PROPHYLACTIC CIRCUMCISION.

During twenty years of active practice in general medicine and surgery it has been my experience to have seen many fads and fancies of our profession arise, flourish for a time, and then fade away. Crede's method of placental expulsion was so thoroughly ingrained in the students of my time, and later, that any expression of criticism of the practice branded one as uninformed. In the passage of years I have seen many cases of hemorrhage that in my secret mind I attributed to the too hasty removal of the secundines. At this time an expression of that opinion does not arouse professional contempt.

I have been awaiting a sensible attitude of our brethren in the matter of circumcision, but by the journals I judge that the acme of that fad has not been reached. I wish to be numbered among the pioneers who protest against the indiscriminate circumcision of male infants. In my experience it has not been usual to find in the new-born prepuces that could be retracted easily. Following the teaching I had received I had circumcised prepuces seemingly redundant and non-retractible in the new-born up to some years ago. Then, on one occasion, upon preparing to remove the foreskin, I fortunately discovered a pneumonia which delayed the operation, and I did not see the child until some months after. On re-examining the patient I found the same apparent condition, but upon producing stiffening I slipped the foreskin over and thereafter advised doing so daily and applying a sterile lubricant. Since that time I do not circumcise, if there is a free flow of urine, until the child is a year old, and I have found very few cases that did not yield to a gentle separation of the foreskin from the glans, and after that a free slipping back of the hood. I apply cocaine to the parts, retract as far as possible, slip a probe under the sluce, or when necessary nick an opening for it to

be slipped under and peel the two mucous surfaces of the glans and prepuce apart, clear the corona, clear out the smegma in the sulcus, apply a lubricant, and instruct the mother to retract daily for a spell. It is astonishing how many cases of phimosis and apparently redundant foreskin yield to this treatment. I most emphatically oppose the custom of indiscriminate circumcision, and I contend that many, many cases supposedly fit for no other treatment than circumcision can be better treated by the method outlined above.

The two main arguments advanced for the routine practice of circumcision are that the prepuce causes reflex irritation and that venereal diseases are the more easily acquired where the foreskin exists. A freely gliding foreskin never irritates. Venereal infection is acquired as readily by an abraded surface uncovered as by one covered. I further contend that an exposed gland is more likely to be irritated than a covered one; furthermore, the protected nerve terminals are a help to the longer preservation of potency. I could enlarge on the unsightly deformities that have come under my observation from this practice of circumcision, but I am only pleading for a common-sense stand by physicians on this fad of clipping foreskins.

[The above was scissored by us from a recent number of the Medical Record. It was communicated to that journal by Dr. J. C. Farmer, of San Francisco, and it is so eminently practical, and shows such good common sense, that we have deemed it worthy of reproduction here. Read it carefully, think it over, and see if you do not agree with us as to its practical worth. If you do not agree with the arguments presented, let us have your own views for publication in THE SUMMARY columns. ED.].

S

A SEVERE CASE OF HEMETEMESIS, WITH RECOVERY.

Editor Medical Summary:

This case happened to fall to me very recently. The woman was a frail little body of about thirty-five, having a family of half a dozen children, the last just weaned. She had not had a return of her menses. When I entered the room I saw she was as pale as paper and her lips were as white as her skin. Hemorrhage suggested itself to me at once. No history of hemorrhage concealed or otherwise was elicited. I thought of ectopic gestation and a ruptured ovum, but found no evidence pointing particularly toward it. There were slight elevation of temperature, extreme weakness, pulse of 120 per minute, weak and thready, and in keeping therewith there was a feeble heart whose first beat was almost absent. Strychnine, digitaline, and diffusible stimulants were prescribed. The next morning all these symptoms

were multiplied several times. The features were like marble and she seemed almost exsanguinated. The heart and circulation were still feebler, and the prostration was extreme. The raising of the head even slightly produced fainting. The husband showed me, after my brief examination, a wash-pan half full of blood and mucus which she had thrown up during the night. The emesis was followed by fainting and prostration. The blood was thickly clotted, and looked to be between a pint next night anoccurred, and

