strenuous efforts and galling rebuffs; you will note that your classmates with lesser talents have won more wealth and prom inence in other lines than you have in yours; you will realize that the successful physician in the next decade must spend twice the time and money which you spent on your medical education; you will realize that his work and annoyances will increase with sterner competition, and you will falter before you take the step to "make the boy a better doctor than his father."

There are many other lines of effort which promise much more remunerativ returns, easier work, and greater eminence, if the boy be really capable; and if he is not capable he can only become a failure, a fraud, or a quack, in medicin. It is very sweet to think of giving your life for your fellow men, and we suppose it ought to be sweeter when you give it by inches rather than in one brief agony; but age gives discretion, and you ought to warn and protect your boy. Our worries and trials were enuf; his will be more. We wore our brain thin in learning useless knowledge; he must learn more. Advise him to become a master in some other art. His work will be easier and his remuneration greater, if he have within him the ability and energy which are always the foundation of success. Under existing conditions, he can be made a leader in any other line sooner and easier than in medicin.

Hematuria.

Bloody urin is always a source of considerable alarm on the part of the patient, ⚫ and too often the physician is led into making a grave prognosis of kidney disease when no such trouble exists. Blood in the urin may come from the kidney,the bladder, or the urethra. It may be a concomitant symptom of grave disease; but suddenly occurring in a person otherwise healthy, is not likely to be fatal or even serious. To such cases the term idiopathic has been applied. In idiopathic

hematuria the blood is intimately mixt with the urin, and is not often found in clots, as it usually is if the hemorrhage comes from the bladder or kidney. The urin is commonly "smoky," becoming darker if the urin is acid, and lighter and redder if the urin is alkalin. Unless the urin be intensely acid or very alkalin, the color becomes darker as the amount of blood becomes larger. It is rare that symptoms other than the change in the urin are developt, altho occasionally a patient will complain of pain in the back, because, as Tyson naively suggests, "He thinks since there is bloody urin, there ought to be pain in the back." There is no nausea; no fever; no pain; no actual illness; but if untreated, and the hematuria be severe and continued, weakness will gradually develop. It is essential that treatment be instituted promptly, and the first requirement is absolute rest. Tannic or gallic acids, persulfate of iron, hamamelis, lead acetate, catechu, kino, alum, or ergot may be used. Often some soothing diuretic, like saw palmetto, is indicated.

It is well to be sure the discoloration is really blood before you begin treatment. Remember that carbolic acid, senna, rhu barb, beet root, and sorrel, will tint the urin brownish red. Blood corpuscles may be found under the microscope if the urin be acid, but if alkalin, there is little hope of discovering them. The chemical test is to place a dram of tincture of guaiacum in a test tube and add a drop of urin ; afterward a little etherial solution of hydrogen peroxid. If blood is present, a blue ring develops at the junction of the fluids; but it is to be remembered that other substances may produce the same reaction. In some cases the urin is first elear and then bloody; in others it is well blended when voided; and inothers, clear urin passes first, and the blood follows the closing of micturition. Careful questioning will draw out these facts; or if the patient be unobserving, three bottles used to

catch the first, the middle, and the last flow of urin, may clear up the matter.

In hemorrhage from the kidney, the urin is commonly smoky, tho it is rarely bright red. The reaction is acid, unless the quantity of pus or blood has been sufficient to alter the reaction to alkalin. In hemorrhage from the bladder the color is bright red, unless the blood has been retained within the viscus for a considerable time In urethral hemorrhage the color is always bright red, and the hemorrhage always precedes or follows the flow of urin.

Hematuria may be due to blood dyscrasia, local affections, injury, calculi, passage of instruments, nephritis in any form, cancer or tuberculosis of any part of the urinary tract, cystitis, ulceration of any part of the genito-urinary canal, or local disease, such as gonorrhea or urethral chancre. The treatment is much the same as in the idiopathic variety; rest is essential; opium is used if nephritis and renal congestion can be eliminated; ice may be applied to the perineum, penis, or suprapubic region, as the indications point; if the hemorrhage be from the bladder, it may be checkt by washing the viscus out with hot water (120° F.); if it be from the urethra, pass a catheter, and compress the penis around it by means of elastic strips; tincture hamamelis or infusion matico may be injected into the bladder; coagula in the bladder may require removal by repeated washings; watch the case closely, as the hemorrhage may become alarming at any time.

Malarial hematuria will be taken up later.

Nutrient Enemas.

Rectal feeding is too little employed by the average general practitioner. This negligence is due to fear of bother, the disagreeable nature of the operation, and a lack of proper understanding regarding the technic. Even without trained nurses, one may teach any intelligent person, by a single lesson, sufficient to enable him or

her to administer the food successfully. It is not to be expected that even the humblest country physician would do such work regularly, even if present at the proper intervals; and if doctors once realized the simple nature of the procedure, and the benefits to be derived from it, it would be oftener employed.

