Spermatorrhea. Despite the claims of quacks, this is a rare disease; yet it is one of vital importance to the victim, and is worthy of a full understanding and the most skillful treatment. The charlatan has tilled the field so thoroly that the honest practitioner is disgusted as soon as he hears the patient's voluble tale of emissions or drains. This reasonable distaste has allowed most of the better class of general practitioners to become deficient in skill in treating cases of this complaint when they present them selves. Every doctor should be qualified to treat it when it actually exists, and to allay the fears of the patient when he does not really suffer with it. Talk will not do; for the patient is generally certain that he knows much more about it than you, if he only knew "what to take." He has probably tried many physicians, and knows all the anaphrodasiacs by taste and smell, and if you so prescribe, will soon consult another physician. A microscope is essential in treating such cases. True spermatorrhea consists in the discharge of seminal fluid independent of genital titilation or sexual intercourse. A man may have a discharge from the penis which he deems spermatorrhea, and yet which, coming from the prostate, or Cowper's or Littre's glands, is not spermatorrhea at all. The physician should not deceive himself; nor permit the patient to deceive him. If spermatozoa be present, the microscope will always show them, tho they may be imperfectly developt and devoid of natural motility. No spermatozoa, no spermatorrhea, is a safe rule to go by. A little medicin must be taught these excited victims, and a considerable amount of time must be occupied in doing it; and as they have generally spent so much money on large fees for quacks, they are likely to listen well, and pay willingly. As soon as you show them what spermatozoa look like, and show them that the discharge they have contains none, they are usually readily convinced and become good and tractable patients. The urin must also be examined, and this is best done without intimating for what you wish to search. If seminal cells are in the urin, it will have a milky appearance, which disappears on agitation with ether after a little potassium hydroxid has been added; but this is a rare form of the trouble. One of the most important features in the confidential advice is the assurance that every healthy male past the age of puberty, if he is not accustomed to opportunity of sexual gratification, will have more or less frequent nocturnal pollutions. With some men it may occur twice weekly, and with others once in two months; and yet both be within the bounds of perfect health. If repeated pollutions occur each night, or if pollutions occur every night, the case may be considered pathological without microscopic examination of the discharge. The cases of diurnal pollution, in which the seminal fluid dribbles away without pleasurable sensations, are so rare as to be accounted medical curiosities; yet you must remember that the patient knows (?) he is just on the verge of this very thing, because he has learned it from the famous (!) and disinterested (?) physicians who have mailed him the literature. (Selah! and do something.) If you discover chronic prostatic inflammation, try electricity, manual massage, and rectal irrigation with normal salt solution hot as may be borne. Let the evening meal be light and taken at least three hours before retiring. Have the mattress hard, and the coverings light. Tie a towel around the waist, and knot it over the spine, so that the patient will waken if he turns upon his back. Have the genitals bathed with cold water at least twice daily. Advise cheerful society, and healthful mental diversions, with exercise (games or occupation) in the open air. If you investigate your cases thoroly, and employ rational measures, you will cure most of them and thereby reap good reward if you are shrewd and judicious. Medication is generally less efficient than advice and hygiene, but sedativs rather than aphrodisiacs are to be advised. Sexual continence is an essential. A little patience; a modicum of common sense; a little therapeutics; and a very little faith, will admit of a cure in the majority of cases. Still sexual desire and insist upon continence, but taboo drugs which will further depress the melancholy mind of the patient. Fees. Had we the space, we would talk with our readers at least three times a year on the subject of fees. If there were proper remuneration, there would be no talk of "an overcrowded profession," "division of surgical fees," "dead work," etc. It is the profession themselves who have brought matters to the present extremity, and it is the profession themselves who must remedy it if it ever be remedied. The struggling young practitioner hopes to curry favor and win friends by making concessions on fees to penurious patients, and the old and establisht practitioner feels able to "starve him out" by lowering fees below the young man's self establisht rate. The laity love to tell the tale; and both practitioners are made a joke until sore need impels the laity to be humble. If we collected just fees, it would not require one's working himself to death to gain enuf to keep up appearances and gain a livelihood; if we collected just fees, the young man could live if he did not have many patients. The The young man