and

other

a quart of it. The attack of vomiting

about the same amount of blood was again ejected. I do not know where it could have all come from, she being very anemic to begin with. The prognosis looked as as anything could be, and a consulta

bad

tion was asked by me, but owing to the indigent circumstances of the family, the man did not wish to incur the additional debt. The woman continued in this low state of vitality four days. Supposing that there had been quite a destruction of tissue to account for all this blood, I looked for an inflammatory action, and this I knew the woman could not well combat with so little blood. The temperature during that time wavered between 100 and 102. If it had gone to 103 or 104 I am of the opinion that death would have immediately followed. But in this case the unexpected happened, and she became slightly convalescent on about the fourth or fifth day. Notwithstanding the low state of vitality, she retained a certain amount of nourishment and stimulants, which greatly aided The nature's other recuperative measures. nourishment consisted of eggnogg, beef tea, chicken broth and milk, and later butter

milk. Codeine and other sedatives were given until the danger of a recurrent attack of emesis seemed past, and after that the bowels were kept open with calomel and Abbott's saline laxative, alternating occasionally with castor oil. Calomel and soda in one-grain doses were well tolerated after the immediate danger seemed past. The most interesting phase of this case, from my point of view, is that the woman got well. W. T. MARRS, M. D.

Peoria Heights, Illinois.

RAKE "UP" OLD ASHES,

Editor Medical Summary:

Some of the old remedies discarded are the best after all, and do better work. I had a case of the old-time itch (scabies).

Sig. Rub in well the last thing at night and first thing in the morning wash off, after morning's application, with "Grandpa's" common wonder soap. It is so full of potassium carbonate and common tar, that it kills the parasite or itch mite.

The salve perfumed with a little oil of bergamot is not objectionable, and does quick work. Where a lotion is indicated use this, and you will find it effective:R Acid salicylic,

....

Potassium bicarb. ...āā. 3vj.
Aqua dest.
......q. s. 3viij.
M. Ft. lotio.

Sig. Use three or four times a day on points that itch, and wash off once a day with soft soap or the bar soap mentioned.

I never believed much in internal medication, as the ravages of the parasite is truly a local affair. Of course, the clothing should be changed often and strict cleanliness observed in every way. Where it is imperative that you make a rapid cure, use a 90-per-cent. solution of liquid acid carbolic with glycerin, and antidote it loIcally at once with pure alcohol; as it most often presents itself on hands, forearms, and lower extremities, you can do this easily and with safety. Oftentimes those cutaneous diseases are overtreated, and a very troublesome irritation produced by the agent employed to treat and control it. I give you a prescription as old as the hills, but very popular with the laity after they have used it. It is indicated in subacute rheumatism and bottled-up uric acid, where we have unhealthy deposits and infiltration in the muscles, and the toxins cannot get in the general circulation, and where we have a false metabolism, if you can use the term. In septic prostatitis or when we have hypertrophy of that gland, it certainly does effective work, and then we have a strong and potent psychical effect, as the terebinthinate odor is so marked the patient thinks the goods go right through to the diseased surface. Verily,

"the mind runs the body," especially in such cases :

Ol. terebinthinæ,

Ol. gaultheriæ ......

Ol. eucalypti

.āā. 3ij.

..gtts. v.

M. Sig. Twenty drops after meals and bedtime on lump sugar, slowly dissolved in the mouth or in a little sweetened water.

