ORIGINAL COMMUNICATIONS

Short stories on the treatment of diseases and experience with new remedies are solicited from the profession for this department; also difficult cases for diagnosis and treat ment.

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 next month. Unused manuscript cannot be returned.

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.

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Malarial Hematuria. Editor MEDICAL WORLD:-Probably no two cases of malarial hematuria can be treated alike. On a general plan, an eliminativ and curativ treatment is adopted and the symptoms treated as they arise. In this form of malarial toxemia we have to deal with the estivo-autumnal type of Laveran's disease, and the destruction of the red blood corpuscles is very rapid, a few hours sufficing to produce profound anemia. The pathological changes are often very rapid. I have stood by patients and seen them become bronzed with the icteric hue in a few minutes, from absorption of bile into the blood, and thence to the tissues. The administration of quinin is frequently followed by the coffee-colored secretions from the kidneys. Just why or how this effect follows the use of this drug is for some investigator to determin. Excessiv nausea and irritability of the stomach, with extreme restlessness, sighing, inordinate thirst are often among the most troublesome symptoms. The specific for this condition is hypodermic injection of morphin and atropin-adult dose, morphin, grain; atropin, to 10 grain, doses to be graduated for children. No remedy equals this. I do not hesitate to use it under any circumstances. No fear need be entertained of an interference with secretion, as there seems to be a tolerance. Use no calomel, as it increases the nausea and irritability of stomach; besides, the liver is already secreting bile too freely. It is not good practise to use mercury in enlarged spleens; and engorgement and enlargement of the spleen is one of the prominent symptoms of this disease. Use Rochelle salts, effervescent salts or

citrat of magnesia to keep bowels open. Spirits turpentine as a diuretic is the remedy sine qua non. Can give in emulsion, or three to eight drops on sugar about three hours apart, being careful not to push too far. M. Berenger-Ferand, whose observations were in Goree and Senegambia, tells us the disease is not new; was known there in 1820. Dr. Day saw this disease on the Wabash and White rivers in 1836 and 1848. M. BerengerFerand shows the remarkable color of urin to be due to bile. Professor Joynes speaks of it as "bile deluging the body." Sometimes blood corpuscles are found from congested and overworkt kidney.

I do not use quinin often, and then only in small doses, incorporated with iron and arsenic. The use of ergot, Monsell's solution, gallic acid, and other styptics is highly reprehensible, and should not be tolerated under any circumstances. By all means keep the action of the kidneys free, in order to eliminate from the system the absorbed bile. The use of ergot, gallic acid and kindred remedies interferes with the action of the kidneys, often causing suppression of the urin. Where the action of the heart is weak from profound poisoning, do not allow the patient to assume an upright posture. Use strychnin, digitalis, nitro-glycerin, caffein, etc., to stimulate and sustain the action of the heart. We often use here Fowler's solution in heroic doses-four to ten drops every four hours, watching the effects. A combination of small doses of quinin, iron, arsenic, and guiacol administered freely is often of service. The tablet recommended in December WORLD by the writer (page 481) is good.

Now, about methylene blue: I have had better success with this remedy in malarial hematuria than any drug I have ever given. The fever leaves gradually after its administration. If nausea and excessiv enuresis supervene, use hypodermic of morphin and atropin to allay bad symptoms, or give benzoic acid and cocain. The methylene blue is reliable, and physicians need have no hesitancy in using it. Give as you would quinin, two to four grains three hours apart. It is impossible to save all cases in this affection, as pathological changes are so rapid and the system is so profoundly affected that medicins avail nothing. We have members of the medical profession whose rates of mortality in this disease and

The Practise of Medicin as a Livelihood.

Notes, Replies and Comments.

Editor MEDICAL WORLD:--Your editorial entitled: "Shall Our Sons Study Medicine?" sets one to thinking. Does the average American doctor really take in $1,000 a year from his practise? I doubt it. But grant that he does. This represents an income of just $2.73 per diem. I am paying my plumbers and furnace men $6.00 for a day of eight hours, and other mechanics 50 and 40 cents an hour; and for unskilled labor $2.00 a day. The doctor must spend four years at medical college, costing him in money about $2,000, besides his time; and this must be preceded by an education over and above what the mechanic must have; so that we may safely put the cost of the doctor's preparation any where between $5,000 and$10,000. And yet he does not get the income of the carpenter; probably not more than an unskilled laborer if the truth were known. And what doctor would not jump at the chance to limit his day's work to four hours in the forenoon, and the same in the afternoon; never driven be yond his easy capacity; his evenings, meals and night's rest undisturbed; no expenses for residence, clothes, etc., necessitated to keep up position; and wages ready at the end of each week, with no drafts on them for drugs, livery, books etc.?

