the man, we may expect to see it plundered by thieves from without and corrupted by rust from within." You have each made a pertinent and timely contribution; in short, struck a key-note and made a strong and direct suggestion to the members of the WORLD family. Physicians of all times have recognized that a certain force, the vis medicatrix naturæ, is what cures disease. Religious rites, ceremonies, drugs and suggestion (direct and indirect) only stimulate, aid or abet this power. More and more the truth is being recognized that the human mind, trained in a knowledge of its power, is the most potent of all agents in arousing into activity this hidden force within. Without discussing the psychological nature of the principles of the law of suggestion, the fact is not to be decried that it occupies a very important place in therapeutics. Mind culture and suggestion skillfully employed on scientific principles are the most potent of our means for the relief of human ills, sickness and poverty included; which, if taught and instilled into the life of the young, would practically annul heredity, and place between them and disease and misfortune the strongest of barriers. "As a man thinkest in his heart" (i. e., earnestly, with a conviction of the truth) "so is he "mentally and physically. "We tend to see, hear and feel what we confidently expect to see, hear and feel." These truths our own experience prove. Prof. Elmer Gates has demonstrated by chemistry that anger, hatred, jealousy, malice and other emotions of the lower nature produce a poison in the system which ultimately produces disease. Every physician has noted at the bedside the untoward effects of fear, imagination, worry, dispondency and the lack of confidence, as well as the beneficial effect of faith, hope, cheerfulness and expectancy on the part of the patient. Fear and imagination invite the very thing or condition feared. Dr. Halcombe cites many instances in the South where yellow fever was spread thru fear, the element of fear without doubt entering into the cause. Dr. Hock Tuke, who is an authority on nervous and mental diseases, observes that "epidemics owe a great deal of their violence and rapid spread to the fear which is generated among the people. When cholera, smallpox, diphtheria, yellow fever and other malignant diseases obtain a foothold in a community, hundreds or even thousands of people fall victims to their own mental conditions, which invite the attack and insure its fatality." cure. I have observed that many of those suffering from appendicitis have stood in great fear of the disease and the operation for its relief, which fear undoubtedly made them more susceptible, and was therefore a factor in the cause and also in the ultimate result. By the employment of more rational means, more people are being cured of consumption than ever before, so that the laity have come to think that consumption is a curable disease, which belief aids materially in the Every physician will admit that the mird has more or less influence over the body. Every physician has seen the woman with her whole attention rivited upon her pelvic organs, and whose ailments are at the outset nine-tenths imaginary, which become realities if she is not speedily set to right by some plan that operates thru her mind. The sufferers from the suggestions gleaned from quack advertisements and patent medicin almanacs are, like the poor, always with us. I believe as physicians we do not fully recognize or appreciate the importance of the power of the mind over the body. The realization of the fact that the mind is superior to and controls the bodily expression, when so recognized and willed. by the individual. is a long step in the right direction, both by physician and patient. "Thoughts control bodily conditions," and this demonstrates the efficacy of "spiritual," "divine," and "mental healing," "Christian Science," and so on. That they do heal, and heal where we sometimes fail can no longer be denied. Because suggestion and the science of the mind have fallen into the hands of various "ists" and "isms," it does not follow that it should be ignored, nor that it might not be the means of greater good in the hands of regular physicians, who would know and teach its true philosophy to the inestimable good of mankind. The physician is coming more and more to be a teacher, and in the future the true physician will not treat the body with drugs so much as the mind with principles. teach the people that healthy, positiv thoughts are as essential to healthy bodies as pure food, air and water; and pure thoughts and a high ideal are essential to a clean life. He will teach them that faith, hope, cheerfulness and a recognition of their own mental superiority over bodily ills places between them and disease the strongest possible barrier. Inasmuch as man has a He will psychic as well as a physical nature, we must appeal to psychology as well as to physiology. In no situation in life does the knowledge of the supremacy of the mind and suggestion play a more important role than in the hands and life of an earnest, conscientious physician. So while we seek to perfect technique, and while we seek for new remedies, new bacilli and new antitoxins, all of which is as it should be, let us not forget to inspire at the bedside, by our every word, act and expression, faith, hope and confidence; and arouse in the sick, ill and susceptible in both mind and body that subtle power: expectant hope. J. E. B. Massachusetts. Calomel