THE SECRETS OF SPECIALISTS A. DALE COVEY, M. D, "Prove all things and hold fast that which is good. u SECOND EDITION. PHYSICIANS SUPPLY COMPANY. Publishers, hi Ledyard Street, Detroit, - Michigan. LIBRARY Of r;0N^RS| vopies Hecm SEP, 1 1905 jOLASg CL AAft Noil I fllffd J copy s. -IT ; _ : Copyrighted, 1905, BY A. Dale Covey, M. D. \J 6 PREFACE y TO SECOND EDITION It has been very gratifying to the author to re- ceive many kind words of commendation and witness the cordial reception the former edition of this publication received. It has demonstrated that physicians are in- terested in "mysterious medicine," and instead of ridi- culing the methods of treatment often used by the so- called irregular practitioner, they are adopting many of the methods of treatment to a professional advantage in many ways. The first edition of several thousand copies was ex- hausted in about eighteen months and in presenting this volume many new subjects are discussed with a view of assisting the establishment of the physician's office prac- tice. I have endeavored to carry out my former policy by briefly discussing the different subjects, believing that physicians prefer condensed facts to exhaustive theoriz- ing. I will be pleased to correspond and co-operate with any physician interested in this line of investigation regarding any subject, believing our mutual interests and the welfare of the profession may be benefited there- by. A. DALE COVEY, M. D. 419 Third Ave., Detroit, Mich. PREFACE. PREFACE TO FIRST EDITION In offering this publication to the medical profession it has been the author's aim to unfold the somber robe which has formerly clothed some of the secrets and mysteries connected with the healing art, and present in a convenient form for reference information which is not generally found in medical text books, relating to the dif- ferent methods of treatment which are successfully used by medical men who style themselves as specialists. It has been said that "one-half the world knows very little what the other half is doing." It is also said that "there are tricks in all trades." This is particularly so in the practice of medicine, for the regular physician is seldom familiar with the methods which are used and have made fame and fortune for many of the so-called irregular and other specialists. The object of this book is not only to expose as far as possible the secret methods used by these medical men and professional promoters who are fleecing the profes- sion by the sale of some secret system with an extra charge for territorial right, but also to offer many sug- gestions and methods of treatment, and legitimate med- ical specialties which have exceptional merit, and are in- dispensable in curing diseases, and establishing and in- creasing an office practice either for a specialist or gen- eral practitioner. Although this is not an exhaustive treatise, I believe that it fills a vacancy which has long existed, more thor- PREFACE. b oughly than any other work of its kind ever published, and I only hope that the practical application of many of the methods given will prove to be as successful in other hands as they have in mine. The compilation of this volume has necessitated the examination of a large amount of medical literature, and a considerable outlay of money investigating the different secret methods used by specialists. While I have no apology to make to the latter, as they were paid in full, I feel under special obligations to the writings of Drs. Andrews, Agnew, Albright, Moll, Cortland, Usher, Shears, Waugh, Scudder, Hammond and others, whose efforts have always been to expose the methods used by the irregular practitioner. I also feel indebted to the Medical World, New Idea, Western Druggist, Medical Brief, Alkaloidal Clinic, and other medical journals, whose formulae I have used with due credit. I would be pleased to affiliate with members of the medical profession in weeding out the mysteries which lurk around the practice of medicine, with a view of throwing more light on the subject in future editions of this book. The information here contained has been gained and can only be maintained by a hearty co- operation on the part of the profession, and I hope the same liberal policy will govern our relations in the future as it has in the past. A. DALE COVEY, M. D. THE SPECIALIST. THE SPECIALIST. Of the genius "City Doctor" Are species not a few; There are many arrant humbugs, There are others learn'd and true. The ever-weening egotist Will tell you all he knows, Some flourish on society, And some depend on clothes. One city man's an oculist; A second treats the ear; A third devotes himself to lungs, And curious sounds doth hear. A fourth with his laryngoscope. Will see your glottis quiver, While many men the kidneys love, And many more the liver. Some specialists prefer the points, A few the brain and nerves; Some spray away at old catarrhs, With hope that never swerves. Some think a man in buttons, A coach and pair to drive, May serve in lieu of wisdom And thus expect to thrive. Eut 'mid these varied callings all, The man who heads the list, Is that gentle fingered ge-in-us, The gy-ne-col-o-gist! He's such a charming fellow, So clever in his way; He always thrives in cities — I meet him every day. His rooms are over-crowded With ladies, quite a host, And if he has a wife, they trust She'll soon give up the ghost. God bless these noble specialists In all they have to do; And God have mercy on the souls Of all the patients, too. W. Tod Helmuth, M. D. THE SPECIALIST. THE SPECIALIST. A medical specialist has been denned as a physician or a surgeon who knows something about every dis- ease and everything about some disease, but we find that this definition is not applicable to all physicians who are in special practice, for we find men at the high- est pinnacle of the profession adding the title of specialist to their names, while the caption is also adopted by the boldest kind of an advertising quack. We therefore find that under the above title we could discuss many types of medical men, but inasmuch as every general practitioner is familiar with the work of the Regular Medical Specialist, we shall first discuss this subject from an advertising and non-ethical standpoint. What is to be said regarding advertising, is to explain the method rather than to encourage the practice. These specialists might be classed as the itinerant ad- vertising specialist; the local advertising specialist; the special disease advertising specialist; the mail order specialist; the ethical specialist; the office specialist; the observing specialist, etc. All of these except the ethical and the office specialist are considered irregular practitioners, whose methods we wish to briefly outline. Those who think all ad- vertising physicians are destitute of a sound knowledge of medicine are entertaining an erroneous idea, which should be released as soon as possible. While I must admit that there are a great many advertising physicians who are nothing more than medical ignoramuses, and are justly entitled to the name "quack" which best S THE SPECIALIST. identifies them, on the other hand we find among them some of the best therapeutists we have ever had the pleasure of meeting. These physicians are advertising purely from choice, as they are better remunerated for their services and their labors are not so hard. Many advanced methods of treatment have origin- ated with the irregular practitioner. Many condemnable, demoralizing influences have also come from the same source. In all other lines of business, if a man makes a discovery he can have it patented and his rights pro- tected, but if a physician holds his special method of treatment a secret, or sells the right to use it, he is at once denounced by the regular physicians. The estates of Drs. Keeley and BrinkerhofT, and the promoters of the various injection treatments for hernia and other methods, would not have been so large if they had made their treatments publicly known. Fortunately "the tricks of medicine will out," and I doubt if there is a secret in the practice of medicine today which cannot be exposed or duplicated with equal therapeutic re- sults. I shall endeavor to throw some light on the sub- ject in the following pages, but I will scarcely be able to begin to tell what might be said. There has been many discussions at medical so- cieties as to the best methods of eliminating the quack, but to my knowledge there has never been any definite decision. My answer to this perplexing question would be, to adopt his methods, whenever they are worthy of recognition. Advertising physicians are, generally speaking, good financiers and business men. They advertise as special- ists for revenue instead of for the honor of practicing medicine. Oftentimes they depend upon their business ability more than on their knowledge of medicine to make a success. At least, I have seen many cases in which their skill was not. apparent, even if they pos- sessed any. Of the advertising specialists I have met, I would say that fifty per cent, of them have a medical educa- tion equal to that of the average general practitioner. THE SPECIALIST. 9 Twenty per cent, have a superior knowledge of certain diseases ; the remaining thirty per cent, are far below the average, and why they should class themselves as specialists is beyond my comprehension. The inducements from a financial standpoint are cer- tainly such as to encourage one to enter the advertising arena, for advertising specialists often receive more money for one day's labor than many physicians do in a year. You may think this, is an overdrawn statement, but it is a fact. I believe that there comes a time in life when a large percentage of physicians feel that they would like to enter the advertising field, but, owing either to a lack of confidence in themselves, or to the fear of being called a quack by their brother practitioners they confine them- selves to the code of ethics, and it is well that these objections are considered, for advertising practices are not all sunshine, and they have been the means of ruin- ing both the reputation and financial standing of many physicians. Many of the most successful advertisers will tell you that if they had their lives to live over again they would prefer the general practice of medicine, wherein they could enjoy the esteem, confidence and respect of their patients and the many social functions of which the advertiser knows very little. I do not mean to say that advertising physicians have no grateful patients, but there is not the same friendly and respectful feeling towards them that there is between the general practi- tioner and his patients. THE ITINERANT SPECIALIST. These specialists travel from town to town and gen- erally plan their circuit so as to make each point either once a month or once in two months. They advertise 10 THE SPECIALIST. either to treat all chronic diseases or else they limit their practice to one or more diseases, such as piles, rupture, etc. Most of the chronic disease specialists who travel have a deficient knowledge of medicine, and could not make a living if they had a permanent residence. It is rather discouraging for the local physician, who labors night and day for the good of his patients, and does more work for sweet charity's sake than any one else in the community, to read the advertisements of one of these specialists an$ witness the financial success of his visit, for, no doubt, he has received more cash in his pocket for his day's work than the local practitioner could book in a month. It is rather amusing to read the headlines of some of the advertising circulars issued by the traveling doctor. I once picked up a bill on the street in a neighboring town with the bold faced headlines, "The President is coming." This certainly was a very "catchy" caption and everybody was wondering at first sight if the Chief Executive of the United States was going to make them a visit, but by reading a little farther it was Dr. Gordon, a traveling specialist, who was President of some Medi- cal Institute. There seems to be no way to suppress the practice of the itinerants, unless it is done by legislation. The laws of many states are so rigid that it prevents their operations to a certain extent. The itinerant specialist treats his patients by the month ; his charges range from five dollars to as much as he can get for each month's treatment, which, of course, includes all medicine. He always tries to bind them by a contract to take several months' treatment for a certain consideration; for this he takes their notes, which are indorsed by responsible parties. These notes are made payable each month as he visits the city. If possible, he will dispose of the notes at the bank and leave the city with cash on hand. THE SPECIALIST. 