Every occupation in life has its drawbacks and hardships; everyone has an opportunity to grumble a little over his lot; but whatever the attractions that the doctor's life may possess, it should be clearly understood that as a means of money-making it does not equal any good mechanical trade.

I would not advise my son to enter the medical profession, but to take up whatever trade he prefers. Tell me you, Doctor, if, when you began the studies that fitted you to be a physician, you had learned carpentering, had saved till you could buy some land, the cheapest to which a five cent fare would take you, built a home and lived in it till your acre had to be cut up in lots at ten to twenty times the cost to you, and your profits reinvested in this simple manner-would you not be a richer man to-day?

My principal objection to Dr. Salter's theory, as to the determination of sex (page 225) is that it is only theory or rather hypothesis. He simply proposes an explanation and offers no evidence whatever to uphold it. A further objection is that in the cases which I have noticed, his explanation has not held good. I recall one couple where the wife never knew an orgasm, but bore two daughters; another bore a son and a daughter, another a son. A woman whose sexual appetite and capacity were enormous, rendering her husband impotent at 40, bore four sons and one daughter. I believe there is nothing in this theory of sexual superiority; if there were, the dominant sex would reproduce its opposit to keep the balance level.

I sincerely hope that "Country Doctor" (page 229 and 230) will keep on writing for THE WORLD.

Dr. Markley's experience with mumps (page 230) leads me to remark that I aborted that malady in my two children in about two days; during which they ate pickles right along. This disease is epidemic here. The remedy was calcium sulfid to saturation. Can a calf have mumps?

Why not? When we know more of the diseases of animals we will be able to trace the origin of more human affections.

Dr. Dunn (page 232) may doubtless have discovered that stretching the prepuce will answer instead of circumcision; but many others have also discovered it. I have been advocating this method more than twenty years, and must have described it in this journal several times. It is a good method.

Cut out Dr. Seal's report on whoopingcough (page 233) and paste it in your hat. It's worth thinking about a good deal.

On page 234 Dr. Kline and I discuss the use of distilled water. Since writing that I have read with interest a report on the experiment of furnishing sterilized air to animals. They died. The conclusion was that while the phagocytes ate up bacteria, they did it not so much to prevent the micro-organisms doing harm as because the eaters were hungry. The leucocytes obtain from the microbes certain elements, ferments, necessary to their vitality and that of the animal of which they form a part.

I see no reason for doubting that the morphin caused the death of Dr. Lawrence's

patient's child (page 242), since this is a well-known effect of the morphin habit.

I began to write something on homeopathy, but concluded it was best not to do So. I have heard and read many discussions, of matters religious, political or medical; but I do not recollect ever knowing of any one who was convinced by argument. There are few men who can long carry on a discussion on any subject that vitally interests them, without losing their temper and getting all riled up. Now, our WORLD has always been a choice medium for the interchange of experiences and views based upon clinical observation. Introduce medical polemics and at once the lines separating the various camps begin to appear, and the men occupying each begin to draw asunder from the others. I prefer therefore to keep on neutral ground.

There is one drug concerning which I would like to ask for information, and this is pulsatilla. With homeopaths it is a favorit remedy and with the eclectics there is remarkable unanimity in recommending it for many conditions of depression, in which a prominent symptom is the appre hension of coming disaster. When this symptom is present in pregnancy, in hysteria, in nervous depression, associated with gastro intestinal catarrh, irritability of the bladder, various menstrual derangements, etc., pulsatilla is recommended with the assurance that comes from the conviction of its certainty in affording relief. Scarcely anything is to be found concerning this drug in the writings of the dominant school. Few of the writers mention it at all; while of those that do, some term it simply a feeble imitation of aconite, while others dismiss it as "inert.”’ As anemonin, the activ principle of pulsatilla, is volatil, it can readily be seen that experiments based upon preparations of the dried plant are apt to give negativ results. I would be very glad therefore to know if those who have used it can verify the above recommendations. Another point: while the American pulsatilla is said to differ from the European, it is nevertheless recommended in about the same line of cases. Are the two identical in therapeutic effect?

WILLIAM F. WAUGH, M.D.

Chicago, Ill.

Dr. C. L. Finch, of Detroit, Mich., renews and says: "Purely neglect that I have not remitted sooner. Would cancel all other subscriptions to medical journals rather than that of THE WORLD."