needs to learn that he would better fall in with the local fee table until he is establisht, and then do all he can to raise it to a.reasonable level. old man needs to learn that people will leave him for younger men, no matter how low he cuts his fees. We wish doctors could learn that people do not consult them for what they charge, but because they prefer them; if physicians once knew this,it would be a hint to them on fees. The average layman will pay any price to any physician or quack, if the promise of aid is given him. If you know you can cure him, charge him a good stiff fee, and he will be satisfied when cured, and will laud you amongst his friends as a doctor 66 who knows something, and tho he is awful dear, he's worth it. dear, he's worth it." Once you get that reputation, you may afford to let younger and "foolisher" doctors contest for beggarly fees. When you get a patient whom you know incurable, charge him a nominal fee, and tell him you prefer that he consult some other doctor who will keep him quiet by promises and take his money without qualm; since you can only promise relief, and never care to treat any one without rendering satisfaction. Ten to one, he will stay with you. The laity do not understand honesty; they like to be duped; and so long as there are practitioners willing to dupe them, and so long as we are not com. pletely organized, they will keep our fees down below an honest level by consulting the quack and paying him such fees that they are unable to pay us reasonable fees in emergencies. The solution of the problem is easy in theory and difficult in fact--for the reasons cited. The nearest we can get to a perfect solving of the problem is to get more thoroly organized. Get every practitioner of note into your local, state, and National society; then resolutely expel every man guilty of quackery. If this were done everywhere, a few years would see all honest doctors arrayed against the quacks. The doctors could set their fees, and collect them; or allow the quacks the business, and the end of the contest would come soon. If all reputable practitioners were organized together, there would be no question of the "division of surgical fees," for the physician would get what his services are worth, and the surgeon, naturally, would get less. If we were organized, there would be no "charity" or "dead work," for the county would be compelled to pay us. Even the labor organizations have solved the question of "payless work," but the educated physician yet seems anxious for it. Organize! they are doing it elsewhere. Unify yourselves! It is the only salvation financially, and the only solution of the fee question. Organization must be thoro and complete, or it is worse than useless. We have many reports of successful organizations, and we want to see every WORLD reader a missionary along this line. Be cautious in the use of morphin subcutaneously, after opiates or morphia has been given by the mouth or rectum. The Protection of the Perineum in Confinement. If Professor Goodell made a great advance in prophylaxis when he suggested hooking the finger in the anus and drawing the perineum forward, but he then knew nothing of the later discoveries of asepsis; when he learned, he advised "supporting" the perineum by external pressure. His first suggestion was more practical than the latter one, if possibility of sepsis be omitted from consideration. The perineal body acts just as the abutment of a dam in a flood, except that it may be counted more resilient. The force and pressure coming from within, and being confined to a definit channel by the pelvic construction, is exerted against the only actual obstructing force; hence the only logical treatment is to retard the pressure until the tissues have had time to dilate. they will not dilate, episeotomy may be required, or laceration may be inevitable. But extended observation convinces us that but few lacerations will occur in properly managed cases, unless it be in primiparae well up in years. The fetal cranial bones will mould to pressure, and if the required expulsiv effort is not present, we may obtain it by generous dosage of quinin and other agents. There are few perineums which will refuse to yield to time and patience; few vulvas but will stretch sufficiently to allow passage of head and shoulders; few women but what may be controled till nature has opportunity. Chloroform is a great aid, but it should not be employed recklessly any more than we would apply forceps when not indicated. We speak of normal cases only; osseous deformity alters the case and the view. We believe that the perineum in ordinary cases is best protected by retarding the head until the parts have had ample time to dilate. Admitting that forceps will release the physician much earlier, that it is easy to repair a laceration, and we yet feel our responsibility because we have seen carefully sutured lacerations which refused to heal. We have never learned of a better method of protecting the perineum than by retarding the head. Even the most rigid perineums will generally yield if the head is held back during the pain just sufficiently to admit of proper stretching, and short of actual rupture. This takes skill and experience and judgment. We admit that many perineums will be torn while this is being learned, but we are certain that there will not be as many torn perineums