11 THE LOCAL ADVERTISING SPECIALIST. This man advertises either under his own name or under the name of a Medical Institute, or both. His business methods are conducted very much like those of the itinerant. Many of these specialists advertise to treat all diseases in general ; others confine their advertising to eye and ear, throat, nose and lungs, catarrh and catarrhal deafness, hemorrhoids, hernia, etc., but the advertisement most frequently seen in the daily papers is one concerning the diseases of the sexual system. I once asked a physician, who had a large experi- ence in advertising and treating all general diseases, why he finally confined his advertising to treatment of dis- eases of the sexual organs. He replied that in his experi- ence he has found that people would pay more money for the treatment of diseases in that part of their anatomy than in any other. He also stated that if he had a patient who was suffering with both consumption and impotency he would be requested to cure him of impotency first. There is a world of truth in what he said, for people will neglect every other disease longer than they will any disorder of the sexual system. Another reason which makes sexual diseases a profitable specialty is, that most people do not care to consult their family physician in such matters, and, seeing the advertisement of a special- ist, will drift into his hands. Many of these specialists endeavor to advertise in a modest way, but the majority are bold and offensive, for the louder the)' shout the more victims they will secure. Their advertisements are often decidedly misleading, with bold headlines of "Free Until Cured," "One Month's Treatment Free," etc. Such advertisements are, of course, only to get the patient to call at the office and the pro- cess of landing them is an easy one, for instead of giving them one month treatment free, they tell the patient that they only offer their services free, but they will ex- pect the patient to pay for the medicine for which they 1 12 THE SPECIALIST. will only charge from five to fifty dollars a month. Their medicines are, of course, very expensive (?). They also issue circulars depicting the despairing future of the masturbator. These are illustrated with pictures of a brainless child born of a masturbator, or a half-naked man behind the bars, made insane by self-abuse. No words can tell the demoralizing influence that such publications have on the half-educated youth who gets hold of them. They are led to believe if they have one or two emissions a month they are afflicted with some incurable disease. It is this state of mind that is desired by the advertisers, for the more morbid- ness and despair, the more money in their pockets. This -systematized method of attempting to create disease and to fatten on the distress of their victims is the foulest possible prostitution of medicine. This class of physicians also treat syphilis, gonor- rhoea, and other venereal diseases. When business gets a little dull they buy a list of letters from some mail order man who is in the same business, and get a new list of patients. They often exchange names in order that each may work the discarded or discontented pa- tients of the other and thus keep the machinery running. Some of the methods of treatment used by these spe- cialists will be discussed in the chapter on genito-urinary diseases. THE SPECIAL DISEASE SPECIALIST. We find that these men are of a more refined nature, and generally very skillful in the special branch of medi- cine or surgery which they are practicing. They are entitled in every sense of the word to be called special- ists. They are conscientious and are interested in the welfare of their patients ; they believe that their methods of treatment are the best and they demonstrate in many THE SPECIALIST. 13 cases that they are. Under this class we find rectal, hernia, diseases of the stomach, cancer and other special- ists, many of whom would be shining lights in the med- ical fraternity if it were not for their advertising, which is devoid, however, of objectionable matter. Whether or not advertising by such men should be allowed by the medical profession, I am not in a position to say, but it seems to me that if a man devotes his time in perfecting a treatment for some special disease, which his brother practitioner has failed to cure or recognize as incurable, he should for the sake of humanity let the world know it, and the easiest way is through printer's ink, unless he teaches his method to the profession, the members of which often do not care to spend the time to learn. This has been illustrated hundreds of times by rectal, hernia, and cancer specialists. I have seen many patients with cancer and hernia cured by these specialists, who were offered little or no encouragement from their family physician. In the following pages I will give several methods of treatment used by these specialists which are worthy of adopting in your practice, and by making use of them you will receive large financial returns. THE MAIL-ORDER SPECIALIST. Most physicians have very little conception of the amount of business done by the mail-order specialist. Up to a few years ago, if any one had told you that he could establish a large medical practice through the mail, you would have thought that he was a fit subject for the lunatic asylum ; but at the present time there are hund- reds of thousands of dollars spent every year in adver- tising, and many more thousands of dollars received by the advertisers. There are about one hundred and seventy periodicals published for the sole convenience of the advertisers. These are called Mail Order Journals or Magazines. The 14 THE SPECIALIST. rates for advertising in these publications range all the way from ten cents to six dollars a line. A four-line advertisement inserted once in the entire list, would cost $529.20. This will give you an idea of the enormous amount of money that can be spent in advertising. A four-line ad- vertisement is the smallest space some papers will allow you to take. A Mail Order Medical Specialist who uses only from two to four inches of space each month is considered rather a small advertiser, although he is paying $2,272.20 each month for his advertising, if he uses the entire list. There are many specialists who appropriate $100,000.00 each year for their advertising. By advertising in the so-called Mail Order Journals, you reach patients in the most remote parts of the coun- try. You will have no idea from what country you may receive a reply from your advertisement. You may re- ceive letters from Australia, Japan or Iceland, or from a mining or logging camp, which is many miles from the nearest railroad. On the other hand, you may receive a reply from your own or from a distant city. Of all the medical advertising business, the mail order business is the most facinating, for when one once gets into it, it is hard for him to get out. The specialists who are following the mail order in- dustry generally confine their practice to one disease or to one remedy and advertise a specific treatment for Kid- ney complaint, Rheumatism, Catarrh, Obesity, Deaf- ness, Diseases of the Eye, Impotency, Female Com- plaints, Consumption, Asthma, Epilepsy, etc. The remedies for the cure of these diseases are gen- erally first furnished to the patient in the way of free samples. If the remedy has any merit, the patient is quite sure to order a supply. In this way he is induced to continue the treatment for several months. There are two important things to be considered in remedies to be sent through the mail. They should possess a certain degree of merit, and should contain few or no poisonous ingredients ; but this rule is not always THE SPECIALIST. 15 adhered to, as will be seen by the formulas which are to follow. The physician who treats all chronic diseases, sup- plies his patients with question blanks which the patient can fill out and send to the doctor, together with a description of his case in his own language. The physi- cian may then prepare any treatment he deems the case requires. The fees for such treatments are from one to ten or more dollars a month. Mail order specialists generally treat their patients by the month, as do other advertising specialists. Mail order patients should be treated with the same integrity and respect as local patients, and, under all cir- cumstances the specialist should endeavor to hold the esteem and good-will of his patients. If a patient should write a tart, pointed, or impudent letter, it should never be answered by one of the same character, although the specialist may feel justified in doing so. No good can be accomplished from such correspondence, and much harm is often done. If one can succeed in holding the con- fidence of his patient and the treatment benefits him, he is sure to send other patients, but if the treatment is abso- lutely worthless, he will not hesitate to denounce it as a fraud. This is oftentimes done very unjustly, for no physician can expect as great a number of cures in a mail order practice as he can in patients who are con- stantly under his observation. Although there are several preparations given throughout this book which have or can be used in mail order practice, I will add several more which have come to my notice and which can be used successfully by the general practitioner. ASTHMA. Remedies for this distressing disease have always found a steady and increasing sale. I know of one gentleman who has made a large fortune through the sale of the following Asthma cure, which is compounded after the formula of Dr. Covert. The formula is a good one and has been published in several Medical Journals : 16 THE SPECIALIST. 1$ Iodide of ammonium . . .2 dr. Fl. ext. grindelia robusta 4 dr. Fl. ext. glycyrrhiza 4 dr. Tinct. lobelia 2 dr. Tinct. belladonna 2 dr. Syr. Tolu q. s. ad. 4 oz. Dose — Teaspoonful three times a day; extra doses during a paroxysm. CONSUMPTION CURE. The Slocum system of treatment for consumption has established quite a reputation, and the company is among the largest of mail-order advertisers. I sent for a sample of their preparations, which consist of a bottle of Psychine, Ozomulsion, Coltsfoot Expectorant and Ozo- jell. The Ozomulsion is about a twenty per cent, cod liver oil emulsion with the addition of guaiacol. Psychine, the "greatest of all tonics," is a decoction of nux vomica and cinnamon, which is to be taken in a wine-glass full of whiskey before each meal to build up the appetite. The Coltsfoot Expectorant is a preparation very much re- sembling Ayer's Cherry Pectoral, given on another page. This treatment will cost from five dollars to ten dollars a month. RHEUMATISM CURE. These are also freely advertised and the patient lib- erally sampled. A gentleman who had the management of a large mail-order Rheumatism Cure Co., said that they only used one drug and that was prepared as fol- lows in large quantities : I£ Ammonium chloride 160 gr. Aromatic elix q. s. ad. 1 oz. Mix. — A teaspoonful from three to six times a day. Each teaspoonful of the above mixture represents twenty grains of ammonium chloride, and it is often sur- THE SPECIALIST. 17 prising to note the influence which this drug has in con- trolling muscular rheumatism. The cheapness of the drug makes it a very profitable remedy to handle, and it is a preparation that will establish a reputation upon its own merits, as the thousands of testimonials which this company possesses will attest. EPILEPSY. "I cure fits," is a headline seen in all mail-order pub- lications, and several men have accumulated large es- tates by selling remedies for fits. A very convenient and profitable remedy for epilepsy and the neuroses is hydro- cyanate of iron. Although this remedy has been used by a few physicians for several years, it has never gained the confidence of the profession which it fully deserves. It will seldom disappoint reasonable expecta- tions and has the advantage for mail-order purposes that it can be dispensed in pill form, each pill composed of the following: ^ Hydrocyanate of iron I gr. Extract hyoscyamus y 2 gr. Powdered valerian (English) 2 gr. Sig. A pill morning and night, gradually increasing. HEART DISEASE. The frequency of diseases of the heart has created a demand for a "heart cure." The accompanying formula is used by one firm and I am told that they have the tablets manufactured in car-load lots. The formula is an old one and extensively used by the medical profession. Each tablet represents : ly Glonoin 1-100 gr. Tinct. strophanthus 2 min. Tinct. digitalis 2 min. Tinct. belladonna y 2 min. [2] 18 THE SPECIALIST. STOMACH DISEASES. A physician who has a large local and mail order practice and advertises as a stomach specialist, claims he can cure ninety per cent, of all cases of dyspepsia by confining his patient to a raw or very slightly cooked beef diet. In connection with this diet, his favorite stomach or digestive tablet is as follows : ^ Pepsin i gr. Sulphite of soda 2 gr. Resorcin 2 gr. Charcoal 2 gr. Capsicum % gr. Nux vomica Ye gr. This treatment is certainly a very successful one and the raw meat diet should never be overlooked in treat- ing stomach diseases, as it has a very soothing influence on the stomach when it is in an irritable or a diseased state. ENURESIS. A western physician has extensively advertised a cure for "bed wetting," which is put up in tablet form accord- ing to this formula: ^ Atropine 1-120 gr. Santonin ....'. *4 gr. Rus aromatica 5 gr. The directions which accompany the treatment in- struct children to retain their urine as long as possible during the day and not to drink any liquid for two hours before going to bed. THE SPECIALIST. 19 CANDY CARTHARTIC. The following formula makes a preparation very much like Cascarets, which has had a remarkable sale: ]J Powd. ext. senna i oz. Powd. ext. cascara sagrada I oz. Powd. ext. licorice. 