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Why? Admitting the influences which personality and environment bring to bear upon the case, the careful observer must discern a factor far beyond either, or both combined.

From what source are our "legally practising". quacks derived? Many of them hang the diplomas of the best institutions of this and other lands upon their walls. They have certainly past the examinations of such schools, else they could not produce the diplomas which they exhibit so prominently. Why are such men seduced into quackery? Has their education been deficient in any point? Why is it that many able men, after practising a few years, abandon the profession, or turn to some 'specialty" which they make but a maskt quackery?

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We believe the solution is found in two conditions. The first condition may be stated as: Given a man with a good education who has too much respect for the potency of drugs, or fear of untoward results following their use. The second condition as: Given a man who does not know much about drugs. The first class fear to give drugs in more than the doses stated in the books; naturally when they meet severe cases or cases in which the system has been accustomed to the use of certain drugs, their timidity prevents their giving enuf to get positiv results. In time they come to believe there is no efficiency or merit in drugs. The other class do not know enuf of therapeutics to properly select the indicated remedy, and generally use the wrong drug; they too become discouraged. Both such classes are prone to drift from a wavering belief in medicin to a state of absolute therapeutical nihilism, when they have no belief in any medicin whatever. Once such a feeling comes to rule in a man's mind, he is ripe for anything, and so it is that many such are quick to leave the ranks of the practitioner for "easier" fields. Once they convince themselves that medicin is a fraud, a greater fraud than the one they believe

themselves to have been practising has no terrors or stings of conscience for them..

"The man who does not believe in medicin does not know how to give medicin," said the elder Professor Wood. It is true to the letter. The remedy for therapeutic nihilism is a more thoro knowledge of therapeutics and remedial agents and methods. If you feel yourself losing heart, read more and study up new books. Once your enthusiasm flags, you are on the road to therapeutic nihilism, which will later prove to lead to the grave of your professional and moral reputation.

"Shot-Gun Prescribing."

Tho the term savor strongly of slang, we know of no other which expresses the thought so lucidly and tersely. It signifies the tossing of drugs into a prescription merely because they have been recommended by some one for some such com. plaint. The practise of employing such measures is even more culpable in the physician than is the infamous act of the "patent medicin man," who prescribes he knows not what. The nostrum vender slugs his drugs together for sale; but the physician who is consulted by a trusting patient has not even such a paltry shield for any such nefarious conduct. trum maker is not supposed to either know or care what his compounds may inflict upon suffering humanity; but the physician is morally bound to know all that his seience teaches regarding the mnaifold action of every drug he may use; and if knowing, he may find no excuse for not remembering. If he but realizes the potency of the weapons he wields, he will never use a "shot-gun prescription ".

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No other season of the year tempts the physician so much as the present time. Coughs are so common ! If a practitioner be very busy, or quite lazy, he may easily compound or prescribe enuf chloroform, morphin or codein to silence any cough this side the grave. But what of the after

effects? What of the habit? Who bears

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the responsibility? Not only the respon- form begins within ten days from the sibility of a chance birth of a "fiend", but also the weighty responsibility of the injurious effects of illy prescribed drugs upon functional activity and subsequent health.

Were it not better to have ascertained what caused the cough, and then to have prescribed, scientifically? Every cough has a definit cause, tho it may be far from lungs or bronchial tubes. Every doctor who is consulted for the relief of cough is ethically, morally (and legally bound to investigate the origin of such cough. When he has so investigated, it is presumed that he will use the indicated drugs; and no less and no more.

The moral is plain: thoroly examin every case, and prescribe for it such drugs

as

are indicated. We must remember that our patients pay us as much for their ideas regarding our knowledge as they do for any relief our compounds may give.

At the same time, one must think, and think hard. It is often possible to prescribe compounds or mixtures which exactly fit the case; but any prescriber must know just what he uses. Every case of cough is entitled to a thoro examination, a careful diagnosis and a rational therapy. One has only to think of the multitude of causes which produce a cough to convince himself that every cough is entitled to his minutest attention. Each separate symptom should be met by a distinct therapy. If a single drug be indicated, prescribe it; but if the indications call for compound therapy, be just as sure of the positiv call for every drug in the prescription as you would be for a single drug, if prescribed.

