15

Gonorrhoea should be treated as if it were an acute abscess; that is, by drainage, with just as much asepsis as possible. Let the urethra hang downwards, with a bag of some sort loosely attached to it to catch the discharge. Do not have it tightly bandaged or plugged up with cotton. In a specific urethritis, where the inflammation has extended into the deeper layers of the epithelium, the various bichloride and zinc injections are not likely to do much good. In an ordinary, non-specific urethritis, however, where the inflammation is superficial, injection has good results. There are certain remedies which will increase the amount of urine and render it aseptic, so that the bladder can be used as an irrigator in gonorrhoeal inflammation. Among these remedies is boracic acid, or, better still, the oil of gaultheria. This drug

ADYNAMIC PSYCHOSES according to Dr. J. G. Kiernan, are those which arise on the basis of the adynamia produced by essential and other fevers, toxic agencies and other causes. The primary confusional insanity of Spitzka occurs

will absolutely sterilize the urine. Five or six drops can be given every three or four hours. During the later stages of the inflammation, mild solutions of the sub-acetate of lead can be used, which will help keep the urethra clean. A syringe with a short nozzle should be employed, so as to only just enter the meatus. The injection should be of moderate size, so as not to over-distend the urethra. During the acute stages, I instruct my patient to take a warm sitzbath night and morning. When the acute stage has subsided, the administration of some of the so-called blennorhetics will be found beneficial. I have found the capsules containing Santal-midy, a preparation made from sandal-wood, a very good thing. I consider these superior to the old-time cubeb preparations, which are liable to disturb digestion.

grains thrice daily of pot. chlorat. was attended with excellent results in recurrent abortion.

"SUCCI" the "faster" has become demonstrably insane, whether from an underlying

among these psychoses. As Rosenbach has shown, these psychoses bear considerable resemblance to the period of transformation of paranoia so that some alienists have designated it an acute paranoia. During ten years of insane-hospital and private practice in Chicago, Dr. Kiernan has observed one hundred and three cases thus (Table 1) divided as to ætiology and the races in which they appear.

POTASS. CHLORAT. IN RECURRENT A BORTION.-Dr. E. S. McKee ("Amer. Jour. of Obstet.") reports several cases in which fifteen

33 70 103

paranoia, the cocaine used by him as a sustenant, or from exhaustion, or from all three factors combined, remains to be determined.

JUDGING from the results of the autopsy the following remarks of the New York "Commercial Advertiser" are close within the bounds of truth:

"Poor young Dr. Scudder. His case was one for hospital, not jail treatment, and he would have had it anywhere but in Chicago."

THE Detroit meeting of the American Medical Association was the most successful in its history from every standpoint. The scientific work of the sections was of an unusually high character. Even the moribund dermatological section leaped into new life and exhibited a scientific spirit that places it on a par with any body devoted to the study of dermatology. The days of the medical politician are evidently numbered since the scientific workers of the sections have been placed at the helm by the beneficent amendment introduced by Drs. J. S. Marshall of Chicago and Leartus Connor of Detroit. This amendment, although deprived of its force to some extent by the removal of the nominating power, places most business under charge of the executive committee of the sections. The beargarden performances which annually disgrace the association will soon become a mere matter of history. The indications of the times point to a revision of the code and the establishment of a modus vivendi with the New York State Society. The high-handed action of the Judicial Council in the expulsion of Dr. Potter excited widespread indignation, and will probably lead to the abolition of that source of pompous senescent platitudes. Its existence and autocratic powers cast serious reflections on the intelligence of the Association. The address of President Marcy, with its high ideals, its courteous, suave style, its delicately worded yet forcible plea for tolerance and revision of the code, was a credit to the Association. President Marcy has borne himself well under circumstances calculated to try the patience of a Job. With senescent reminiscences setting parliamentary law at defiance and thereby provoking the wellmeant but illy-regulated turbulence of veterans in medical science, Dr. Marcy's task was one which might try the diplomacy of Talleyrand, and was conquered with the courteous suavity of the American gentleman Dr. Marcy has shown himself to be.

THE action taken by the Association in regard to the West Virginia resolutions was decidedly in the right direction. There can be no doubt that railroads have taken undue advantage of the charitable tendency of physicians to render gratuitous services to victims of accident, and have saved money by refusing to pay any one but their own surgeon. Some New York phy

sicians have attempted to remedy this evil in a Spartan manner by refusing to treat such emergency cases. This course, while legally and morally justifiable (since a physician is under an implied contract with his regular patients who have the first right to his services), tends to cast discredit on the profession. These and other questions arising out of railway surgery should be relegated to the section on that subject soon to be created. There is no good reason why the profession should bow down to corporation plutocrats, who notoriously "have no sculs.”

