doctor the following: Three days before, while out riding, she was seized with a sharp pain in the right side. So severe was this that it caused fainting. She was at once driven home. The doctor found the patient in collapse, with a temperature of two degrees below normal, pulse fifty-eight, with cold hands and feet. After resorting to stimulants and a full dose of morphin, the patient after some eight hours showed symptoms of improvement, which continued until the evening of July 2, when she again was stricken down with pain and fainting spells. It was on this occasion that I was despatched for, and on arriving I found the patient in profound shock. On vaginal examination I found a soft boggy mass situated at the right side of the uterus. I at once pronounced the case one of ruptured tubular pregnancy, and advised a speedy operation, which was consented to by all concerned. As it was now two o'clock in the morning, it took a little extra time to arrange our lights and prepare the patient for the operating On opening the abdominal cavity it was found full of clotted blood of several days' organization. I at once proceeded to clamp the broad ligament and thus shut off the source of hemorrhage. This having been accomplisht, the tube and ovary were brought forward into the external wound and ligated and cut away. The abdominal cavity was now flusht out with hot water, the external wound closed, and patient placed in bed, surrounded by dry heat, and after several hours she recovered from the shock of the operation.

There is nothing worthy of being recorded regarding the after treatment of this case; but in twenty-one days, to the very hour, I was again operating on this patient's abdomen for the relief of acute obstruction of the bowels. After relieving the constricted bowel I passed my hand down into the pelvic cavity of the left side, and much to my surprise found a large mass; and on bringing it forward into the external wound I saw that I had another tubular pregnancy to deal with. While the right tube had ruptured in such a manner as to allow the blood to flow freely into the general abdominal cavity, the left one had ruptured so that the blood flowed downward between the so-called folds of the broad ligament and thus formed the mass. On examination of the tube it was plainly to be seen that the rupture had taken place at the abdominal end of the tube, and so had the right one. The question now presents itself, Did these tubes become pregnant at the same time? and did they rupture at the same time? I am frank to admit that I should at the first operation have passed my hand over and examined the other tube, but I

did not do so, never for one moment thinking but that one tube pregnant was quite enuf.

We country doctors have quite often been told by a class of operators (not surgeons) that for a country doctor to open an abdomen is to commit a crime no less than manslaughter. On the other hand, what would have been the result had we so far forgot our calling as to have sent to the city for some one of the nowadays many great "I ams" in abdominal surgery. While waiting for his arrival the patient loses the only chance for life. In this case did we do right in operating early?

Traverse City, Mich. Z. H. EVANS, M.D.

Like

The Arkansas legislature, at its last session, passed a bill which was approved by Governor Jeff. Davis on the seventeenth of last February, entitled "An act to regulate the practise of medicin and surgery and to provide for the appointment of three boards of state medical examiners, and defining their duties." Dr. Steele's bill, this bill was fought by osteopaths, "Christian science" people, and every "ism," "ist," and "ite" that tries to disgrace the profession in our state. The socalled Christian science crowd even shipt lobbyists from St. Louis to Little Rock.

I will give you a short synopsis of the law: It provides for three state boards of medical examiners to be appointed by the governor, consisting of seven members each; they must be appointed from a list furnisht the governor by the three medical societies of the state, "regular," "eclectic," and "homeopathic,' each board to exam'n applicants wishing to practise its particular school. Every person now practising medicin in this state has ninety days from the passage of this act to prepare a written statement giving his name, post office address and county; when and where he received authority to practise medicin, where his certificate or diploma is on record; if a diploma, from what school or college. This statement must be sworn to before some officer authorized to administer oaths, this to be sent

258

to the secretary of the board of his school of practise. If found satisfactory, the board will place his name upon their list of accredited physicians and send him a certificate to that effect, which he must have recorded in the county in which he practises. The law provides that any person residing in this state or coming into it, of the age of 21 years, who has not been licensed to practise medicin in this state, desiring to practise in this state, must make application to the secretary of the board of his school of practise, accompanied by $10 (ex. fee), for examination at the next meeting of the board; the board to hold four meetings each year. Any member of the board has the right to grant temporary permits to practise pending the meeting of the board. It also provides that any itinerant vender of any drug, nostrum, ointment or application of any kind intended for the treatment or cure of disease, or who may by writing, print or other method profess to cure or treat diseases or deformities by any drug, nostrum, manipulation or other expedient, in this state, shall be deemed to be in violation of this law. This does not apply to licensed physicians.