It can be employed as a liniment with good results, and it has been of great service to me for years. I have used an oldfashioned teniacide for years with good results, and as it is a little unusual, many of you have not been familiar with it. Give the patient weakened doses of Epsom salts, in strong lemonade, for two days previous to taking the antidote, and a light slop diet. The magnesia and lemonade will take away the mucus protection from the worm, and have your patient take a pint of kershaw or crooked neck squash seed pounded up in a strong mortar, with enough water to make a light emulsion, and strain through cheese cloth. Take onehalf, and in one hour the rest; three hours after take two tablespoonfuls of castor oil, or one dram of comp. jalap powder, and six drams of sulphate of magnesia in half a glass of water. You get the head every time. The kershaw seed can be gotten at any seed store, and you can often get the squash at the grocery store. Did you ever notice, you men of the profession, that all anthelmintics act on the great sympathetic chain of nerves, and the majority dilated the pupil. Santonin, spigelia marilandica, or pink root, one of our most efficient preparations for the annoying lumbricoides, will cause light delirium and a dilated pupil: Santonin, pelletierin, all of them, and kousso. The kershaw-squash does it in some cases to marked degree. Pumpkin seed is good in some cases, but too mild in many. In writing a practical article for a journal, one digresses and gets Iway out in the stream, and in a future article I will stick to the text and try to draw from the cortical cells of my brain a few thoughts that will amuse and perhaps edify. Some that are willing to recognize that a man of forty years' experience has a few good cards up his sleeve yet, and is willing to play them for the benefit of those that are willing to absorb.

St. Joseph, Mo.

A. V. BANES, M. D.

PHYSIC.

Editor Medical Summary:

We learn from "Rollins' Ancient History" :

"In early times the origin of physic, the beginning of which, as of all other arts and sciences, were very rude and imperfect, Herodatus, and after him, Strabo, observe, that it was a general custom among the Babylonians to expose the sick to passers by in order to learn of them whether they had ever been afflicted with a like distemper, and by what remedies they had been cured." From hence several people have pretended that physic is nothing else but a conjectural and experimental science, entirely resulting from observations made upon the nature of different diseases, and of such things as are conducive to and prejudicial to health. It must be confessed that experience will go a great way; but that alone is not sufficient. The famous Hippocrates made great use of it in his practice, but he did not entirely rely on it. The custom in those days was for all persons who had been sick and were cured, to put up a tablet in the temple of Aesculapius, wherein they gave an account of the remedies that had restored them to health. That celebrated physician caused all these inscriptions and memorials to be copied, and derived great advantage from them. Physic was, even in the time of the Trojan war, in great use and esteem. Aesculapius, who flourished at that time, is reckoned the inventor of the art, and had even then brought it to great perfection by his knowledge of botany and chirur gical operations; for in those days these several branches were not separated from one another, but were all included under profession.

one

The two sons of Aesculapius, Podalirius and Machaon, who commanded a certain number of troops at the seige of Troy, less excellent physicians than brave officers, and rendered as much service in the Grecian army by their skill in medi

were no

cine as they did by their courage and conduct in their military capacity. Nor did Achilles, himself, nor even Alexander the Great in aftertimes think the knowledge of this science improper for a general or beneath his dignity. On the contrary, he

learned it himself from Chiron, the centaur, and afterward instructed his friend, Patrolus, in it, who did not disdain to exercise the art in healing the wound of Eurypilus. This wound he healed by the application of a certain root, which immediately assuaged the pain and stopped the bleeding. Botany, or that part of physic which treats of herbs and plants, was very much known, and almost the only branch of the science used in those early times. Virgil, speaking of a celebrated physician who was instructed in his art by Apollo himself, seems to confine that profession to the knowledge of simples. It was nature herself that offered these innocent and salutary remedies, and seemed to invite mankind to make use of them. Their gardens, fields, and woods supplied them gratuitously with an infinite plenty and variety. As yet no use had been made of minerals, treacles, and other compositions since discovered by closer and more inquisitive researches into nature. Pliny says that physic, which had been brought by Aesculapius into great reputation about the time of the Trojan war, was soon after neglected and lost, and in a manner buried in darkness till the time of the Peloponnesian war, when it was revived by Hippocrates and restored to its ancient honor and credit. This may be true with respect to Greece, but in Persia we find it to have been always cultivated and constantly held in great reputation. The great Cyrus, as is observed by Xenophon, never failed to take a certain number of excellent physicians along with him. in the army, rewarding them very liberally and treating them with particular regard. He further remarks that in this Cyrus only followed a custom that had been anciently established among their generals, and he also informs us that the younger Cyrus acted in the same manner.

