in, and closure by a kind of healing process of, the inguinal canal, or other opening thru which the hernial tumor escapes. After making about four thousand injections in about three hundred patients upon this theory, I concluded that this theory of treatment was wrong. Nature seems to have a habit of persistently absorbing and dispersing such temporary reparativ tissue, and while temporary cures were the rule, and permanent cures frequent, I found relapses too numerous to suit me or the patients.

It then occurred to me that if I could place a charge of aseptic bird-shot in the tissues around the internal abdominal or the crural ring, without producing a wound, each shot would become encysted in a dense fibrous mass of tissue or callus, which the shot, as a foreign body, would continually perpetuate, hence would not disappear by absorption. I argued that a sufficient number of such calluses, each with a shot as a nucleus, would form a vital as well as a mechanical obstruction, or a kind of natural support or truss which would not impair the strength of the natural retaining muscles as a mechanical external truss does, and yet would retain the hernia perfectly and indefinitly, without pain or inconvenience to the wearer, and no danger of breakage. Upon this idea I began to experiment.

Of course the shot was not practicable, so a substitute must be found which could be injected thru a needle of medium size. It must be insoluble in the fluids of the body so it can not be absorbed. It must be nonirritating so it will not form an abscess. Rabbits and guineapigs were called into service, as well as the subcutaneous tissue of my own arms and legs, which still carry some calluses. My patients now carry calluses too; but they also carry their intestins in the abdominal cavity without that instrument of torture called a truss. Neither do they ever suffer the excruciating pain upon treatment that they occasionally did when the sheath of the pudic or other nerve was pricked and a solution of zinc sulfate, ext. witch hazel, tr. arnica, etc., were used.

I now inject into the tissues about the internal ring and near the peritoneum from five to twenty minims of a mixture of the finest ivory black and refined paraffin softened with fluid glymol [What is glymol?-ED.] to about the consistence of vaselin. This is so proportioned that each ten minims contains about one grain of the ivory black. This is sterilized by heat. It is then injected at a temperature between 102° and 105° F. The treatments are given two or three times a week. If uncomfortable soreness is produced, suspend treatment until it subsides. A properly adjusted support must be worn until the hernia is safely retained without it, when it must be left

off, as its pressure now becomes injurious. If the patient is long accustomed to a truss he may feel a sense of weakness for a time, but will soon enjoy its absence. Examin the patient from time to time for two months and fill in any apparent weak point that may exist. Several treatments should be given after the truss is discarded, as its pressure may have displaced some previously made calluses. It should hardly be necessary for me to say that strict asepsis should be, observed in giving these

treatments.

Many physicians tacitly acknowledge their incompetency to treat hernia by advising or performing a cutting operation in nearly all cases, when, if properly treated, only a small percentage require cutting.

Many other physicians acknowledge their incompetency by sending the unfortunate sufferer to the druggist for a truss, thus dismissing the case. Might he not with equal consistency send his patient with a fractured bone to the pharmacist? Both require a knowledge of the anatomy of the parts involved, and also mechanical skill of a high order, and the adjustment of a truss properly, usually requires more of both than does the ajdustment and fixing of a fracture. If the patient happen to fit the truss, it may do fairly well as a support; but this rarely occurs, and then it becomes necessary to make the truss fit the patient, and then the trouble begins.

I have never seen an adjustable truss in the market, and if one were at hand, neither the doctor nor the druggist would know how to adjust it, nor would they know when it was properly adjusted without large experience with all kinds of cases. A truss properly molded to any case would probably not be suitable for any one of the next ten cases with the same measurements. Each case is a problem that must be solved with its own conditions.

Knowing that about one man in every ten, and about one woman in every sixty, is ruptured, and considering the pain, the danger, the mental anxiety, the debility and general distress this affliction causes in the majority of cases, it seems to me a subject worthy of careful study, thoro discussion and intelligent treatment. These sufferers are certainly entitled to better treatment than they now get from the profession.

If members of the WORLD "family" who have ideas upon this subject will come forward and give us all the benefit of those ideas, I shall be glad to contribute my mite toward its discussion. And I have no doubt that brother Taylor, as the father of the “family” and Editor of the most wide awake journal in America, will gladly open its columns for such discussion. "SIERRA."

