negative and on the right is painful, the burden of evidence is against the appendix as being the offender.

Remember, if you please, that none of us are infallible, and that no one realizes more fully than I how difficult of solution are many of these problems; but I do believe most emphatically that a close and careful study of the character of the pain, and of the rational as well as of the physical signs, will help us to a correct diagnosis, which is the keystone to all of our highest achievements and of prime importance in cases of painful pelvic disorders in young women, where a vent in the abdominal wall for the removal of a normal appendix by the "stump operation" (Price) creates a far worse pathology than that which existed before.-International Journal of Surgery.

CACTUS.

BY H. W. FELTER, M. D., CINCINNATI, OHIO.

The form of cactus employed by Eclectic physicians is the specific medicine cactus, a beautiful green alcoholic preparation, prepared from the green stems of Cactus grandiflorus. It is a fully representative medicine. A form prepared from cactus flowers is valued by some, but is little employed as compared with the green stem preparation. So-called cactin, if there really be such a derivative, has found little favor with the members of the Eclectic school of medicine.

Cactus is primarily a nerve remedy, acting secondarily upon the heart, and to a lesser extent upon the blood-vessels. It acts upon the circulatory mechanism by impressing the intra-cardiac ganglia and accelerator nerves through its control over the great cardiac plexus of the sympathetic. It appears to interfere but little, if any, with the inhibitory centers, nor to impress very greatly the vaso-motor control. Unlike digitalis, it shortens the ventricular diastole, quickening the pulse and thereby, rather than by vasomotor effects, increases blood pressure. Besides this action on the circulatory nervous apparatus it stimulates the spinal nerve centers and gives increased tone to the nervous structures. Clinically it is the ideal remedy for heart weakness due to enervation, and for the control of nervous depression. The experience of Eclectic physicians, whose interest largely centered in drug medication has made them competent observers, shows that the chief value of

cactus lies in its power to control the nervous element and all that depends upon it in functional disorders of the heart, and that for organic troubles of that organ it is less valuable, but is extremely useful to control the nervous phenomena naturally dependent upon such disorders, and in such as can be ameliorated by increasing the nutrition of the heart muscle. While curative in the majority of functional cardiac disorders, it is chiefly palliative in structural wrongs of the heart, and must not be expected to repair damaged valves, enlarge stenotic contractures, constrict expanded rings (only relatively), and repair degenerated heart muscle. However, its control over the action of the organ tends to better many of these conditions through the increased nutrition of the organ, and thus make these torments of life bearable. On the other hand, old-school physicians look upon cactus as of as much value for organic as for functional cardiac disorders.

The effects of cactus are nutritional and quite permanent. It increases nutrition of the cardiac muscle, augments the contractile power, and regulates irregular movements. In this day, when cactus has been assailed by laboratory workers as devoid of therapeutic power, we are glad to place our indorsement upon the statement of Professor R. W. Wilcox when he says: "Cactus has a sphere of action entirely its own, not, however, replacing other remedies for cardiac disease, though it is useful in many cases where these drugs are not only dangerous, but absolutely contraindicated. Failures to obtain results depend upon the fact that many adulterated specimens are found in the shops or upon the use of inert, dried material. If made from the green plant, as it should always be, the fluid extract is of a peculiar green color. Cactus... is the only known remedy which will quicken a slow heart. It deserves better recognition in cases of this kind; few indeed, yet nevertheless presenting themselves; for in such it oftentimes yields brilliant results." (Pharmacology and Materia Medica," p. 296.)

The chief uses for cactus are: (1) As a cardiac governor in functional disorders where weakness due to nervous impairment is marked, and in organic heart disease as a palliative remedy to control the nervous phases and to increase the muscle-tonus of the heart; (2) in depressed conditions of the nervous system with weak heart and poor brain circulation, interfering largely with all the body functions.

The specific indications for cactus are: (1) Impaired heart action, whether feeble, violent, or irregular; (2) heart weakness, functional in character, and dependent upon abuse of other functions; (3) cardiac disorders, with nervousness, precordial oppression, anxiety, and apprehension of danger or death; (4) tobacco heart; (5) "army heart," heart-tire, and other forms of muscular cardiac weakness, due to lowered innervation and muscle fatigue; (6) sense of constriction, as if a band were around the heart region or any other part of the body; (7) dyspnea, with cardiac palpitation; (8) marked mental depression, with precordial oppression, sense of weight and constriction, difficult breathing, and hypochondria.

