all doubt, climate is possessed of decided curative value in this disease. At least, that is my opinion, based on six years' observation and a limited office practice of two years of this time.

There are several factors that cause eastern physicians to have little faith in climate. Many come to the Southwest too late; they defer coming until the disease has reached a stage where recovery should not be expected. It seems to be a fact that a large number of physicians treat all of their tubercular patients just as long as there is any chance of recovery left, and then send them to the Southwest, and one can hardly escape the conclusion that the majority of eastern physicians advise their patients to go to the wrong place and the case continues to grow worse until they are advised to go to some other place to die, or return home in worse condition than when they left.

At least this is the opinion one forms from talking with many who have been sent to California and Colorado. It is, to say the least, strange that any eastern physician should send his patients that are subject to hemorrhage to Denver, or Colorado Springs, or to California for a winter residence.

One lady said to me: "I was not in Denver 48 hours before I had a hemorrhage, although I never had a hemorrhage before I went there, and the physician I called told me that he was surprised so many physicians of the East sent their tubercular patients to Denver; that no cases subject to hemorrhage should be sent there, and told me to get out just as quickly as I could, and since I came to New Mexico I have had no hemorrhage."

Another class come to the Southwest that make satisfactory improvement and at the end of several months they are so much improved that before fully restored to health, and regardless of the advice of the physician and friends, return to the East and soon relapse.

Another class pick up and gain after coming and improve in every respect, yet this class enjoy improved health by an arrest of development of the disease, and should not return to the East under three to five years, as relapse is very liable to occur to this class, even in the climate where the improvement occurred, though they may regain perfect health after a time, but so long as they remain in the state of arrest only, a mild attack of lagrippe or a cold may get them back to where they were, or even worse. This class may count on an early relapse, with absolute certainty, on return East.

Many of the old residents of this section who have observed many cases, do not hesitate to say that the climate will cure all who come soon enough, and if the most skeptical physician of the East could drop into some of the older towns or settlements of the Southwest, and take a census of all those who have had tuberculosis but that are now in the best of health, whose personal appearance does not indicate that they ever suffered from the disease, he would be surprised.

We see many that are in good health that we are told came here in such a debilitated and reduced state that they were not able to walk a few blocks, that it was necessary to carry them on a stretcher to their rooms, and for the most part these cases all recovered their present good health from the effects of climate alone, as they took no medicine, except cod liver oil, the hypophosphites, etc., so-called constructive remedies, but it must be admitted that we see fewer recoveries in so far advanced cases as resulted in former years.

Whether this is due to a change having taken place in the climate since the country is being settled and the soil cultivated, or whether due to a different method of treatment (all advanced cases of late years take some one of the hypodermic treatments in vogue), and I must say that my observation and what I glean from patients