patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicin to any one, if askt, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practise my Art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practicians of this work. In to whatever house I enter I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and further, from the seduction of females or males, of freemen and slaves. Whatever in connection with my professional practise or not in connection with it, I see or hear in the life of men which ought not to be spoken of abroad, I will not divulge, as reckoning all such should be kept secret. While I continue to keep this oath unviolated, may it be guaranteed to me to enjoy life and the practise of the Art respected by all men in all times; but should I trespass and violate this oath, may the reverse be my lot. Fistula in Penis. Editor MEDICAL WORLD:-What course would you advise to close a fistula in the corpus cavernosum? Calibre very small; one opening about one inch posterior to corona glandis externally, and another just posterior to corona glandis in the cervix. Both are on right side of the penis, and the fistulous tract slips between the fingers when pressure is made over the area. No urin escapes thru either opening. Patient, aged 32, rugged constitution, contracted gonorrhea two months ago. Used some prescription furnisht by a friend, which immediately checkt discharge, but a swelling appeared where fistula now exists; pus formed and the evacuation took place spontaneously thru the two openings mentioned above. No pain nor discharge, but fistula fails to respond to treatment. What can you suggest? Authorities on genito-urinary diseases make no mention of such cases. C. S. P. California. [There being no pain or discharge or leakage of urin, we would hardly consider the case worth spending much time on, unless the patient worries greatly about it and is willing to pay well for a cure. We would suggest, if you treat it, that you try the following plan: Cocainize the fistulous tracts with a little cotton wrapt around a fine probe and dipt in 10 per cent solution cocain; pass a sound into the urethra to avoid injury to the urethral mucous membrane; pass a fine bistoury from the outside to the sound, and cut thru the hardened lining of the fistulous tracts; withdraw bistoury, and cauterize with pure formaldehyd (40 per cent commercial solution); leave sound in situ for a short time to prevent formaldehyd entering urethra. Pass sound every other day beyond the site of the fistulas to prevent contraction and consequent stricture. If the fistulous tracts have not healed by the third day, the formaldehyd application may be repeated; but if the canals seem to be closed, do not risk re-opening them in the attempt to make a second application.-ED.] The Cocain Habit. Editor MEDICAL WORLD:-The reading of an edi torial in a large and influential daily newspaper in which it is asserted that the cocain habit is alarmingly on the increase, prompts me to write this note to THE MEDICAL WORLD to ask for information on the subject. I have been practising medicin for fifteen years, and I have yet to see a single person addicted to the habitual use of cocain. If the Editor or any of the readers can give us anything instructiv about this habit, please let us have it thru THE WORLD. Do not give us anything from hearsay, please, nor quote the books; but let us have your personal knowledge and experience. How is this habit contracted, anyway? And in what way and manner is it practised? How do they take it? by the mouth or hypodermically? How much does the habitue take at a dose, and how often? What is the effect physically, mentally and morally? What the treatment? When we remember that cocain is a very expensiv drug and an activ poison and little used in general practise, the statement so frequently made that this habit is very extensiv, it seems to me is open to grave doubts. L. C. ALLEN, M.D. Hoschton, Ga. [There is no question whatever as to the alarming increase of the cocain habit. Naturally it is more common in the cities where the source of supply is more readily at hand. The habit starts in most instances at the instance of a friend, or from the use of a certain well known proprietary "catarrh cure," which contains cocain. Many druggists make up a "catarrh cure" which contains any simple diluent powder like sugar of milk or boric acid or talcum and contains from 8 to 24 grains of cocain to the ounce. The sales of one druggist, to our knowledge, amounts to pounds of such a compound weekly. The negroes are bad habitues; they use the diluted powder by snuffing it up the nose, and call the habit "coking," and when they go to