Renal Insufficiency in Pregnancy. Editor MEDICAL WORLD:-Your forcible and timely editorial in the March WORLD on Renal Insufficiency, and Dr. Waugh's suggestiv article in June WORLD touch points of recent irritation in my mind. I frequently recall to my patients the words attributed to Sir William Gull calling for a supplement to the ancient maxim, know thyself," by the addition of "and test your urin." Certainly the individual never needs more careful consideration than when her anatomy includes the developing form and energies of one or more additional lives, as in the condition of pregnancy. So, with your kind permission, I will present some recent clinical observations in this relation.

Mrs. M, aged 28 years, married four years, was in an apparently steril condition, suffering from severe retro-flexion, endometritis dysmenorrhea and copious, offensiv leucorrhea. These conditions were amended by mechanical repositions, and the use of vaginal suppositories of unguentum Credé and intra-uterin pencils of collargolum, combined with suitable internal treatment, and for a time the nightly wearing of the Neptune's girdle. However, the importance of the aid given by the silver germicidal treatment in this and similar cases cannot well be given too strong a record. In due course after the abatement of the above symptoms, this patient became pregnant; and with high hopes lookt for a permanent betterment of her health and the acquisition of a child.

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The course of this pregnancy presented some unusual phenomena. The early months past without much nausea other disturbance of the normal faculties. But in October, 1900, pregnancy being then about five months advanced, this patient was suddenly stricken with cerebral congestion and amaurosis. She had been in the habit of walking about the house in her night dress and bare feet, being sleepless and inclined to worry. The urin was of light specific gravity, and without albumin. Rest in bed and treatment directed to support the kidney function gradually brought relief of the violent headache and restoration of normal sight. Two and one-half months later, when this patient was seven and one-half months advanced in her pregnancy, after night exposures and mental worries similar to the preceding instance, she was attackt with violent convulsions, being found about

ten o'clock a. m., alone in her house, her body partially under her bed, her face on the floor, entirely unconscious. On my arrival two hours later convulsions still continued with violence. Noticing a large chamber full of very light-colored urin, and remembering her disposition to insufficient kidney function, I at once administered hypodermically one-third of a grain of muriate of pilocarpin, this securing a very free diaphoresis and prompt restoration of the nervous balance. Urinalysis one day later showed sp. gr. 1006, no albumin. This patient is of full habit and prefers to be lightly clothed, and objects to wool next her skin. But I at once ordered a heavy woolen shirt and drawers to be superimposed over cotton underwear next the skin. With this change in raiment the skin became habitually moist, her condition rapidly improved, and she came to the period of accouchement in good condition and fine spirits. After a labor of nineteen hours I delivered her, under chloroform, by the aid of forceps, of a ten-pound boy. There was no accident in the delivery nor incident following more notable than that the patient's ample breasts have seemed incapable of supplying sufficient nutriment for her lusty offspring.

The phenomena of the urinary function. seem to be far less noted and cared for by the average man and woman than is warranted by their importance to life and health. In this respect physicians too often fail to know their patients.

Seattle, Wash.

ARTHUR DEVOE, M.D.

Renal Deficiency.

Editor MEDICAL WORLD:-Prof. Waugh's article on page 218 of June WORLD is very instructiv and practical. Now if the readers will bear with me, I will give a little history of my personal experience with renal deficiency, as I have been a sufferer from it for some years. My age is 37 years. Some authors say it is rare under 40. About eighteen months ago, after a severe attack of grip, I found myself incapacitated for work. Prior to that attack I had been doing an activ practise, tho my health had been below par for some years. I had suspected my kidneys and tested for albumin, but found none. After the attack of grip I went to a hospital for treatment, for I was a great sufferer from the various symptoms too numerous to

mention described by Prof. Waugh and others. I will say here that no one can possibly realize the suffering entailed by these uremic symptoms unless he experiences them.

My urin was analyzed and pronounced normal; and my malady was variously diagnosed and as variously treated. A weak stomach was injured, and I was almost electrocuted for neuritis. Three months past while I was under the care of three eminent physicians, without relief; during which time I felt the utter despair that only one can feel who has lost all hope, while suffering from one of the most depressing diseases known.

I consulted the fourth physician and found that which I had failed to find before, viz. a thoro, painstaking and scientific man; and in forty-eight hours after first seeing him, and after an analysis, a diagnosis was based on the small amount of urea I was passing. Proper treatment was followed by immediate improvement. (From this experience I can no longer wonder why the laity resort to patent medicins.)