Therapy. Editor MEDICAL WORLD:-Recent contributions to your valued journal relating to the therapeutic effects of calomel given in both large and small doses are so conflicting that I venture an attempt to harmonize the discordant claims by a brief synopsis of the principal clinical and scientific facts. Advocates of the large dose present a formidable array of distinct and logical clinical effects as evidence and not mere coincidences, while the users of small doses bring forward equally satisfactory results, and that, too, they claim without danger or harm to the economy. Let us follow up the ingestion of a dose of calomel, large or small, studying its movements, together with its effect upon the cellular structures. Entering the stomach, much depends upon its physical condition as well as upon the reaction of the stomach contents. Absorption is favored by thoro trituration, but an excess of hydrochloric acid may convert at least a portion into the bichlorid, and this in turn uniting with the albumin forms the albuminate of mercury. The latter product is dangerous, owing to the uncertainty in elimination and the liability to produce cumulativ effects following some change in the systemic reactions, as when nitro-muriatic acid is given in typhoid or intermittent fevers, after the employment of large doses of calomel. Curiously enuf, it is this very condition or effect, this danger, which makes calomel in large doses. efficient as a remedy for croup, and for the early stage of pneumonia, and it was highly regarded a generation ago as most efficacious in the treatment of shock, to re-establish the secretions-twenty grains being given at once and repeated in one or two hours. Twenty years ago we were taught that the "revulsiv" action of the remedy was responsible; later we learned that other causes were at work. In croup, for example, the probabilities are that the albuminate of mercury has some occult action upon the cellular structures in connection with leukocytosis, by which the formation of membrane is arrested, the diseased portion being detacht and a normal condition of cell function re-establisht. A similar train of circumstances might be followed in the case of pneumonia, but in the case of shock other factors must be taken into consideration. The fact remains, however, that mercury employed in this manner is not without immediate and consecutiv dangers, and that this is not an imaginary evil is confirmed by the precautions taken to secure elimination, and that, too, by a method which is, if possible, more reprehensible than the use of the large doses. Magnesia sulfate, the remedy usually employed for this purpose, not only deranges osmotic pressure, but the acid radicle combines with the calcium content of the protoplasm, thus lessening or destroying the vital capacity of the intestinal cells. The magnesia salt is not, therefore, a conservator of energy, but a disturbing factor, and its employment, instead of "clearing the decks for action," is more like throwing overboard the most valuable ammunition. The foregoing exposition will show that I do not deny the clinical effects of large doses, my contention being based upon the expediency of the treatment from both the professional and utilitarian viewpoint. Now, a word on the other side. The physician who prescribes calomel in small doses will secure excellent clinical results and still avoid any untoward after effects, provided he observes certain precautionary measures as to diet, frequency of administration, together with osmotic pressure and physiological reactions as factors. Above all, is it of first importance to secure thoro trituration, presently to be considered, but even then the small doses are not adapted to the treatment of croup, pneumonia and shock. Other medicaments, however, are available, which are more effectiv and free from danger. Small doses of calomel, employed as outlined above, are supposed to be efficient because of the influence of the particles upon cellular activity. Thus, we know that calomel is eliminated by the liver, and it is said to have a "selectiv" action upon this organ because of the stimulus of the above-mentioned small particles upon the hepatic cells. Modern investigations show that this conception is at fault, since there are no small particles to be eliminated except when the crude substance or large doses are employed. Galeotti, studying the oligo-dynamic action of metals, finds that electrolytic solutions are less poisonous to proto plasm than ordinary metallic solutions. Notably is this true of copper, the toxicity of the electrolytic solution being approximately one million times less than a simple solution. Thus, applying my illustration to calomel therapy, by assuming that mercury in electrolytic solution is modified like copper, we can understand how the small dose is both useful and harmless since, when introduced into the system it is promptly taken up by the electrically charged body fluids and thus becomes a colloidal solution, the name given by Bredig to electrolytic solutions of metals. This conception of the physiological action. of calomel would also account for the untoward effects of large doses, not only of calomel, but of all other metals, provided we are dealing with a law which is universal, and this is precisely the subject to which I desire to direct special attention, introducing a new factor of vast significance in the future development of scientific therapeutics. Within the past two years, Bredig, a