1. As a Cardiac Remedy.-Cactus will slow a fast heart due to nervous or cardiac weakness, and will likewise stimulate a slow heart due to overstimulation of the sympathetic or to muscular degeneration, to increased action. It seems to matter little whether the heart be feeble, violent, or irregular, provided the underlying cause is lack of innervation, associated with mental depression, or in excitable or nervous individuals it relieves because of its therapeutic tendency to promote normal rhythmic action of the heart muscle. Thus we find cactus of the utmost importance in the treatment of functional cardiac irregularities, as pain and palpitations, whether purely nervous or due to excesses, exhaustion, or dyspeptic association. In the latter instance it is, of course, only of relative importance, for the gastric disturbance demands primary attention. We find it of great usefulness in cardiac dyspnea, rhythmic intermission, spasm of the heart muscle, heart-stitches (pseudo-angina pectoris), all of these associated with the sense of constriction. In true angina pectoris it sometimes relieves, and is especially valuable in cardiac neuralgia and rheumatism when associated with marked enervation. It is of the utmost importance, and this point we would strongly emphasize, in the heart weakness following typhoid fever, pneumonia, la grippe, and other exhausting diseases, when valvular incompetency threatens, the heart muscle is impaired and the nerve force is low. It is equally useful in the cardiac exhaustion following in the wake of excesses-the toper's heart, the smoker's heart, the heart worn from sexual exhaustion, masturbation, and the muscle exhaustion from bicycle riding, of the soldier on long marches, and the brain worker, and of the fretted heart of worry and sorrow and the disordered heart

of the tea and coffee victim. It sustains the heart during fevers, in endocarditis, and in pericarditis. Though not curative in the following, it alleviates and gives nerve strength and comfort: Fatty degeneration, aortic and mitral regurgitation, and valvular insufficiency. It is universally agreed upon that it acts unfavorably in mitral stenosis. Persistent subnormal temperature has been corrected by cactus, and it relieves the unpleasant palpitations in Graves' disease. Cactus gives more blood to the organs by improving the heart action; hence the nutrition of the nerve centers of the whole body is re-enforced, and better health results. Remember that it is only relatively useful in structural heart disease, but that it is nevertheless most serviceable.

2. In the Neuroses.-Cactus is a leader in functional nervous disorders with depression. It acts much like pulsatilla, and is indicated by closely similar indications. If nervousness be associated with cardiac symptoms, cactus is all the more efficient. It increases the blood supply, and hence the nutrition of that organ and the nerve tissues. In our opinion the greatest value of cactus as a remedial agent lies in its power to control the nervous element of cardiac as well as other forms of disease. Cactus improves innervation, and is thus the logical remedy for enervation. Gloomy thoughts, despondency, melancholia, tendency to view life darkly, apprehension of impending danger or death, fear of insanity, irascibility, vague fears, and extreme sensitiveness frequently fade away under the use of cactus. A very common and direct indication is that already referred to a sense of a bandlike or viselike constriction in any part of the body. Cactus is one of the very best agents with which to combat the nervous exhaustion consequent upon excesses of tobacco, tea, coffee, liquor and venery, and brain-tire, brain-fag, weakness from overwork, and the nervous exhaustion from hemorrhage. Few agents are more satisfying in meeting the needs of the woman at the menopause, in those distressing phenomena that make life a burden: nervous oppression, in headache at the vertex, heart palpitation, dyspnea upon the least exertion, hot flashes, cerebral fullness, and outbursts of emotion and temper. During the active menstrual life of woman it relieves many of the neurotic symptoms when due to enervation and association with irregular action of the heart, or due to menorrhagia. For the menstrual headache with pressure at the top of the head it is most serviceable. For the nervous weakness of the aged, cactus is

unexcelled, and the only case of Raynaud's disease in which we obtained satisfactory results, cactus alone was used, with the result of keeping the circulation of the fingers free from vaso-motor spasms. No neurasthenic should be given up without a thorough trial of cactus. It has recently been praised in epilepsy. The dose of specific cactus is from the fraction of a drop to ten drops.Eclectic Medical Journal.

THE TREATMENT OF GASTRIC ULCER.

BY CHAS. LYMAN GREENE, M. D.

Professor of Medicine in the University of Minnesota, St. Paul, Minn.

Aside from pulmonary tuberculosis there is no subject so involved in conflicting opinion, dogmatic statement, and imperfect reporting as is the treatment of gastric ulcer, and this despite the fact that surgical technique and the diagnostic armamentarium of the internalist have reached a remarkably high level.

The past two years have yielded a large amount of literature, much of it extremely valuable and bearing abundant evidence of an earnest and sincere desire to reach the truth, yet, owing to the glaring defects of the medical and surgical statistics quoted, much of the labor has been in vain. We still lack figures of a convincing nature, which might absolutely determine which cases are surgical, what are medical, and what belong to the boundary line; yet into this darkness there has been thrown sufficient light to enable us to say that only in exceptional cases is surgical interference justifiable as a primary measure. This conclusion is inevitable if one compares the surgical statistics of Mayo, Moynihan and Robson, representing the highest type of achievement in gastric surgery, with the figures furnished by Leube, Lenhartz, Friedenwald and other eminent clinicians, whose treatment represents the best medical practice.

It is futile to attempt to pass upon average mortality based upon a great number of collected cases without taking into account the nature and location of the hospital, the locality, and the treatment pursued. One great source of fallacious interference has been the failure to take into consideration the fact that in private practice the mortality from gastric ulcer under medical treatment is negligible, and that the results of treatment, both medical and surgical, as between the private or semi-private hospital and the ordinary