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great foe to mankind. Not that the tubercle bacillus can be entirely rendered passe, for its presence is to be taken as only a factor in the causation of this wide-spread But we have and death-dealing disease. learned that the cause of consumption is due to two things: bad environment and bad heredity, and in the future we shall bend our efforts to overcome both of these. What will the practice of medicine be like thirty years hence? Surgical skill will not be more excellent than now, that being an impossibility. However, surgery will be more conservative than now, "exploratory laparotomies" will be fewer, and men who have dessicated consciences and a penchant for the mezumma will be fewer -let us hope. Appendectomies will not then be performed any oftener than operations upon other portions of the viscera, and only when the operation is indicated. We will have learned that the appendix and all our other organs and appendages serve a useful purpose in the physical economy. Diagnosis in the future will be still more highly perfected, which is putting it pretty strong. We will still use drugs, but a good portion of the old stuff we now employ will be relegated to the snows of yesterday. We will give drugs for a purpose, and for some semblance of indication. We will have a few specifics and serums that may be in some measure dependable. There will be fewer doctors, because people will live in a manner that will make many medical men seek other vocations. The doctors who do remain with us will be thoroughly educated men, broad-minded and altrusitic, versatile and accomplished. He will be both physician.

and metaphysician. He will recognize the value of suggestion and psychotherapy, and it may be that he will be able to administer to the patient spiritually as well as physically. Medicine and religion will, in the future, gradually make overtures toward each other, and ultimately coalesce, each profession losing much of its traditions and Orthodox principles. In the future people will live longer and be sick less than now and in times past. Longevity is increasing, and most diseases are becoming less fatal. Both mental and physical hygiene will be the thing in the future. People will leave the large cities and hike for the fresh air of the country, and millions will live the simple but healthy life.

Some may think that these thoughts are the emanations of a mind not in harmony with the present order of things. Not so. We have faith in our profession, but believe it is destined to undergo some marked changes in the future. In the meantime let us hope that those who get sick will not forget to send for the family doctor as usual.

THE HYPOCHONDRIAC.

Psychoses and neuroses have been given so much attention of late with the naming and tabulating of so many symptoms that are new to those not in close touch with modern psychiatry that some of our erstwhile friends are, in a measure, lost sight of. The hypochondriac is one of these. He has somewhat lost prestige. The hypochondriac is an introspective individual who may have some real infirmity. More often he has no tangible ailment, but suffers the protean and often agonizing symptoms of a morbid mind. His life is full of vagaries, relating mainly to his own

sweet self. In this matter he may have delusions and reason without premises. He cannot get away from himself and his ailments, and he imagines that his case is without a parallel in medical annals. He reads medicine advertisements and acquires a speaking acquaintance with disease symptoms. The physician is often startled at his versatility in nosology. His symptoms always relate to that which is unseen and intangible, and he may state that he has cancer of the bowels, disease of the liver, tumor of the brain, and so on. The hypochondriac is usually a medicinetaker, and goes the rounds of physicians and runs the gamut of well-advertised patent medicines. He will often believe the almanac in preference to a conscientious and educated physician. As time goes on the hypochondriac becomes more fixed in some of his absurdities. He may discard some of them, but he picks up new ones. He has the unhealthy habit. Out of the ranks of the hypochondriac come many of our dope and medicine fiends, alcoholics, ne'er-do-wells and mental derelicts These people should, early in their wrong career, be taught the right kind of mental and physical living. Above all, they should adopt an avocation or line of work which is to their liking and should stick faithfully to it. Every hypochondriac should forget that he has organs-in fact, that he has a body.

TO PREVENT BLINDNESS.

Ophthalmia neonatorum, as everybody knows, causes the greater number of cases of blindness. It is the one cause of congenital blindness that we always think of. It is preventable. It ought to be criminal. for any obstetrician or midwife to allow a case to develop under his or her care, unless he can show that he made strenuous efforts to cope with the disease. If such

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effort has been made, loss of vision is the exception. Some of our legislatures will this winter have bills presented favoring better legislation on this matter. There should be some way of attaching the blame. Every case of ophthalmia should be promptly reported along with detailed measures adopted for its alleviation. Energetic prophylaxis should be required in this matter when cases occur in the slums and among the ignorant. There should be a dissemination of knowledge on this subject among those who are about to become mothers if there should be the least suspicion of venereal disease. Let us have laws by which we may know who are wilfully negligent in the accouchement chamber.

RHEUMATISM.

Dr. F. L. Wachenheim in Archives of Pediatrics, says: "It is of the utmost importance, in children of three years and over, to regard every slight muscular or articular pain with apprehension. In these cases an examination of the heart will often show cardiac lesion, where the clinical evidence of rheumatism is insignificant or even doubtful."

