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peated purging, with violent pain and passage of considerable amounts of blood. Diarrhea was continued to some extent during the next day, with frequent donations of "gallstones," which promptly rose to the top of the chamber of water, used according to instructions.

This behavior of the gallstones was anticipated by the patient, for the directions upon the bottle stated plainly that "only the heavier" stones would sink. There proved to be none of the heavy-weight class, however, but the other variety was passed in liberal quantity. These "stones" ranged in size from minute globules to the size of a hazelnut. They were light green in color, soft in consistence and easily crusht. They are readily soluble in ether, and upon exposure to heat the spherical or oblong form is lost, the individual stones losing their identity and becoming melted together in a greasy mass.

Under separate cover I am mailing you a sample of the "gallstone cure" and also a vial containing four of the "stones" passed; these are now, however, fused into one mass because of the bottle being left in a warm night.

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Patient says she feels much relieved and notes an absence of the usual fulness in the right hypochondriac region. She refuses, however, to duplicate the treatment (as directed by the Hepatola concern), owing to its drastic action and because of her waning confidence in the genuinness of the stones.

For a time, however, she felt enthusiastic over her cure and would probably have been willing to add her testimonial to those already possest by these quacks, who obtain them under like circumstances from those who are not familiar with the real appearance and characteristics of gallstones, and who consequently fall easy victims to the advertising shark. The relief from distress following such a course of treatment is probably only such as would naturally follow a thoro cleaning out of the intestinal tract. Glyndon, Minn.

L. M. Lowe, M.D.

[The "gallstones" sent us were undoubtedly oliv oil soap lumps made in the woman's intestins by the action of heat, sodium bicarbonate, Rochelle salt, tartaric acid and oliv oil. It reads very much like the "fruitola" fake (see "Nostrums and Quackery," second edition, page 481). Oliv oil and Seidlitz powders will do the same thing and are considerably cheaper when bought as such. The oil in the other bottle appears very much like oliv oil. See MEDICAL WORLD, September, 1914, pages 374 and 375.-ED.]

Locomotor Ataxia.

DEAR DR. TAYLOR:-Do you know anything as to the success of Dr. C. H. Burton's, of Detroit, Mich., treatment of locomotor ataxia? He sends out a booklet to prospectiv patients, and claims to cure many and greatly help practically all. I am writing you this for the benefit of a patient of mine that has gotten hold of some of this man's literature. He says in his booklet the patients must come to his office and receive hypodermic medication for one month and then return in four weeks and repeat the treatment two or three times at intervals. I supposed it to be a fake, but decided to ask your opinion. Floyd, Va.

M. L. DALTON, M.D.

["Nostrums and Quackery," page 690, gives the following:

"Burton, who is a graduate of the Detroit Homeopathic Medical College, used to live at Hastings, Mich., where he was associated with that notorious fraud, 'Drs. Mixer,' the cancercure fake which was put out of business by a fraud order issued by the postoffice and by prosecution under the Food and Drugs Act. Since the Mixer concern has ceast to be a source of income for Burton he seems to have turned his attention to the exploitation of an equally cruel fraud, that of selling a fake cure for locomotor ataxia."-ED.]

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[We quote the following from the Journal of the American Medical Association:

Collier's paid its respects to the Kellam concern some time ago and we cannot do better than quote from its pages. Thus:

"Grief is the portion of the Kellam Cancer Hospital, of Richmond, Va., because in these editorials it has been grouped with other exemplars of the Great American Fraud. It offers the invariable and hollow mockery of testimonials and endorsements, which, as has been repeatedly shown, can be wheedled, browbeaten or bribed out of the victims of any form of quackery. It, of course, courts the fullest investigation, and desires that we send a representativ to investigate whether its claims are not well founded. Unsuspected by the Messrs. Kellam, our representativ has already investigated their claims, notably their statement that they are endorsed by the Legislature of the state of Virginia. Upon request for a copy of the endorsement they forwarded a weak subterfuge, and finally, on pressure, admitted that they could not produce the proof they had boasted. For their further consideration we present a brief parallel :

