Fl. ext. belladonna. Camphor liniment, q. s.

3ij Ziij

M. Shake. Indications, any acute, painful swelling, with unbroken skin.

Doctors, study your materia medica, and stop the proprietary people from using you as a tool by advertising their preparations among the laity (in original packages). See that the formula is on the package when you use a proprietary, as a proprietary without a formula is to the doctor what a patent medicin is to the laity, and is used about as intelligently. Treat the case yourself as well as diagnose it. Brazos, Tex. J. L. NUNNELLY, M.D.

Summer Headaches. Editor MEDICAL WORLD:-The headaches prevalent in summer are generally due to one or more of the following causes:

1. Autotoxemia. Overeating, the use of food too rich in nitrogenous elements, iced drinks that prevent digestion and engender gastric catarrh, constipation, lack of exercise; all these act by favoring the development of toxic bodies in the alimentary canal and their absorption into the blood. A muddy complexion, yellowish conjunctivæ, dull expression, foul tongue and bad breath, are frequent concomitants.

The headache is frontal or universal, sometimes most severe at the base of the brain extending from the cerebellum to the eyes, which ache. There is a tendency to relieve this aching by pressure, or by closing the lids

tightly to exclude the light. The pain is aggravated by light or by noise, and especially by attempting to read.

Treatment: Empty the bowels with a saline laxativ, and limit the diet to a cup of hot, unsweetened tea. Begin with salicylic acid, one grain every ten minutes till relief. Not ever my well-tried sulfocarbolates do as well. The salicylic acid must be chemically pure, as the commercial acid contains impurities that irritate the stomach and depress the heart. If the saline is given first the headache is apt to be increast as the contents of the bowels are liquefied.

Great benefit is derived in these cases from washing out the stomach and flushing the colon. For this a solution of salicylic acid is preferable.

Prevention lies in the regulation of the diet, exercise, etc.

2. Deficient renal elimination. When one considers the enormous importance of this, and the elementary character of the observation, it is incomprehensible that so little attention has been paid to it. If the kidneys should be excreting over two ounces of solid matter each twenty-four hours, and are only excreting five or six drams, it is inevitable that trouble should follow. The liver gets rid of a part and suffers. The skin may eliminate so much that the perspiration has a urinous odor, and how many skin diseases result? Part is stored up in the various cells, tissues or fluids of the body, and how much of our pathology is due to this alone? The calculation of the excretion of urinary solids is made with sufficient accuracy as follows: Collect all the urin for twenty-four hours, take the specific gravity, multiply the last two figures by the number of ounces, and add one-tenth to the result. This gives the solids in grains. If the excretion falls below 500 grains in a woman, or 650 in a man, trouble is inevitable. Up to that point the body seems to take care of the left-over part, but it surely is wrong to leave it to the organs that are only accessory eliminants of urin.

Nitric acid increases renal elimination; so does boldin, grain seven times a day, and this often answers admirably. But the most satisfactory results I have obtained were from veratrin, grain 1 three to seven times a day. If this alkaloid irritates the stomach, let it be taken after meals or well-diluted.

The headaches from this cause are general, dull, constant, and are relieved by a saline laxativ, by caffein, or by veratrin. Prevention lies in excluding nitrogenous foods from the diet, and keeping the emunctories carefully open.

3. Heat. The direct rays of the sun are

especially apt to cause headache in persons affected with one or both the preceding conditions. These should be lookt for and the appropriate treatment applied. Otherwise the sun headaches call for the thermometer. Any decided rise of temperature should be understood as indicating the danger of insolation, and treated accordingly. The bowels should be emptied by repeated doses of a saline laxativ, the cerebral hyperemia subdued by veratrin, grain every fifteen to thirty minutes, or in less severe cases by aconitin or gelsemin. These are superior in every way to the bromids and do not upset the stomach.

The patient should be kept quiet, in a cool dark room, and food withheld until the hyperemia has been brought under control. Persons once affected by the sun must be extra careful about exposure to it subsequently. Chicago, Ill. WM. F. WAUGH.

Circumcision: Painless Method.

Editor MEDICAL WORLD:-Where the glans can be uncovered and washt, it is wrong to circumcise. If a chancre is hidden behind the glans, circumcision is needed to bring it into view and successfully treat it. One should not do like the Jews and trim off all the loose skin. That plan should have gone out of use two thousand years ago. It is evident that the

foreskin is intended by nature as a covering and protection to the glans; so when circumcising we should remove only what is redundant. The head of the penis is tender and needs the skin to hood it and keep off the friction of the clothing. I have had patients whose glans penis was swollen, when I could discover no reason for the condition except friction. Physiologists say that the filaments of the nerves of the glans penis are the most sensitiv, excepting those of the mouth and tongue.