as if the fallacy of supporting the perineum were continued. Both young and old men need to learn the maneuver, since the majority of practitioners yet "support the perineum." During the act the perineum is crusht between the pressing hand and the descending head, and this crushing weakens the tissues of the part rendering it all the more likely to tear. If this crushing be avoided, the perineum will be more likely to stretch, particularly if the too rapid descent of the head be prevented. A few lacerations occur with all skill exercised and all precautions taken, but too many occur for which there is no excuse. Firm pressure with the thumb and forefinger of both hands upon the fetal head, with digits so placed as to form the largest possible diamond, will retard the head under all ordinary circumstances. The posture of the woman has little effect on the perineum if the legs and thighs be well flext; let the obstetrician learn to accommodate himself to any posture the woman may choose to assume, so long as he can maintain control of the head. A Neat Method of Cauterizing Chancroids and Dressing at One Operation. When one has decided to cauterize a chancroid, one of the most satisfactory methods is to use Ricord's carbosulfuric paste. This is prepared by adding pure sulfuric acid, drop by drop with thoro mixing, to finely powdered willow charcoal, until the mass has the consistency of thick cream. This mass is spread over the chancroid with a glass or porcelain spatula. Care must be taken to work the mass into the undermined cavities around the edges, and it is well to allow it to take in a little of the sound skin. This not only destroys the virulence of the ulcer, but it leaves a firm adherent dressing of charcoal after the acid has evaporated. In a few days the crust drops off, and the ulcer is found nearly healed. Nitric or carbolic acid may be used in the same manner, and carbolic acid has the advantage that it is somewhat anesthetic, tho it is not so good a caustic when used alone. Eye-washes of nitrate of silver, if long used, discolor the eye. Eye-washes containing lead are apt to leave a permanent opacity where there is any ulceration. A Word from the Editor. Talent, ability and scholarship are modest; mediocrity, ignorance and intellectual indolence are presumptuous. Whenever an article comes accompanied by a modest note (as many do) stating that if the Editor should consign it to the waste basket the writer will not be offended, such an article is almost sure to be from a superior man, and almost invariably such articles are found worthy of publication. On the other hand, when an article comes with practically a demand that it appear in the next issue "sure," the probabilities are that the article is not worth space. Also, when an inquiry comes asking "why" an article sent previously has not appeared, we have by experience learned to feel certain that the article was not worth appearing anywhere but in the waste basket. However, there may be some exceptions. There may be reasons aside from lack of merit why an article may not appear at a certain time. Our columns may be overcrowded; the subject may not be seasonable; or there may be several articles on the same subject, and the Editor may not consider it profitable to his readers to spare space for all, in which event he chooses the most suggestiv. All such things must be left to the discretion of the Editor. Before sending a contribution, read carefully the standing conditions at the head of this department. Some people never read standing notices, nor the prefaces of books. This is a great mistake. Any contributor wishing the receipt of his article acknowledged may have it done by inclosing a stamp or postal card for this purpose. It will then be acknowledged by the mail clerk as soon as it is reacht, and before it reaches the Editor. As to the return of unused manuscripts the Editor usually deviates from the condition standing above to the extent of returning same if the request and postage for return accompany the manuscripts. After sending an article, don't get nervous about it. It may not be reacht by the Editor for some days; conditions may make it impossible or impracticable that it be publisht for a month or two, and possibly it may not appear at all. Don't feel that it is a personal matter at all; for the Editor must consider the interests of his many, many thousands of subscribers, rather than your personal pride. The efforts of all of us should be directed to the single purpose of serving the profession. Editor Veratrum Viride. MEDICAL WORLD:-In THE WORLD for June, page 221, Dr. W. T. Marrs, suggests for discussion the merits of veratrum viride. I would like to make a statement of the following facts. concerning it, which I know from long use of it are true and deserving of note. As the following points taken from Wood and the U.S. Dispensatory, coincide completely with my experience, I will just forward them to you almost exactly as I find them there: The drug is nearly similar in its action to aconite and can be used in most cases when the latter is indicated. It is a powerful arterial depressant, lowering the pulse rate and the force of the heart-beat by direct action the cardiac muscle. The stimulating action it has upon the inhibitory nerves also influences the pulse rate. It causes vasomotor paralysis, greater or less, according to the