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"The italics are our own, but we cheerfully present them for elucidation to the Kellam Hospital. A little careful thought devoted to reconciling the irreconcilable may help them to forget their wo. Meanwhile, they make themselves out worse than they really are by pretending to withhold from the bitter need of humanity a true, non-surgical cure for cancer. If this were true; if, indeed, they had solved the problem which has baffled the greatest minds of modern science; if, having a genuine cure for the dreadful ailment which claims its increasing thousands of tortured victims yearly, they secrete their discovery for the sake of a few paltry dollars, then they are as cold-hearted as the sailors who pass within fair hail of the naked island on which some shipwrecked crew is starving, and keep their stony eyes on the compass. They have not even the excuse of the fanatical among the Christian Scientists who, denying the existence of pain, refuse to take measures to ease the cancer victim's suffering even at the last. Human nature is seldom so callous." After all is said and done, it is enlightened public opinion that is causing publishers of lay magazines and newspapers to eliminate fraudulent "patent medicin" and quack advertisements.-Jour. A. M. A., October 18, 1913.-ED.]

CURRENT MEDICAL THOUGHT.

Gleanings from Current Literature. Simon observed the sudden appearance of hematuria in six cases following large doses of urotropin.— Amer. Jour. Urology.

Sacroiliac strains are perhaps responsible for the great majority of the so-called sciaticas.-GAENSLEN, Wis. Med. Jour.

The lactose test is of great value diagnostically in determining the existence of abnormal renal function. The significance of its delayed excretion is obscure.-WARFIELD, Wisconsin Med. Jour.

The endoscope showed a large, deep red, bleeding, extremely sensitiv colliculus. Three applications of silver nitrate, 2% to 5% solution, stopt the bleeding and reduced the organ to normal size and appearance.-McCown, Indianapolis Med. Jour.

Arnold Lorand joins Metchnikoff in the fight against old age. He advises many remedies, among them being marriage, iron, arsenic and iodids; and gives twelve commandments for preserving youth. Unfortunately, nobody cares for the preservation of youth until it has passed by.

Properly used, collargolum is as surely a specific for scarlet fever as is antitoxin in diphtheria.— VAN ZANDT, Charlotte Med. Jour.

In treating ague Marshall uses a mass made by adding to an ounce of quinin a dram of capsicum, a dram of hydrochlotic acid and enuf gylcerin to make a pill mass; then dividing into 2-grain or 5-grain pills.-Jour. Ind. State Med. Assoc.

The most telling advantage seems to come from the systematic and thoro emptying of the intestinal tract, in many cases the manufactory of the toxic products. When the bowel has been deliberately rendered and kept clean, the heart has, in my experience, seemed to have its best opportunity for rehabilitation. The moment the bowel has been neglected the heart has apparently suffered in a measure that is not to be explained on the basis of mere mechanical embarrassment.-WILLSON, Jour. Am. Med. Assoc.

Strychnin is a well-selected remedy for abdominal enlargements, as this salt contracts the relaxt veins of the abdomen.

Nobody has yet explained how or why viburnum stops threatened abortions, but many observers testify to the fact that it does so.

Has the enlightened science of the twentieth century developt any better application for slight wounds than the ancient Fryer's or Turlington's balsam, or opodeldoc, otherwise compound tincture of benzoin? It is antiseptic, and, forming a varnish over the wound, keeps germs out.

While mammary abscesses may be aborted by applying and giving phytolacca, the same benefit may be had by applying very hot wet cloths, changed very frequently, and keeping the bowels open freely. The prompt injection of a vaccine is the best treatment.

The excessiv generation of gastric acid is restrained by full doses of atropin; better than by any quantity of soda.

Vast quantities of soda are taken habitually by the French; this element forming the principal ingredient of their favorit Vichy springs water.

For acne empty the bowels and give the arsenic salts, any of them, pushing the doses to full tolera

tion. Echinacea has been advised, applied to the prostatic urethra and given internally. And acne vaccines have been used successfully.