Downieville, Cal.

OCTOBER, 1903]

Helps and Hindrances in the Practise of Medicin.

Editor MEDICAL WORLD:-There is so little certainty in continued success that it behooves us to watch. Eternal vigilance is the price of liberty (or success), professional or otherwise. You may today enjoy a paying practise, and have the implicit confidence of your patrons and confreres, but before another year rolls around the tide may be turned against you. Hence, it is well to consider the helps and hindrances in the practise.

First and foremost in the list of helps is good health; without which other helps would not avail. Second is knowledge. These two helps are presupposed. Sufficient health and

strength to execute, and knowledge to utilize other helps. If I were dependent upon only one help outside of health and knowledge, I would ask for energy. To the healthy, energetic physician all things professional are possible. The lazy man may succeed, but he is sorely handicapt. People seem to have less use for a lazy man than for any other. I presume most think that money is the best backer in any enterprise, and if properly utilized it is indeed a great help; but we have often seen the rich young doctor, or at least the young man who had wealth to back him, make a dismal failure, while his competitor, who was extremely poor, climbed the ladder of success. It is the right use of helps that wins.

If there were nothing in our way except to learn how to diagnose and treat the common diseases cf the country, our's would be easy sailing indeed. But a doctor is a target at which every man, woman and child in the community feels at perfect liberty to shoot, and were it not for the helps that I will mention we would sooner or later be demolisht.

We must be cheerful, and have good mixing qualities. A good mixer is nearly always a successful practician. What I mean by a good mixer is this: A man who makes friends fast and enemies slowly (if at all)—a man who understands human nature; one who can appease wrath and keep in the good graces of his patrons. I do not mean toadyism. I have

reference to tact. To illustrate : A patron comes into your office in a bad humor and "has blood in his eye." The man without tact will let him go away angry, while the man with tact will see that he goes away in a good humor, and thus hold his patronage.

Everybody admires the cheerful, hustling doctor. Cheerfulness is not the result of mere

You may resolve and reresolve, but you cannot be cheerful unless you are a man who does his duty. Duty well done produces cheerfulness. Duty well done prepares

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a man for emergencies. You may laugh at the calamities that befall your patrons and pretend not to care what results follow your treatment, but this is not cheerfulness. If you can say to your despondent patient: "Cheer up, old man, I can soon relieve you," and you feel that you can do so, then you have the cheerfulness that lights up your countenance and cheers your patient. Also a man who has no sympathy for suffering humanity can never be a successful physician.

On one occasion I was prospecting for a location and askt a doctor who was leaving the town in which I wanted to locate, what he thought of my chances. He answered my question by asking me the following questions:

"Are you an odd fellow, a knight or a workman ?"

I said no..

"Do you belong to the church ?” I said no.

"Have you a political pull ?" I said no.

"Well," said he, "if you are not a lodge man, nor a church man, and have no political pull, how on earth do you expect to build up a practise in a town like this, where the people all go in gangs ?"

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I said I have nothing to depend upon except merit. He seemed to think that I was off mentally (and was probably right). Out of mere curiosity, I suppose, he askt me: Say, do you drink?” Not much, said I. "Well, sir," said he, "let me give you a pointer : Don't never get drunk in this town."

I askt, why not get drunk here as well as elsewhere?

"Well," said he, "if you once get drunk here you will never be allowed to reform. I got drunk here once, and only once, about a year ago, but you may ask any man in town about my morals, and he will tell you he saw me awful drunk on one occasion, and will leave the impression on your mind that I am a drunkard."

I have thought of this conversation, and think I have profited by it. I assure you that temperance is a great help in the practise. Modern society demands sobriety of its physicians.

How much there is in lodge affiliation I am unable to state, but I presume it is a help to those who have it. I do not look upon politics as of any advantage except to those who are seeking public positions. As to church membership, it is a help from a moral standpoint, provided a man lives in harmony with his professions. People have no confidence in a hypocrit, whether he be a church member or not. Church membership puts a man in good

society, and good society is a help that you cannot afford to ignore.