2 oz. Powd. sugar 2 oz. Oil anise 2 dr. Oil wintergreen 2 dr. Aqua •• q. s. Mix the first six remedies and add sufficient water to make a paste, then divide into tablets of thirty grains each. OBESITY. Pills for reducing weight have found a great demand. These pills are made from the active principals of the Phytolacca berry and bladder wrack, and put on the market under different names. THE EYE SPECIALIST. For the last four years eye specialists have been using large space in mail order publications. They advertise to cure every form of eye disease, from cataract to the simpler forms of inflammation, and the surprising part of it is, they have been remarkably successful. Since the last edition of this book I have received many letters from physicians, requesting information regarding their treat- ment. Finally I secured the secrets of their business from a physician who attended to the compounding and shipping of the treatment for one of these specialists, whose income from mail order patients exceeded over $100.00 a day. Their treatment for the diseases of the eye is somewhat stereotyped. Their principal panacea for all diseases of the eye is the oil of thuja. This is cer- 20 THE SPECIALIST. tainly a remarkable remedy, and offers us one of the best means of treatment for many diseases of the eye. This remedy is advertised as "a harmless, painless, soothing and healing preparation that gives instant relief and ab- solute cure for all aches and pains, burning of the eyes, from inflammation, strain or granulated lids. It is also a sure cure for corneal opacities, etc." The above statement, made by them, is true in many cases. This remedy is often combined with cocaine hy- drastin and coloring matter, to disguise it. Referring to this remedy, Prof. W. C. Converse, of Chicago, says : "In cases of ophthalmia neonatorum on gonorrhoea! ophthalmia, where there has been considerable destruc- tion of corneal tissue, the cicatricial tissue which takes the place of the destroyed cornea is hard and opaque, and cannot be absorbed or rendered transparent; it is not in cases of this kind that I report success, but in the diffuse nebula, or in the more dense form called a macula, which follow corneal ulcers, that I have had my best results. The classical treatment of calomel dusted in the eye, or the daily application of the yellow oxide-of-mercury in cosmoline, plus the indicated remedy, have helped to a certain point, and then improvement has stopped, and it is in these cases that I have used Thuja oil, and been surprised and gratified with the results. The Thuja oil seems to stimulate the blood-supply of the conjunctiva, promoting the reproduction of clear corneal substance. My method of application is to have the patient drop one drop of Thuja oil on the affected eye; then close the lids and gently massage the eye over the closed lids, and apply a hot wet cloth to the lids for five minutes once a day after the massage, but the Thuja oil three times a day. The two following cases whose records I give are College clinic cases that have been watched with interest by members of the present Senior class : Olive S., ii years old, has had many attacks of phlyctenular keratitis. The cornea had the appearance of an interstitial keratitis ; she had been treated at the THE SPECIALIST. 21 neighboring college clinics. She was not attending school, because of poor vision, for six months. She said they had used a yellow salve on her eyes with but slight improvement. This was one year ago. I commenced the Thuja oil, which she used faithfully. Improvement was noticeable in two weeks. Vision at the last visit was 20-30, and she is now attending school. J. P., 29 years old. A large macula following a large corneal ulcer treated one year at different eye-clinics, with no improvement. Up to date he has used one ounce of the Thuja oil, and now there is but a slight haziness of the cornea which can be noticed only with oblique illumination. In the past year I have used Thuja oil on many other cases in my clinic and in private practice with uniformly favorable results. I consider that the Thuja oil treatment is superior to any other method now in use for corneal opacities. " Another remedy which has obtained quite a reputa- tion as a solvent for cataract and other diseases of the eye is cineraria maritima. This is another remedy im- ported from South America, (the land of healing pro- ducts.) I am not familiar with the use of this remedy, but many favorable results have been reported from its use, and it is worthy of trial in many cases. The sale of these remedies, together with the fitting of glasses, makes a very profitable industry for the mail order eye specialist. SELLING RECIPES. Every mail order Journal contains advertisements for selling recipes ; this is particularly so with toilet articles, household preparations, etc. These recipes are sold at prices ranging from twenty-five cents to ten or more dol- lars. I give the following as illustrations of this class, the former representing a $1.00 hair restorative recipe 22 THE SPECIALIST. and the latter recipe for making artificial maple syrup, which has been sold many times to manufacturers fron\ $10.00 up : GRAY HAIR MADE DARK. IJ Tannate quinia I % dr. Lavender flowers 4 dr. Rosemary leaves 6 dr. Bay laurel leaves 2 dr. Oil myrbane 20 min. Oil citronella . . 20 min. Put one pint of boiling water on the above, and set it aside to cool for one hour. Then strain through a cloth and add one ounce of glycerine and two ounces of alcohol (or bay rum). It is then ready for use. If your hair is naturally oily, you may omit the gly- cerine. DIRECTIONS FOR USING. After shaking the bottle, pour a few spoonfuls into a vessel. Take a sponge, moisten with compound, and rub the scalp thoroughly. Do this every other morning and evening until the hair has resumed its natural color, and then apply once a week thereafter. It will not stain the scalp, and contains no poisons. HARMLESS BLACK OR BROWN HAIR DYE. I£ Pyro-gallic acid 4 dr. Sulphite sodium 30 gr. Alcohol 1 oz. Soft water. 3 oz. Dissolve the Pyro-Gallic Acid in the Alcohol, and the Sulphite Soda in the water. Mix the two (2) solutions together, and then it is ready to use. THE SPECIALIST. 23 DIRECTIONS FOR USING. Before using, the hair should be thoroughly washed with soap and water. It can be so applied as to color the hair either black or the lighter shade of brown. If black is the color desired, the preparation should be applied while the hair is moist, and for brown it should not be used till the hair is perfectly dry. To apply, dip the points of a fine tooth comb into the compound, and gently draw the comb through the hair, commencing at the roots, till the dye has preceptably taken effect. When the hair is entirely dry, oil and brush it as usual. I send two recipes. — The first is my own original recipe, and the one I recommend. The second one is given because of its easy use, and combining both black and brown, according to the way applied. It is excellent for dyeing the whiskers. Ingredients for the first recipe (except Alcohol and Glycerine) sent post-paid for 25 cents. Ingredients for the Harmless Dye (except Alco- hol and Water) sent post-paid for 35 cents. NOTE — It will be noticed that their object is not only to sell the recipes but also to supply the ingredients. ARTIFICIAL MAPLE SYRUP. Although this formula is a deviation from the theme of this publication, the product is a useful household article, and the process of manufacture is so simple and valued so highly, that I feel justified in giving it, as much of the maple syrup bought at stores is made by this or a similar process and produces an article which is hard to detect from the genuine. The simple process of man- ufacture is as follows : Crack two quarts of hickory nut shells, remove the meat ; tie the shells in cheese cloth and boil for about one-half hour in one gallon of water. When the solution becomes brown, add sufficient sugar to make the syrup the right consistency, and strain while hot. 24 THE SPECIALIST. THE PREMIUM TRUST SCHEME. Another way of introducing proprietary medicines is to advertise for agents and give premiums. The appli- cant answering the advertisement is at once forwarded fifteen packages of head ache powders, which he sells at ten cents a package. He remits the full amount, $1.50 and receives, as a remuneration for his services, jewelry and other articles. This is a very successful scheme and rather an honorable way of introducing remedies. If the remedy has merit the medical company receives many orders, as their address is printed on each package. THE FREE PRESCRIPTION C. O. D. SCHEME. This scheme has formerly been used by the "Lost Manhood" fakirs, and consists of advertising a free pre- scription for lost vitality. The prescription is sent to the applicant as ordered, in due time, and contains the fic- titious names of many remedies. The patient also re- ceives a flowery letter stating that these remedies are imported from Central Africa, South America or some other foreign country, and thinking perhaps, their local druggists might not carry them in stock, they decide to send them one complete month's treatment, by express C. O. D., $6.00. If the prospective patient is slow in ac- cepting the package, he is frequently written to by what is known as the "follow up system/, which consists of a series of letters extolling the valuable properties of the treatment. The price of the treatment is also gradually reduced during the correspondence from $6.00 to $1.50; in the meantime the express company is notified if the package is not accepted, it can be destroyed, as its value is less than the express charges to return it. This has proven to be a very successful scheme, as fully three- fourths of the packages are accepted. There were no less than twelve of these medical companies in operation at one time. The Postoflice authorities have refused them the use of the mail, however, and they have clo c cd out their business. THE SPECIALIST. 25 THE OBSERVING SPECIALIST. DIAGNOSING DISEASES WITHOUT ASKING ANY QUESTIONS. This is a new feature which is being practiced by many advertising specialists and, although this method cannot be applied to all cases, it is surprising to note how often they will hit the nail on the head. I had occasion to visit one of those physicians for the purpose of learning his secret if possible, and was somewhat surprised at the accuracy in which he would often describe symptoms, and the weight it had in gain- ing the confidence of the patients, which is a very im- portant feature from a financial standpoint. People generally think that if a physician can tell their ailments without asking any questions he must be a healer of wonderful skill and ability. This physician had charge of one of the largest med- ical and surgical institutes in our country, which afforded him an opportunity to examine from twenty to seventy- five patients a day, and after watching him take cases, I am thoroughly convinced that the face will map out many diseases and the physician, who is the least ob- serving and familiar with the symptoms of disease, can tell many of them by studying the physiognomy of his patients. The expression and the color of the face, tempera- ment, the carriage of the body, conversation, breathing, eye, the pulse, tongue, and, the occupation, are the prin- cipal things upon which these "physiognomy diagnosti- tions" locate disease. There are only three questions which are asked the patient, namely: To see the tongue, his age, and his oc- cupation. During my stay with this physician I watched him take many interesting cases, and I think it will be of sufficient interest to outline the ones which are quite familiar to every physician. 26 THE SPECIALIST. The first patient was a gentleman, forty-six years old, who entered the consulting room rather slowly and took a seat. There was an expression of melancholy on his face ; he looked sad and friendless ; the skin and com- plexion was slightly yellow, but not decidedly noticeable; the doctor looked at his tongue, which had a brown coat, and told him he had disease of the liver; a feeling of fullness in the right side, laying his hand on the right hypochondriac region ; he also told him that he had a pain under the right shoulder blade ; at times would feel drowsy; had no ambition; the urine at times was scanty and high-colored ; was troubled with indigestion. He also mentioned other symptoms which are generally as- sociated with diseases of the liver. In this case you will see that his diagnosis was founded upon the color of the skin, the general torpidness of the body and the coating of the tongue. The next case was still less difficult. A young lady eighteen years old, whose face at once would explain her symptoms, for she had a pronounced case of anaemia. The doctor immediately told her her disease was due to lack of red blood corpuscles in the blood ; that her menstrual periods were scanty and irregular; that her heart would palpitate on the least exertion ; that she would get dizzy when rising from a recumbent posi- tion, etc. The next patient was a lady thirty-seven years old, mother of four children; was nearly as pale and anaemic as the former patient. The doctor examined her care- fully and told her that she was suffering with female troubles ; that her menses were too profuse and appeared oftener than they should ; that this excessive loss of blood would not allow her body the proper nourishment, and at times she was extremely nervous and irritable ; and also that her digestive organs were feeble, due to lack ot nourishment from the excessive lors of blood, and that like the former anaemic patient, she had palpitation of the heart, faintness, etc., all of which she admitted to be true. THE SPECIALIST. 