While pilocarpin certainly increases the milk secretion, it does so at the expense of the mother, and may occasion mental derangement. Rather give better food and more rest; and if the mother does not give enuf milk, use a substitute for her or it.

Before treating any amenorrhea wait a few months. All women are liars when it comes to facing shame; and no unmarried woman, when pregnant, has any conscience.

Tuberculosis is never an effect, but always a cause of amenorrhea. Nothing is gained but much lost by forcing menstruation in consumptivs.

In most cases of debility there is a leakage of force. It may be the constant irritation of a corn, a defectiv eye, improper eyeglasses, unsound sleep, worriment, trouble, a nagging wife, a hectoring husband, or any one of innumerable causes that deplete the stock of nerve energy and prevent the accumulation of a reserv.

In all cases of neurasthenia look for the leak, and for tapeworm and other intestinal parasites. How often we stumble over the little and the common things while looking over the far-distant mountains for causes of trouble!

For collapse raise head and shoulders, stimulate by strychnin, caffein, oxygen, saline transfusion and pressure on the abdomen.-OVERTON, Southern Practitioner.

Cervical erosion with backward displacement and endometritis are the most common causes of leucorrhea in the virgin.-POLLARD, Southern Practitioner.

Forceps applied to the breech is not generally advocated by obstetricians, but I have succeeded many times in bringing the breech down far enuf so that I could hook my finger in the groin to advantage.-WILLIAMSON, Journal-Lancet.

Phosforus-codliver oil seems a specific for spasmophilia as it is for rickets.-SCHLUTZ, JournalLancet.

Engstad, treating of psychic shock following operations, tells, in the Journal-Clinic, of a girl with appendiphobia, who was submitted in turn to appendectomy, oöphorectomy, hysterectomy, renal decapsulation, and at last began to improve under the treatment she needed, which was nothing at all, as there was and had been nothing the matter with her.

EXAMINATION QUESTIONS.

Kentucky, December 11-13, 1913.

PATHOLOGY.

1. What are the pathologic changes in appendicitis? 2. What are the structural changes in the various types of cirrhosis of the liver?

3. What are the causes of stricture of the esophagus? 4. (a) What changes take place in progressiv muscular atrophy? (b) What is the cause of the changes?

5. Give the pathology of arteriosclerosis.

6. What lesion of the brain and spinal cord would you expect in a syphilitic in the tertiary stage?

7. Differentiate between the sounds of an acute pleurisy and acute bronchitis that you would expect to hear with your ear against the chest walls of a patient.

8. If you were given a specimen of pus and askt to determin the identity of the organ sm that caused its production, give some of the details as to how you would proceed. 9. (a) What lesion do you consider most characteristic of typhoid fever? (b) Describe it.

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* Will accept a diploma without examination if from a recognized college.
† Reciprocal fee is the same as that charged by the state from which applicant comes.
Or its equivalent in the medical college.

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1. Catarrhal appendicitis is characterized by slight swelling and minute erosions of the mucosa. The muscular and serous coats will show slight infiltration and the lumen will contain epithelial and pus cells. In the necrotic or gangrenous variety the inflammatory processes are destructiv. The mucosa is destroyed and the muscular and serous layers are soon attackt. The inflammation involves neighboring surfaces and a fibrinous peritonitis develops. This may be local, and by giving rise to adhesions between adjacent tissues no further extension takes place. The process may be very rapid and perforation follow before any restricting adhesions form; this is accompanied by a general and frequently fatal peritonitis. In interstitial appendicitis there is a tendency toward excessiv connectiv-tissue formation and it generally terminates as a chronic thickening.-(McConnell's "Pathology.")