buy their supply they ask for "a quahter's wuff of coke." Many physicians are addicted to the habit. One physician of our acquaintance carries his bottle of "catarrh cure" in his pocket; he carries an ordinary syringe bulb to which he has attacht a short piece of rubber tubing; he fills the end of the tube with the powder and blows it well up the nares by sudden compression of the bulb. does this at the bedside of his patients, and recommends the nostrum as "the best thing he ever tried for catarrh." One of his victims became so addicted that he has been known to consume as much as four bottles of the nostrum in one day, and when refused by his pharmacist sent others to the store to buy it for him. This physician practises medicin and has a large and enthusiastic following among the lower classes. The victim referred to attends the boilers of a large manufacturing establish ment. He A habitue may be deeply under the influence of cocain without his giving any manifestation of his intoxication by look, gait, word, or action; yet he is not to be trusted and can not be believed in any statement he may make, particularly if it has any bearing upon his habits or the effect of obtaining further supplies of the drug. Later in the habit, confusion of ideas replaces clearness and volubility, and prolixity is noted. Some take it by the needle, others by the mouth, and many by the nostril. The wide advertising and the evident large and growing consumption of wine of coca of various brands doubtless leads to the spread of this habit. "Vin Mariana" is a leading preparation of this kind. All wines of coca should be dispenst only on a physician's prescription, and used only under his supervision. A full account of the habit and its symptomatology and effects may be found in "Morphinism and Narcomania from Other Drugs," Crothers, publisht by W. B. Saunders & Co., Philadelphia, Pa., 1902. Price, $2.00.-Ed.] CURRENT MEDICAL THOUGHT Prophylaxis of Venereal Diseases. At the last (fifty-third) meeting of the American Medical Association, held at Saratoga Springs, June 10-13, 1902, a joint resolution from the Sections of Cutaneous Medicin and Surgery and Hygiene and Sanitary Science was introduced in the House of Delegates as follows: "WHEREAS, There is a burning necessity to check the spread of venereal diseases, and, assuming that the states cannot with impunity ignore the condition, it lies in the province of the medical profession to discuss and recommend to the respectiv state legislatures and municipalities means not regulamentativ, but social, economic, educativ and sanitary in their character, to diminish the danger from venereal diseases "Resolved, That the Section on Cutaneous Medicin and Surgery of the American Medical Association invite the section on Hygiene and Sanitary Science to co-operate with the Section on Cutaneous Medicin and Surgery in bringing about a propaganda in the different states, looking toward a proper recognition of the dangers from venereal diseases, and to arrange for a national meeting under the auspices of the American Medical Association for the prophylaxis of venereal diseases, similar to the International Conference for the Prophylaxis of Venereal Diseases, which meets again this year at Brussels, under the authority of the Belgian Government." This was later submitted to the House of Delegates, which endorsed the action of the Section and adopted the following: "Resolved, That a joint committee of six from the Sections on Hygiene and Sanitary Science and Cutaneous Medicin and Surgery be appointed by the president to stimulate study in and uniform knowledge of the subject of the prophylaxis of venereal diseases, and to present to the American Medical Association a plan for a national meeting, similar to the International Conference for the Prophylaxis of Venereal Diseases, which meets again this year in Brussels, under the auspices of the government of Belgium." The Committee on Prophylaxis of Venereal Diseases consists of: Dr. Henry D. Holton, chairman, Brattleboro, Vt. Dr. George M. Kober, 1600 T street, Washington, D. C. New Dr. L. Duncan Bulkley, 531 Madison avenue, New York City. Dr. Frank H. Montgomery, 100 State street, Chicago, Ill. The peculiar social, racial and political conditions of our country are so different from those on the continent that they necessitate an expression of solely American ideas on this mooted question, both from a socio-economic and sanitary point of view. The committee desires the support of the medical profession and the aid and powerful collaboration of the medical press of the country to help them in this work. It takes the liberty of soliciting expressions and