German scientist, assisted by a number of his pupils, has been conducting experiments with a view to demonstrate how colloids, or metals in electrolytic solution, act; and strange to relate, these investigations show that colloids act like soluble or unformed ferments, the socalled enzymes, to which is due the activity of pepsin, amylopsin and ptyalin from the animal kingdom and also the ferments obtained from vegetable life. There is one important difference, however, namely, in respect to persist ence. That is, in order to maintain "catalysis," the inorganic ferment must be reapplied from time to time, and this brings out the necessity for repetition of the dose. Again, the small dose in the form of colloid solution affects tissue metamorphosis in such manner that the harmonious relations incident to molecular changes (vibrations) are favored and the transmission of nerve impulses promoted. In advocating physiological cell medication, therefore, I am simply applying the scientific facts of laboratory research to practical, every day therapeutics, as I am convinced that it will be greatly to the interest of the profession and to the advantage of the public. Indeed, from present appearances, I am led to infer that the laity take a more lively interest in these investigations than the profession, judg. ing from the popularity of Professor Loeb's lectures and the numerous magazine articles which have appeared during the past year. These popular papers have been called for by the public in connection with the interest shown in extracts from scientific papers which have appeared in the technical journals. Contributors to medical literature appear to have overlookt the practical bearing which these come into every home, however humble. Here is a chance for good missionary work.-ED.] A Possible Double Conception. Editor MEDICAL WORLD:-I have recently had a case in my practise which I wish to report in your columns, as it has been of unusual interest to me and perhaps will prove so to a large majority of your readers. In a practise of ten years it has not been my privilege to see a similar one; however, it may not be as rare an occurrence as my experience would lead me to suppose. I would like to have the views of the Editor, and would also be glad to hear from any member of the WORLD family. Was called Friday, October 10, to see Mrs. A., aged 28, who stated that she had last menstruated July 14, and that she supposed herself to be about three months pregnant. She was suffering no pain, but complained of a bloody discharge which had existed some few days. On digital examination I found the cervix elongated and but very slightly dilated; advised absolute rest in recumbent position and prescribed viburnum (Hayden's). She experienced no pain until about 1 a.m. Sunday, at which time I was called. There was as yet no appreciable dilatation. Administered 4 gr. morphin hypodermically and inserted tampon. Was called again at 7 a.m. She was suffering then from urinary suppression. Catheterized her, which relieved her completely. Called at 2 p.m. and found she had passed the tampon together with a large clot, which, on close examination (after thoro washing), I found to contain an embryo of seven to eight weeks, with membranes intact. After this she experienced no further trouble except at times a few slight pains (after pains?). Called twice on Monday; found her resting well and she exprest herself as "doing fine. I was called away on Tuesday morning for a couple of days. Visited her on my return and found her in good spirits and fine humor. But you can imagin my surprise and chagrin when she stated that at 2 p.m. on Tuesday she had passed a larger clot, had phoned for me to come, but that Dr. L. had responded and told them that it was a placenta, and had made inquiry as to the disposition of the fetus. She told the doctor that she had passed some clots early in the morning, which were thrown out without being carefully examined, but that she thought it was all over" and did not take the trouble to examin further. Dr. L. stated that the placenta was three and one-half inches in width and one and one-half inches in thickness, and that a fetus of at least three and onehalf months had been attached to it. This evidently passed with the clots during the early Blackwell, Okla. Imaginary Pregnancies. Editor MEDICAL WORLD:-Last year I had two cases of phantom or imaginary pregnancies. First case was a midwife, fifteen years in month of her supposed pregnancy. She had practise. She engaged me in the sixth everything prepared for the arrival of the little prince which she joyfully expected. My first examination (she said she was six months pregnant) revealed nothing but suspicion of her pregnancy on my part. The second, five or six weeks later, confirmed my first, and I told her my belief. She got mad at me and went to another doctor, who is a friend of mine, and who told her the same. She then went to a clinic for examination, with the same result. Second case: A woman, 28 years old, mother of two boys 6 and 8 years old, engaged me in the seventh month of her supposed pregnancy. Her history was normal excepting that she had had her periods regularly till now. This caused a little suspicion on my part. My second examination revealed nothing, and so I could baby. She got mad at me and I kept away not help asking her where she carried the from her. After ten months from my first visit her husband called me one night to attend her, as she had labor pains and exthe