To summarize: Good health, knowledge, energy, money, vigilance, tact, cheerfulness, sociability, sympathy, temperance, lodge affiliation, morality, good society, are all important. And with these I close as to helps; not that I have exhausted the subject, nor even mentioned some of the most important helps, such as honesty, promptness, charity, etc.

As to hindrances: Well, you say, we will take it for granted that that which is not a help is a hindrance; but much depends on how we use a thing, whether it is a help or hindrance. For example, wealth will assist the worthy and ruin those who do not make proper use of it. Poverty is a great hindrance, but can be overcome by energy and good management. Laziness has already been mentioned incidentally, but not as forcibly as it should be. I suspect that laziness has ruined more doctors than any other vice. Laziness induces carelessness, both in quality and quantity of work done, and carelessness is fatal to any doc tor. The lazy man will not act promptly when called, and after reaching his patient, will not make a careful and thoro examination, nor will he formulate a full treatment. We all know how important it is to know what ails the patient, and to meet every indication, giving especial care to the main lesion. We also know that the side issues (so to speak) often prove fatal, even when the treatment of the main lesion was correct. To illustrate : In scarlet fever, if we fail to look after the kidneys, we apparently relieve the patient of his scarlet fever, but within a few weeks he dies of Bright's disease. This is a result of laziness, carelessness, and indifference, all of which are serious hindrances in the practise.

Another evil is very prevalent: talking too much-blowhardism. Blowhardism is a contagious malady; and doctors are not exempt. Have you a competitor who is busy when all the rest of the doctors are idle? Do you know a man who says he has not had a night's rest for months? Yes, every neighborhood is blest (or curst) with a blowhard-a fellow who treats pneumonia cases by the hundreds each year and never loses a case, and can talk of nothing but the amount of work he has on hand or has just finisht. Talk is a hindrance that upsets many otherwise good men.

Charleston, Mo. W. P. HOWLE, M.D.

Do not circumcize every case of contracted prepuce in early childhood. If the glans can not be exposed, if there are absolutely no symptoms of general ill health or local trouble, withhold operation till the child is at least four years old At about that age the opening in the prepuce becomes larger, and many cases formerly considered as indicating operation will be found do not require it at all.

Caution in the Use of Heroin. Editor MEDICAL WORLD:-As the time of year approaches when coughs and colds will demand our attention, it might not be out of place to offer a word of caution as to the use of the much and justly lauded heroin., Have been using heroin in my practise for three or four years, and have never found anything as effectual in relieving an irritating cough; especially that which comes on at night and will not allow the patient to sleep; or that which accompanies tuberculosis. But I wish to relate a little personal experience with it in hope that it may prevent a reckless and indiscriminate use of the drug.

During last winter I suffered from a bronchial cough accompanied by fever. For six weeks. I had fever every day, temperature ranging from 100° to 102.5°, and very severe cough, worse at night. Most of this time I attended regularly to my practise with the exception of night calls, which I would not answer. My most annoying symptom was the cough, which nothing seemed to relieve except the heroin, and it I limited to the night attacks.

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Finally

I determined to stop that cough, and began taking regularly a gr. tablet of heroin every four hours. Kept this up for about five days. By this time my cough had in a great measure ceast to trouble me and the medicin was stopt at once. Now my observations are these: Contrary to the claims of its advocates that it does not constipate, I found that my bowels immediately became very badly constipated; and this condition I have noticed in others for whom I have prescribed it. But worse than this was the reaction on the nervous system on the suspension of the medicin. I presume I was bordering on the condit on of the "morphin fiend" when he is without his regular allowance. I could not be still. A sense of some great impending danger haunted me. I knew what was doing it and tried to "laugh it off," but it "would not down." I never was subject to nervousness, and consequently never had much patience with those who were so afflicted; but if they suffer as I did for about thirty-six hours they certainly have my sympathy. That this condition was due to the heroin, or rather to the sudden withdrawal of it, there is no doubt. The fever had not entirely left me yet, so that it could not be attributed to that. I still continue to prescribe heroin and have taken a few doses myself since then, but I am a great deal more cautious in its use than I was before.