Dr. Joseph E. Winters, in the Medical Record, says: "In a young child pro

nounced unmistakable rheumatism is exceptional, while obscure, disguised forms abound. Recurrent causeless vomiting is an unfailing portent of lurking rheumatism."

Dr. J. Dardel, in the Medical Record, says: "Rheumatic patients should wear woolen undergarments at all seasons of the year, and affected joints must be protected by flannel bandages. As it is of the greatest importance to maintain the skin in a state of functional activity, the patient should be well rubbed with a horsehair glove or Turkish towel moistened with spirit (eau de Cologne) every morn

ing. Regular exercise short of fatigue is indispensable, with special provision for movement of the affected joints."

The indigestion seen in infantile rheumatism (acidism) is caused by food and not acids. Baths help, by promoting the action of the skin, to eliminate acids and the excretion of poisons.

SMALL-POX VS. CONSUMPTION.

We build lots of emergency hospitalspest-houses-for the small-pox patients. We loathe the disease and run from it. We carefully isolate the victims of it. But how inconsistent we are! We do not fear

the hawking, expectorating consumptive who is likely to infect us with a disease that will kill us dead as a door-nail. We let him run at large, a possible menace to his family and the community. The consumptive needs more attention from a humanitarian standpoint. In caring better for him and trying to restore him to health our work is altrusitic, and we are protecting the well people around him. To close the argument, we wish to state that very few now die from small-pox, and it is only to be dreaded from a cosmetic standpoint.

RHEUMATISM IN CHILDREN.

Dr. Thomas F. Harrington, in the Boston Medical and Surgical Journal, says that "rheumatism in children differs somewhat from that of adults. The tonsils are the most common source of suspected infection. The arthritic symptoms are not as well marked as in adults and are more apt to come on insidiously. Recurrent tonsillitis, chorea, erythema, or nose bleed, are often associated with arthritis. Continued fever with slight remissions suggests endocarditis. There is not the same successive involvement of joints seen in adults. The

family history, or a history of 'growing pains,' especially if accompanied with even slight swelling (fibrous nodules), suggests rheumatism."

Simple bitters, cathartics, aid, by toning up the stomach and assisting the excretion. Muscular pains are not always due to rheumatism, but are often incidental to growing children. The heart symptoms will not be found in acute cases, but in long standing ones. It takes time to infect the system. Exercise is necessary in order to keep the joints movable; if neglected, stiffness is sure to happen. As to the glands, the disease may produce inflammatory conditions.

Dr. Harrington must be a man of experience and skill, for his wise remarks will apply to nearly all cases of rheumatism, the complications found being numberless. It is a safe plan to administer aconite in small doses where tonsillitis is present, and to follow general treatment also.

GOUT.

Dr. William H. Thompson says: "Gout is originally a disorder of intestinal digestion causing derangement of the metabolism of the liver, and when its habit is settled, only attention to digestion affects its cause, however specific drugs may modify its pathological process in parts removed from the alimentary canal."

Gradual and progressive, passive motion, will, in the majority of patients, overcome the disease, break up the fibrous adhesions, but it must be commenced and carried on persistantly, and done by one expert in the trade, for trade it is.

The child that is properly clothed, can, from the very first month of its existence, almost live out-of-doors the greater part of the time, winter and summer.

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AN EXPERIENCE WITH AN ENLARGED LYMPHATIC.

BY JAS. R. PHELPS, M. D.

In the course of a conversation with a valued friend, whose methods of thought lead him deeper beneath the surface of things than many care to delve, he remarked:

"I am certain that there is not an antitoxin in the world that is not hidden somewhere in the human body. The trouble is we either ignore or disbelieve this fact, or we do not know how to awaken and direct its energy. If we possessed this knowledge, or did not forget its application just when most needed, we might handle confluent small-pox as safely as birch bark."

I thought this idea over considerably, for I have long believed that everything in nature has its antagonist, and that every known or possible disease has its remedy if we knew how to look for it and apply it. Perhaps the time may not be far distant when we shall cease our wild chase after coal-tar synthetics, and see what God, through the operations of Mother Nature, has brought under our hand among the living principles of plant life as evolved by men like Lloyd and Burggraeve. Of course my remarks are addressed to believers in the (supposed) exploded science of therapeutics, for it would seem that Isaiah had a vision of these days when he wrote: "This people hath refused the waters of Shiloah, that go softly." The fragrant little wintergreen, so plentiful in our northern States, has no chance in the modern pharmacy with its poisonous synthetic coal-tar imitator.

But, it is not my purpose to write a condemnatory critique on our U. S. P. While Lloyd and Merrell and Squibbs carry on business, pure plant derivatives can be obtained, even if one has to jump over the

head of the corner soda and cigar divan. But to my story, which I will tell plainly. For some three years my wife has been troubled with a virulent eczema of the right leg. Last summer, while boarding a street car, she struck her leg, just midway between the knee and foot, which caused a deep ulcer to form. The middle of December I concluded to send her to bed until some improvement could be effected, and I went to work on it with 10 per cent. resorcin ointment with white petrolatum base. The improvement was marked from the beginning, and after the growth of an entire new skin, I finished it up with a dusting powder called "Modoformal," which I obtained from Armstrong Mantz Co., of 78 Broad Street, Boston. Common justice compels me to say that I never saw its equal.