Study thoroly and diagnose accurately every case appealing to you, and you will lose nothing in the end. A hurried or careless doctor is certain to become an inefficient physician. If you, in all truth, have not the time to properly attend your patients, tell them so. Select your clientele, or move. What you do do, do right.

Nephritis Secondary to Scarlet Fever. It is important for the diagnostician to differentiate the various varieties of nephritis secondary to scarlet fever, if he wishes to retain his reputation for keenness in prognosis. The acute degenerativ

appearance of the rash. The urin is diminishtor, there is only a moderate amount of albumen, and but few casts. Recovery in a month is the usual rule. The acute exudativ form develops two or three weeks from the onset of the fever, and the symptoms are much more severe. The urin may be totally supprest for a number of hours and be very scanty for a number of days. The albumen is abundant and the urin carries blood cells casts, and an excess of urates. There may be disturbed heart action, delirium, and general and pulmonary edema. Despite the gravity of the symptoms, recovery often ensues in a few weeks. The acute diffuse form quickly follows the late stage of desquamation. There is obstinate anemia, vomiting and dropsy. The scanty urin is loaded with albumen and casts, and death follows within a few days. A return of vomiting or continued high temperature is always a suspicious indication.

Disinfection of the Excreta in Typhoid Fever.

It is now known that not only the vomitus and the stool, but also the urin of the typhoid patient carries the infectiv material, and it is therefore important that every physician make sure that the nurse both appreciates this fact and follows out the proper precautions efficiently. There are a number of cheap disinfectants which even the poor may afford, but even the best and costliest disinfectants are useless unless properly used.

One of the surest methods of rendering the excreta harmless is by fire. In the country where shavings, saw-dust or slack may be obtained for the hauling away, the military "sink" is a handy contrivance. It is easily constructed and requires no attention beyond occasional replenishing of the fuel. It is constructed and operated as follows: Dig a bowl shaped hole in the ground about 18 inches deep at its deepest part; line it by laying smooth, flat stones all over its bottom and sides in such a way that the bowl shape will be retained. Start a good fire in the bottom, of sufficient size the stones hot. When it is desired to deto keep the bowl pretty well filled and all stroy excreta, throw it on the fire. The fluids are immediately vaporized and the

solids are soon consumed. The construction of the sink and the depth of the fire without the effect of draft from the bottom or breeze at the sides, permits a fire to burn for many hours without replenishing the fuel. Then a few shovels will keep it going a long time. Slack or saw-dust are the cheapest and best fuels, but coal or wood may be used. This method is cheap, convenient and absolute.

Boiling is efficient, but it is seldom that this plan can be carried out with satisfaction. It is slow and bothersome, the odors are not quickly destroyed and numerous vessels are required. The method of stirring the stools and urin with boiling water is apt to prove deceptiv, because of failure to secure disintegration of the stool to a degree sufficient to permit the water to reach every particle while the water has an efficient temperature. Few nurses will add enuf water and still fewer will stir the mass long enuf.

Receiving the discharges in a vessel in which the disinfecting matter is kept constantly is a good plan if one be certain that the disinfecting agent is there in sufficient amount. It is always necessary to have a number of vessels, since the stool should always be well stirred with the disinfectant, and then allowed to stand for several hours before being emptied. If purges are being used in the treatment, or if diarrhea or hemorrhage be a complication, one is apt to find the supply of vessels deficient and be tempted to shorten the period of standing in contact with the disinfectant. In the contact, stirring and standing method, carbolic acid, milk of lime, creolin or chlorid of lime may be used. Permanganate of potash, bichlorid of mercury and sulfate of iron are not to be relied upon. They are excellent deodorizers but are not always efficient disinfectants for excreted matters.

For country work, the sink is the best and surest, as well as the cheapest and most convenient plan with which we are acquainted. There are few dwellings even in towns where such a sink cannot be constructed in "the back yard." Since one can never be certain that perfect chemical disinfection has been obtained, and since the most careless or ignorant nurse cannot misunderstand the directions for handling the sink, we commend the plan to the attention of our readers. We have never seen it used by any one else for this purрове.

