is often of service and especially if the cystitis follow exposure to cold. Hold the diet rigidly to milk and demulcent drinks like infusion of flaxseed and slippery elm. Give a brisk cathartic of epsom salts; no other drug acts so well in cystitis, as it has a selectiv action on the vesical mucous membrane in these cases. Never combat the fever with quinin, since the drug is irritating to the bladder. Do not bother with vesical irrigations unless the disease becomes chronic. The treatment outlined above will usually be all that is necessary, and with a tractable patient, should soon have him on his feet. Therapeutic Cowardice. Bravery is said to be a characteristic of the body, and courage a feature of the mind. Cowardice may be either of the mind or of the body. We undoubtedly have seen courageous and noble men who were physical cowards; soldiers have been known to charge into the very mouths of volleying cannon, with their teeth chattering thru physical cowardice. There is a wide and distinctiv difference between courage and bravery; a man may have abundance of the one and deficiency of the other. So there ought to be another word in our language to modify the meaning of cowardice, or to which the word might be contrasted or compared. While we have mental cowards, physical cowards, and moral cowards, we have among doctors yet another variety of cowards, i. e., therapeutic cowards. This form of cowardice might be supposed to exist among the more inexperienced or the poorly informed among the profession, but such is not the case. We know many old practicians who fail in doing all the good they ought, and who never learn the powers and capabilities of a drug, because they have never dared to go with it into the depths of its potent mysteries. To them, the maximum dosage printed in their text-books and manuals is a wall beyond which they have never dared to go-an unexplored depth which they have never sought to fathom. They can quiet the rapidly bounding pulse of simple fever with small doses of veratrum viride or of aconite, but to them "2 minims" and "5 minims are the limitations of the drugs, and they are baffled by the pulse which they cannot (?) control, and horrified by the awful'convulsions of the eclamptic. If they are told that they should give 12 or 15 drops of Norwood's tincture of veratrum viride in eclampsia, by the hypodermic needle, and repeat it until the pulse rate falls to 60, they gasp a little, and make a mental note of it, with the resolution to try it in the next case. They are sure to think that this will be tried if what they have been accustomed to use fails, but by the time it has failed in the face of some trying emergency, their courage has oozed out at their finger tips till they have not the therapeutic bravery to use the necessary dose, and they fail again. It is always noble, conscientious, kind men who manifest therapeutic cowardice. They may be well up in the theoretical and scientific lore regarding drugs, and this very knowledge of the awful results following a lethal dose blunts their acumen and stays their hand. The young and inexperienced practician is prone to show more therapeutic bravery than many older practicians. Indeed his bravery might often be better styled recklessness, for either he does not know the results of an overdose of a powerful medicin, or he does not have the sense to have a cautious respect for such result. Of all men, he who does not know the pos sibilities of the agents of which he is master is the most pitiable. He is doomed to chagrin and disappointment, when he believes that he has done all that was safe to do. In time, he becomes a therapeutical nihilist, or he is dubbed by the reckless ones "an old granny doctor;" even the laity are quick to note timidity on the part of the practician and to comment unfavorably upon it, because of their ignorance of the great spirit of kindliness that actuates it, and because of their ignorance of the potency of the drugs being employed. It is desirable that every practician, early in his career, overcome all therapeutic coward How is it done? Knowledge of drugs, alone, will not accomplish it, for often the most learned are the most timid. Experience, alone, does not do it, for often the most experienced show the greatest caution. The secret consists in combining the two in so far as one's capabilities and time has permitted, and in learning to exhibit drugs, not by tables nor by dose, but once their exact indication has been decided upon, dose succeeding dose, till the effect has been secured, or the drug has absolutely failed. However, the recklessness or ignorance that gives regardless of reasonable quantity, or that repeats without allowing time for absorption and manifestation of effect, is more to be avoided than timidity. Should we Purge in Typhoid Fever? "O, the times," and "O, the customs," as we used to drone out our latin. Formerly, we checkt the diarrhea in typhoid at all times; then following the teachings of the great Pepper, we checkt it when it exceeded "two stools in twenty-four