It must, nevertheless, be acknowledged, that it was Hippocrates who carried this science to the highest perfection. And though it be certain that several improvements and new discoveries have been made since that time, yet is he still looked upon by the ablest physicians as the first and chief master of that art; and as the person whose writings ought to be the chief study of those who would distinguish themselves in that profession.

Men thus qualified, who, to the study of

the most celebrated physicians, as well ancient as modern, as also to the knowledge they have acquired of the virtues. of simples, the principles of natural philosophy, and the constitution and contexture of the human body, have added a long practice and experience, together with their own serious reflections; such men, in a well ordered state, deserve to be highly rewarded and distinguished, as the Holy Spirit itself signifies to us in the Sacred Writings:

"The skill of the physician shall lift up his head; and in the sight of great men, he shall be in admiration," since all their labors, lucubrations, and watchings are devoted to the people's health, which, of all human blessings, is the dearest and most valuable. And yet, this blessing is what mankind is the least careful to preserve. They not only destroy it by riot and excess, but through a blind credulity, they foolishly intrust it to persons of no credit or experience, who impose upon them by their impudence and presumption, or seduce them by their flattering assurances of infallible cure."

There were, it seems, mountebanks in those days. We have them in every community; not that they are ignorant and devoid of medical education, but that they make promises they know they cannot meet, and covertly decry the merits of some other brother's capabilities and treatment, as compared to their own superior attainments and skill. Of all men, they are the most contemptible and dishonorable. D. L. FIELD, M. D.

Jeffersonville, Ind.

BRUCINE.

Editor Medical Summary:

This alkaloid is found in varying proportions in nux vomica, ignatia amara, angustura, and in general throughout the family of Loganiacea. The process for its extraction is simple and well known. It is more soluble in hot than in cold water. It forms crystallizable, soluble salts. The brucine of the shops is almost always inixed with strychnine, and the variations in relative strength assigned to brucine may be attributed to this fact.

The physiologic action of brucine resembles that of strychnine, but the former is much less powerful. Various writers have pronounced the difference as great as I to 6, or even 20. Bouchardat denied that any such difference existed, and in America brucine is considered equal to one-half or one-quarter the strength of strychnine.

The therapeutic effects of the two are closely analogous, both being applicable in the whole line of paretic maladies, torpidity, and atony of the whole body or of any special member or organ. In such conditions as occurring in young children, brucine is preferable to strychnine. Laura counsels the milder remedy in atony of the gastro-intestinal musculature, in tympanites disordering digestion and giving rise to diarrhea or to constipation, or to an alternation of the two. This is a common and at times a perilous condition with infants. Tympanites sometimes embarrasses both respiration and circulation.

Laura found brucine especially effective in the treatment of the paralyses of infancy as manifested among the poor children of the Children's Hospital. The cures thus obtained, he adds, were no secret among the physicians and the benefactors of this institution.

Brucine suits the young and the feeble. It increases the force of expectoration, facilitates respiration, digestion, and defecation; it aids in the generative act without endangering collapse and syncope like the direct aphrodisiacs (Burggraeve). It is preferable to the latter also, as it has not their well-known (to the laity) reputation, a source of the gravest peril and occasionally a cause of death when these drugs are taken ignorantly or injudiciously.

Laura, who had a large and happy experience with brucine, placed the dose at two to three times that of strychnine. Something is to be credited to individual susceptibility also. Taking the granule of 1-134 grain, he advises as a mean daily dose 12 to 20 granules for adults, 5 to 10 for children, in acute cases. In chronic maladies adults may take 6 to 10 granules daily, children 2 to 4. The remedy should be suspended occasionally for a week out of each month, or for every sixth day. In cases of long standing it is well to begin with one granule four times a day for adults, adding one daily dose every alter