views, editorially and otherwise, and would be glad of personal correspondence from those supporting the movement and who will contribute by papers, to make it a success in case the House of Delegates should favor the holding of such a congress. Mix 12 fluid ounces of alcohol with 36 fluid ounces of water. With this menstruum moisten the previously ground drugs and macerate during twenty-four hours. Then pack firmly in a percolator and pour on the remainder of the menstruum, allowing the percolate to drop slowly. In this dissolve the sugar by agitation. Finally pass sufficient water thru the exhausted drugs to make the finisht elixir measure two pints. Caramel may be added if the color is not deep enuf. Each fluid ounce of this elixir is taken to represent saw palmetto berries, 120 grains, sandalwood, 30 grains. -Am. Drug. Dose: A teaspoonful every hour to children 2 to 6 years of age. Therapeutically the mixture is a good one, possessing good antiseptic and tonic properties. But what the poor kids think of the taste of the stuff can better be imagined than described. It really would be a good thing if doctors were in the habit of tasting all the medicins which they prescribe for other people. There is no doubt that many combinations would never be prescribed the second time, and nasty, nauseating mixtures would soon become a thing of the past-in pediatric practise at any rate.-Med.-Pharm. Critic and Guide. 1. What are the laws of chemical combination (a) by weight and (b) by volume? What relation exists between the specific heat and the atomic weight of elements? 2. What is the usual process by which metals are obtained from their carbonates? From their oxids? What chemical changes take place in each case? 3. What is commercial ammonium carbonate chemically? How is the pure carbonate prepared? How would you determin whether a given substance contains ammonium or is an ammonium compound? 4. How would you distinguish (a) magnesium sulfate from zinc sulfate, (b) bichlorid of mercury from potassium chlorate? How would you distinguish morphin sulfate from quinin sulfate? 5. Express all quantities in the English and metric systems. 1. Write a prescription, containing not less than three activ ingredients for acute bronchitis, the apothecary's directions, and directions for administration in English and Latin. Explain the action expected of each ingredient. 2. What are expectorants? diuretics? diaphoretics? How do they act? 3. What is cocain? its physiological effect? the symptoms and treatment of poisoning by? its therapeutic uses? its preparation, and its doses? 4. Under what circumstances is it proper to resort to "feeding by the rectum?" Describe the operation, also the preparation of the nutrients used for the purpose 5. What is heroin? urotropin? protargol? suprarenal extract? Their therapeutic uses, doses, and administration? 6. The diagnosis of opium poisoning, from alcohol poisoning, from cerebral hemorrhage, from uremia, from diabetic coma. BACTERIOLOGY AND PATHOLOGY. 1. Describe the proper method of making moist and dried blood preparations. What can be learned from a study of these? 2. Discuss the causes of the edema that accompanies the large white kidney, mitral disease, advanced anemia, respectivly 3. How would you make a bacteriological diagnosis of the following diseases: Asiatic cholera, bubonic plague? 4. Mention the various channels by which bacteria may enter the body. Give examples. State also the several ways in which these agents may bring about their harmful action after effecting a lodgment within the body. 5. From what vessels do leucocytes emigrate? How is this phenomenon explained? 1. Discuss the etiology, symptoms, diagnosis, and treatment of strangulated inguinal hernia. 2. What are the suture materials used in surgery and how are they sterilized? 3. Discuss the etiology, symptoms, diagnosis, and treatment of malignant pustule. 4. Give the surgical treatment of stone in the pelvis of the kidney. 5. Describe in detail the conservativ treatment of a compound fracture of the head of the tibia opening into the knee joint. PRACTISE OF Medicine. 1. Give the symptoms and physical signs of aortic insufficiency. 2. Give the differential diagnosis between gastric ulcer and gastric cancer. 3. Give the symptoms and diagnosis of typhoid fever in the first week. 4. Give the symptoms of smallpox. 5. Give the symptoms and physical signs of acute miliary tuberculosis of the lungs. 6. Give the symptoms and differential diagnosis of locomotor ataxia in the pre-ataxic stage. OBSTETRICS AND DISEASES OF WOMEN AND Children. 1. Discuss the changes which take place in the organs of the mother during normal pregnancy. 