2. There are two important forms of cirrhosis of the liver; hypertrophic and atrophic. The following table (from Thayer's 'Pathology") will assist in distinguishing them:

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3. The following classification of the causes of stricture of the esophagus is taken from Herrick's Medical Diagnosis": (1) Intraesophageal: Foreign body, mass of food. (2) Interstitial: Neoplasm; cicatrical tissue, as from toxic gastritis, ulcer (syphilitic, peptic); esophageal abscess; congenital; spastic stricture. (3) Extraesophageal: Enlarged glands, e.g., sternal, cervical, bronchial, from tuberculosis, cancer, suppurativ adenitis; mediastinal, or cervical cellulitis; vertebral disease; dislocation of hyoid bone or clavicle; cancer of leura or lung; ossification of stylohyoid ligament; swelling of cricoid; pericardial effusion; cardiac hypertrophy; aneu

rism.

4. Progressie muscular atrophy.-"Two theories as to the origin of the pathological changes are held: one that the initial lesion is in the cord (Charcot), the other, in the muscular interstitial connectiv tissue (Friedreich). The morbid alterations are of two groups: spinal and muscular. The spinal changes consist in the atrophy and degeneration of the anterior columns, wasting and disappearance of the multipolar ganglion cells of the anterior horns with hyperplasia of the neuroglia; rarely, the hyperplasia extends to the lateral columns (amyotrophic lateral sclerosis); also atrophy, and degeneration of the anterior nerve-roots. The muscular changes consist of a progressiv wasting of the muscular tissue, with increase of the interstitial connectiv tissue. The final result is that the muscle is converted into a more fibrous band with numerous fat cells, the development of this latter material taking place outside of the muscular elements and in the newly formed connectiv tissue."-(Hughes' "Practice of Medicin.")

5. Arteriosclerosis. Causes are: Age, male sex, heredity, high living, alcohol, syphilis, uric acid, nephritis, tuberculosis, rheumatism, diabetes.

The large arteries are chiefly affected. The earliest changes are a small-celled infiltration of the subendothelial tissue, which may be either replaced by fibroid tissue or undergo fatty degeneration.

Degeneration usually occurs, and the softened mass either bursts into the artery or becomes converted into a calcareous plate. The process extends to the middle coat, which is at first softened, and the muscular tissue is destroyed in patches. The result is either weakening of the wall and dilatation into an aneurism, or the deposit of lime salts and calcification of the middle coat. The external coat is thickened, and helps to prevent dilatation. The conditions which are secondary to atheroma are thrombosis, detachment of a plate forming an embolus, or "dissecting aneurism," due to the blood-stream getting under a plate and tunneling under the tunica intima. 6. Gumma.

7. Acute pleurisy will give friction sounds, generally on one side only; bronchitis will give fremitus, and is generally bilateral.

8. A pure culture must be obtained. Liquefied gelatin must be inoculated with the mixture of bacteria, and after thoro agitation so as to separate each cell from its neighbor, the liquid is poured on to the surface of a steril plate. The

gelatin now solidifies and imprisons, as it were, the separated cells. Each of these now multiplies and reproduces its kind; eventually, in the course of a day or two, a small growth, perhaps of the size of a small pinhead, appears. This is called a colony, and since it is derived from a single cell it constitutes a pure culture. Such is the principle of the dilution method for obtaining pure cultures. The isolation once accomplisht, all that is necessary is to transplant the colony to steril culture media so as to keep up the growth—("Reference Handbook of the Medical Sciences.")

9. The most characteristic lesion of typhoid fever is found in the lymphatic structures, especially in the solitary follicles, Peyer's patches, mesenteric glands, and spleen. In the first stage of typhoid fever Peyer's patches become swollen, hyperemic, and reddened; a few days later they appear as whitish or gray elevations, and the hyperemia has disappeared; the surface of the patch is smooth and its edge is sharply defined; after the first week necrosis may occur; the center of the patch becomes softer, more yellow, or sometimes even red from the absorption of blood pigment. The necrotic portion falls off, leaving an irregular ulcer, with necrotic and undermined edges. These ulcers are elongated, with the long axis parallel with that of the intestin, and a smooth floor. The ulcers may heal or go on to perforation.