Are we nct in danger of producing a condi tion of heroinism, or something similar to the morphin habit, by its continued use? If any of the WORLD family are in the habit of prescribing its continued use, I wish they would

Try Big Doses on Yourself. Editor MEDICAL WORLD:-I have just read an article in a medical journal of wide circulation in which a contributor recommends for a young child with whooping cough 3-grain doses of quinin every three hours for three or four days. It appears to me that this is too heroic. I once wrote to Dr. John Aulde, of Philadelphia, for some information concerning large doses of nitrate of strychnin. In his reply he advised me to try the effect of large doses on myself and I would soon find out that it would produce headache, and disturb the nervous sys

tem.

I have applied his valuable advice to many drugs and I wish to sound a note of warning to my brethren, and to say to them what this distinguisht physician said to me: "Try the effect of the medicins on yourself and you will soon find out how disagreeable large doses are to your patients."

I do not think it is a good plan to adopt the exact doses of medicins as they are recommended for certain conditious by contributors to medical journals. They are frequently not properly tried, as I have found to my own sorrow. As an illustration I will relate the following: In a reputable medical journal I saw : Ꭱ

Ichthyol

Mercurial ointment

M. Sig. Apply twice in twenty-four hours and wash off. Guaranteed to cure barber's itch in two days.

I cut this out and filed it away in my scrap book and waited for Mr. Tinea Sycosis to come. He did soon. He came but once.

He was not cured in two days. He got mad at me and never came back, but I heard all about it. Altho the case was in its incipiency when I saw it, the application not only proved an irritant, but the disease continued to spread. I have been in the practise of medicin for over thirty years and yet I am frequently fooled by some cock sure" plan recommended in my journals.

Be not the first by whom the new is tried,
Nor yet the last to cast the old aside.

But when you do first try a new remedy or
recipe, be very cautious about the dose.
Haddam, Kan.
H. M. OCHILtree.
Keokuk Medical, 1872.

Hot baths in salt water, of twenty minutes' duration, taken each night before retiring, rapidly relieve the flushing and attacks of heat and sweating to which women are subject about the time of the menopause. The beneficial effect is noticed at once, and a month's treatment is often sufficient to cure the trouble altogether.

The Man, and Not the School of Practise. Editor MEDICAL WORLD:-A letter lying on my table takes me to task for classing homeopathy with Christian science and Dowieism, and inquires if I ever investigated the merits of that school.

Yea! verily, I was once, way back in my youth, a bright and shining light in that system of cure. I have no crows to pick with the law of similia similibus curantur, for it has done a question the power in high potency, altho I power of good in modifying the huge dose. I concede the fact as demonstrated in suggestiv therapeutics. For example, when I practised that system I was often able to cure warts with the 30th of antimonium crude. I was able to do the same with water taken from the same bottle, after emptying out the former dilution, and I found I had as good results with lachesis, rhus tox., bryonia, apis mel, and spigelia. The labels were all that was required to get results. I was personally acquainted with Hale, Hammond, Hering and many of the leaders of the homeopathic school, and all of them were hightoned and cultured. But they all were not high potency doctors, for I have known Hale to give as high as 80 grains of chloral at one dose, and Hammond 10 grains of calomel.

The

The only thing I object to is the name; it is misleading, and used more for advertising the physician than to inculcate a new system. law will not always work, and what there is in it belongs with all proven facts to all physicians, regardless of school. All try to cure disease. Then why not let the name of the school take a decided rest? It makes one tired to read in print: "I am a homeopath; " "I am an allopath; "I am an eclectic, and I am proud of it." This we often see in the journals, when the facts are only just this: They are all physicians, and all out to cure and to get the -what shall I say?-to get the stuff. Let us cease fooling ourselves, for we can't fool the people. They are going to employ no school, but will employ the man if he impresses them favorably. Men are wanted; not schools. Chicago, Ill. H. S. BREWER, M.D.

A Glowing Tribute to the Governor of Utah, and a Scathing Rebuke to Osteopathy. Editor MEDICAL WORLD:-The honest, honorable, conscientious members of the medical profession without regard to creed or ism, should rise as one man and call blessed the name of the Honorable Heber M. Wells, Governor of Utah, for placing upon osteopathy the everlasting stamp of his disapproval. While he wields the scepter, this malignant growth that is exerting its toxic influence elsewhere cannot fasten its tentacles upon the fair soil of Utah. His should be a noble