The penalty for violating any of the provisions of this law is a fine of not less than $25, nor more than $500, or imprisonment of not less than ten days nor more than ninety days, or both fine and imprisonment.

This law does not apply to so-called midwives, or to the administration of domestic remedies.

This bill was introduced and engineered thru the legislature by Dr. Daniel, a member of the lower house from Boone county, this state. Our state for a number of years has had a county board in each county, composed of three members, to examin applicants for license, which were good only for the county in which he was examined. After this, if a physician desires to move from one county to another, all he has to do is to have his license recorded in the county to which he

moves.

This law knocks quackery, patent medicin men and Christian scientists higher than a kite in Arkansas.

Now for medical reciprocity.

Murfreesboro, Ark. J. L. ROBERTS, M.D. [We will leave osteopaths to give their own definition of osteopathy. But the construction of the word expresses "bone-pathy." We understand their claim to be that disease is caused of displacements of bones and also other parts, and their treatment to be the replacement of these parts. Some doctors who have investigated, say that osteopathy is a system of deep massage-very beneficial in many cases.

Editor MEDICAL WORLD:-Can a person be color-blind and at the same time be successful in the practise of medicin and surgery? In other words, is color-blindness an absolute barrier to a man who is otherwise perfect, mentally and physically, and who likes the study of medicin and surgery?

Four percent of men and one-half percent of women are said to be color-blind; and Dalton, the discoverer of color-blindness, was himself color-blind, altho eminent in chemistry.

I would like to hear, also, what the WORLD family has to say, for surely among such a large number it must be that some are colorblind, discovering it, however, only after they had been in practise. Nothing can be more discouraging for a physician than to discover, after years of study at college and spending his saved-up earnings in college expenses, that he is color-blind.

Do any of you know of physicians who, tho color-blind, still were or are successful in the practise of their profession?

Wis.

G.

What is the Condition of the Liver and
Kidneys?

Editor MEDICAL WORLD:-I desire to report the following interesting case, at least interesting to me:

Charles B., aged 20 years at this writing, had an attack of articular rheumatism, affecting the legs, arms, and ultimately the heart. The attack came in March, 1900, and at the end of May, same year, he learned cigarmaking and continued at work until February, 1901. Some time after, while walking out with a young friend, he became dizzy and fell forward, injuring his right side and over epigastric region. After resting awhile he got up, and his companion assisted him home. He took medicin off and on for some time. He noticed that he was somewhat swollen, but the doctor told him it did not amount to much. When he fell, his bowels and bladder moved involuntarily and unconsciously into his clothing.

In April of same year a similar attack overcame him, with the same results.

Soon after his first attack of giddiness he noticed his abdomen getting larger and his feet and legs edematous. His family physician diagnosed his trouble as dropsy, due to heart trouble, the result of rheumatism. Another doctor was called in to consult and he suggested elaterium, which cleaned out all the water in a few days and it was supposed that "the goose

was cookt." In another week the patient was as full as before, and the elaterium was of no use whatever.

At this time, in June, 1902, I was askt to see the patient and if advisable to tap the young man. I found him suffering, as stated, with an enlarged heart, valvular disease and dropsy; also enlargement of the liver, but was not certain on account of the large collection of fluid in his abdomen. We concluded to give him one tablet every three hours, each tablet containing 1 grain of calomel, I grain chlorate of potash, 21⁄2 grains of nitrate of potash and 2 grains of powdered squills. The kidneys and bowels responded nicely, and in one week's time the fluid was gone and I could discover enlargement of the liver. The young man desired that I should attend him, and am doing so now. What I feared most was the heart trouble.

I now placed him on Tilden's elixir iodobromid of calcium comp. in connection with syrup of hydriodic acid; also one to three tablets a day to keep bowels and urin free. He did very well with the above treatment, but his liver seemed to be slowly enlarging.

He now got tired of taking medicin, and he again began to fill up. I suggested tapping, and on January 1, 1903, I removed a bucket of water. His urin had no albumin when I examined it, yet I did not examin it every day.

I gave him for some time cod liver oil and the syrup of the hypophosphites, but the liver continued to increase; at this time it is down to the umbilicus and reaching out into each iliac space. He has very little fluid in his abdomen, none in his legs, fairly good appetite, sleeps well, and walks out daily. His countenance is pale, but he has had very little of any icteric color during his whole sickness. Within the last three weeks his liver seems to be getting some smaller and is not so painful on pressure.

What seems peculiar is that the hundreds of grains of calomel he took in all this time did not affect his gums nor teeth in the least. He has a set of good teeth.