hours; " now the question is raised,Shall we purge?" is raised, Each practician needs to think over every case, and think hard. There is no possible hope of ever instituting a routine treatment for the condition in the bowels of a typhoid patient; one must always act according to conditions and indications. It is likely that free passage of feces is an effort of Nature to free herself of ptomains and poisons, and we must decide whether it is better to allow such poisons to be expelled (even at the risk of "weakening the patient from the prolonged diarrhea "), or to administer drugs to check the diarrhea so that the strength of the patient may be guarded, and thus retain the poison in the system and invite absorption. Will the expulsion of the poison weaken the patient? We believe a certain degree of intestinal antisepsis may be secured by a judicious use of mild antiseptics, without stomachic derangement. the fact that frequently the st virulent type of smallpox springs from a case of the mildest type. Every state now has laws which will enable any one who really desires to, to do much toward stamping to utter extermination this pest. It is true that in many localities the laws are neither known nor enforced, and it is in most instances the fault of the doctors that they are not in actual operation instead of lying idle on the statute books. The doctors are at fault, first, because they fail to make a diagnosis in the very incipiency of an epidemic; or, second, if a diagnosis be made, they do not trouble themselves to see that existing laws are enforced. There is some excuse for error in diagnosis in many cases. The practician who has never seen a case of smallpox may easily fail to know a case when he sees it We are certain that a diarrhea insti- for the first time, especially if the case be of gated by Nature in the effort to get rid of the milder type. When the first case appears, putrid matter before it can be absorbed, is in- there is nothing about it for the first fortyterfered with at the patient's peril; and we do eight hours to cause one to suspect smallpox, not believe that such expulsion of poison can unless the patient may confess to having been possibly "weaken" the patient. Even if re- exposed to contagion. There is no eruption, peatedly turned down by "authorities," there and the alleged obstinate vomiting and excruis something in the "Woodbridge" plan. We ciating backache universally spoken of in the do not fully endorse it, but the idea is worth text-books, are in many cases conspicuous by mature study. We must admit that hyperpy- their absence. There is malaise, fever, and rexia, subsultus tendinum, and coma vigil, are loss of appetite; just such as may and do occur all the immediate results of septic intoxication; in the onset of a score of other acute diseases. and these are the symptoms which indicate the No doctor, in attendance on the first case in a gravity of the case, and fly the signals for given locality, under such circumstances, can danger of hemorrhage and heart failure. It is It is be censured for failing to correctly guess the for each of us to decide whether strong intes- onset of the disease; and he is especially tinal antiseptics are worth the risk of distaste, entitled to leniency if he has never seen a case loss of appetite, nausea (with possible dangerous of true smallpox. But, on the appearance of vomiting), or whether the milder ones are suf- the eruption, the circumstances alter at once; ficient. However, it does seem plain that free no practician is then excusable in making the bowel movement is an essential feature in the error of declaring that the disease does not treatment of most severe cases of typhoid. exist. One may assert that a case of measles or of chickenpox is smallpox, and cause a quarantine to be establisht; but his error is excusable, and the law defends him from prosecution for his laudable and honest efforts, and if a later epidemic happen, the very laity who first condemned him the loudest, will sound his praises the highest. But the practician who asserts that a case of smallpox, however mild, is but measles, "Cuban itch," or chickenpox, has no protection, and is not deserving of either protection by the law or sympathy from the laity or his professional brethren. Whenever a patient, no what age, social condition, sex, or previous condition, presents fever, with the appearance of an eruption which is papular, and which may be rolled between the fingers under the skin, the practician is justifiable in quarantining the house for forty-eight hours until the symptoms develop. He does not need to say Our Power over Smallpox, and our Duty Probably smallpox has never before been so widely distributed thruout the United States as it is at the present time. In many instances the epidemics are limited in extent, and the individual cases are as a rule, mild; but in other locations, even if the epidemic is quickly controled, the mortality is frightful. The impression has gained credence among the profession that the smallpox now raging is