27 After the patient was dismissed, I asked the doctor why he should diagnose her disease as originating in the female organs. He discussed the temperament of the patient; the tissues of the body were sleazy in texture and would readily yield to the congestion in the parts during the menstruation, and owing to this excessive loss of blood would naturally bring other organs into sym- pathetic suffering. The next patient was a man, fifty-one years old, who apparently seemed to be enjoying the best of health, but, after examining the tongue, he was immediately told that he had dyspepsia. The tongue had a heavy white coat, which indicated that an excessive amount of acid was being secreted by the stomach and that he would have sour eructations, heart-burn, occasionally, pain in the pit of the. stomach and soreness on pressure, etc. In this case it was plain to see that the tongue told the story. The next case was a man sixty-one years old, with rather a plethoric temperament. After the doctor felt of his pulse, he at once advised him that he had a valvular disease of the heart. He called my attention to the re- ceding pulse which was particularly characteristic with its forcible impulse, which rapidly declined ; the so-called water-hammer" pulse. The blood vessels throughout the body would pulsate so that they were visible to the eye. The use of the stethoscope showed plainly that the patient was suffering with arotic regurgitation. The above only illustrate a small number of cases met with and, although he made many failures, he was rea- sonably successful in the majority of cases. I have seen him locate diseased organs by finding a sore spot on the spinal column, and relieve pain by making pressure on this spot and desensitizing the nerve supply, which is the method used by the osteopaths. He would locate rectal diseases by the position which the patient sits in the chair. Kidney troubles can also be located by the condition of the eye, and the desire of the patient to press the small of his back .upon some hard substance. The color of the skin will point out diseases of the blood and 28 THE SPECIALIST. liver; the character of a cough will locate disease of the throat, bronchial tubes or lungs by its volume. Acna rosacea is not always due to the use of alcohol, but is frequently associated with disease of the stomach and bowels. Falling out of hair is also connected with diseases of the kidneys. Dark circles and discolorations under the eyes are associated with disturbances within the pelvic cavity, female diseases, etc. Masturbators and those who indulge in sexual excesses can often be identi- fied by the sheepish expression of thir faces. Notched teeth are often a symptom of hereditary syphilis, etc. The late Dr. J. K. Scudder, of Cincinnati, was among the first to call attention to the different coatings of the tongue and their relation to diseases of the stomach, bowels and blood. The doctor says, "If the tongue is heavily coated at its base with a yellowish white fur, we know that there are morbid accumulations in the stomach. If the tongue is uniformly coated from base to tip with a yellowish fur, rather full, and moist, we have the history of atony of the small intestines. If the tongue is elongated and pointed, red at tip and edges, papillae elongated and red, we have evidence of irrita- tions of the stomach with deterioration of the blood. "Again, we have a tongue that might be designated as 'slick.' It is variously colored, but it looks as if a fly should light on it he would slip up and break his neck. It is evidence of a want of functional power, not only of the stomach and the bowels, but of all parts supplied by the sympathetic nerves. "The tongue tells us of acidity and alkalinity of the blood in language so plain that it cannot be mistaken. The pallid tongue with white fur is an index of acidity of the stomach and blood, and it is surprising to note how rapidly these conditions can be cured by the use of sul- phite of soda. A deep red tongue indicates alkalinity and is readily cured by the employment of an acid. "Impoverishment of the blood (sepsis) is indicated by a dirty dark colored fur, and requires a treatment that will antagonize this septic process." THE SPECIALIST. 29 You will notice that this "unruly member" alone tells us a good deal and by careful study might tell us more. It is with these objective and semi-objective symptoms, together with the sense of touch, that these spe- cialists become familiar and use as a foundation for their diagnosis. Although I have only given you a rough sketch of the subject and present this article only as good material for thought, hoping that it may prove ot some assistance to you in locating diseases by observa- tion. THE ETHICAL SPECIALIST. We find that medical men, even of this description, often like to see their names in print, which will react to a financial advantage on their part, but these men differ from the regular advertisers inasmuch as they do not pay for their advertising. There is hardly an edition of a local paper that does not contain an account of the discovery of some physician or the dexterity of some surgeon in a certain operation. The detailed copy was, no doubt, handed to the editor by the physician himself, with a request that it should be printed. This, of course, is profitable advertising for the practitioner, but the editor is led to believe that the article was written for the advancement of science. This is well illustrated in the world-wide advertising which Profs. Roch and Brown-Sequard have received out of their consumption lymph and the "elixir of life." Al- though they were only scientific bubbles, the advertis- ing these gentlemen received has had much to do in bringing their names before the public. In smaller towns local items of births, fractures, etc, are handed to the editor with the name of the doctor attached as being the attending physician. This is a very judicious way of advertising. 30 THE SPECIALIST. I remember once meeting a young physician, who had just located in a small city, who was called to ad- just a fracture. The papers wished to encourage the young man and devoted a half column to praising his success. He afterwards tolcl me that the editorial was instrumental in placing several cases of fracture in his hands that year. Accoucheurs have also established a large obstetric practice by having their names published in connection with births. The mention of a physician's name in con- nection with any case, medical or surgical, will be of more or less advantage to the physician and is considered legitimate advertising. Perhaps the most dangerous member of the Medical Profession is the ethical medical hypocrite. We can have some respect for the bold faced advertiser, as he makes no pretentions other than what he is, but the tricks prac- ticed by many physicians under the cloak of ethics, would make many advertising physicians hang their heads in shame. I once employed a stenographer who formerly was in the employ of a surgeon who was the shining light of the community. From this source I learned many of his business tactics, which will outstrip the methods of the lowest forms of quackery. This surgeon's principle ob- ject was money making, and it made no difference from what source. A lady wrote to him that she was afflicted with uterine cancer ; he advised her that he could cure her by undergoing an operation and removing the organs. The fee asked was $200.00; she replied the only posses- sions she had in the world to secure money was to sell her cow and piano, which she was advised to do. She finally secured $90.00 and her hospital fees ; she entered the hospital with the understanding that she was to have her uterus and ovaries removed, but instead the surgeon simply curetted the ulcerated surface. She left the hos- pital at the end of a week, thinking she had departed with her diseased organs. She continued to menstruate, which created much suspicion. She finally consulted another physician, who told her she was still in possession of THE SPECIALIST. 31 both her organs and disease. The patient finally died. But the brother still preserves the organs, pending legal action against the surgeon for mistrust. Another well to do patient wrote this surgeon regard- ing her case and the cost of an operation. He replied, ''The price of the operation will be $400.00; if you are a pauper I will charge you only $100.00." It was a ques- tion in this case whether or not one could admit being a pauper for $300.00. I do not wish to be understood as entertaining pessimistic ideas regarding the ethical sur- geon or specialist, for as a general rule they are noble, conscientious and charitable practitioners, but occassion- ally we find one whose trickiness surpasses that of the regular advertiser, still he is protected under the wings of ethics. Of all the specialties, those which incorporate surgery in its different branches are the most compensa- tive. The shrewd and unscrupulous physician realizes this after he has been in practice but few years and never allows an opportunity to pass where an operation can be justly (or perhaps, unjustly), performed. You will ob- serve that as a rule specialists who have the largest in- come are classed as surgeons or are practicing some speciality involving some of its branches. This often has a tendency to produce a narrower type of medical men by exaggerating the minute and advising operations when unnecessary. When you hear of a physician re- peatedly saying, "he just arrived in time to save her life, or an operation will be absolutely necessary," he can gen- erally be regarded as a medical or surgical "grafter." THE OFFICE SPECIALIST. I fully realize that most physicians do not care to advertise, and as I have previously stated, I do not wish to be understood as advocating the practice, but owing to the purpose of this book I thought it would not be out of place to briefly outline some of the methods of medical 32 THE SPECIALIST. advertising, which are in use at the present day. With justice to all and malice toward none, we have now come to the point where we can consider one of the most greatly neglected features of a general practitioner's work — office practice, and office specialties. Of all the professions, the Medical Profession is the most over crowded, and still our 155 Medical Colleges are turning out Physicians at the rate of about 6,000 a year. Referring to Polk's directory, we find there are over 135,000 physicians in the United States, which, according to the population, makes one physician to every 6.55 in- habitants, with an average income of about $1,000.00 a year, or $2.73 a day, which is about equal to ordinary skilled labor. There are thousands of learned and skill- ful physicians in the United States who scarcely make a living and there is no profession in the world which has so many side issues as medicine, and the general practi- tioner finds as competitors all kinds of speculative med- ical philosophers. When we stop to think that there are over one million Christian scientists, to say nothing of the various healers, hypnotists, mind curers, self inspired medical pretenders, patent medicines, etc., on the illegiti- mate side, while in legitimate medicine our cities are crowded with free clinics, dispensaries, hospitals, etc., which are visited by many people, who are perfectly able to pay for their medical services. It is rather discouraging for the young physician who has spent four years in medical college and several hun- dred dollars, to confront the world with a laborious pro- fession, which does not offer him a yearly income much greater than ordinary labor. The question arises, what can be done to make the practice of medicine remunera- tive in proportion to the amount of skill required, capital and time expended in obtaining the knowledge? It has been said that this is the age of specialists, which is quite true, and with this we find the general practitioner lean- ing towards a tendency to become sort of a general ad- visor and distributing agent, we find him sending his surgical patients to the surgeon, female patients to the gynaecologist, eye patients to the oculist, ear patients to THE SPECIALIST. 