The spleen becomes congested and enlarged, is liable to infarction, and contains the bacilli.

10. A sequestrum is a portion of dead bone which is separated from the living bone.

"This separation occurs by the process of demarcation, as in necrosis of the soft parts. This line consist of an area of absorption of the calcareous matter and proliferation of the cellular elements. The necrotic portion, or sequestrum, acts as a foreign body, and by its continued irritation keeps up a suppurativ inflammation of the surrounding tissues. Fistulous communication with the exterior is usually observed. If the sequestrum is peripheral and has been discharged, the periosteum or the bone may replace the lost tissue by regeneration. If the fragment is large or centrally placed, discharge is impossible and suppurativ inflammation continues, sometimes for years. In these cases considerable hyperplastic material may be deposited over and around the sequestrum, and thus irregular thickening of the bone may be produced." -(Stengel's "Pathology.")--Medical Record.

(To be continued.)

BOOK REVIEWS.

A TEXTBOOK OF GENERAL BACTERIOLOGY. By Edwin O. Jordan, Ph.D., Professor of Bacteriology in the University of Chicago and in Rush Medical College. Fourth edition, thoroly revised. 647 pages, fully illustrated. Philadelphia and London: W. B. Saunders Co., 1914. Cloth, $3, net.

A new chapter on "The Filterable Viruses" appears in this edition, and important matter on poliomyelitis and whooping cough has been added. Bacteriology of streptococcus sore throat has a new section. A general introduction to pathology is attempted with emphasis on the general view rather than on special lines. Enuf bibliographic references are given to be of "first aid" to the investigator who wishes to follow the line deeper. The fundamental principles of laboratory work with the methods followed are outlined, but it is pointed out that successful laboratory work is possible only under a capable instructor. The text is excellently devised for the use of the general practician wishing to glean a general comprehensiv view of the vast field he has no time to go over thoroly, yet of which he cannot afford to remain entirely in ignorance.-A. L. R.

PSYCHANALYSIS: ITS THEORIES AND PRACTICAL APPLICATION. By A. A. Brill, Ph.B., M.D., Chief of Clinic of Psychiatry and Clinical Assistant in Neurology, Columbia University Medical School: Chief of the Neurologic Department of the Bronx Hospital and Dispensary. Second edition, thoroly revised. 393 pages. Philadelphia and London: W. B. Saunders Co., 1914. Cloth, $3, net.

This edition contains fifty-seven more pages than the one preceding, made up of new material of a practical and instructiv character. A glossary of psychosexual and psychanalytic terms is added, and many supplementary notes are incorporated. While the text is thoroly revised,

there has been little need of change, even in the face of the mass of psychanalytic literature appearing since the first edition. Without doubt the profession is becoming more favorably imprest with the views of Freud, and this text sets the basic ideas forth fully and painstakingly plainly. The author places psychanalysis among the specialties, and deplores the "work" of "wild psychanalysts who had no conception of what they are doing." Anyone who intends taking up this line of investigation will be guided straightly in the channel mapt out by Freud when he follows this text. The author is intensely earnest, and without question honest and sincere. He deplores the condition in many circles, as follows: "Unfortunately there are very few men in this country who take the subject seriously. Most physicians either ridicule or scorn those who have the courage to cope with sexual problems." A text like this will do much to change such conditions.-A. L. R.

A TEXTBOOK OF MILITARY HYGIENE AND SANITATION. By Frank R. Keefer, M.D., Lieutenant-Colonel, Medical Corps, United States Army; Professor of Military Hygiene, United States Military Academy, West Point. 305 pages, illustrated. Philadelphia and London: W. B. Saunders Co., 1914. Cloth, $1.50, net. Subjects of chapters are: The Care of Troops; Recruits and Recruiting; Personal Hygiene; Physical Training; Preventable Diseases; Clothing; Equipment; Water Supply; Foods and Their Preparation; Sanitation of Posts, Barracks, and Transports; Hygiene and Sanitation of Marches, Camps, and Battlefields; Disposal of Wastes; Tropical and Arctic Service; Venereal Diseases; Alcohol and Other Narcotics. The book will prove of great service to the National Guard medical and line officers, and incidentally to all medical men in these times of war in foreign countries. It is excellently devised and executed, small, compact, clear and concise.-A. L. R.