universally mild in type. No doubt such an impressiom has been fostered by the many mild epidemics which were formerly labeled "Cuban itch," and wherein few if any deaths occurred. But, now that it is universally conceded that "Cuban itch" is purely a mild form of smallpox, the profession needs to recall some of its elementary learning in regard to matter it is smallpox, but his few hours of grace will settle the matter beyond cavil, if the fever drops and the eruption becomes vesicular and the fever again rises; he would better not say anything further than that he requires a little time for the development of the disease, and that he forbids anyone from leaving or entering that house till the true diagnosis is establisht. One here feels the need of counsel, at least with the local health authorities. It is always well to respect your own quarantine by immediately returning to your office and changing every article of clothing, and by thoro ablution in bichlorid of mercury solution or formaldehyde solution. To establish a quarantine, and then to leave the house and immediately enter another for the purpose of making a call, is justly resented by the intelligent laity. Should infection follow, any blame which may accrue is justly merited. The expense of such procedure will generally be borne willingly by the local board of health, the poor commissioners of the county, or other officials, when the case is laid before them. If the doctor really becomes involved in an epidemic, he should use one suit of clothes exclusivly for his smallpox patients, changing to it just before going to see a case, and immediately donning another as soon as possible after leaving it. Probably the best plan for the general practician with long drives, is to carry a suit of some cheap material with him wrapt in oil cloth, and provided with gloves, cheap watch, thermometer, and handkerchief. Before entering an infected house, the suit is sprinkled liberally with bichlorid solution, and on leaving it is doft and wrapt in the oil cloth ready, for the next case. Such a suit is always ready, but despite great care, many suits of clothing will become infected, and then they must be laid aside. It is proper to include the cost of such clothing in the bill one renders to the authorities in charge. In the last report of the Public Health and Marine Hospital service appears a summary of the cases reported in the United States from June 27, 1903, to October 16, 1903. A few of the larger states make the following showing: who had not been vaccinated. In the 63 cases were 24 deaths. Between the dates mentioned, Philadelphia had 264 cases and 74 deaths; Pittsburg 396 cases and 79 deaths. case. Every case of smallpox is preventable. Every case is contracted from a pre-existing Vaccination and isolation have the power to stamp out the disease; it does not appear at this time that either, alone, can do it. Vaccination modifies and limits it, but it does not entirely suppress it; isolation protects outsiders, to a certain extent, but is severe on those confined in quarantine. Every case of smallpox is loathsome to all who see it, and is a terror to the surrounding community. It causes inestimable loss to every community in which it gains a foothold. In the doctor lies the power, which, with the aid of the local health board and the existing laws to enforce vaccination and isolation, smallpox may be driven out of the country. The immigrants are protected from it by foreign powers better than our own people are protected, with few exceptions. Let every doctor do his duty towards smallpox during the coming winter, and a lasting and permanent impression will be made. This duty not only involves treating the cases properly, but in seeing to a rigid quarantine, and in getting a suitable remuneration for the work and worry involved. Smallpox is a public calamity and is so recognized in every community, and the local authorities and not the victim should be the ones to reimburse the doctor, since his fees should be liberal enuf to really pay him for his trouble, loss of practise by reason of attendance on the disease, and for the personal risk he incurs. In most communities the fee has been settled at $10.00 a trip unless several trips to different patients are to be made, when the compensation is generally fixt at from $20.00 per day upward. The doctor who attends smallpox for less than $10.00 a day or a trip is very short sighted and entirely too easy to be intrusted with the safety of himself, his family, and the public. Ergot in the Drug and Drink Habit. Dr. Alfred T. Livingston, of Jamestown, N. Y., described his method of treating these patients, before the New York State Medical Association at a recent meeting. He does not use any amount of narcotic stimulant to replace the one which has been withdrawn, finding that he can more certainly control the insomnia, pain, and restlessness by the use of ergot. The symptoms following withdrawal are due to lack of equilibrium of the circulation, and the normal balance is best and most quickly attained by