Well, during the summer and fall I had exhausted my vitality by overwork, and I was in no condition to endure the burden that fell on me. The housemaid went away for the Christmas holidays, and I could get no one temporarily. So I had to be cook, doctor, nurse, scullion, and everything except washerwoman.

One day I got a small splinter in my thumb, which I pulled out and paid no further attention to, and I kept on rubbing the resorcin on the eczema three times daily. In a day or two a small pimple, about the size of a pinhead, that would not heal, appeared on my thumb, but I did not pay much attention to it. A week after Christmas the girl returned, and the next morning I found a hard, painful bunch under the axilla, as large as a hen's egg, and hard as leather. My first thought was that I had strained the serratus magnus, and I used an old forgotten remedy which I have found very useful-Fenugreek. It accomplished no good, and acting on the suggestion of my wife that "a lawyer who conducts his own case generally has a fool for a client," I called in my friend, Dr.

W

-. He examined it and pronounced it a deep-seated enlargement of the lymphatic gland, and said the only course was to poultice it and bring it to a head. Then he spied the pimple on my thumb and pronounced it the whole cause of the trouble. Surely "great oaks from little acorns grow."

For three days I used flaxseed poultices, and no sign of softening. But the thing began to decrease in size, and I telephoned Dr. W― to call. He coincided with my opinion, that the thing was going to work off by absorption, not a pleasant anticipation by any means, but what could one do? And then I began to understand the "ministry of pain," for the pectoral muscles were so sore that I could hardly draw a breath. Dr. W said "paregoric," and

paregoric it was, although I despise opiates. And the constriction about the larynx was horrible. Still all through the whole affair there was not a hint of fever, so my ever present Abbott defevescent granule was not invoked.

The next indication was urine loaded with bile, showing that the urine had got at work on the liver. And then one evening I had a fit of nausea, and after depositing my frugal supper in the bowl, I followed it with a volume of bile. I thought this was all, but it was soon followed by a compound for which I have no name, and don't want any. The next morning Dr. W appeared and found the swelling nearly gone, and advised application of iodine to finish it up, syrup hypophos. comp. U. S. P. as a tonic, and sodium phosphate three times a day to clear the liver, instead of podophyllin and leptandrin, which I was using. This latter salt made me pause, for I have seen specimens of this salt containing enough arsenic to make its use dangerous, not that arsenic is used as an adulterant, but not enough care is taken to eliminate the poison. But on taking down my Squibb's Materia Medica, I found that they made a preparation of guaranteed purity, and the guarantee of that house goes with me. Their products cost more than some others, but cassimere costs more than satinet, and I will have Squibb's or Merck's if I have to send to the home office for them.

Well, I don't know that I have added much to the world's knowledge in this arti

cle. I have cured similar cases in three days by driving a solution of iodide of lithium into the gland with a galvanic current, and using eliminants. This case of my own lasted me five weeks, probably owing to the fact that I was run down, and an old chap of 71 is not always wise. At least if he is, he does not understand exactly how to apply his wisdom.

I am fast gaining by the use of a constructive which I find invaluable-Abbott's triple arsenates with nuclein, No. 413. I don't know how you will regard the free advertising I have been sandwiching into this article, but you can cut it out or send the bill to the proper parties. I have only endeavored to give a succinct account of a case in which, for obvious reasons, I was much, perhaps painfully, interested.

I would like to say one word regarding "Fenugreek" (Foenum Graecum), which I mentioned at the beginning of this article. It was brought to my notice a year ago by an old German, a follower of Father Kneipp. I hunted it up in my botany, but could find no mention of it. Finally in an English work, in the public library, I found an exhaustive description of it, with the information that, while formerly in great repute with European practitioners, it had fallen into disuse except among veterinarians, who used it largely for spavin and ringbone. I reasoned that if of value in these conditions, it might be of use in other abnormal deposits, and I set about looking for it. But the druggists never heard of it, as I could learn, until I inquired of one of our Dorchester druggists, who told me that he sold large quanMeantime I tities to veterinary doctors. had got some from an obscure house in New York City. The first trial I made of it was in a case of goiter, with marked effect, and for sprains it is a fine remedy, and I consider it a forgotten remedy that may well be remembered. It resembles in odor pulverized slippery elm. I mix it with vaseline into a stiff paste, and use as I would a poultice, and my experience with it leads me to further experiment with it. Some years ago a queer old chap in this city had great success in curing sprains, and I have questioned if this powder was not an important factor in his practice. Dorchester Centre, Mass.

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