Recently it was recommended in cases of diphtheria, to spray the throat with cultures of staphylococcus, or "pus germs." The physician recommending the treatment, in a number of instances caused, by means of such a spray, the disappearance of the diphtheria growth and the convalescence of the patient. More recently a case has been reported in which the use of the staphylococcus spray was followed by tonsilitis. In the same issue of the Journal A. M. A. (August 6) another physician recommended a spray of lactic acid bacilli (Bacillus acidi lactici) for the removal of diphtheritic membranes. The latter recommendation would seem to be less likely to be followed by bad results.-Life and Health.

THERAPEUTIC VACILLATION.

The mantel-piece in the room where there has been a protracted case of sickness is often literally covered with half-emptied bottles, powder and capsule boxes, etc., etc. Now, all this vacillation and unsteadiness in treatment would not occur if the physician took the pains to get a correct diagnostic line on a case, and pursue a stable, definite course. The difficulty is, too much haste, carelessness and failure to note the true symptoms. If a definite treatment, persevered in, is followed, one can get results that can never be obtained by instability and vacillation.

In bronchitis or pneumonia when sharp, cutting pains are present, or when the cough is dry, accompanied with tightness in the breast, asclepias should be one of the agents prescribed. In these pectoral troubles, just named, the large dose is to be avoided, the small dose being required. Ten to fifteen drops to the four ounces, the age and the state of the patient considered, is a sufficient one.-Dr. Simmons in Therapeutics.

The London Radium Institute believes that radium furnishes the best treatment for psoriasis, rodent ulcer, certain forms of eczema, localized moles, warts, vascular nevi, and keloid, and such opinions are confirmed by the French investigators. We are rejoiced to know this, but it is doubtful if such treatment will become universal at the present ruling prices of radium.

Dr. L. L. Ten Broeck, of Minneapolis, Minn., claims to have discovered a fungus that will destroy the germs that form the membrane in the throat of a person with diphtheria. This fungus is helpful in the treatment of the disease, but is not a substitute for antitoxin.

In cases of inability to evacuate the bladder without special irritation, an injection of a two per cent. solution of boric acid and glycerin into the urethra will prove very effective.

our next.

A FEW NOTES AND COMMENTS.

Editor Medical Summary:

Permit me to kindly criticise the December SUMMARY as being very good-the more practical articles I read the more a number of text-books of theory feel like a dry scab on the mental horizon. The man that has self-confidence and courage to profit by experience is the medical scientist of today, and the man that will occupy the field, should not be selfich with his hard-earned information, but should share liberally with the laboratory man.

I read everything medical that comes in sight, at the age of sixty-seven, while in the prime of life, my practice is more interesting to me than ever before.

As the season of pneumonia is with us, and I have recently read many articles relative to treatment, but none on etiology or pathology of the disease, will write on neither, but wish to present a method of treatment which I have practiced for more than twenty years, and which has very seldom failed of success, and will say for the information of readers that it is no experiment, as I can cite a great many that have recovered by this treatment, and the fact of it is known by all observers on my field of practice, I make the above statement, hoping that the following report may prove interesting enough to persuade other clinicians to try it and prevent the great mortality of the disease, which I wish humbly to say is unnecessary.

While the report may be contrary to long established theories and practice, permit me to kindly say all of the theories in the world cannot successfully contradict it.

As soon after the initial chill as possible, I institute eliminative treatment and con

tinue it until the disease is aborted or resolution is established by securing free alimentary canal and glandular elimination, relax nerve tension and reduce temperature, if indicated, which is seldom necessary if proper elimination is secured, thus relieving the lungs of the toxins which have accumulated and caused congestive inflammation and blood stasis during the effort of the lungs, whether vicarious or not, to rid the system of the poisons, whatever they may be. A diffusible stimulant may occasionally be indicated, but never a true heart stimulant, if the heart is normal to commence with. It seems possible to my mind that heart stimulants administered in treatment of pneumonia might be responsible for much harm by forcing coagulated blood into the pulmonary artery.

A fact worthy of mention is that during all of those years I have never prescribed a dose of opium for relief of pneumonia pain, and if I ever gave a dose of opium to the desired effect that did not appreciably affect some secretive organ of the body I do not remember it.

With by far the greater number of my pneumonia patients the disease is aborted or resolution is established from the fourth to the seventh day by lysis., A case so treated seldom ends by crisis.

In closing permit me to say the above fact has been demonstrated time after time, and is being demonstrated with patients now under treatment.

I think I have written my former experience and observation of treatment of the disease many years ago, when it was diagnosed as lung fever, or winter fever; also my experimental reasons for adopting my present method of treatment.

Bennett, Mo.

T. C. ESTES, M.D.

SYRUP OF HYDRIODIC ACID.