2. Discuss the causes and treatment of difficult labor. 3. Give the etiology, pathology, symptoms, and treatment of puerperal eclampsia. 4. Give the causation, pathological anatomy, symptoms, and treatment of rickets. 5. Give the pathological anatomy, differential diagnosis, and prognosis of tubercular meningitis. Sample Set of Questions, Illustrating the Scope of the Written Examinations Before the Naval Medical Examining Board. [Candidates are examined orally in literary and scientific and professional branches, embracing spelling, punctuation, the use of capital letters, geography (descriptiv and physical), grammar, syntax, arithmetic, history (ancient and modern), history of the United States, mythology, the constitution of the United States, anatomy, physiology, surgery, medicin, pathology, microscopy. obstetrics, medical jurisprudence, materia medica, chemistry, physics, hygiene and quarantine, and if a candidate has any knowl edge of botany, zoology and geology, he is examined orally upon these subjects and credit is given him for them.] ANATOMY AND PHYSIOLOGY. 1. Describe the artery, its branches and their distribution, 2. Describe the (bone) and give the origin and insertion of the muscles connected with it. 3. Give the relations of the femoral artery in Scarpa's triangle, and name the branches it gives off as it descends the thigh from Poupart's ligament. 4. How is the brachial plexus formed? What nerves supply the fingers with sensation? 5. What arteries, muscles, and nerves would be severed in a crosssection of the arm at the middle of the humerus? 4. 5. Describe epistaxis, causes, symptoms, diagnosis and treatment. PATHOLOGY AND MICROSCOPY. 1. Describe one of the degenerations, the process of repair, the pathology of some special disease. 2. Give the morphology of bacillus 3. Describe the principles upon which a compound microscope is constructed. 4. Identify mounted specimens (histological, bacteriological, pathological). 5. Examin chemically and microscopically specimen of urin, Write out report of examinations, OBSTETRICS. 1. How should puerperal infection be guarded against and how managed when present? 2. What is the position of the woman and of the physician in applying the obstetric forceps, and how should the forceps be applied in the L. O. A. position at the inlet? 3. Describe the management of the third stage of labor. 4. Post-partum hemorrhage, its symptoms, causes and treatment. 5. Describe the hygiene of pregnancy. MEDICAL JURISPRUDENCE. 1. What is insanity? Define types most frequently met with? 2. Define infanticide and state what means should be resorted to in order to establish it. 3. How would you proceed to examin in a case of suspected criminal abortion? 4. What is a poison? How are poisons classified and what are the prominent effects exhibited by each class? 5. What circumstances would guide you in deciding whether wounds have been received ante-mortem or post-mortem. MATERIA MEDICA AND THE PHYSIOLOGICAL ACTION OF DRUGS. 1. Describe chloroform, its history, preparations and therapeutical uses. 2. Give the habitat, the part used, preparations and dosage of nux vomica, pilocarpus and rhubarb. Unprofessional Conduct. What is unprofessional or dishonorable conduct is thus answered by the Colorado State Board of Medical Examiners in its draft of a proposed law to regulate the practise of medicin in the state: The revocation and refusal of certificates shall be for any of the following causes, to wit: The employment of fraud or deception in applying for license on diploma or in passing the examination provided for in this act; conviction of crime involving moral turpitude; habitual intemperance in the use of ardent spirits, narcotics or stimulants; unprofessional or dishonorable conduct. The words "unprofessional or dishonorable conduct," as used herein, are hereby declared to mean: First, the procuring or aiding or abetting in procuring a criminal abortion; second, the obtaining of a fee on the assurance that a manifestly incurable disease can be permanently cured; third, betrayal of a professional secret to the detriment of a patient; fourth, causing the publication and circulation of advertisements of any medicin or means whereby the monthly periods of women can be regulated or the menses can be re-establisht, if supprest; fifth, causing the publication and circulation of advertisements of any kind relativ to diseases of the sexual organs tending to injure the morals of the public. The Iowa Supreme Court has rendered a decision of much interest, in which it is declared that the State Board of Medical Examiners has the right to revoke the certificate of a physician if it thinks him incompetent to practise.