os closed, pains very irregular and infreOn examination I found pected delivery. quent. After watching her three or four hours, without any progress, I left her. After six months, that is sixteen months from my first visit, she called in another doctor who delivered from her a mole (I have seen it), an irregular lump or ball of flesh and cartilage of about three and one-half pounds. LEWIS O. STICKEL, M.D. 667 East One Hundred and Forty-eighth street, New York City. I inclose $3.00 for four years' subscription to your most practical and liberal WORLD. Your "Talks" on Government ownership of public utilities are much appreciated, and your advice concerning doctors' investments is well worth the four years' subscription price -C. F. OSGOOD, M.D., Morgan, Utah. Ergot's Place in Obstetrics. Editor MEDICAL WORLD:—In the November WORLD, page 486, Dr. Frost says he gives, as routine treatment in labor, nearly half a dram of fluid extract ergot every hour. It would be unwise and unsafe to use ergot such as we have in this northern country in this manner, or the number of lacerations would be very much increast; besides there would be not a few fatalities to the infants. At least this is my opinion, after a practise of twenty years. My rule is to not give ergot before delivery, and I think this is the general practise thruout the country. In a few instances where there has been some inertia I have given it in even less doses than the Doctor uses; I have rather regretted it, as the child has been much more cyanosed than usual. I regard the use of ergot after labor of great importance in most cases. Formerly I used the fluid extract, but, of late, I have been using ergotin pills, because pleasanter to take. For three or four days I order one to one and onehalf grains ergotin every three hours; and for a week or ten days longer one-half to one grain three times a day. I am satisfied the condition of the uterus is much more satisfactory two or three weeks after labor than when the ergot is omitted; besides there is less danger of sepsis when the uterus is kept well contracted a number of days. A few primiparas do not need it, and an occasional case is met that will not tolerate ergot, even in quite small doses, owing to the painful contraction that occurs in these cases. Inertia had better be overcome by other means than ergot. Quinin in five-grain doses will generally act satisfactorily. When the os dilates slowly I have found that atropin 1 gr., emetin, strychnin nit., every hour, materially aids dilatation. I use forceps occasionally, probably in about 5 per cent of all cases, and delivery is prompt, too. The use of forceps in more than 10 per cent of cases is an abuse of a valuable instrument. S. E. CAMPBELL. Winona, Mich. Miscarriage with Triplets; also Measles. Editor MEDICAL WORLD:-On August 3 I was called to see Mrs. T., who had had a chill that evening, but had a little fever for two days previous to my visit. I found her having pains up high, and they continued to grow harder; in four hours I delivered her of three six months' babes, all girls; first one natural presentation, other two feet foremost. Her temperature was 102° when they were born. Now, the rub was to come later. Statistics show that 50 or 75 per cent die when they more miscarry from measles. In two days she was broken out all over. Her cough was bad. I kept her bowels open with laxativs. I tried to control her fever with acetanilid, but it seemed to do no good. I feared eclampsia. I have always heard that an ounce of prevention is worth a pound of cure. So I "rested on my oars" for a short while and then put twenty drops of the tincture of veratrum in her arm. In four or five hours it reduced her fever two degrees. In all, during twenty-four hours I put forty drops in her arms. It did not do the good at last that it did at first, so I resorted to ice water, from a pint to nearly a quart by enema, every two or three hours, just as fever demanded. It got to cramping her, and then I put ice bags on her bowels. In three or four more days I dismist her. Some will be ready to say, when they see this in print (if they do), that he might have known that ice water would stop the lochial discharge. Yes, it stopt; but I would much rather have it stopt than for that woman to have had convulsions. In four or five days she took the slow fever, as we all call it here, and lay for four and a half weeks longer. She got up six weeks from the time she was confined, and could walk alone; and this fall has pickt from 175 to 200 pounds of cotton every day when the weather would permit. She is 26 years of age, brown hair, fair skin, blue eyes, weighs 135 pounds, and has had six children. J. D. HARRIS. Sylvania, Ark. If "A. B. C." December WORLD, page 544, fails to derive the desired relief from the treatment outlined for him, after using it faithfully for several months, I would be pleased to have him try acid nitro-hydrochloric dilute m XX or xxx, well diluted after each meal, and report results to THE WORLD. I may have a few words on this subject later. C. O. HENRY. Denver, Pa. Bradycardia. Editor MEDICAL WORLD: Inclosed please find a year's subscription. A peculiar case of idiopathic bradycardia may be of interest to report. The patient is a fullblooded Navaho Indian, male, aged 16 years, normal in every other respect. Pulse is full and strong with the faintest tendency toward dicrotic form. Beats, sitting or standing, number 50 to a full minute; in recumbent posture, 45 to 46 to the minute. |