He is taking at this time syrup of the iodid of iron, syrup hydriodic acid, and syrup hypophosphites, equal parts, teaspoonful three times a day. Paint over region of liver tincture of iodin once a day. Heart does not seem to improve.

There is no history of any specific contamination in his system. He is no drinker nor user of tobacco. Had thought he might be suffering from lardaceous disease of the kidneys, or from an injured liver, or from a thickened peritoneum. Now for your prognosis and treatment, gentlemen. Eshbach, Pa.

FRANK R. BRUNNER, M.D.

[Write directly to Dr. Brunner and he will report to THE WORLD any suggestions used, with results.-ED.]

Is it Cancer, or Syphilis?

Editor MEDICAL WORLD:-Mr. R., an old Confederate soldier, came to me six months ago stating that he had a cancer on his penis, and askt me to examin and treat him. On examination I found the entire glans penis covered with a warty-looking growth. The prepuce was long and was also involved, there being a warty growth on the prepuce about an inch in diameter. He stated to me that he had a chancre in 1863 while in the Virginia army under General Lee, which healed by local applications, the only treatment that he received. He saw no further indications of syphilis until this growth appeared, three years ago. He had been examined and treated by several physicians before applying to me, all of whom pronounced his case one of cancer, and advised the amputation of his penis. I diagnosed Mr. R.'s case as syphilitic condyloma, and am treating it as such. I first put him on proto-iodid of mercury, which I pusht to the physiological effect. Second, I cut off the prepuce and all of the condylomatus growth that I could take off without taking off the glans. Third, I apply to the condylomatus growth once or twice daily a solution of boracic acid 3ij, acetic acid q. s. ad. 3ij, with a soft brush. January 16 last, I stopt the proto-iodid of mercury and put him on potass. iodid, x grs., three times daily, with 30 m. fl. ext. sarsaparilla, and have increast the dose of iodid of potass. gradually until he is now taking 300 grs. three times daily, or 900 grs. daily, which he bears nicely. His condition is greatly improved, but he is yet far from well, and sometimes I almost lose all hope of a cure. The condylomatus growth is not so large, and there are patches here and there over the glans of sound flesh; there is not any accumulation of pus on the parts as when I took charge of the case; he can pass urin without pain, and also hold his urin, neither of which he could do when he first came to me. Now to the point: I want the readers of THE WORLD, also the Editor, to tell me whether or not I can expect to cure this case; also to give me any advice that will be of benefit to my patient. He is an old true and tried friend, and I am very anxious to cure him without amputating his penis if it is possible to do so. I think I will continue to increase the dose of potass. iodid till I get the physiological effect, even if I have to give him 1,200 or 1,500 grains per day. J. C. MATHEWS.

Greenville, Ga.
[In a case that is puzzling at best, it is well

to continue any course that gives encouraging results. So we would say, continue your present course as long as there is improvement. But why be so delicate about cutting off a little of the penis in a man of his age, if it seems indicated?-ED.]

Collection Agencies.

Here is a letter from the Comstock Collection Agency to one of our subscribers which shows how they insist on the terms of the contract note. The Doctor writes that he has refused to pay, and he has invited them to collect by law. Please notice that in their letter they do not claim to have rendered any service to the Doctor, nor do they even mention a desire to render service. Stress is put only upon the fact that the Doctor signed the note, and failed in some non-essential to fulfil the rather complicated and arbitrary terms of the

contract.

Collections made in all parts of the United States and Canada. Specialty: Collection of Claims for Physicians and Retail Merchants.

The Comstock Collection Agency

Rooms 1, 2, 3, 4, 5, and 6, City Savings Bank Building.
Oswego, N. Y., April 10, 1903.

Dictated. S. O'C.
M. C. BELL, M.D.,

Wallis, Texas.

Dear Sir:

We have your communication in which you speak of some arrangement which you made with our agent, and it appears to us that it should only be necessary for us to call your attention to the sentence at the bottom of the note which you signed. You appear to be a fairly intelligent man, and you ought to know without our telling you or anyone else telling you, that any arrangement you made with our agent we would not be bound by, when that sentence is at the bottom. That means that you must go by the promises you made in that note. Now in that note you agreed to send to us the names of thirty or more of your debtors. It says plainly thirty or more, and in no place in the note does it say that a less number than thirty would answer, provided you sent $150.00 worth of accounts. You did not do that, you only sent thirteen, less than one-half the number required. The fact that that number amounted to $150.00 or more would not be of itself sufficient. It was just as necessary for you to send the full number of thirty names as it was to send the required amount.