The Medical Pickwick makes its first appearance with a magnificent January issue. It relates to the leisure of the doctor, giving history, anecdotes, fiction, poems, etc., of medical men, medical lore and medical topics of all sorts, containing many snappy articles. The Pickwick is to amuse and entertain the doctor, and will not contain any articles on the practise of medicin. It is publisht by Dr. Joseph MacDonald, Jr., of New York, and Dr. S. C. Martin, Jr., of St. Louis, and will be edited by Samuel M. Brickner, A.M., M.D., of Saranac Lake, N. Y. The subscription price is $2 per year. Address the Medical Pickwick Press, Saranac Lake, N. Y.

Acknowledgments.

Lantern Slides and Exhibit Cards Illustrating the Evils of Nostrums and Quackery. Prepared by the Propaganda for Reform Department of the Journal of the American Medical Association. This is a catalog of lantern slides and placards prepared to show the public the fraudulent side of various nostrums. The use of these thruout the United States should be productive of much good. Publisht by Amer. Med. Assoc., 535 N. Dearborn St., Chicago, Ill.

Malaria: Lessons on Its Cause and Prevention. For Use in Schools. By H. R. Carter, Senior Surgeon, United States Public Health Service. Supplement No. 18 to Public Health Reports, Washington, D. C. Cancer in Plants. By Erwin F. Smith, U. S. Dept. of Agriculture. Washington, D. C.

The Continuous Warm-Water Bath the Rational Treatment in Tetanus. By A. Rose, M.D., New York. The Effects of Goiter Operations upon Mentality. By W. S. Bainbridge, Sc.D., M.D., New York City.

OUR MONTHLY TALK.

In the realm of public affairs, one subject overshadows all others. Who cares now for old age pensions, or any other socio-political subject? Over 300,000,000 people, white people, supposedly civilized people, are at war! No such war was ever dreamed of before. No such murderous! machines were ever used against mankind be fore. Battles in air have become a horrible reality; and battles under the sea.

No epidemic that ever occurred compares with it. Epidemics take the weak, the aged, the diseased. War takes only those in the prime of life and health-the best blood and only males. It leaves the aged and decrepit, women and children, and makes slaves of them. What's the use of trying to save life when war destroys life so_ruthlessly?

Deficiencies in government kill faster than the medical profession can save life. If the human race knew how to govern itself properly, of course there would be no war. If disease is ignorance, certainly war is ignorance. A street fight usually denotes ignorance (low development) or intoxication, or both. Enlightenment shows how to settle difficulties amicably, preventing fights, and would prevent wars. It seems that the study of government is the most important study in civilization, even more important than medicin.

So many men were never in armed conflict before. Offensiv military operations were never prest so vigorously and so continuously before. It is now midwinter. Armies used to go into camp for winter and resume operations in the spring. Now battles are continuous regardless of the weather, and in several widely separated sections of the war-infected countries at the same time-in northern France, in Poland, northern Austria, etc. Nothing like this has ever occurred before in military annals. Two or three important battles sometimes occur in a single day, involving millions of men! Compared with this stupendous tragedy, other public affairs seem small indeed.

But we, here in this country, have had sense enuf to federate our states, and place all matters concerning war and peace, as well as many other important matters, in the hands of a central government, made up of all the states, thus securing peace and a community of interest among the states.

The business of government, even under the conditions of peace, is an important and difficult business. We are 3,000 miles from the war. Our Congress and about forty state legislatures are in session. New governors have just been inaugurated in many states.

Many problems, new and old, local and national, are pressing for settlement. While we are stunned by the war, we must attend to our own problems.

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*Talk” may be separated from THE WORLD by cutting this and the nex

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