-Toledo Med. and Surg. Rep. An exchange prints some interesting, if not very cheering, statistics on the financial side of medical practise of medicin in the French republic. It states that there are 2,600 doctors in the French capital, and that of these forty make from $40,000 to $60,000 a year; fifty make $20,000; fifty make from $10,000 to $20,000; two hundred make from $6,000 to $10,000; two hundred make from $4,000 to $6,000; seventeen hundred make an average income of $725. In all France there are reported to be 16,000 doctors, whose gross incomes average $725 apiece. Apparently they are little better off in France than they are in America.-Detroit Med. Jour. 2. Jesus Christ-I don't know whether he was divine or not, but he was good enuf to be so, and taught the sweetest and best system of morality known among men, and he was diviner, greater and nobler, as a man than as a God. 3. That we will live again, but whether we do or not we have been fortunate in having been permitted to live at all and add our mite to the sum of human happiness. 4. It is only a question of time until the English-speaking nations will rule the world, and America will be the dominating power. 5. The Henry George single tax theory. 6. The government ownership of all public utilities. 7. Postal savings banks-let Uncle Sam go into the banking business and make every postoffice a savings bank, and the money king and shylock will be less likely to try to run the government. 8. Education universal, not only of the mind, but of the hands and of the soul. Every child born into the world belongs to the state, and the state should assume the obligation of making it a good citizen; and if it fails, the failure should not be punisht or killed, but should be cared for, and cured, whether it is affected mentally, bodily, or morally. Another Creed. Here is another creed, sent by a live and energetic doctor who lives and practises in the western part of Pennsylvania. It is a good thing for a man to formulate a creed occasionally, but his formulated creed should not bind him. Better by far never to have a creed than to have a binding one. We would like to receive a copy of your creed, but please leave the religious or theological part out before sending to us. We want only medical and political creeds. Here is the one just received: I. I believe in God, the Father; Christ, the 2. I believe that after death we shall live 3. I believe the Holy Bible to be the inspired word of God, and a safe guide for all men in all times and under all circumstances. 4. I believe, with Webster, that "there is no evil we cannot face or flee from, but the consequences of duty disregarded." 5. I believe that the practise of medicin, honestly followed in truth and purity, will ennoble and elevate any man or woman. 6. I believe that English will be the universal language; that English-speaking people will rule the world; and that the United States will be the dominating power. 7. I believe in government ownership of all public utilities. 8. I believe in postal savings banks and a parcel post. 9. I believe in a universal compulsory education law that will give to every child not only a good common school education, but will also teach him or her enuf proficiency in some trade which will enable him or her to earn a livelihood by manual labor, should such necessity arise. 10. I believe in every precept of the decalog. I believe that every word of it is a natural law woven into the very fibre of man's being and antedating the printed word as much as man II. I believe in moral education as much as I 12. I believe in teaching the child that every time he strays from the path of rectitude he hurts himself, and that if for no higher reason he must not trangress the simple fundamental laws of right living. 13. I believe the physician is a man who is ignoring and neglecting his manifest mission if he fail to teach the primordial laws of Nature and warn the erring of the penalty to come. 14. I believe that every transgression of Natural law is visited with punishment in this life; that Nature is slow to warn, yet swift to strike. 