Then again another default consists in your not sending us the list for five times, so even if there was no dispute in regard to the number of names you were to send, you would still owe the $36.00. You only sent the list once, several months ago, when you should have continued for five times. By reason of your default, the note became due under the sentence which says: "Should I fail to comply with above conditions, I agree to pay to said Agency said sum of Thirty-six Dollars within ten days after default." The words "to comply with above conditions" mean to live up to the promises made in the note.

Now we would like to get the matter closed up in some way satisfactory to both of us. We want to be on friendly business relations with you, we want you to feel that you are treated fairly, and we are going to make you an offer. We honestly believe that under the terms of this contract you owe us $36.00, but for the purpose of getting it closed up now, we are going to cut that sum right in two, and for payment at the

present time accept $18.00 in full. It has been said among good business men, that where a misunderstanding occurred in regard to a business matter, a very good way was for each side to yield something and to split the difference, and we believe that statement is true. We think it would be better for you to meet us half way and pay $18.00 on this matter. Certainly neither of us can afford to get into a big lawsuit, for whoever won, they would have to pay out considerable money.

If you agree with us on this, send us your check or money order for the $18.00, and we will send you the contract receipted, or we will send it by the Express Company, and you may take it up upon payment of that amount, if you desire and will let us know your wishes.

Thanking you for your courteous letter, we are,
Respectfully,

THE COMSTOCK COLLECTION AGENCY,

Editor MEDICAL WORLD:-About five years ago I made a contract with the Comstock Collection Agency, signing note: no money to be paid if I supplied the names and postage. I sent names and postage. After some length of time the company made complaint that I had not furnisht true addresses; and if I didn't furnish the proper number and true addresses, they would demand payment of contract note. A few months later I was threatened that if I didn't remit $30.00 the agency would cause me trouble. Some correspondence followed and I supposed the affair was all closed. September 10, 1902, I received the inclosed demand and copy of agreement note. I made answer, telling the agency we had closed the deal long ago and they had no just nor true account against me, and that I refused to pay. I received no reply to that letter. I would advise all doctors to put on a bold front and refuse payment. You will not be bothered very long. Just a word regarding collection agencies. I have been interested in five different agencies. Many are rank swindles; but there may be some good ones. My luck has been poor. In the future I shall let them all alone. The best way to do is to let a local attorney handle your accounts. One bad feature about an agency is that often important letters and data are placed in their hands that are never returned. G. H. FULFORD.

Sioux Falls, S. D.

[The letter from the agency is rather long, and not worth reproducing here. They insist on the payment of the $30.00. And they say "after that is done" they will be glad to receive a list of names and give them prompt attention. This membership fee plan, the fee to be paid before any service is rendered, or regardless of the rendering of service, is suspicious, to say the least. We sometimes send delinquent subscription accounts to a collection agency (see last part of "Talk" in this issue) and no fee is askt. We simply send the accounts (keeping a careful duplicate list), and they make a monthly report, retaining 25 per cent. of all payments on said list, whether paid to them or direct to us. This is fair. There is no "membership fee," and payment is according to the service, after the service is rendered.-ED.]

Editor MEDICAL WORLD:-In regard to collection agencies I wish to give the readers of THE WORLD the benefit of my experience. Several years ago I gave several thousand dollars' worth of accounts to a Chicago collection agency, and in about a year and a half they collected about $50.00 for me, which was what I paid them. About this time one Guy L. Hatfield, representing Sayers & Co., of 408 Olive St., St. Louis, Mo., struck my town, and insisted on my taking my business out of the hands of the Chicago firm and placing it in his company's charge. My experience made me skittish about having anything more to do with collection agencies, but he offered to guarantee over and above what the usual guarantee was, viz.:

"In the event of our failure to collect at least $900.00 (eighteen times the amount of our subscription fee), within three years from date, this contract shall remain in force until said amount is collected."

In addition the following was written in the contract by the agent:

We further guarantee that in the event of our failure to collect at least $100.00 (one hundred dollars) above subscription fee within six months from date, to refund the $50.00 paid this date.

July 27, 1901. (Signed) SAYERS & Co., per Guy L. Hatfield, Agent."

I added other and better accounts to first list. I thought that I was dealing with a set of responsible men and that I had made a safe contract; but up to this date I have not had one cent collected by them and turned over to me. I wrote to get my money refunded, but the firm declined to do so. They put in a plea that my accounts were old and that many postoffice addresses were incorrect. Now it is a fact that all these collecting agencies know that the accounts are old, and the parties owing them are often a moving, shiftless set. This was discust with the agent. In the case of this firm, they did not in some instances address the letters properly and they fell into other parties' hands. They did not attach "col." to negroes' names, and white people would get them. They rarely spelled my name correctly. From my experience I would adjudge these collection agencies to be a delusion and a snare. C. W. ROBERTSON, M.D.