33 the aurist, and throat and nose patients to the laryngolo- gist, etc. While this is often advisable in many cases they could often receive as effective treatment in his hands if he would provide himself with the proper in- struments and equipment to treat them and thus receive the credit of curing them. If there is any credit or glory in the practice of medicine he will keep it within his bounds. The physician who walks the street with his office in his hat and depends upon writing prescriptions The above cut illustrates the Physicians Supply Co's Improved Opera- ting Table. This table is made of oak, highly polished, and fills all the requirements of a physician's operating table or chair. Both ends can be raised or lowered independently, at any desired angle. It is provided with an exten- sion, sliding out from either side, convenient for holding the arm or instruments during £n operation. It has two stirrups, which can be adjusted to any length and concealed when not in use. As an economical (Price $10.00) and desirable piece of office furniture it is doubtful if the table can be excelled. and visiting the bedside of the sick for one dollar a visit, is generally a physician who is always financially em- barrassed ; while on the other hand, we find the physician who has a well equipped and regulated office, with a working library and endeavoring to keep abreast with the times by subscribing for the leading medical journals and providing himself with suitable instruments, we find a physician who is progressive and prosperous and who no doubt is receiving the cream of the medical practice, [3] 34 THE SPECIALIST. which he justly deserves, for he is better able to combat with disease, as he has every modern appliance at hand for the benefit of his patients. This brings us up to the point of what may be considered a properly equipped office and what is the best way to make the practice of medicine remunerative in a legitimate ethical way. This depends upon two things, a reasonable amount of tact and skill and a proper office equipment, and utilizing of- fice specialties which has formerly been monopolized by other specialists. In the following chapters we will endeavor to give the details of several specialties, many of which have made fame and fortune for their promoters, and can be as suc- cessfully used today as ever before, but in order to suc- cessfully conduct that much neglected part of the general practitioner's work — office practice — requires the expen- diture of a small sum of money for equipment, the more extensive the equipment, the greater his success and in- come. If a physician were to enter any commercial business, one thousand dollars would be a very small capital to commence with. By appropriating this amount for the purpose of an office equipment which will assist him in his life work, he can have nearly every modern appliance and instrument in present use, and is far better able to meet the demands of the public and cure diseases than the physician who confines his stock in trade within the walls of his cranium. There is no other way in the world which will give a physician as much prestige and patron- age as to conduct a small private sanitarium, or equip a suitable suite of offices with all modern appliances. I have seen this plan of properly equipping offices carried out on several occasions and in every instance the plan has been sufficiently remunerative to justify the extra expenditure in securing the equipment. Nearly every physician who has adopted this plan will tell you that his increased income for the first six months has paid for his complete outfit. It requires considerable room to equip offices of this kind and a good, modern, centrally located house, or a flat over some store is best suited for the pur- THE SPECIALIST. 35 pose. The sanitarium, or office, as you choose to call it, should have a finely furnished reception room. Physi- cians as a rule, do not appreciate the value of a well furnished reception and consultation room, which has The Physicians Supply Co's Toilet Cabinet and Instrument Case. The accompanying cut illustrates one of the neatest, most convenient and prac- tical pieces of office furniture a physician can possibly possess. It is a complete water works within itself in a compact form. The cabinet proper contains a towel rod, shelves for instruments, medicines, etc. Below this is a five gallon galvanized reservoir, by simply unfolding the front part you have a wash stand which can be filled with water through a half- inch nickel faucet. Below the wash bowl is a place for soap, comb, brush, instru- ments, towel, or whatever you desire. All you have to do to empty the wash bowl is simply to close the cabinet, this throws the water into a galvanized iron tank below which can be removed by opening the lower part in the same manner and drawing out the lower reservoir. In the lower part of the cabinet is a place for soiled towels, etc. In the front door of this cabinet is a plate glass mirror 12x18 inches, and on the sides "are two movable hooks which can be used for coats, hat or towels. The cabinet is made of oak, modern in design, sanitary in construction and richly finished. The dimensions are six feet high, one foot 8 inches deep at its base. The accompanying cut shows the cabinet opened and closed. Price, $15.00. much to do in favorably impressing patients regarding the prosperity and refinement of your institution of bus- iness. You should also have an electrical room, containing all modern electrical apparatus, a static machine, an ^>b THE SPECIAL- ST. X-ray outfit, a galvanic and faradic cabinet, etc. Baths of every description can be added at very little expense and are very profitable. I know of one physician in this city whose income is over six thousand dollars a year from baths alone, who is using the same bath apparatus and methods given in another chapter in this book. Other rooms should be equipped _ with a compressed air outfit, for throat and nose work, vibratory massage, etc. Other appliances can be added as you desire. This will give you a decidedly up-to-date office, and I dare say there is not another office anywhere near you which is prepared to offer the treatment for diseases you are able to supply I have been a very close observer of this method of con- ducting offices and sanitariums, as they are frequently called, and I have never known of a failure where there was a reasonable amount of energy back of them. I know of no other field which offers the general prac- titioner as great a prestige or a richer financial harvest than a well equipped office outlined above. This institu- tion requires no advertising and can be conducted in a strictly ethical and legitimate way, for "by their work ye shall know them." Many physicians are conducting these offices in small towns on a profitable basis. I recently met a physician who resided in a hamlet of only six hun- dred inhabitants, who stated he increased his business two thousand dollars the first year after adding the equipment. In selecting a location, however, it is best to establish yourself in a city of at least ten thousand in- habitants. In the following pages I will outline several special- ties and methods of treatment which will be of much service in establishing an office p-ractice. "Go to the pillow of disease When night brings no repose, And on the cheek where sickness pre3 ? s Bid health to plant a rose." BATHS. 37 THE BALNEOTHERAPEUTIC SPECIALIST. BATHS. In this chapter may be outlined the value of hot, cold, warm water, steam, medicated vapor, superheated air, sand, mud and electric baths, also the value of friction and massage, drinking water, etc., as therapeutic agents. The earliest history has given facts that baths have al- ways been an important feature in the healing art, and bath institutions were established long before the birth of hospitals and sanitariums. Romans served their armies with all the advantages of the bath and wherever their armies were stationed elaborate bath institutions were founded, which had no doubt much to do with the physical superiority of the nation. During the reign of Tiberius, from 14 to 37 A. D., there were nearly nine hun- dred public and private baths in Rome alone, and no Villa was considered properly furnished unless provided with suitable bath apartments. Many of these were the grandest constructions that architectural genius has ever created. The Augustan age was an epoch conspicuous for the development of sanitary measures for the promo- tion of public health and officers of high dignity were ap- pointed for the management of these establishments. The magnitude and gigantic proportions of some of these establishments is almost beyond comprehension, the era embraced by one of these immense establishments was equal to the space occupied by twenty-five ordinary city blocks. There were no less than eleven similar institu- tions in one city, some of them covering a space of one square mile, and accommodating- 18,000 bathers at one time. 38 BATHS. During the excavation of Pompeii, in the years of 1824 and 1825, many public baths were opened in a good state of preservation. It is my belief that if some of the modern philanthropists, who wish to immortalize them- selves by building public libraries, etc., for their monu- ments, would build public bath establishments, their ef- forts would be better appreciated, as the former is only a luxury for the few, while the latter is a necessity for the many. Most sanitariums of the present day have well equipped bath accommodations. Many of these in- stitutions are located near Mineral Springs, where their principal drawing feature is in extolling the virtue and healing properties of the water, and thus we learn how the Warren Springs, Ind., mud baths were discovered by a laborer, who was cured of rheumatism while excava- ting for a ditch. Since then thousands have been burying their anatomy with the same results. It is also handed down in history that the famous Bethesda Springs, lo- cated at Waukesha, Wis., was accidentally discovered by a well known gentlemen who was cured of diabetes by drinking the water. Similar history is generally con- nected with most watering places and mineral springs in both this country and abroad, where thousands of people go every year to wash out their ills. Although a large number of sanitariums are located at these watering places, it is not necessary to be estab- lished near a mineral spring to derive all the benefits ob- tained from baths. With a very little outlay of money, any physician can incorporate baths with his armamen- tarium with equal results and receive large financial re- turns. THE EQUIPMENT. The equipment required to conduct a bath establish- ment can be secured at prices ranging from fifty to sev- eral thousand dollars. The four essential things required is water, a bathtub, a bath cabinet and a massage table. Realizing the fact that many physicians live in places where they have no waterworks, the equipment can be BATHS. 39 arranged independent of this privilege, with an outlay of capital amounting to a very few dollars ; by securing a portable folding bath tub and heater complete, a bath cabinet, and an operating table, which can be used for massage. With this equipment and whatever accessories you require, you are prepared to administer nearly every kind of bath in present use. If your bath patronage is PORTABLE BATH TUB — FRENCH PATTERN. very extensive, you should have four rooms, two for ladies and two for gentlemen, although the entire bath can be conducted in one room, but to save time, you should have a drying room for both ladies and gentlemen where they may rest after the bath and their bodies have the proper reaction to resist the prevailing atmospheric temperature. BATHS. Is the exposure of the body by immersion or other- wise to some medium to which it is unaccustomed, or else one to which it is accustomed, but is applied in an 40 BATHS. unusual manner ; therefore, we may take baths in air, water, mud, vapor and medicated air, superheated dry air, etc., either for the purpose of cleanliness or medi- cation. Baths taken in water, mud and sand have a range of temperature from 32 to 120 degrees F., according to the effect we desire to obtain. The temperature of baths are divided as follows : Cold baths 32 to 60 dgrees, F. Cool baths range from 60 to 70 degrees F. Temperate from 85 to 92 degrees F. Tepid, 92 to 98 degrees F. Warm baths have a temperature of 98 degrees F. Above this thev are considered hot. COLD BATHS may be had either in the sea, stream or bath tub, the former offers no advantage over the latter, other than the motion of the water and the proportion of salt the sea water contains, which varies at different points. An artificial sea bath may be obtained by adding five pounds of common salt to 30 gallons of water, which adds much to the pleasure and stimulating effect of the bath. Cold baths should only be given to the robust, as they cause contraction of the external capillaries with a reduction of the external and a primary increase of the internal tem- perature, therefore should be avoided by patients suffer- ing with heart disease, and those with a tendency to in- ternal hemorrhage, also emaciated, anaemic and con- valescent people. Cold baths are given for their tonic and stimulating effect and to reduce the temperature in fevers ; they are used by athletes as a "hardening pro- cess," to develop muscle and to render the body less sus- ceptible to atmospheric changes, they are also beneficial in neurasthenia, insomnia and scrofula; they seem to in- crease the weight in thin, and decrease the weight in fleshy people ; the appetite is increased and general ani- mation of the body is experienced after a cold plunge bath, which is best taken immediately on rising while the body is warm. After the bath the body should be rubbed with a harsh towel until the blood returns to the BATHS. 41 surface, which gives the skin a fine glow and is very in- vigorating and refreshing. The cool bath has a similar effect in a less degree and is the proper one for infants, the weak and aged, where the tonic effect is desired Before immerging, the head and face should be damp- ened with water of an equal temperature. THE HOT OR TEMPERATE BATH or a bath in liquid about the same temperature as the body, has a larger field of usefulness than all other baths combined. This bath has no marked effect upon the tem- perature of the body, which remains about normal. A bath with the temperature varying from 103 F. to no F., acts as an antiphlogistic and analgesic, and is partic- ularly advantageous in the treatment of neuralgia, mus- cular and articular rheumatism, convulsions, hysterical and maniacal excitement. It also hastens the appearance of the rash in measles and other eruptive fevers. It may be used to an advantage in many external and internal in- flammations. These baths have both a local and general sedative effect in dysmenorrhea, cystitis, vesical spasms, and relieve the tension in strangulated hernia ; they also sustain the animal heat and relieve depression in cholera, dysentery and many other morbid conditions. Very hot baths should be administered carefully and of not too long duration, as prolonged baths are generally followed by considerable debility and muscular lassitude. They should be particularly avoided in heart disease and dia- betes. A hot or cold graduated bath may be had by add- ing hot or cold water to the bath water at 98 degrees F. until the degree desired is reached, thus avoiding the im- mediate shock of either the hot or cold water. MEDICATIONS FOR BATHS. The following formulae for the more commonly em- ployed medicated baths used in diseases of the skin, etc., are as follows : 42 BATHS. THE ACID BATH. 1$ Acid nitric fort i l / 2 oz. Acid hydrochloric fort i oz. Aqua 30 gal. These baths are employed in pruritus urticaria and papular eczema. THE ALKALINE BATH. I£ Soda carb 3 oz. Potassium? carb 4 oz. Borax pulv 2 oz. Use one of these powders for 30 gallons of bath water, with one-half pound of starch employed in acute eczema ichthyosis psoriasis erythema and urticaria. THE CREASOTE BATH. 1^ Creasote 2 dr. Glycerine 2 oz. Aqua 30 gal. MERCURY BATH. IJ Hydrarg. chlor. corrosive 45 gr. Ammonium chloride 2 J / 2 dr. Aqua 2y 2 oz. This solution is to be poured into 30 gallons of bath water, is used in pruritus parasitic skin diseases and syphilis. Great care should be taken in this bath and avoid the water from coming in contact with the eyes or mouth. TAN AND TAR BATHS. Tar baths are employed by rubbing the diseased patches with tar, and then removing the tar by the or- dinary bath. This bath was much employed by the late Professor Hebra in psoriasis. Tan baths contain a hand- ful of fresh tan bark in each bath. This has been recom- mended for purpura. BATHS. 