Where and How Shall the Medical Student Get Information Concerning Medical Ethics? With all the everlasting hue and cry about medical ethics, one can not but wonder that there is so much loyalty existing, if he but know even a little of the actual condition of affairs.

ance.

The medical student enters the medical school "fresh from college;" or fresh from the farm; or fresh from his preceptor's office. He has never heard a word of medical ethics, and when he first hears the term, if he has the timber of a good doctor in him, he looks wise and remains silent while inwardly cursing his abject ignorSo soon as he may, he looks up the term in every lexicon, dictionary, book, and periodical to which he has access, with absolutely no results in so far as information goes. That is, the good student does; the coming ignoramus or quack has not the energy, brains, or enthusiasm to do such labor. The good student has learned enuf to attract his attention, and has done his full duty when he has studied all available references; but the very familiarity with which the subject is treated by his professors impels him to conceal what he supposes is his supreme ignorance, and he is afraid to ask what this term means. Probably he does not again hear it in his entire curriculum, and graduates without knowledge of this important branch of medical education. All he learns thereafter will be over a very rocky path. He meets those as ignorant as himself; those who deliberately steal from him all his hard won prestige; the foul and slimy back-biter; the quack, as well as some versed in ethical lore. What wonder that he blunders? Who is to blame?

We recall the case of a young man who had graduated from one of our best colleges, with honors: he had served under a preceptor whose diploma was endorsed by the leading medical institution in the United States; he entered the curriculum of the said college and passed it with high grades, and some prizes; he was chairman of his class; yet until a few weeks before graduation he had never heard of "medical ethics." At once after hearing it he lookt it up faithfully, and found nothing. He first heard it in a casual reference during a lecture on therapeutics in which the professor promised to devote

one hour to a consideration of the subject of "Medical Ethics." The student, tho he has practised for a number of years, is yet waiting to hear that lecture. After After laborious search, he found where he could obtain a copy of the " "Code;" when he perused it his horizon widened, and in the twilight he saw numerous shadows of failure, insult, mis understanding, abuse and heart sickness and disgust, all of which might have been avoided or thwarted had he but known. When he obtained the copy of the Code he was a member of his County, State, and American Medical Association, and had written articles attracting attention in more than our continent. It is very easy to blame him for his ignorance; but were it not better to arraign the professors who should have given him a glimpse of light?

These were the actual conditions in one of the leading medical teaching institutions in the United States What they may have been in the more modest institutions we cannot tell. We have assurance that they are no whit better to-day.

It is certain that if the medical students are not taught the vital principles of medical justice and equity, they cannot practise them. When they meet their peers in ignorance, some one is injured; and probably the most honest man. We enter an emphatic plea for the teaching of the fundamental principles of medical ethics in every medical school; we urge every National, state, and county medical society to furnish every new member with a copy of the Code; we suggest that every doctor who has never seen it write to the Journal of The American Medical Association, Chicago, Ill., for a copy. If the schools have no time to mention it, they might at least present each graduate with a copy.

Wrinkles.

While wrinkles are not a disease, their cure or the ability to retard the time of their appearance would be gratefully received by many of our lady patients, both young and old; and even the man who is careful of his personal appearance is often slightly worried by the early appearance of wrinkles which tell too much of a rapid and foolish life, or a body and brain tiring struggle for existence.

Wrinkles always tell something, if the observer can but read the written, the silent, language of Nature. If they do

not speak of overwork or dissipation, they tell of a temperament easily unbalanced by the every day affairs of ordinary life; of a suspicious trend of mind which leads its possessor to search out causes for worrying where no actual cause exists; of prolonged mental or physical suffering or trouble; of perhaps, only a man's appreciation of his responsibility to his fellow man, his country, and his God; but whatever they may portray, they are always truthful and eloquent.