Editor Medical Summary:

It is a well known fact that iodine has a wide range of action in various diseased

IN RE DOCTOR CURRAN.

Editor Medical Summary:

When, a few months ago, I remarked that the country doctor was coming into his own, it was not with the intention of

of iodine and iodides, and each has its special indications to a more or less extent. In many cases with no special indications only for the use of iodine it will be found that the syrup of hydrodic acid is the best preparation, as it is better tolerated by the stomach than any other iodine preparation, and is more readily absorbed and more pleasant to take. I was licensed to practice medicine December 16, 1902, and have found by personal experience that most patients prefer medicine in fluid form and in a palatable form or vehicle. Syrup of hydriodic acid has these advantages, it being in a palatable fluid form. In my personal experience of a little over ten years' practice I have found that acids have a far wider range of action than alkalies, and that acids are more often indicated than alkalies. I discussed this subject fully in my article on "The Acid and Alkaline Theory," April, 1906, American Medical Journal.

Syrup of hydriodic acid, the way it is usually made, is not a stable article, but Henry K. Wampole & Co. make a syrup of hydriodic acid called glycerodine, which will keep indefinitely, and this is a matter worthy of consideration. In some cases of syphilis the stomach will not tolerate potassium iodide very well, but will tolerate the syrup of hydriodic acid. If desired the syrup of hydriodic acid can be combined with mercury in syphilis. Here is a prescription for a two-months child that was used with a case that made wonderful improvement in three weeks:

R Syrup hydriodic acid..... .3j.
Mercury bichloride.
.gr. 1/8.

Aqua and syrup....ãã q.s. ad 3iv. M. Sig. A teaspoonful every six hours. In cases of enlarged glands, chronic eczema, bronchitis, and the numerous other conditions which iodine is used, the syrup of hydriodic acid will prove of much value. J. A. BURNETt, M.D.

Hartshorne, Okla.

tend that I am right in the assertion. I have traveled quite widely among both country and city doctors, and have found the former, in case after case, to be the equal, if not the superior of the latter, as an entire class. I have also read much that has been written by the country doctors, all over the land, and it appears to me that they are equal, in many ways, to the city men.

Of course there are a few men in every city, and more particularly where schools are to be found, who are superior in certain ways, but as compared with the majority, not attached in one way or another to these schools, they are but a handful. In the vast majority, even in the cities, there will undoubtedly be found as much mediocrity. as elsewhere. It was my good luck to carry on a practice in one of the cities of the central part of the country for several years. There were some four or five hundred doctors in practice there. Out of that number about one hundred were connected, in one way or another, with the three medical schools located there. Of the other three hundred it was to be noticed that but few relied wholly upon their own resources, but when encountering a tough case, one out of the ordinary, one of the specialists was called in. On the other hand, in the country, and more especially in the West, where so many of us are far removed from any medical center, I have found the local doctors coping with every problem presenting, and very frequently doing work which the average city man, not a specialist, would not undertake.

And then let us look at some of the city specialists. Some of them have gone into special lines immediately after leaving school, and without having had the benefit of any experience as general practitioners, and there are quite a number of this class. While they may be well posted in the particular work they may be doing, are they as equally well informed in other medical lines? I have been acquainted with quite

a number of this sort of men and have found them sadly lacking in the fundimentals of general medicine. And still they are set up as shining examples for we of the country to follow.

It happens that I have had, for several years past, more than twenty medical journals of all classes coming to my desk regularly. Some of these show very conclusively, based upon the contributions thereto, that many country doctors are subscribers to the various journals, or else the editors have "faked" a good many articles and given credit to the men of the country districts. Even the Journal of the American Medical Association very frequently has an article or two from some obscure country doctor, and it is supposed to be the leader of the American medical press.

Not so very many years ago the Mayos, of Rochester, Minnesota, were classed as country doctors, and reality they are still in that class, in so far as their location may be concerned, as, aside from their own personal clinic, they are not the residents of a recognized medical center. Still they have achieved greatness and are looked upon, both in this country and abroad, as authorities on certain lines of work.

If the country doctors do not read the current medical journals what becomes of the vast number that are printed. The J. A. M. A. is now issuing upwards of 50,000 copies weekly, and I know that many of these go to the country districts. One of the lesser journals, in so far as price is concerned, prints over 30,000 copies every month, and if one can base his ideas upon contributions thereto, it is very apparent that a goodly number go to the men in the country. Even THE SUMMARY, which I have every reason to believe has a considerable circulation, certainly does not circulate entirely within the cities. So that the assertion that from 5 to 6 per cent. of the country doctors are the only readers of the medical press must be wrong. I happen to have, during the years that I was a traveler for chemical and pharmaceutical houses, called on hundreds of doctors, and with but few exceptions I found the current journals, in numbers of one to several, on the tables or desks of practically every man I called on, and they were not sample copies, either, nor were their wrappers still

intact. Not only did I find these journals everywhere, but I also found that they were being read religiously. To determine this fact, on numerous occasions I brought up articles therein and discussed them with the doctors, and found that every one of them was able to give the matter intelligent attention.