43 MUD AND SAND BATHS. Are also sometimes called Moor baths, antiphlogistic baths, and lava baths. They are of ancient origin and have recently become popular through the advertising efforts of the Sanitarium located at Warren Springs, Ind. They consist in burying the entire body, except the head, in mud mixed with mineral or common water until it assumes the consistency of the homogeneous mass. These baths can be given either in a bath tub or on a large table with elevated edges. The mud should be sifted and devoid of all coarseness before mixing with the water; the body is then packed in this substance thor- oughly. These baths can be given in a higher degree of heat than ordinary water. The friction and heat from these baths is very stimulating to the skin and seems to have the power of eliminating many substances from the body, hence the term, "antiphlogistic." These baths are of special value in skin diseases, rheumatism, neuralgia, syphilis, diabetes and chronic exudations and indura- tions in the pelvic cavity, and are also useful in peripheral paralysis, contracted muscular ankylosis, etc. Baths of this description can be successfully conducted at any place. I recently visited a physician who was conducting a very successful and prosperous Sanitarium, and although he was not located near a Mineral Springs, he adminis- tered nearly every bath utilized at the more fashionable watering health resorts. For the simple mud bath, he used a good quality of blue clay, which he secured from a neighboring town, in car load lots. His patients were led to believe, however, that the clay was imported from a long distance and looked upon this earth very mysteriously, as being the panacea for all ills. Aside from the simple mud baths he made a great "advertising hit" with his sulphur, and what is termed "sulpho-lava" baths. Most invalids who visit health resorts expect an odor of some obnoxious healing water, and he successfully covered this point with the following fluid : 44 BATHS. ARTIFICIAL SULPHUR BATHS are generally obtained by adding- one or two ounces of sulphurated potassa in forty gallons of water. The fol- lowing, however, is the one used at this institution : I> Sulphurated potassa or soda y 2 oz. Sodium bicarbonate i oz. Sodium chloride 60 gr. Castile soap shavings 30 gr. Alum 30 gr. Calcium carbonate 30 gr. Water 1 gal. Mix and boil, stirring with a wooden rod until thor- oughly dissolved. This gives oft an odor of sulphureted hydrogen, which has the characteristic odor of most sul- phur mineral waters. This solution is added to forty gallons of water for the bath. The most popular bath given at this institution, however, was called the SULPHO-LAVA BATH. It was this bath which gave this Sanitarium its great- est reputation. The bath was a mixture of the above so- lution, with the blue clay and an addition of sufficient water to make the mud the consistency of plastering mortor. The patient was placed upon a massage table with elevated edges, and completely covered (except the head) with this mixture. During the bath the patient was constantly massaged by kneeding and rotating the muscles from head to foot. This might seem rather ludicrous to one who is unfamiliar with baths, but as it was, it was very curative in its effects in many cases, and when patients left the institution they would ever sound the praises of Sulpho-Lavo baths. SAND BATHS. Are given in a similar way to the mud baths by com- pletely covering the body with the sand. There is no place in the world in which sand baths are taken in the BATHS. 45 natural state so extensively as at Atlantic City. You can stroll along the "Board Walk" for miles and see peo- ple burying their anatomy in sand. Most of the bathers take these baths for pleasure, while others claim they derive much benefit from the practice. On a recent visit to this resort I counted no less than one hundred and fifty, fat and lean, rich and poor, awkward and indiffer- ent, isolated in a place back of the "Board Walk" not over eight rods square. HOT AIR AND VAPOR BATHS THE TURKISH BATH CABINET. Are also called Turkish, Roman and Russian baths. These baths are best administered in a bath cabinet, where the entire body is concealed (except the head) which is allowed to protrude through an opening, with 46 BATHS. a tight-fitting cover around the neck. There are several cabinets on the market, which can be secured at prices ranging from $5.00 to $100.00. The accompanying cuts illustrate the bath chair and the Betz hot air apparatus, the two styles which are the most frequently used in hospitals, sanitariums and habitue institutes. The super- heated air and vapor baths are indispensable as a "boil- ing out" process for the elimination of the poisonous ele- ments of many diseases. The smaller cabinet, although not as impressive, is equally as serviceable in many cases and has the advantage that medicated vapor can be ob- tained by placing the medicated solution in a receptacle over a heater. These two cabinets should be added to a physician's equipment to make it complete. The use of vapor baths to aid the penetration of med- icinal ' substances is well known in the treatment of syphilis by the use of the mercurial vapor bath. While the body is immerged in the mercurial vapor bath, it not only eliminates the syphilitic virus, but we get the con- stitutional effect of the mercury. This is also true with many skin diseases, where sulphur and its compounds are chiefly used. A higher temperature can be tolerated in hot air than in vapor; by wrapping the patient in robes a temperature as high as five hundred degrees F. can be reached. If the body is naked, however, it cannot stand this degree of heat. In giving these baths the heat should be admitted gradually, and when a sufficient degree of heat has been reached to produce profuse perspiration or the bath feels uncomfortable it should be modified or discontinued. These baths should not be of longer dura- tion than twenty or thirty minutes. The patient is al- lowed all the water to drink he desires, and to prevent cerebral congestion, the head should be wrapped in cold BATHS. 47 cloths ; the pulse should also be watched carefully, and never allowed to exceed 125 pulsations per minute. By the use of the Betz apparatus these baths may be local- ized to any diseased part of the body, as the arm, leg, back, etc., where we wish the specific effect of super- heated air to cure certain organs and conditions. Super- heated air, vapor and medicated baths will unquestion- THE BETZ SUPERHEATED AIR BATH APPARATUS. ably cure many diseases where other medications are a total failure. They are of special value in the treatment of kidney diseases, rheumatism, gout, obesity, and as an eliminative process in the treatment of syphilis, malaria, lead and other metallic poisons, alcoholism and the drug habits, colds and certain forms of insomnia are also rapid- ly cured. In some instances it is a good plan to follow these baths with a hot water or shower bath, which can be gradually cooled as desired. 48 BATHS. Drs. Skinner, Sterrett and others have made micro- scopic and chemical observations with patients taking hot air baths, with the following results : Both the white and red blood corpuscles are greatly increased. The quantity of urine passed for twenty-four hours following the bath is increased from twenty-five to one hundred per cent, as is also the excretion of urea. Dr. Skinner in his excellent little book "The Thera- peutics of Dry Hot Air," says: "When we consider the large number of pathologic conditions in which the re- constructive functions are deficient, the modifications in the composition of the blood noted above assume an in- teresting significance ; and when we think of the number and variety of diseases which are dependent wholly or in part upon the retention in the system of products of sub- oxidation, the sphere of the body hot air treatment as indicated by its effect upon oxidation and the excretory functions become extended within the limits of consider- able magnitude/' THE ELECTRIC LIGHT BATH Is supposed to have been originated by Dr. Kellogg, of Battle Creek, Michigan. This bath is conducted upon the same plan'as the hot air bath, only electric lights are depended upon to furnish the heat. The cabinet contain several incandescent lights to produce the required heat ; the globes are of different colors, which are supposed by some to have a curative effect upon disease ,but this is doubtful. BATHS. 49 THE ELECTRIC BATH EQUIPMENT. THE ELECTRIC BATH. The electric bath is a great benefit and is applied in all cases where electricity in general is of service as a therapeutic agent. These baths are obtained by applying the two poles at different points of the bath tub by means of two portable electrodes used for this purpose, as illus- trated in the accompanying cut. Any small portable battery will be sufficient to supply the current. These baths are very stimulating and invigorating, and are of special service in nervousness, paralytic diseases, insom- nia, etc. [4] 50 BATHS. THE SHOWER BATH EQUIPMENT. THE SHOWER BATH Is generally used as an after bath, as a stimulating, cleansing, rinsing or cooling process, after mud, soap and other materials have been used. It offers a very agreeable morning bath, where the plunge bath is ob- jectionable. This bath can be added to any equipment at very little expense by the use of the portable attach- ment illustrated in the accompanying cut. OSTEOPATHY, MASSAGE AND PHYSICAL CULTURE. 51 OSTEOPATHY, MASSAGE AND PHYSICAL CULTURE. The above caption describes subjects which are fast becoming recognized as holding respective plates as a means of restoring and preserving health. To the phy- sician who has formerly been wedded to drugs, physical methods of curing disease may seem absurd. No at- tempt will be made in this chapter to give the minute technique of the different manipulations and movements used by these specialists, but I feel the subject is an im- portant one, especially if used in connection with baths and deserves at least a passing notice, as it is a valuable adjunct to the healing process in many ways. Osteopathy and Massage have been denned as a scien- tific method of treating disease by systematic manipula- tion, and it can be executed with better results if used in connection with baths. No bath institution in the coun- try could obtain the results and the percentage of cures they do if it were not for the manipulations used during and after the baths. Like many others, I have always objected to the term Osteopathy, believing these manipulations have a larger field of usefulness on nerve centers and muscular tissue than oh bones, as the term suggests. The Osteopath has a decided advantage over the ordinary masseuse, as he generally possesses an accurate knowledge of anatomy and physiology and can determine when and where to manipulate and what results can be obtained. Although Osteopathy was a subject of much ridicule in its infancy, the same as many other healing processes, its value has been demonstrated and I believe I am safe in prophesying that in a few years the subject will be- come recognized by all Medical Colleges. This subject has too broad a scope to be discussed here, but if I can succeed in pointing out its value, text-books can be con- 52 OSTEOPATHY, MASSAGE AND PHYSICAL CULTURE. suited with the complete technique of all manipulations, and a physician's time will be well spent in becoming familiar with these manual and mechanical agents. When a physician can suppress pain and open canals, that re- fuse matter may escape through nature's drainage sys- tem, or allow nutritive matter to enter without the aid of medicine, it is my belief that it is a far more scientific accomplishment than to give an opiate or cathartic pill for the same purpose. Although this practice may have a limited field of use- fulness, it can be specifically applied in many cases where other therapeutic measures do not have access. The fundamental principal of Osteopathy, Massage, and per- haps Physical Culture, is to create activity of cell life; equalize circulation, restore misplaced organs and func- tions, relax contracted muscles, nerve tissue, partial or complete ankylosed joints, stimulate nerve force and re- lieve nerve pressure. With this end in view the masseuse depends upon stroking, kneeding, friction and percussion, while the Osteopath has access to the more remote organs through manipulation of the nerve centers, using the en- tire length of the spinal column for his principal operat- ing grounds. The spinal column bears the same relation to the Osteopath as the keyboard of a piano does to the pianist. Those who are not familiar with this method of treat- ment, it may seem exaggerating to state that fully one- half of all aches and pains of the body may be instantly relieved and cured by making pressure and interrupting nerve force from the spinal nerve centers. I have learned that in many cases it is more convenient to have educated fingers than to possess drugs. I will illustrate this point with my first introduction to Osteopathy: While in attendance at a social gathering in the coun- try, a lady was taken suddenly ill with excruciating pain in her stomach, and unfortunately, or perhaps fortunate- ly, I could not relieve her Avith the usual hypodermic in- jection of morphine, she had been in the habit of taking for these attacks, as I had left my medicine case at home. There was an Osteopath present, however, who grace- OSTEOPATHY, MASSAGE AND PHYSICAL CULTURE. 