WHILE the "Journal of the American Medical Association" has improved decidedly from a financial standpoint, its editorial work is below even the standard of the previous editor; the most namby-pamby of whose platitudes were at least dignified, which is more than can be said of many recent editorials. The previous editor showed some slight skill in the selection of collaborators, which as a rule is demonstrably absent from the present management. Some articles admitted during the present regime bear decided evidences of having been written, if not in an insane-hospital, at least by a paranoiac with delusions of persecution by electricity. Several pages are wasted in platitudinous slush about the decadence of "Our Republic," which no self-respecting newspaper would admit to its columns. Some editorial supervision should be exercised over these matters. With all its defects, the previous editorial management herein was far superior to the present. The American Medical Association is rising in scientific status, but its "organ" is as rapidly sinking in professional estimation. Papers published in it are as effectually buried as in a graveyard or an editorial waste paper basket. Every section of the Chicago medical profession has excellent editorial material, but except to a very slight extent under the previous editorship this was never utilized. The importation of a cheap medical Philadelphia snob as editor was one of the multitudinous short-comings of the first administration.

THE nihilists of Russia neglected a great opportunity when they did not go into the patent medicine business. An engineer named Gatchkowsky traveled into the land of the "astral body" and the "mahatmas," Thibet, and there

obtained an "elixir of life." He called it "vitaline," and was paid at a high rate for it by "all the leading nobility, business men and (as he tried the orthodox dodge) by the clergy." The prefect of St. Petersburg died from "vitaline," whereupon nihilism was suspected. Gatchkowsky was arrested, and "vitaline" was found to be neither nihilistic nor mahatmic but a plain every-day mixture of glycerin and borax. Russia can't endure nihilistic executions of itself but the patent medicine autocracy has its privileges, wherefor Gatchkowsky was released although the killing of a prefect by anyone else would have resulted in Siberia and the knout for scores of persons.

THE position taken in the June MEDICAL STANDARD anent medical fees has been scurrilously assailed by two daily sensation scavengers of Chicago. Their action is in marked contrast with that taken by the "World" and "Times" of New York. The "World," discussing this question as it arose in Dr. Polk's suit for services, says:

A New York jury called on to decide whether a physician summoned from New York to Atlanta for special advice was justified in charging $250 a day for his time and services was unable to agree on any higher figure than $150 a day. Doubtless even this amount will seem unreasonable to many, for the old belief still lingers that a doctor ought not to get rich from his practice. However comfortable this belief may be for those who hold it, the doctor himself is entitled to a voice in any agreement involving the use of his skill and experience. It is not fair to compel the physician to establish his reputation and to allow the patient to fix the fee. It is a curious contradiction in human nature that the bill which is least willingly paid is the bill of the gentleman who has saved one's life.

The "Times," with equal truth and fervor, says:

In the case of the physician the ready explanation is that when he is summoned, the people who summon him are too deeply moved by their emotions to have a thought of such practical things as fees. To be consistent, however, their emotions should control them until the fees are paid. As a matter of fact it does not make life much harder to live, or death and sickness much harder to bear, to ask one practical question even when burdened by grief; and any competent physician will always be found perfectly willing beforehand to state the value he places on his services. It would be awkward, though, for him to name his price when not asked to do so.

It is not likely that any New York physician will regard this sum as exorbitant, and probably most of them look upon the original bill as perfectly fair. It must be remembered that a physician's life is generally more than half spent before he begins to earn a bare living. If he starts his medical studies as soon as he has finished the essential academic course in college, what with the year or two of additional study abroad and the hospital practice that every young physician who hopes to make his mark must have in these days, and the more or less patient waiting for general practice that is always the lot of the beginner, he is thirty-five years old, or older, before the return for his labors begins to come. He must, moreover, keep abreast with the new discoveries and new theories if he hopes to

17

retain his practice and increase it; his studies never cease, his hours of labor are not fixed like the artisan's and the clerk's, he sleeps when he can, and in curing others he often injures his own health. The physician is surely worthy of his hire. When his charges for work that requires great knowledze and the finest kind of acquired skill seem too large, it is well calmly to consider all the circumstances.

It administers the well-deserved rebuke to cant too prevalent among certain "fee-cutters," which does much to keep medical fees at starvation rates:

The Atlanta physician who had charge of the case in which the New York physician was called in consultation testified that he received only $300 for all his services, and that $500 would have been sufficient for the consulting doctor's fee. But when the case seemed to be at its worst there was a call for "a New York doctor." It costs more to be a doctor in New York than in Atlanta, and it costs a great deal more to live and practice here after you have become one. Obviously, a New York physician is a better judge of the value of his own services than one in Atlanta.

The New York "Times" is a newspaper. The Chicago sheets are "write-up" "organs" of realestate speculations, patent-medicine "fakers" and other financial uncertainties.