Our lay press particularly forces every one of us to do more or less current reading. The general public is being educated in things connected with our profession and the doctor who fails to keep himself posted, through the medical journals, as to what may be happening finds himself very frequently in an unenviable position. When "606" was first mentioned it was in the secular press, and thereby the public at large was made known of the possibilities of the remedy. Within a few days the medical press began mentioning salvarsan, and it behooved the doctor to post himself in the matter, else he expose his ignorance. When the notorious Friedmann signified his intention of visiting this country, his advance was heralded by the lay press, prior to any news to that effect in the medical journals. However, within a very short time the latter had something to say and the doctor who read both was in a position to comment intelligently on the subject, and I have every reason to believe that a great many country doctors did not rely wholly on the daily newspapers for their information, at least those whom I met or those whom I read after in the medical journals seemed to have gotten both sides of the question.

In the medical profession it happens to be results that count. This applies both in the city and country. If this is a fact, then it is very apparent that the country doctor must be prepared to get results, and that those must be equal to any gotten by the men of the city. That they are doing this is very apparent. In order to do this they must be obviously well posted, not only in what may be taught in the books, but that which is taught by the men who are continuously making researches. The latter very frequently does not get into the books for a long time after the work has been accomplished, but it does get into the medical journals at a comparatively early date thereafter. Consequently, if the country doctor

is successful, it is very apparent that he must give more or less attention to the current journals. That he does this I believe to be a fact, Dr. Curran to the contrary, notwithstanding.

I am free to confess that there are some "weak members" in the country districts, but no more in proportion than in the cities. In my city experience I saw just as much poor work done, proportionately, as in the country. On the other hand, I have seen country doctors do just as good work as was ever accomplished in any city, even by a medical teacher.

Dr. Curran brings out one very good point, that of the "reprint" distributing city specialist. It is a notorious fact that many men of this class either write papers for the express purpose of having them gotten out subsequently in reprint form and distributed among both the profession and the laity. This is a form of advertising which is considered ethical. They do not write the articles with the idea of giving the profession any particularly new ideas, but that they may tell others that they, themselves, are doing one or the other special lines of work and with the hopes that cases will be referred through such publicity. The pronoun "I" very frequently figures largely in such communications. All of us receive many reprints but rarely do they come from the country writers. I have watched the progress of the medical associations closely and have noticed that those who have read the most papers have been men in special lines from the cities, and such papers have been read with the express idea of influencing the country doctors to refer more

cases.

The facts of the matter are, that the average country doctor is timid and, to use the language of the street, the city man "has his (the country doctor's) goat." This timidity is very frequently in evidence in the communications sent in to the medical journals and is due to just such contributions as has come from the pen of Dr. Curran. The country doctor is, and always has been, the under dog, and he will so continue until such time as he becomes independent and self-assertive. Communications of the sort that Dr. Curran has favored us with will never act to stiffen a single backbone, for if you continually tell

a man that he is mediocre he will rarely make any effort to be otherwise. If you give him an occasional boost, however, he will soon begin to "sit up and take notice," and finally will begin asserting himself.

That there is more or less jealousy within the medical ranks we all confess. That the country doctor may use the "sledge hammer" in his efforts to gain practice is also to be admitted, or that some of them act in this manner is the truth, but that all are of this class, we cannot admit. Many of the country men are as refined as are those of the cities, and the rapier is employed as frequently in the suburban as in the urban districts. It is true that some country doctors do "cut fees" in order to gain practice, but I have seen city men do the same thing. No one is hurt by this but the man who does it. He invariably fails to give more than value received and is prone to become careless after having done so. And it is not long until the people become aware of the fact that the "cheap man" does "cheap work." Nor is it very long until the man who maintains decent fees gets the major portion of the local practice, and that regardless of fees charged. The people, in this strenuous age, demand results, and these quickly. The man who neglects the determination of proper diagnosis, or who overlooks proper indications for application of remedies, does not last in his community, even though he may make low charges for his services. He who undertakes every mode to make proper diagnoses, and who studies his indications closely, has no trouble in gaining practice, even though his fees may be considerable for each individual observation. The latter invariably gets results, if obtainable, and that quickly, and the people who employ him quickly note that his methods are really economical in the long run, as his cases usually submit early to treatment and his aggregate bills are lower than are those of the man who does poor work at low charges. And this is true in country and city alike.

I regret to note that Dr. Curran will not give attention to any more communications of a personal nature, as this shows an apparent weakness on his side of the affray. If he is so absolutely sure of his ground he should be willing to reply to both public and private arguments. I also regret that