The best equipment is a smoothly working piston syringe attacht to a large calibre soft rubber catheter. The catheter is lubricated with glycerin or olive oil, and is left in position after insertion, until enuf food has been injected; when one syringeful is injected, the syringe is detacht and filled, and again attacht to the distal end of the catheter. When enuf has been injected, the catheter is removed, and the patient instructed to endeavor to retain the injection by avoiding all bearing down. The discomfort generally passes away in a few moments. Catheter and syringe are then boiled and allowed to cool until the hour arrives for the next injection. The rectum should be washt out once each 24 hours with warm water and non-irritating soap.

In giving the injection, the patient should lie upon the left side, with the hips elevated a few inches on pillows, or the foot of the bed may be elevated on bricks or books. The fluid should be at a tem

perature of 100° F., and should be injected slowly. The intervals between injections may be four to eight hours.

Easily soluble medicins not likely to irritate the bowel may be often incorporated with the nutriment, and thus save the patient the annoyance of taking them by the mouth.

No one can rightly deprive a patient of the benefit of rectal feeding thru a plea of inadequate equipment, or lack of skilled nurses; for any syringe will do in an emergency, and any one who can give a sick person a drink of water can operate it. In our reading columns of this issue will be found a number of the best formulas for rectal feeding; the physician will

readily determin what medicaments will blend properly with the ingredients.

When a patient cannot swallow; when prolonged vomiting causes a threatened collapse; when any other condition excludes the advisability of administering food by the mouth; then rectal feeding is indicated. Every physician should become familiar with the simple technic and be able to give extemporaneously the popular formulas and method of administration,

and illustrate the method personally if

the circumstances demand it. The mode of procedure is little different from the practise of rectal irrigation for summer diseases of children; and no doctor in the coming season dare ignore the advantages

of this treatment. In the name of humanity, so long as you pretend to practise medicin, practise it as well as anyone can. Ignore no valuable suggestions, and learn the technics of all the simpler plans, at least.

A Superior Local Anesthetic. Bonain, in Revue Laryngologie, Bordeaux, mentions a new combination of anesthetics with which he has obtained better results than he ever could with the drugs uncombined. It is composed of equal parts of hydrochlorate of cocain, menthol, and pure carbolic acid. The

cocain and menthol are dissolved in the acid. It has been used with notable results in the ear for operations upon the tympanic membrane and tympanum; and for the opening of the numerous abscesses which occur in furunculosis of the canal. It is applied by moistening a pledget of cotton with the solution, and allowing it to remain in the canal ten minutes. It has also been employed in similar cases to relieve the pain where operation was not required. It is also a success in the nasal fossa for purposes where the galvanocautery was necessary, and in puncture of the antrum. It is efficient in the larynx and pharynx for operativ procedure, and has been found excellent in the dysphagia of tuberculosis and in laryngeal ulceration; in one case the relief lasted four days. It is both anesthetic and antiseptic. If one wishes to combine the benefits of anesthesia with those of a caustic, Bonain recommends adding 50 centigrammes each of the cocain and menthol to 1 gramme of the pure carbolic acid.

Drugs Taken by a Nursing Woman Which Affect the Nursling.

The following drugs have been found in milk:

The purgativ principles of rhubarb, senna, and castor oil.

One whole raw egg..

No. 5. Whites of two eggs. Peptonized milk...

2 ounces

Iodin
Bismuth

Turpentine

Salicylic acid
All Bromids

All Iodids
Lead
Iron

Chloral

Hyoscyamus Digitalis Atropin Ergot

unless the infant has been removed from the breast until all danger of ingestion is past.-Ed.]

Uses of the Thyroid Gland as a Medicin.

In Practical Medicin for December, 1900, (Lea Brothers), a number of investigations of the action of thyroid gland have been collected. The observers include a number of noted foreign investigators. The gland is declared to have proven its usefulness in myxedema, cretinism, obesity, nonunion of fractures, the gastric disturbances of the early stages of phthisis, in acute mania, in melancholia, and in puerperal and climate insanities, in psoriasis vulgaris, to establish the menstrual flow when delayed by developmental changes incident to puberty. It is best given twice daily, in five grain doses, gradually increast. Any excessiv dose is followed by vertigo, tachycardia, nausea, chills or fever.

Internal Antisepsis.

In a very interesting discussion on Internal Antisepsis before the New York Post-graduate Clinical Society Dr. Wilcox concludes that bacteria are not essential to digestion, and that perfect digestion is possible in a sterile medium. As antiAs antiseptics, he favors chlorin and soluble forms of silver. Dr. Satterthwaite favored calomel, quinin and muriatic acid in striving for intestinal antisepsis in typhoid fever. Perfect antisepsis of the alimentary canal was hardly considered possible, but it is undoubtedly proven that excessiv action of the ptomain-producing bacteria, may be controlled and modified.

Poisonous Compounds.

Poisonous compounds may be formed by mixing potassium chlorate with potassium iodid, in solution; it does not react at ordinary temperature, but in the system probably forms potassium iodate. Potassium chlorate, if blended with syrup of ferrous iodid, liberates iodin in the stomach, and may cause gastritis of dangerous degree. Dilute hydrocyanic acid or potassium cyanid, if united with calomel, will form the bichlorid and bicyanid of mercury; and both are virulent poisons.