SEVERAL homoeopathic exchanges are greatly exercised over the alleged dishonesty of the New York "Medical Times" in attempting to extirpate the advertising sectarian label. The charges made by that ably conducted journal anent hahnemaniac duplicity are fully established by the appearance of the following advertisement in the columns of that embittered defender of hahnemanianism, the Chicago "Medical Current":

Orange Blossom, a positive cure for all female diseases. Some symptoms: A tired, languid feeling, low-spirited and despondent, with no apparent cause. Indigestion, headache, backache, bearing down pains, pain across the lower part of bowels, with great soreness in region of ovaries. Tumors, bladder difficulty, frequent urination, leucorrhoea, constipation of bowels, piles. With all these symptoms, patient nervous and irritable. The Orange Blossom treatment removes all these by a thorough process of absorption. A local application, perfectly harmless, which every lady can use, herself. Medicines taken internally will never relieve the many forms of female weakness. The remedy must be applied to the parts to obtain permanent relief. A plain talk to ladies in our circular Ask your druggist for one, or send two-cent stamp to home office for sample box and circular. Every lady can treat herself. O. B. Pile Remedy, O. B. Catarrh Cure, O. B. Stomach Powders, O. B. Kidney Cones. $1.00 for one month's treatment.

Advertisements of this kind demonstrate the use of such patent medicines by hahnemaniacs of the "Medical Current" stripe.

THE acme of newspaper absurdity is reached by the following dictum enunciated in a usually well-informed Chicago paper:

Insane men may exercise ingenuity in concealing their crimes, and may in many ways render it extremely difficult to detect their madness, but insane men never commit suicide.

THE Minnesota Medical Society has taken the best possible means to place the medical profession of that state under the heel of the judicial demagogue by urging the legalization of a court system of experts. This, as was shown

by the late discussion in the Chicago MedicoLegal Society, has practically proven a failure on the continent of Europe. It would result in experts being appointed at the dictation of the press. Sensational "write-ups," paid for antecedent to malpractice suits, would then inevitably mulct the physician victims of such suits.

LEO XIII. is very sceptical about "faith cure," to judge from the following anecdote: A French lady of high social station recently obtained an audience from the pope and informed his holiness that she had procured one of his stockings, put it on her diseased foot, and was cured. "Madame," replied the pope a little maliciously, "fortune has been very kind to you. You need only put on one of my stockings and your foot is healed, while I put on both my stockings every morning and I can hardly walk."

DR. C. D. PALMER, of Cincinnati, in a recent address ("Ohio Medical Journal") thus re-echoes the denunciations of the abuse of gynæcology by Goodell, Emmett and the neurologists:

Many pages might be written concerning modern gynæcological abuses. Every department of medicine and surgery has been subject to abuses. Intra-uterine medications,the Emmett's operation of trachelorrhaphy, Sims' operation of cervical discission, Battey's operation of oophorectomy, and not a few other operations by laparatomy, and vaginal hysterectomy, have each and all been abused. No rational physician will, however, for a moment, attempt to assert that these surgical procedures have no place in practice, and should be ignored. Well would it be, if every medical man would carefully consider the supposed curative effects of operations per se. Medical records are full of them. The psychical influences at work are, at times, a most interesting study. The power of the body, especially the pelvic organs, upon the mind, is ever to be held in view. Always endeavor to avoid developing a neurosis, through introspection, especially in mobile patients. The modern tendency of to-day is to make many of the female pelvic operations on a very small pretext-made unnecessarily, either for life, comfort, or the preservation of health. Many of the well-recognized failures of oophorectomy and salpingo-oophorectomy have followed operations done for hystero-neuroses, under a mistaken diagnosis. Doleris claims that four-fifths of the oorphorectomies done in Paris have been unnecessary. How many times unnecessarily, in this country, no one can tell.

DR. WEIDERHOLD, director of the Cassel (Ger.), nervine hospital, has decidedly Spartan views as to the treatment of hysteria. He admits that he boxed a hysterical female's ears, beat her with a stick, and whipped her because she screamed and moaned as though she was suffering great pain. She was suffering from hysteria, and her pains, the doctor said, were entirely imaginary. The punishment he inflicted upon her, he contended, was the best treatment for hysteria, and everything he did was for her benefit. It is gratifying to learn that such heroic treatment of hysteria was rewarded by three months imprisonment. No American physician would be capable of such perform

ances.

THE "American Institute of Homœopathy" had too much of a concealed scientific atmosphere for certain honest victims of hahnemania who thereupon seceded and formed the "International Hahnemannian" Association. These ultra-orthodox disciples of Hahnemann have, to their honor, expelled their president "Dr." James B. Bell, for heresy. He is accused of decidedly bizarre and somewhat contradictory lapses from the faith. He is charged with teaching "christian science" doctrines, with unduly advocating the use of surgical procedures, with advocating vaccination and finally with teaching that tapeworm is a parasite not a "dynamic result of the human organism." As "Dr." Bell evidently has been a "go-as-you-please" practitioner he merited expulsion since in joining the Hahnemannian Association he agreed to abide by its laws. Until they were repe-led he was bound by this contract. His course as an honest man would have been either to secure their abolition, or, failing in this, to resign. Certainly under admitted legal decisions he was guilty of false pretenses in obtaining money for other practice than that laid down in the Hahnemannian Association code.