Many of us assign their etiology solely to age, or dissipation; a moment's thought would convince us of our error. A dozen other causes are fully as potent. Their pathology, if pathology it may be termed, is simple: the skin, thru being drawn by the underlying muscles of expression into certain positions day after day, gradually relaxes so that no effort of the muscles is required to hold it in such a position. When the skin is thus relaxt, no abnormal action of the muscular structure is required to retain it in its accustomed pose, and as the position is itself to a certain extent abnormal, the underlying muscular structares undergo an atrophy from failure to exercise the muscular cells. Thus the deformity becomes permanent, if untreated. We say "deformity," " permanent," and "untreated," advisedly; for rational and persistent treatment will cure all cases of wrinkles, except those of advanced age.

Massage and inunction do the work. The finger tips of the patient may supply the massage after one lesson of instruction, and lanolin is the best agent for inunction. The massage is given in plain stroking movements at right angles to the direction of the wrinkles, and is firm enuf to include the skin and underlying superficial muscular structures. Enuf lanolin is used to give abundance for absorption, and allow the skin to remain slightly greasy after the massage. Unsalted butter, linseed oil, castor oil, or codliver oil may be used with perhaps equally good effect, but the lanolin is as good as any, and is nearly devoid of any objectionable features.

The commercial cosmetics containing glycerin, zinc, lead, arsenic, flake white, etc., are, of course, not only useless, but positivly harmful, and should never be prescribed by the physician. If the patient importune one for a lotion, there is no better than witch hazel and bay rum, equal parts.

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We continue to receive reports from all parts of the country concerning the strange eruptiv disease that is prevalent over a great part of the country. In presenting these reports from various sections we aim to "hold up a mirror," as it were, in which we can see the condition just as it is in various parts, that comparisons may be made and conclusions reacht. The reports are thus far too various to form a conclusion that will fit the conditions in

all sections. We will continue publishing these reports as long as anyone has any thing new to say. This is a very interesting collectiv investigation and will no doubt lead to much good. The visitation is a remarkable one.

"In a Nutshell."

Editor MEDICAL WORLD:-We have noticed several communications in your valuable journal in reference to an eruptiv disease which has been terrorizing various parts of the Union. There is apparently a diversity of opinions entertained by the various correspondents as to whether or not it is small pox. Small pox has a history reaching back nearly as far as that of Adam. We are told that it is of Asiatic origin. Our earliest Chinese writers regarded it as almost a fatal malady, and tho Jenner's researches and teachings threw light upon it, strange to say that in England to-day, at their medical societies, they debate the advisability of vaccination-this its mother country.

In our town and vicinity, within the last eighteen months, we have seen two or

three hundred cases. We exprest our diagnosis with considerable reservation at the outset. In fact, a physician who bad not met with this peculiar disease, to at once decide would be considered as entirely too hasty for safety.

We spared no time nor pains to get at the bottom of the disease. It is a germ disease, both infectious and contagious. The period of incubation, the head and back symptoms, the degree of temperature, the sore throat and the localities of the eruptions, and the appearance, correspond with small pox.

It appears in the papular, vesicular and pustular stages, and while, as has been said, the colored race is less susceptible than the whites, they are far more susto yellow fever or even malarial fever ceptible to this disease.

Attending this disease there are some cases of as genuin umbilication as ever occurred in any small pox epidemic. There were isolated cases of the characteristic odor, but they were the exceptions.

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The fatality was only 1 or 2 per cent., and they were complicated cases. eral infants had spasms from high fever. There were several still-born babes that had recent good scars, as also those who were perceptibly broken out. Those who had undergone small pox, had immunity.

We did extensiv corresponding and made thoro research, but failed to find any similarity existing between this disease and the Cuban or the squaw itch.

After long and patient experience with it, we gradually met with symptoms that for a time were lacking till we determined that we had conclusiv evidence of small pox of a less degree of severity than had ever invaded this country before.

G. HUSTON CHAPMAN, M D. | Uniontown, Ky.

Editor MEDICAL WORLD:-I see a good many communications, pro and con., on the disease called "small pox." I had some experience in treating it as long ago as January and February, 1896. At that time I did not call it "small pox," and received the imprecations of my community, had the State Board of Health after me, and really was "hard run" for a friend. After a careful and conscientious. study of this malady I am, like the old woman, "of the same opinion still," for several reasons, which I will try and state as concisely as possible: First, this dis

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