53 fully came to her assistance ; he advised her to remove her corset, and in less than two minutes he located the nerve centers in the spinal column, which were very sensitive to the touch. With a few manipulations and increased pressure, the patient experienced immediate relief. This terminated her suffering for the day and consequently gave him much credit for his display of skill. From this observation alone I learned the value of an educated finger and its superior advantages to morphine and other drugs in many cases. Baths and manipulation are companionable adjuncts in restoring health ; both can be practiced with a greater degree of success if used in conjunction. In visiting any reputable bath establishment much stress is laid upon massage and manipulations, and although many cures are credited to the baths and water, equal credit should be given to the manipulations. Simple friction of the skin with the hands or a rough towel, has long been recognized as a valuable means of suppressing local pain, while vigorous rubbing of the extremities ^hastens the general circulation and secretory functions of the skin, also soothes the nervous system even to a state of drowsi- ness, especially if used in connection with baths. These facts illustrate its value in conditions ranging from the simple stroking of the head to cure headache, to the more vigorous rubbing used to restore collapse, with which every physician is familiar. If these conditions can be relieved by simple friction of the hands of the uneducated masseuse, is it to be wondered at that scientific manipu- lators with the knowledge of anatomy and physiology can manipulate surfaces which will have a specific reac- tion on the more remote organs of the body? Masseuses, or rubbers, as they are called, which best identifies them, as founded at bath houses, have a defi- cient knowledge of massage other than superficial rub- bing and kneeding. With a rheumatic patient coming under their care they are instructed to give a general rubbing, not only of the effected parts, but of the entire body and to apply gentle tension to the local muscles surrounding the diseased parts ; this is done by rotating 54 OSTEOPATHY, MASSAGE AND PHYSICAL CULTURE. the muscles on the bones and stretching the extremities. This results in a readjustment of circulation, elimination of waste and a general stimulation of the tissues and nerve centers, all of which tend toward the restoration of health. These rubbings and baths are taken with great ben- efit by those who live a sedentary life and with the lazy and luxurious, as a rejuvenating and beautifying process. I quite agree with physical culturists that these groom- ings are not a suitable substitute for exercise and pure air, but the effects received from the combined treatment is wonderfully beneficial in many cases. PHYSICAL CULTURE. Since the beginning of the present century physical culture has created wide spread interest and perhaps has gained more followers among the laity than any other subject for the preservation of health and preventation of disease. Although many physicians who are devoting their lives to the application of drugs as the only healing agents, look upon this subject in the same skeptical way they do regarding Osteopathy, massage, etc., it is the writer's belief, that much good can be accomplished in many ways from this source. Physical Culture differs fromOsteopathy and Massage inasmuch as its principals endeavor to teach the patient how to care for and cure their own weaknesses, while the Osteopath depends upon his knowledge of anatomy and skill in making the proper manipulations of the weak and diseased parts. Physical culture teaches people how they may establish hygienic methods in dress, diet and habits, relax stiff joints and contracted muscles, reduce adipose tissue and convert it into muscle, how to create vivacity of manner, sprightliness of carriage and activity of circulation ; it teaches those who live sedentary and in- dolent lives as well as the hypochondriac, round shoul- dered and ill-shaped persons how they may overcome their difficulty, or develop their bodies to healthy, and graceful proportions and cure many diseases by devoting OSTEOPATHY, MASSAGE AND PHYSICAL CULTURE. 55 a small portion of their time to this practice. If we can accomplish these things, it certainly should receive a few tender thoughts from physicians. Exercise and living close to nature is the foundation of the teachings. Of all exercises there are none from which more benefit can be derived than in walking. The people who are most in need of physical culture are those who live a sedentary life. In our crowded cities there are hundreds of clerks and business men who hurridedly eat their breakfast, take a car to their place of business, sit at their desk all day, return to their home in the even- ing; after dinner read the paper and retire. By following this out for years their limbs become devoid of muscle and strength. Although their stomach may be "rounded out" the tissue is sleazy in texture, while if they had walked to and from their employment, their brain would be more active and all their mental and physical functions greatly improved. It is this class of people who furnish material for the various schools and "professors" of phy- sical culture who manage their business, either by direct teaching or by a course of instruction through the mail. They outline different movements which can be carried out either by personal efforts or with the assistance of a developing machine; the latter is generally included in a course of instruction, which costs from $10.00 to $25.00. I have investigated several of their systems and find they are very much alike. Their principal object is to incorporate such movements of the body, which will, during the course of the exercise, bring every muscle of the body into action. If certain parts of the body require developing more than others, this is the part which re- ceives very particular attention. In carrying out this systematic way of exercise, each movement is practiced a certain number of times. These exercises are never al- lowed to be carried to the extreme, and as soon as the patient feels fatigue from one movement, he is placed upon another until the regular routine is completed. I admit that at the present time physical culture is somewhat a fad. It is instrumental, however, in anima- ting many lazy livers. 56 MINERAL WATERS. MINERAL WATERS. If physicians were to accept the testimony of the proprietors of the various mineral water resorts, they would be led to believe that mineral water was a panacea for all ills. The fact of the matter is mineral waters are very much overestimated therapeutic agents. Although the water is the commercial drawing feature for many health resorts, the invalid who visits these places receives more benefit from the change of scene and the freedom of cares, business worry and the rigid dietetic and hy- gienic restrictions instituted at these watering places than they dofrom the medicinal properties of the water. I am located only a few miles from Mt. Clemens, which has a world-wide reputation for its "wonder work- ing water." I venture to say if the thousands of invalids who visit this city seeking for health, depended only upon drinking this water, many of them would be doomed to disappointment, but the use of water in connection with baths and massage eliminate many poisonous elements independent of any mineral the water may contain. I be- lieve invalids can receive equally as effectual treatment with appropriate medication and the use of ordinary pure water. The chemical and medicinal constituents of all mineral waters are well known, and if we decide they are the remedies required for an individual case, apply the medi- cation in its regular commercial form, or they can be given in the way of artificial mineral water if preferred. Although this country supplies mineral waters equal in medicinal value to the imported waters, distance seems to lend enchantment and more value is placed on the foreign products. It has been stated that much of the imported water bottled and sold in this country as the genuine, is made from artificial salts, according to the following formulae : MINERAL WATERS. 57 HUNYADI JANOS WATER. The following 1 makes an excellent imitation : L t5 1^ Potassium sulphate 6 gr. Calcium sulphate 60 gr. Sodium sulphate 3^2 oz. Magnesium sulphate 4^ oz. Water enough to make 1 gal. Mix, dissolve and filter. CARLSBAD WATER. (Sprudel Springs.) ^ Sulphate of potassium 2 gr. Chloride of sodium 18 gr. Bicarbonate of sodium . .36 gr. Sulphate of sodium, dried 44 gr. Triturate the ingredients previously well dried to a fine uniform powder. A solution of about sixteen grains of the above with six fluid ounces of water represents an equal volume of Carlsbad water in its essential con- stituents. KISSINGEN WATER. (Rakoczi Springs.) I£ Chloride of potassium 17 gr. Chloride of Sodium 357 gr. Sulphate of Magnesium, anhydrous. 59 gr. Bicarbonate of soda 107 gr. Triturate the ingredients, previously well dried, to a fine uniform powder. A solution of about 24 grains of this preparation in 6 fluid ounces of water, represents an equal volume of Kissingen Water in its essential con- stituents. , 58 MINERAL WATERS. VICHY WATER. (Grande Grille Springs.) I£ Bicarbonate of sodium 352 gr. Carbonate of potassium 16 gr. Sulphate of magnesium, anhydrous. . 16 gr. Chloride of sodium 32 gr. Triturate the ingredients, previously well dried, to a fine, uniform powder. A solution of about 14 grains of this preparation, in 6 fluid ounces of water, represents an equal volume of Vichy Water in its essential constituents. CONGRESS WATER. ^ Potassium bicarbonate J4 oz. Sodium bicarbonate .5^2 oz. Magnesium sulphate 2>H oz - Sodium chloride (pure) 2^4 ° z - Calcium chloride (anhydrous) 3^2 oz. Water 10 gal. Mix., dissolve and filter. FRIEDRICHSHALL WATER. 1^ Sodium bicarbonate 384 gr. Sodium sulphate crys i}4 oz. Potassium sulphate 165 gr. Magnesium sulphate 20 oz. Sodium chloride (pure) 10 J4 oz. Calcium chloride (anhydrous) 1 oz. 'Water 10 gal. Mix., dissolve and filter. CANCER. 59 THE CANCER SPECIALIST. Surgeons, as a rule, regard the knife as the only effective means of removing tumors and cancerous growths, consequently, in systematic treatises very little is said concerning other means for their removal ; and what is said is often in condemnation of them as useless, if not pernicious. This indifference, neglect and perhaps prejudice on the part of surgical teachers has opened a field for the cancer specialist who can remove these growths without cutting operations. I have had the pleasure of visiting several of their in- stitutes, and I find them enjoying a very remunerative practice. I consider their methods of treatment far more successful and desirable than those of the surgeon who depends upon the knife exclusively. It may be laid down as almost a positive result of surgical practice that a cancer extirpated with the knife returns sooner than one removed by the caustic treat- ment. The separation attendant upon the latter, seems to remove the remaining cancer cells, while excision leaves them to begin anew their destructive proliferation. We therefore find that the principal objection to the knife in removing malignant growths is, that no surgeon in the world, no matter how skilled he may be, is able to dis- tinguish the healthy from the diseased tissue, and after he feels that he has thoroughly removed every trace of the difficulty, some diseased cells may be left behind, and the growth will again develop. From a therapeutic standpoint, there have been three methods devised for destroying these growths. First, by local external applications; second, by hypo- dermic injections into the substance of the growth; and third, by internal treatment. While the two latter methods are not practical, the former, in my opinion, is 60 CANCER. the treatment par excellence for all superficial malignant growths. I have had quite an extensive experience in the use of the caustic treatment and in this chapter I wish to disclose the methods which were used by myself, and which are identical with those used with success in mosi of the cancer institutes. Before discussing the treatment, I wish to outline in brief the characteristics of the dif- ferent forms of malignant tumors, which may be of some assistance to you in forming a diagnosis. SARCOMA. Definition. A malignant growth composed almost en- tirely of cells, which have their origin in those of the con- nective tissues and which are embryonic in character. Character and Growth. The connective tissues are always the starting point of sarcoma. The cell elements are either round, spindle-celled, or in large, plate-like forms, and may exist either separately or in conjunction in the same tumor. External injury or local irritation seems in many instances to be the cause of the growth., but in others there is no evident cause. It may occur at any age, but is most common between the ages of twenty and forty. It begins as a single nodule, or several may commence at the same time, and it grows rapidly. After a time the neighboring glands become the seat of dis- ease, the primary tumor ulcerates, and with the advent of ulceration the growth increases rapidly, the system be- comes infected, and death supervenes. Sometimes the most distant organs, for example, the lungs or the liver, may be involved, without the intervening lymphatics be- ing affected. Diagnostic Features. Always begins in the connective tissues, is most common in the skin, periosteum and bone, infrequent in secreting and glandular organs. Differs in feel according as it occurs in hard or soft tissue. In the former it may be firm, tense and elastic, but is gener • CANCER. 