I do not detail these facts as a reflection on my profession, for my love and honor for my profession are second to none. I only do it with the hope that it will prompt others to post themselves on this subject. Do not, for the sake of your reputation, tell a patient that there is nothing wrong with his kidneys, simply because you cannot find any albumin in his water. Be satisfied with nothing less than repeated quantitativ analysis, and be ready at all times to take pains with all obscure troubles, and your patient will not go on for months without a diagnosis and proper treatment.

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As to treatment: During the acute stages when the digestiv function is paralyzed, nearly always accompanied by ǹausea, stimulation is first; strychnin, with liquid peptonoids, has served me well. Eliminativ: Give large quantities of a light mineral water as a diuretic; be careful not to purge too freely, for the heart is easily deprest. When stomach take it, give plenty of milk-two to three quarts in twenty-four hours. No drugs can equal milk and water as a diuretic. Predigest the milk if necessary. Gradually return to a more solid diet; partake sparingly of nitrogenous substances. As a constant treatment I use nitro muriatic acid, strychnin and essence

of pepsin before meals, and iron after. (Will try nitric acid after Dr. Waugh). Wool next to skin all the time; guard against sudden atmospheric changes. I have analysis made every six to eight weeks; albumin seldom found; amount of urea varies from fourteen grams to eighteen grams in twenty-four hours (about thirty-five grams are normal). The comfort of the patient largely depends upon a proper diet; give easily assimilated diet and attention to skin and bowels. Will someone give me a vegetable laxativ for constant use? Salines I find do not act well as a constancy. More often than not they only produce a watery discharge and leave the intestinal tract full of solid feces, which I have proven by giving an enema after the saline, and bringing away these masses. There are a great many questions I would like to ask, but will only ask one: If the disease is due to the liver, why is there an inflammatory action in the kidney, with casting off of the lining of the tubes, and contraction of the organ? I would like to see a fuller discussion of this subject.

Editor MEDICAL WORLD:-In diabetes mellitus I have had patients from six to sixty years of age and as yet have never failed to make a complete cure. I have had patients whose urin when first seen showed twenty-four grains of sugar to the ounce. It entirely disappeared within three weeks. It is now more than three years and there has been no recurrence. As Dr. Holmes wishes treatment, I will not go into detail with cases treated, but here give my treatment:

I first take the urin for twenty-four hours and estimate the percentage of sugar; after which I have them bring their urin each time they come to see me, and note progress. My first prescription

disappears. The urin becomes a straw color with normal specific gravity and constituents. They will not have to get up to pass water more than once in the night and as a rule not at all. When they have reacht this stage I put them on two doses a day of the lactic acid and keep them there for about a year.

My diet list is as follows:

Soups.-Soups or broths of beef, chicken, mutton, veal, oysters, clams, terrapin, turtle (not thickened with any farinaceous substances).

Fish.-Shell fish and all kinds of fish, fresh, salted or pickled (no dressing containing flour).

Eggs. In any way.

Meats.-Fat beef, mutton, ham, bacon, poultry, sweetbreads, calf's head, sausage, kidneys, pigs feet, tongue, tripe, game, (all cookt free from flour, potatoes or crackers).

Farinaceous. Gluten porridge, gluten bread, gluten gems, gluten biscuits, bran bread, cakes.

Vegetables.-String beans, spinach, beet tops, kale, lettuce, plain or dressed with oil and vinegar, cucumbers, onions, tomatoes, mushrooms, asparagus, oyster plant, celery, dandelion, cresses, pickles, radishes, olives.

Desserts.-Custards, jellies, creams (without any sugar), walnuts, almonds, filberts Brazil nuts, pecans, cocoanuts.

Drinks.-Tea or coffee (without sugar), water, peptonized milk.

Must not take liver, sugars, sweets, starches, wheaten bread or biscuits, corn bread, oat meal, barley, rice, rye bread, sago, macaroni, tapioca, potatoes, parsnips, beets, turnips, peas, carrots, melons, fruits, puddings, pastry, ices, honey, jams, sweet or sparkling wine, cordial, cider, porter, lager, chestnuts, peanuts.

If the readers of THE WORLD would care to have the history of some cases I would be glad to give them.

R. G. McCULLOUGH, M.D.
Providence, R. I.

[Doctor, the text books agree in declaring that true diabetes mellitus is always fatal. What do you think of the editorial comment following Dr. Holmes' query on page 255, June WORLD? How long has any well-markt case of yours stayed cured? Did you ever use arsenic in any form for diabetes, and with what results?-ED.]

Dr. W. H. Young, of Quincy, Ill., renews his subscription and says: "If I did not like THE WORLD I would quit it.'