My plan is this: Use a 10 percent solution of cocain for five minutes in the sheath; then insert the point of a hypodermic needle thru the mucous membrane and inject 10 to 15 gtts. of a 2 percent solution along the line of incision and do the work painlessly. Insert a grooved director up to the ridge, cut with a bistoury to the border and clip with scissors. I have on several occasions done the slit opera tion and thought at the time that I had spoiled the man's penis, but it would heal in nice shape. W. J. BROWN, M.D.

Lindale, Ga.

Editor MEDICAL WORLD:-Tell Dr. J. O. Matthews, Taylor's Bridge, N. C. (page 281), to apply castor oil to warts on horses. Daytona, Fla. J. M. JONES.

Editor MEDICAL WORLD:-It would be extremely interesting to have a WORLD discussion on appendicitis, its medical and surgical treatment. The experience of physicians who for twenty-five years have treated the disease medically without loss of a case, and during this period saw but one case of suppuration and abscess following acute attack of great severity, and having seen no cases in which the disease recurred, or other complications followed, is a startling experience when compared with the literature and treatment of the present day. We believe with Nothnagel and others that this affection, recognized early and treated with opiates, will afford startling results when compared with surgical methods. Why, at present one can not have a pain in the belly without being advised to be operated upon immediately, and it seems that two-thirds of these cases operated upon die. I would compare the two methods to the past methods of treating stricture of the urethra. Newman has practised with uniform resu ts and great success the electrolytic treatment, and others have been equally successful; while on the other hand, men equally eminent, and scores less eminent, have ridiculed and condemned electrolysis, and claimed that urethrotomy was the only method-until of late its dangers and worthlessness have been admitted, and it is being abandoned. But what of the useful lives sacrificed to this dangerous procedure? Recall the ovariotomy craze. Wait and see if same way. the appendicitis craze does not pass in the

As to the Widal test spoken of by Dr. Daniel (page 280, June WORLD). possibly I can give him some information. Some years ago, while in general practise, I tested all my cases of suspected typhoid. I was using the then new Woodbridge treatment, and with such uniform and satisfactory results that I wisht to have my diagnosis correct, so that the record of my cases would not be questioned. I had no difficulty in securing cultures from other physicians and from laboratories, and made my own bouillon. I was engaged in a country practise and had no trouble in using the test in my laboratory. It is a very satisfactory way to reach a conclusion that is positiv and definit.

The cultures may be kept a long time in the sealed tubes, and from them we make the fresh cultures as we need them. Fresno, Cal.

W. N. SHERMAN.

Infantil colic is quickest and best relieved by a warm enema containing a few drams of glycerin, or of milk of asafetida. In breast-fed infants suffering from colic the remedy is to be found in regulating the hygienic conditions surrounding the nurse.

JULY, 1903]

"The True Shepherd."-Confidence in Drugs. -Text-books for Study, or for Reference?

Editor MEDICAL WORLD:-May I call the attention of country doctors (at least) to the following quotation from your address before the American Medical Editors' Association at New Orleans, May 4, 1903? (See page 286, June WORLD.)

Then there are the house organs, college organs, and medical book-publishing organs. All these help to spoil the field, and make it hard for a purely legitimate medical periodical, which I will define as one which devotes its reading pages solely and entirely to the interests of its readers, and confines advertising matter entirely to the advertising pages; one which has no other interest than medical journalism, pure and simple.

As the above quotation is its own interpreter, I will attempt no comment, but merely hint that the intelligent sheep ought to be able to recognize the voice of the "true shepherd."

Should the Editor not "rap me down" at this point, I would be glad to notice a few things that appeared in June WORLD. On page 266, Dr. A. C. Foster asks: "Do you who have practised medicin fifteen or twenty years have as much confidence in drugs as you had when you began ?"

Answer: Yes! If a doctor will select twentyfive or thirty good drugs, study them well, learn how and when to use them, he will find his "confidence in drugs" keeping pace with his growth as a physician. I have very little respect for, or confidence in, a doctor that practises medicin by "proxy." A man (doctor) that is not "short on anatomy and physiology, and who is "long" on material medica, and one who regards himself as nothing more than a humble student of medicin, even after he is able to hang five vowels, twenty-one consonants, and the twelfth line of the multiplication table to the latter end of his name a man of this build, I say, will find his confidence in drugs going hand in hand with his bedside experience. No. I don't like a "proxy" doctor (one who lets the nurse, the druggist, and the neighbors do half his thinking and all of his doing). Nor do I infer from Dr. Foster's article that he is particularly "sweet" on the "proxy" boys.