the hypodermic use of ergot. Ergot contracts the muscular coat of the blood vessels, but its most pronounced effect is upon those tissues which have been relaxt by the use of the drug, and hence its action on dilated blood vessels is highly satisfactory. He cuts off the customary indulgence absolutely and immediately, and gives nothing to take its place, but at once institutes the ergot treatment. The bowels are purged at the same time the ergot is given. He employs a solution of one dram in an ounce of water, and of this he gives two or three doses of half a dram each during the day; yet in severe cases he has found it necessary to employ this dose every two hours. He never saw evidence of any desire for morphin after 48 hours' treatment. A form of treatment embodying the ideas of those who insist upon gradual withdrawal, is to give a small part of the amount of the drug formerly consumed by the patient and to administer one or two doses of ergot each day by the hypodermic needle. The drug is reduced by one half each day until the eighth day, when it is forever discontinued. In discussion, Dr. Alex. Lambert said that formerly during his six weeks' service in the Bellevue Hospital, 25 or 30 deaths from alcoholism were common, but since the use of ergot this mortality had been reduced to 6 or 7. He employs 30 minims of a 121⁄2 percent solution of extract of ergot, repeating it in an hour, and afterwards every two hours. Formerly, in the "wet brain " cases, he never saved but about 3 in 100; under the ergot treatment he has lost but two out of 30. Dr. Wiggin had also employed it with satisfaction in delirium tremens and in insomia. He gives 50 to 60 minims of the solution hypodermically, equivalent to 6 or 8 grains of the extract of ergot, and finds less inefficient. The hyoscin treatment of morphin habitues has proven itself very efficient, but it has many distressing features and various disadvantages. The new ergot treatment gives promise of being pleasant and efficient, and it is not harmful. Some Injections for Treatment of While the injection treatment of hemorrhoids has never received the sanction of authority, it is well known that the dangers accompanying such treatment have been grossly exaggerated, and that the percentage of cures in experienced hands is very great. Altho quacks have nearly a monopoly of this method, many regular practicians have used it for years with success and satisfaction. When a patient declines operation, it is always right to tell him of this treatment, and after explaining the possibilities of unfortunate sequela, allow him to choose whether or not he will submit to the treatment. Many drugs have been employed, but carbolic acid, alone or in combination, is the favorit. To avoid the objectionable features of the dangers of aqueous solutions of carbolic acid, it has been suggested to use equal parts of extract of witch hazel and water with 10 per cent. of carbolic acid; we have not tried it and do not see any promise of any special advantages in it. The percentage of carbolic acid used by various operators varies from 5 to 50 per cent.; the stronger the solution the less bulk of fluid is employed. The trend of opinion at this time is toward the weaker solutions. Dr. Arthur Terry has employed the following formula for a considerable time, and has found it efficient. Rub a dram of salicylic acid into a dram and a half of glycerin, and incorporate two drams of pure carbolic acid; to this add a dram of borax and a dram and a half of glycerin, and allow to stand until clear. A small hemorrhoid requires 3 to 5 drops, and a large one 5 to 8 drops. This is injected every ten days until a cure is effected. In many cases no suppuration follows, and the tumors gradually shrivel up and disappear. Health Insurance. Germany has many "Health Insurance companies. For a certain stipulation, the company agrees to pay the policy holder a certain amount in event of sickness, or care for him thru the sickness. The Hanseatic Co. is a colossal success. They have undertaken to' treat their consumptiv patients under their immediate supervision. Their results have been surprisingly encouraging. Of 1231 consumptiv patients, treated on an average of three months, and taken from factory workers, house painters, tailors, sewing girls, nursery girls, clerks, domestics, and other laboring people, 190 died, 107 were incapable of work, and 847 have returned to work for periods of one to more than four years, and 87 have been untraced. It would appear that such companies would be an advantage for the working classes in our country. Fournier makes the suggestion that when a married woman presents herself with syphilis, it is well to tell her you wish to talk with her husband. If she is conscious of innocence, she will neither object to the interview with him nor suspicion the cause of her trouble; if she is guilty she will object, when one may tell her plainly the condition and the consequences. She may then make her own arrangements for the necessary treatment and sexual separation. In the former case, the burden of explaining matters is thrown upon the husband, rather than borne by the physician. ORIGINAL COMMUNICATIONS Short articles of practical help to the profession are solicited for this department. Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors. Copy must be received on or before the twelfth of the month, for publication in the issue for the next month. We decline responsibility for the safety of unused manuscript. It can usually be returned if request and postage for return are received with manuscript; but we cannot agree to always do so. Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than anything else,-RUSKIN. COMPARE RECORD READ REFLECT Consumption and the Opium Habit. [REPLIES FROM DRS. CROTHERS, MAYS AND OTHERS.] Editor MEDICAL WORLD:-In answer to Dr. Ruppert's letter, November WORLD, page 518, middle of first column, I would say, that consumption and opium addiction are often associated. I have seen at least a dozen cases of the opium and morphin addiction who have died from consumption. In some instances acute consumption terminates a long period of opium addiction. It is thought by some authors that the use of opium checks the formation of tubercles in the lungs. I have never seen evidence of this. Opium always masks the degeneration of the lungs, and by lowering the vitality must necessarily increase the predisposition to the formation of toxins. It does not seem possible that the use of opium would be curativ to consumptivs. The rule is, that all opium takers die either from pneumonia, consumption or some acute affection of the liver or kidneys. I should be very glad to hear of any authentically reported cases bearing on the question that the Doctor has askt. T. D. CROTHERS. M.D. Hartford, Conn. DEAR DOCTOR TAYLOR :-That consumption occurs very rarely among opium eaters, or that the opium habit is seldom met among consumptivs, is a fact which I noticed long ago, but I do not know of a single author who refers to the subject. I vividly recall only a single case of opium addiction in my long experience with this disease; this was a female who rapidly succumbed. I am certain, however, that I met others, but have no notes of the cases. Asthma, prolonged and persistent, very frequently leads to consumption; and in such cases opium addiction is common, the patient having become habituated to its use in efforts to relieve the asthmatic attacks with the drug. Dr. John Gordon Hill reports (Lancet, July 11, 1891, p. 60) that opium smoking has given him good results in several cases of consumption in which he used it, and states that opium smokers in China are exempt from this disease. On the strength of this I began the use of this drug by the mouth in several cases of consumption, and while it eased the cough and expectoration, and gave them sleep, it did not show any decided advantage over other drugs, and I discontinued it. It is also certain that consumption prevails among the nativs in China, and presumably among those who consume opium, since this habit is largely in vogue there. THOMAS J. MAYS. Philadelphia. THE MEDICAL WORLD:-I wish to offer my views from experience, on the question, "Consumption and the Opium Habit." In all the histories I have recorded during the past six years, a most striking feature is the non-susceptibility to diseases of all kinds. In the few hundreds of cases I have on file, not one ever had a disease during the period of using opium, and I have had cases extending over 35 years Not one of addiction to this awful drug. patient ever had a cold during addiction; and among the physicians I have treated, the opinion prevails that it is utterly impossible to contract contagious diseases while using this drug. I have studied the matter over most carefully, and while no definit reason can be given, to my mind it is due to the peculiar inhibitory influence opium has on every tissue in the body; likewise on everything that comes in contact with the body. The opium habit is a most serious evil, and this is the very reason why opium should rarely be prescribed in chronic cases, and should be given only by the physician, unknown to his pa tient. ARTHUR LAWRENCE. Lawrence Sanitarium, Natick, Mass. Tape Worms. Editor MEDICAL WORLD:-Dr. Shirk, in August WORLD, page 360, informs us of having removed seven tape worms, average length twenty inches, from a child one and a half years old, and concludes by asking "are so many often found ?" In October WORLD he says: "The worms were not large like full grown worms in a grown person.” Holt, in his excellent work, Infancy and Childhood, tells us that most tape worms in infants are taenia cucumeria; that they are much smaller than the other varieties, the full length varying from six to twelve inches. The larvae of this variety are developt in a louse found on the skin of cats and dogs. Children playing with these infected animals are very liable, by fondling and kissing them, to convey the parasites to their mouths, and swallowing them, to develop tape worms. Taenia solium, or solitary tape worm, is so |