Somerville, Tenn.

Another Business Experience. Editor MEDICAL WORLD:-I noticed in May WORLD, page 206, a letter from Dr. J. C. McAllister, of Ridgeway, Pa., in regard to a microscope sold him by E. H. & F. H. Tighe, of Detroit. I have had a similar, only a little worse, experience with this same so-called firm. I purchast one of their fifty-five-dollar microscopes; some very fine specimens were shown to me, and the instrument seemed all right. The price appealed to me at that time. I tried to use it for ordinary bacteriological work and I found it very deficient. Having a contract for the return of the microscope with the so-called firm, I wrote them three different times that I wisht to return the microscope and received no reply. I sought the advice of an attorney and he wrote them, and yet no reply. I then sent them a registered letter for the sake of determining whether they were still in Detroit, and received in reply a register card and a very curt note from the firm. shipt them the microscope, intending to sue them for the amount I had paid on the contract which I held. The microscope was received in Detroit and held. They wrote me that I could have the instrument on the payment of one dollar. Having business in Detroit within a year of that time, I lookt up the firm and found that it consisted of two brothers who were purchasing and selling microscopes on the road, and had no establisht standing in Detroit. I sought the services of an attorney to either sue them for the amount or for securing the microscope, and he lookt up their record and said I would get more by taking the microscope than by suing them, as they had no property. I have no doubt that a great many others have been duped by these same brothers. My advice to brothers of THE WORLD is to have no dealings with this firm, having proved themselves thoroly unreliable and unbusinesslike, and buy only of reliable manufacturers. Dunkirk, N. Y. JOSEPH RIEGER.

Jamaica Dogwood for Cystitis. Editor MEDICAL WORLD:-I have been engaged in the practise of medicin a little over 49 years.

I read in THE WORLD of April, page 187, of the aged doctor who askt for help in an affliction of so much pain while urinating. I would advise him to use the extract of the piscidia erythrina (Jamaica dogwood) in full doses every two to four hours-fl. ext., two drams; solid ext., three to five grs., and

when the anodyn effect is felt, reduce the dose to one-half.

After other physicians had exhausted their skill with the usual remedies, I also exhausted mine. I then tried the above as an experiment. I have not yet had it to fail in inflammation of the bladder and urethra. I do not, wish to be understood that it will cure diabetes, but I do mean that it will cure that torturing pain and distress that our friend complains of if there is no enlargement of the prostate. I hope the old doctor will report to me the result of the above. J. W. LUSE, M.D. Clyde, Ohio.

Neurasthenia.

Editor MEDICAL WORLD:-The cerebrospinal nervous system regulates the various functioLS and vital processes of the body, just as a horse is controled by the lines we hold in our hands. Any change in the nerve force, be it deficiency, excess, or perversion, will produce a multitude of symptoms, in some cases so intense and protracted as to indicate organic changes. Many digestiv disorders have a nervous origin (nervous dyspepsia), and must be handled accordingly. Nor is it surprising, since the processes of assimilation, heat production, and other elements of tissue metabolism are known to be under this nervous control. The rest of the body is rested frequently, the nervous system never; as a result, nervous exhaustion arises; the head becomes painful or the ideas confused, dimness of vision, and vertiginous sensations make their appearance. The tongue becomes coated, the once cheerful person complains of not feeling well, is deprest, anxious, careworn, irritable, and peevish. Everything in life's journey has a dark side. To relieve these symptoms alcohol and narcotics are used so frequently. Morbid fears of hypochondriacal and other types appear.

Irregular muscular pains and twitchings. occur; irregular flushing of the head and face with irregular distributed areas of sweating; dyspnea, cough or cardiac irregularities of nervous causation, varied type and of emotional origin appear. The so-called nervous dyspepsia occurs and is troublesome to both patient and physician. The patient is apt to go from one physician to another, allowing no one sufficient time to do any good. Appetite is variable, subject to quick changes; the patient may sit down at the table feeling as tho he could eat a hearty meal, when suddenly the craving for food is gone and there may come a feeling of disgust, not only for the sight of the food, but its odor. Then again we have a class who bolt their food, and not being like cows who can chew it over again, they pay the penalty with gaseous eructations, gastralgia,