AN ophthalmological operation which converts the Mongolian into the Aryan eye is much patronized by the Japanese. A Japanese ophthalmologist claims ("Sei-i-kwai Medical Journal") that the difference between the two types is not caused by either the size of the eyeball or the color of the iris, which are practically the same in both, but results from the shape of the eyelids. The fold of the skin covering the inner slit of the lids is rare in adult white persons, but exists physiologically among the Japanese, so that it is sometimes called the Mongolian fold. In the

majority of cases this fold runs obliquely inward and downward from the upper lid, so that the inner angle of the opening is not round, as in white people, but sharp. When the fold is large it spreads to the inner part of the lower lid, in which case the upper lid does not cross the eyeball horizontally but obliquely, giving the peculiar expression to the eye often met with in the Chinese and Japanese.

THE "British Medical Journal" says with equal force and truth anent the stupid mendacity of the one year practitioner just now health commissioner:

It is not by denials of the capacity of Chicago doctors to diagnose a disease so easily verified, nay, so difficult to mistake, nor by minimizing the serious import of facts respecting the water supply, that needful sanitary works can be executed. The lake water and its derivatives, and the potable compounds into which it enters, must continue to be regarded with just suspicion until such works are executed.

Unlike other cities, Chicago has had a gradually decreasing death rate with an increased typhoid fever rate. This typhoid fever rate varies so greatly, moreover, in different parts of the city as to indicate that local conditions, other than the water supply, exert an influence. As the MEDICAL STANDARD pointed out five years ago, the speculative atmosphere also causes mental phenomena in many diseases which simulate typhoid mental states. Under the asinine enforcement of the contagious diseases ordinance many of these are no doubt reported as typhoid fever-not because physicians do not know better, but because they prefer not to subject themselves to the contumely of callow health inspectors. This factor, fully considered, however, does not account for the disproportionate typhoid fever rate to deaths from all causes and to the decreasing death rate. The bad management of street and alley sanitation explains many cases. Here remedies can be immediately applied. The general health of Chicago will, however, compare favorably with that of New York and most of the cities in the British isles and on the continent of Europe. With the precautions adopted at home visitors to Chicago will have the same life expectancy at least.

DR. A. P. BROWNE, of Ft. Worth, Tex. reported (MEDICIL STANDARD, Vol. X) a case of genital precocity in a three-and-a-half-yearold boy. Dr. Pla, of Havana, Cuba, reports the case ("Doctor's Weekly") of a boy of three

19

Of.

years and ten months with abnormal development of the genitalia. The father of this boy is a robust man fifty-six years old, twice married, having had six children with the first wife, and fifteen with the second, who is still living. his twenty-one children, nineteen are alive, sixteen males and three females; this one being the thirteenth child of the second marriage. When nine months old, this child had a continued fever that lasted two months. Since then began the abnormal development. His physiognomy is

that of an adult, which makes a great contrast with his height, 45 inches; weight is 60 pounds.. The intelligence is below normal for a child of his age. In regard to the genital organs, the penis, in a flaccid state, measures 4 inches, and when erect, 5 inches; its circumference then is 44 inches. He has frequent erections, which are provoked at the least contact, but has no ejaculation. All the pubis is covered with hair. The testicles are unusually large, especially the left one, that measures 3 inches in length by 5 in circumference. The larynx has also an abnormal development, the tone of the voice being basso profundo or low base, and the words sometimes do not seem human. He has no hair under the axillæ, but a dark shaded line is shown over the upper lip, formed by very tiny, silky hairs. When one year old he had all his teeth changed, that is, his permanent set of teeth are to-day like those of a boy fourteen or fifteen years old.

DR. THEODORE MEYNERT the celebrated Austrian alienist and cerebral anatomist, died May 30 at the age of 59.

THE month of June ("Doctors' Weekly'), although it is more popularly known as the month of roses, is also known as the month of suicides, for it is at this season of the year that the suicide rate usually reaches its maximum. The reason for this is probably to be found in the depressing effect produced by the onset of the hot weather. The rate grows less during the colder months of the year, and reaches its minimum in January.

THE Rhode Island legislature has passed a contagious eye-disease act, but has provided no machinery for its enforcement or for payment for reports.

POSBEDONONSZENS, the Russian minister of religion, has induced the czar to refuse his consent to the establishment of a school of medicine for women.