15. I believe that medical science will yet discover a cure for every known disease and infirmity, and that men will die only of old age or accident, or as a direct result of transgression of the laws of Nature. Here is another good medical and political creed (we do not wish to discuss the religious part of it). Here are two good models to work from. I suggest that every reader study these creeds, and then write one for himself and post it up where you will see it often (say in your bed-room, if you don't want others to see it), and put both it and yourself under rigorous examination, say about every month. Don't hesitate to change the creed whenever your views change-and if you are a progressiv man they will change occasionally, for progressiv men are constantly getting new light, and new light may give reason for the changing of views or opinions. They say that "a wise man seldom changes his mind, but a fool never does "-maybe because he has no mind to change. Well, you have a mind; use it and change it. They say that some democrats never change; that they inherit it in the blood. My observation is that this is equally true of republicans-that is, some republicans and some democrats. Politicians and corruptionists use this fact to their profit. They are sharp enuf to not be bound by any party, and the only creed that they know is: personal gain; use everybody possible to that end. Were you ever used in that way? At every city election in New York City thousands of democrats are used in that way, and in Philadelphia thousands of republicans are used in the same way. That is what makes political corruption possible, particularly in our cities. Nationally it is done in this way: the trusts and corporations usually contribute to the funds of both parties. Exceptions were made in 1896 and 1900, for then the candidate on one side was plainly outspoken against the corrupting influences of trusts and corporations; but in many congressional districts the old policy was practised, as it will doubtless be in the future. I believe in creeds, and I believe in parties; but I do not think that a free man should be bound by either. You should be bound by your convictions: and you should change your creed and your party as your convictions change. But don't base your convictions on worn out and superseded theories, nor on old facts which are no longer true. Keep up with the movements of the times. Read books as well as newspapers and magazines. For example, what have you read on the subject of Government ownership of public utilities, favored by both the above creeds? Please notice the fact that both of the above creeds predict the domination of the English speaking nations, and the second one predicts that English will be the universal language. Before this can be possible we must simplify and rationalize our horrible spelling. The world won't speak, read and write our language with all its present burden of inconsistencies and lack of rule or reason. Don't expect such an unreasonable thing of the rest of the world. Think of though for tho; through for thru; thorough for thoro! These words and some others we are rapidly changing to the simpler forms; but there are hundreds of others just as bad that we are not changing. Let us have rules without exceptions. For example, let us drop those ugly gh's and ugh's universally, when they are silent, and they usually are. Dr. Cooper, he with the muse's gift, kindly sent me a poem for THE WORLD. I wrote thanks and appreciation on the part of all of us, and told him that I would put it in next "Talk." Here it is: "Armed Peace." Hail Rhetoric-" a pæan to thee!" Thou hast bridged us over a chasm; "Armed Peace"-how better this speech courtesy Than low, frank pleonasm. If we're fixt for a fight, and ready to fight, To invite, resolved to repel, in the end- Still, all men see, and all men agree, But we're all agreed we must ever concede So we lavish our substance to foster and feed The spirit of might, and the spirit of fight- So, the cat stretcht flat on the restful mat For the claws of the cat, and the teeth of the cat- Peace with a chip on her shoulder! Oh, men, Is this the triumphant, transcendent birth, then, God gives us men! A time like this demands And damn his treacherous flatteries without winking; RECENT BOOKS The Internal Secretions, and the Principles of Medicin. By Charles E. Sajous, M.D. Publisht by The F. A. Davis Co., 1914 Cherry street, Philadelphia. 800 pages: 42 illustrations. Vol. 1. This is the first volume of what apparently will be a new system of medicin based on principles different from our accepted theories. This volume is really a theoretic work on physiology, made up chiefly from existing medical literature, selected and analyzed with a view to bring out theories that were not before sus pected. In this new system the supra-renal capsules are brought up to the first rank as physiological organs. The claim is that they yield an "internal secretion," which is carried into the venous circulation by the supra-renal veins, thence thru the vena cava and right heart to the lungs, where this secretion absorbs oxygen, in which process the carbonic acid gas is driven off. From the pulmonary vesiculi the (Continued over next leaf.) |