Editor MEDICAL WORLD:--A good deal has been written during the past few years on the subject of deficient elimination on the part of the kidneys. It is now generally admitted that the escape of albumin with the urin, tho highly significant in a diagnostic way, is in itself of little consequence to the patient, the greatest loss being made up by swallowing a raw egg or two. But the passage of the solid constituents of the urin thru it and out of the body is of vital consequence. the elimination by this channel to be totally stopt, life would be in such imminent peril that unless relief came the patient would die, self-poisoned, in two or three days. The most markt cases of total suppression of urin I have seen were due

to ether anesthesia.

Were

The elimination of solids by the urin varies considerably, but may be rufly estimated at 1,200 grains daily for the average man and 1,000 for the average woman. Nature provides for wide departures from her averages, and the human body accommodates itself even to prolonged excess or deficiency in this matter. But there can be no question that when the elimination sinks to one half, one-third or one-fourth of this quantity, there must be trouble.

And there is trouble. One of my patients I well recollect. She was eliminating about 200 grains in 24 hours. She ached from head to foot. Not an inch of her body but had its special discomfort. She could not eat, drink, sleep or perform any function with comfort. could not sit still without wriggling. She was cross, captious, fidgety, everything worried and annoyed her, nothing pleased her, her mouth was drawn down like

She

that, temper awful, complexion dreadful, sallow, dark rings about eyes-altogether the universal verdict of her friends was that she needed killing. Her pulse was 46, she had no appetite, constipated, feces dark and malodorous, breath offensiv, skin dry, urin scanty and pale.

In estimating the excretions of solids here is a very unscientific and inaccurate method that answers every practical purpose: As each grain of solids replaces a grain of water, double the last two figures of the specific gravity and you have the percentage of solids. Thus, a patient passes urin a pint daily, s. g. 1,025— double the last two figures and you have 5 per cent., representing the solids. Sixteen ounces contain 7,680 grains, and 5 per cent. of this is 384 grains of solids eliminated in 24 hours.

Poor soul! How could she help being nervous? Evidently it is help she needs instead of killing. The wonder is that it doesn't kill her; for, if the body dies from the total suppression of urin by the time about 3,000 grains of its solids have been accumulated, why doesn't death occur in the time necessary for that quantity to accumulate gradually?

Well, possibly the most highly toxic portions are those thrown off. And then the skin and lungs help out the suffering kidneys, as is shown by the urinous odor to the breath and perspiration. But above all, the bowels aid in carrying off the surplus, and the dark, offensiv stools may present the odor of stale urin. This is a reversion to more primitiv types, where the urin and feces are both discharged by the anus.

Nevertheless, all these are insufficient, and much excretory material is retained in the body. How can this be gotten rid of? Easily enuf. Just give diuretics. But, unluckily, just when you most need them the diuretics won't work.

I have tried the diuretic salts but they proved worthless. Then I gave, in succession, the vascular tensors, digitalin, caffein, apocynin, spartein, but they made matters worse and the patient more uncomfortable. Besides, the pulse of 46 did not indicate these remedies, which really only act as diuretics when the flabby vessels need stiffening up to enable the heart to pump thru them. Just try to inject the bladder thru the urethra, or compare the passage of a very soft rubber catheter to that of a metallic one, and you

will get the correct indication for the tensor diuretics. Then I tried the stimulants to the dialyzing apparatus of the kidneys, oil of juniper, and from onefourth of a drop I got a little effect; but when I increast this dose the elimination almost stopt, and my hair began to rise. Finally I tried glonoin, taking a hint from the effect of the tensors, and at last I got a decided good result. Changed to sodium nitrite to obtain more prolonged action, and under this the elimination rose to over 800 grains. She had the bowels well flusht daily with saline laxativs, and the diet consisted largely of milk and fruit. The mental symptoms did not immediately improve until several weeks had past and much of the accumulated toxins had been washt out; in fact, we had to read the riot act to her several times. After eight weeks she returned to her home in Pennsylvania, by no means well; in fact, I was by no means satisfied with the results achieved, but judging from the reports sent by her family her improvement far exceeded their highest expectations. She has continued to improve, and, after a year, is now considered well in body and actually amiable in disposition. As her long-suffering nurse remarks: "After that I'll believe in anything but Christian Science ! "

Since that one of my good friends gave me the hint to try nitric acid, and in several less markt cases it has given prompt relief. I much regret that I did not hear of this remedy sooner. It is still nitrogen you observe.

And here I am going to transgress my custom and dip a little into pathology. Why does the kidney fail to excrete normally? We now know that the normal excitant of the renal dialyzation apparatus is urea, and hence infer that there is a deficiency of urea. We note here that the next experiment will be the hypodermic injection of urea as a remedy. While working with Dixon some years ago we obtained, in tuberculosis from urea, reactions closely resembling those of tuberculin. should give relief in failure of renal elimination, but still could not cure, because it does not yet reach the true malady; which is evidently the failure of the body to provide its own urea. And here we trace the disease to the liver, in whose mysterious laboratories urea is generated.

This

How little we know! God! If only I comprended the functions of that wonder