size of the dose. Veratrum viride is a powerful spinal depressant, the motor centers of the spine being directly affected, while upon the sensory centers or the motor or sensory nerves it exerts little or no distinct influence. Uses. As an arterial depressant and to control spasms of spinal origin. (It is contra indicated in adynamic fevers). In the first stages of pneumonia (to this I can testify), or whenever it is sought to control true sthenic arterial excitement (except, perhaps, in gastritis or peritonitis), it is indicated and will be found a prompt, efficient and safe remedy. It is useful in chronic cardiac diseases when there exists excessiv hypertrophy (quite true). It may be well to remark that it should be administered while the patient occupies the recumbent position. The best preparations are the fluid extract, dose min. 1 to 3, and the tincture, dose, min. 3 to 6, given every one or two hours, the remedy to be discontinued upon the appearance of nausea. THE WORLD is the best practical magazine for the general practitioner I have ever seen. I find it an almost indispensable aid to me in my work. Much success to you! H HARRY O. SNYDER, M.D. Lewisburg, W. Va. Medicins administered by the hypodermic method should be given in one-half the dose by the mouth. Morphin and Veratrum Viride for Puerperal Convulsions. Editor MEDICAL WORLD:- Seeing the article on veratrum viride for puerperal convulsions in the August WORLD, page 323, by Dr. F. G. Thomason of Punta Gorda, Florida, causes me to give a little of my late experience with this remedy in puerperal convulsions. On August 4, 1901, at 11 o'clock p.m., I was called to see Mrs. M, who had been confined just one week to a day. This woman was young, stout and healthy, also hid an easy normal labor, but by acting imprudently, getting up too soon, and exposing herself, the lochial discharge stopt, and before I arrived she had three convulsions, the last one coming on her just as I stept to her bed side. I reacht her in time to place a spoon in her mouth to protect her tongue. I at once gave her, hypodermically, one fourth of a grain of morphin dissolved in a small amount of water; to this I also addel ten drops of Nor wood's tincture veratrum, and she had no more convulsions after that one, and only one injection of the above mixture. As soon as she was conscious enuf to swallow it, I gave her about ten grs. of calomel, to be repeated if necessary in four hours, and follow this in four hours more with Epsom salts to open the bowels well, which all acted nicely. In order to assist in bringing about the lochial discharge again, I had her feet bathed in warm water, and applied over the region of the uterus heavy towels wrung out of warm water, which in a few hours had the desired effect. I will say right here that this woman's temperature was normal when I first saw her, and remained so. I called in to see her twelve hours later (this was as soon as I could return). The convulsions had ceast, and the lochial discharge had appeared again all right; so I left her three five grain capsules of quinin, to be taken four hours apart. I find that to open the bowels well with calomel, and follow with a few doses of quinin is good to start up the lochial discharge when it stops too soon after confinement. However, in some few instances I have known the lochial discharge to stop within a few days after confinement, not to return any more, and it seemed to cause no trouble in any way. In the above case we can't tell what part the morphin played in stopping the Veratrum Poisoning in a Case of Puerperal Convulsions. Editor MEDICAL WORLD:-I was seen by Mr. E. and requested to take charge of his wife, who was expected to be confined in about six weeks. I was informed that in her previous confinement she had puerperal convulsions, and came near, very near dying at each time. I saw the lady and obtained the following history. Parents healthy; from puberty had painful menstruation, and two or three days before each epoch she suffered with facial neuralgia. I at once put her on tonics, chief ly iron, and about three weeks before her expected confinement, put her on tr. viburnum prunifolium, and beginning one week from the expected event, put her on thalion, giving her a heaping teaspoonful in a glass of hot water the first thing in the morning and last thing at night. This gave her one to two large mushy stools each day, but at the end of a week it began to act a little too freely on the bowels, so I stopt it. At 2 p. m. that day I was called hurriedly, the messenger stating that she was in labor. As soon as I could get there I made my toilet, which had to be done hurriedly, so much so that I had to dispense with the usual routine of prepar ing my patient. With not more than two good labor pains I delivered her of a fine 10 lb. boy, the secundines all coming away beautifully in less than 5 minutes. I waited as usual a half hour and took my leave, patting myself on the back all the way back to my office. I never in all my life saw a more beautiful case of labor, everything absolutely normal, except there was not as much as a tablespoonful of blood past with the afterbirth. Well, I went around all the afternoon patting myself on the back, and congratulating myself on having run across a drug that would rob the puerperium of one of its greatest terrors. At about 10 p. m. her husband came |