On page 269, Dr. Goodman says: "Graduates in medicin should use text books only for reference, not for study." The Doctor should have added: Provided, however, that the said graduates shall be like a nest of guinea's eggs (all alike) and not like a gross of corks! (Will the Doctor accept my amendment?)

We can all point out to "Pelplext" what he should have done, and what we would have done; but unless we could always "see the end from the beginning," it is safer, ninety

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five times in one hundred, to "rest on your oars!" A. C. GORE.

Hohenlinden, Miss.

Substitute for Quinin Treatment of Malarial Fever.

Editor MEDICAL WORLD:-The relation between malaria and biliousness, tho known to all physicians, is not sufficiently considered in the treatment of its various manifestations. The steps in the development of a well markt malarial condition are, first, a depression of the nervous system, due to unwholesome telluric influences and the enervating heat which characterizes the summer and autumn in these malarial districts; second, the resulting nervous indigestion, with the inhibition of the activity of the secretory organs-in other words, biliousness. If this condition be allowed to run on, we soon have a full-fledged case of malaria which will break out in one or another of its multiple forms, according to the location of the weakest part or organ. Intermittent, remittent and typhoid fever, dysentery and malarial hematuria are its more common forms of expression in this community. In these manifestations the sole dependence upon the use of quinin will never do; it merely serves to keep the fires of the disease burning low. Moreover, the large doses necessary are apt to disorder the stomach, and no disease can be cured while the nutritiv function is deranged. It gives the physician a false sense of security.

Having been taught that quinin is a specific for malaria, the physician feels that he is doing all that can be done. His treatment of the case is apt to consist of a morning, and if the case is serious, an afternoon call, at which he takes the patient's temperature, and repeats the admonition to continue the quinin and capsicum capsules every three hours. By the way, I believe the capsicum does more good than the quinin. In this way the patient is apt to linger for two or three weeks, or to become discouraged and employ another physician. The object of medicin is to cure and to cure promptly. The patient has a right to demand something more than a sympathetic friend in his physician. I have been for a number of years giving the following:

M. Sig. Apply to eye as often as needed to relieve. pain.

I have used the above prescription in cases of conjunctivitis and neuralgic affections with satisfactory results.

Mr. Editor, could you advise a "country" where to get the best blank forms for keeping clinical data? Many cases of interest could be more accurately reported if we country doctors could keep a history of our interesting cases for reference after the essential facts have grown cold.

Please allow me to extend the right hand of fellowship to "Perplext."

Riddleville, Tex. J. WOOLSEY, M.D. Vanderbilt, 1894.

[We wish to commend the desire to keep case records. It should be a habit of every physician. No special blanks are necessary; a plain record book can be made to do very well. However, any who may have found any particular form of special convenience, please let us know about it. We like the spirit shown in the following from a letter accompanying the above: "About February I sent you an article which probably found its way to the waste

basket. I inclose another short article which you may dispose of in like manner if you find it has no merit." An article from that kind of a man usually has merit; and if not, he will persevere until he is as good as the best.-ED.]

Neurasthenia.

Editor MEDICAL WORLD: -THE WORLD is the most practical and helpful journal that comes to my office, and the June number is especially pregnant with good things.

Let me compliment Dr. W. M. Beck (page 251) for his suggestions. They are helpful to me, and doubtless to others also. Dr. Wildman's article on neurasthenia (page 261) is good and the treatment is highly commend

able. I have treated many cases of this disease simulating various affections with good results, but one applied to me for treatment not long ago that I had little hope of improving. The result, however, was better than I expected, and I relate the case that it may be helpful to other brother M.D.'s.

Early in January Miss E., a seamstress, age about 25, came under my care. There were some emaciation and insomnia, but the chief symptom was the illusions. If she saw two people talking together on the street she imagined they were talking about her. If spoken to jokingly, she thought she was a subject of sport. Would talk and cry about her troubles, and imagin some one would do her bodily harm or kill her. One physician of our city, after treating patient some time with negativ results, advised parents to place patient in an asylum without further delay.

First: I sympathized with patient and gained her confidence.

Second: I had her to walk out and practise deep breathing.

Third: I ordered a light, easily digested diet, with plenty of water internally between meals and also externally.

Fourth Massage of bowels night and morning when day clothing was off.

Fifth Medical treatment was intended to stimulate the bowels, kidneys, lungs and skin. To aid digestion I gave the following after meals :