61 ally soft and fluctuating. May occur at any age, but is most common between twenty and forty. Growth is generally rapid and may attain a large size. Ulceration is usually present, but does not take place until late in life of the disease. Little pain until ulceration occurs. The subcutaneous veins are only slightly enlarged. The contiguous lymphatics become infected with the disease, but not until late in its progress. Unless thoroughly re- ->affi^> 1133 Mr ^ H WmB Sarcomas— Supposed to have their origin in the periosteum of the inferior maxillary bone. moved the tumor usually recurs and in the locality from which it was removed. The microscope shows the tumor to be composed of a mass of connective tissues without alveolar arrangement. Prognosis. Is never favorable unless the growth is promptly removed by the caustic treatment. If allowed to run their course they terminate in death in six months, while others may continue for several years. SCIRRHUS. Definition. A malignant growth, composed of fibrous tissue and undeveloped epithelial tissue, known also as atrophying cancer, and stone cancer. 62 CANCER. Character and Growth. Cause cannot always be de termined. Frequently follows injury. Attacks in most cases the liver, uterus, or breasts. In the latter organs is more frequently found than all other forms of tumors. Is very rare before the fortieth year of age. Commences as a firm, hard, dense nodule under the skin, being at first easily movable. As it grows it contracts adhesions to the surrounding parts, becomes firmly fixed and is the seat of sharp, lancinating pains. As the disease pro- gresses, the integument becomes infiltrated, hard, livid, and traversed by numerous blood-vessels. The glands in the immediate neighborhood take on the cancerous disease, the tumor ulcerates, the whole system becomes depraved and the patient dies. Diagnostic Features. Seldom occurs before th»' fortieth year. Most common of all tumors of the breasi at that age. Is uniformly hard. Grows slowly com pared with other epithelial tumors. Early becomes anchored to the skin and surrounding tissue. Does not attain a large size. Sharp shooting pains. In the breast the nipple is retracted. The superficial veins are but slightly enlarged. Ulceration in about one year. The edges are steep and abrupt, and the discharge is very offensive. The neighboring lymphatic glands are early affected with similar disease. There is a marked consti- tutional involvement. The microscope shows small round cells with little pits or depressions, surrounded by a fibrous stroma. Prognosis. Invariably bad. Case usually terminates fatally in from two to four years, unless thoroughly re- moved by proper treatment. ENCEPHALOMA. Definition. A malignant growth containing loss fibrous tissue than scirrhus, but a greater quantity of epithelial cells. Known also as the soft cancer, the cere- briform cancer, rose cancer, fundus nematodes. CANCER. 63 Character and Growth. Is most common in the bones, the testicles, the eye, the lymphatic glands, mammie, uterus and liver. It may attack any portion of the body and occur at any age. It is almost the only form of cancer that occurs in childhood. It may begin as a single nodule, or many nodules may appear simultaneously. Being an extremely vascular structure it grows with great rapidity, and often attains a large size in a short period of time. It is usually soft and fluctuating, and being easily compressed is modified much in form by the tissues surrounding it. Is peculiarly liable to extend int. 1 the muscular and other interspaces, acquiring deep- seated connections and surrounding important organs. At a period varying from a few months to a year and a half, ulceration takes place, a foul ulcer is formed, the lymphatic glands become affected, and the whole system becomes diseased. The disease may terminate by ex hausting the strength of the patient or by the destruc- tion of some important organ. Diagnostic Features. Occurs at all periods of life. Soft, elastic and lobulated. Grows rapidly and attains a large size. Pain dull and heavy; not pronounced until ulceration takes place. Superficial veins early enlarged. Ulcerates readily. The ulcer has undermined edges. The lymphatics are early involved, and the constitutional symptoms pronounced. Microscopic appearances sim • ilar to those of scirrhus. Prognosis. Very grave. Terminates fatally in from eight months to two years, unless thoroughly removed in the early stages. EPITHELIOMA. Definition. A malignant growth, developed from the squamous epithelium. Comprises the malignant dis- eases of skin and mucous tissue. 64 CANCER. Character and Growth. Most frequent locality is the lower lip, but it is often found in the tongue, cervix, uteri, face, anus, vagina, penis and scrotum. It begins EPITHELIOMAS OF FACE. usually in the skin or mucous membrane, but by exten- sion may occupy any tissue, bone, muscle or cartilage. Occurs most frequently after the fortieth yeai. Long- continued irritations is the most common cau^e. It be- EriTHELIOMAS OF LOWER LIP. gins early as a crack, tubercle, wart, or incrustation, and extends with the progress of the induration. Lymphatic involvement occurs, but not until the disease has made CANCER. 65 considerable progress. The extension of disease, except in epithelioma of the tongue is not rapid, many years oftimes elapsing before its termination. Diagnostic Features. Situated at the junction of the skin and mucous membrane or upon either of these structures. Originates in a crack, fissure or wart-like excrescence. Has an indurated base. Slow growth. Ac- companied by similar disease in neighboring glands, and eventually by constitutional disease. Microscope shows squamous-celled epithelium with the characteristic al- veolar arrangement. Prognosis. Very grave. When the tongue is affected terminates fatally in from six to eighteen months, in the lip and upper jaw, may exist for years. Free and early removal is followed by permanent cure. COLLOMA. Definition. A malignant growth resembling structur- ally the encephaloma, but containing besides a quantity of clear colloid material. Known as gelatiform cancer. Character and Growth. Is found most frequently in the omentum, stomach, ovary, tectum and bones of the extremities. It may occur as an infiltration, its most common form, taking on the shape cf the organ in which it is situated, or it may grow as a pionounced tumor. Its general history is similar to that ot encephaloma, except that it rarely occurs in childhood, grows somewhat more slowly, and does not so readily involve lymphatic glands. Diagnostic Features. Is difficult to distinguish, previ- ous to removal from other forms of carcinoma. Is often situated in the abdominal cavity. Grows slowly. Upon section, clear, gelatinous substance is found in abund- ance. Prognosis. Grave. Usually terminates in death in a short time if allowed to run its course. [5] 66 CANCER. MELANOMA. Definition. A malignant growth resembling enceph- aloma, but containing in addition a large amount of black pigment. Known as black cancer. Character and Growth. Occurs most commonly in the eye and skin. In all the main facts of its history it is in close conformity to the encephaloid cancer, but is particularly noticeable on account of the pigment which marks it in varying shades from iron gray to deep black. This coloring matter is similar to that which is found in the choroid membrane, and the rete-mucosum of colored skins. The cancer is very apt to begin in or underneath a pigmentary mole. Although popularly believed to be excessively malignant, its rate of progress differs but little from the ordinary encephaloid cancer. Diagnostic Features. Has the same general character- istics as the encephaloma, except that it is marked by an excess of pigment. Prognosis. Grave. Terminates in death in a short time, unless early removed. THE TREATMENT OF TUMORS. Must necessarily be divided into two methods, viz : The knife and the caustic treatment. For all tumors of a benign nature, whether internal or external, I would recommend a thorough dissection with the knife, as it will not leave as large a scar, and can be done more, quickly, and causes less suffering, making use of either a local or a general anaesthetic. If the tumors are no longer than a hen's egg, I hav~ frequently removed them without any suffering what- ever, by injecting cocaine as given in the Obtundent formulas on another page. CANCER. 67 The injection should be made around the borders of the tumor, rather than into its center. There are also a ENCEPHALO MELANOMA. few well-selected cases of malignant growths that can be removed by the knife in this way, but as a general 68 CANCER. practice, the caustic treatment is the best. On the other hand, there are tumors of a harmless nature which may be removed with the caustic treatment if preferred. People usually have a perfect horror of the knife and the surgeon who will remove their unwelcome visitors without its use, is the one they seek for relief, and he is the one to judge of the best method of treatment. INTERNAL TREATMENT. There have been many internal remedies highly lauded from time to time as a cure for cancer, but I be lieve that nearly every physician will agree with me that their use will be attended with more of a psychic effect than one of any real curative value. Lassar stands almost alone in the belief that the iodide of arsenic, given internally, has an influence in curing carcinomatous formations. Denissenko recently reported good results from the use of chelidonium majus as a constitutional and local remedy. But the good results that he seemed to have at first, have later failed both in his and in other hands, although this remedy does seem to have some deterrent action upon epithelial cell-growth. Conium and phytolacca have been advocated at dif- ferent times, but have fallen into disuse. CAUSTIC REMEDIES. The local remedies used for destroying these growths are numerous. Nitric acid, sulphuric acid, lactic acid and pyrogallic acid have all been advocated, but are of very little use. Nitrate of silver has also been used, but its action is too superficial to be practical. Caustic potash is another remedy worth mentioning, but its action has a tendency to destroy too much healthy tissue. In my CANCER. 69 opinion, there are only three remedies worthy of men- tion in the removal of cancers by the caustic method of treatment, viz : Salicylic acid, chloride of zinc and arsenic. Salicylic acid has only a limited action, but, often- times it is a valuable one, as this agent may be used to good advantage in softening and removing the super- ficial layers of epithelium and preparing the way for other caustics, as will be mentioned later. Chloride of zinc is perhaps the oldest caustic used in the local treatment of cancer, and has formerly entered largely into the "plasters" of the older cancer specialists. Its action is very effective, but causes considerable pain. It establishes an aseptic slough and thus avoids any hemorrhage or constitutional poisoning. I have removed several growths by its use and have fqund it very satis- factory. ARSENIC. Dr. Marsden, the surgeon-in-chief of the London Cancer Hospital, was among the first to bring the use of arsenic into prominence as a caustic for cancer. He has used it in over six thousand cases with phenomenal suc- cess, and arsenic stands today the banner remedy in the local treatment of all forms of cancer. This remedy has many advantages over any other caustic. It can be used with less pain, and seems to produce just the degree of sloughing required to destroy the growth, whether super- ficial or deep-seated. It is rather select in its action, as it destroys only the diseased tissue and does not damage the healthy structures or through absorption cause arsenical poisoning, even if used over large surfaces. It removes every particle of the growth, and does not leave any cancer-cells to develop again. It does not leave an ugly-looking scar, as do other caustics. The deformity is very slight, even if the growth has been of large size. 70 CANCER. Dr. Marsden's original paste was two drachms of arsenic and one of powdered acacia, but I prefer the ad- dition of cocaine, which lessens the pain, as used by Prof. John A. Wyeth, M. D., in the following formula : ly Acid arsenious 2 dr. Powdered acacia I dr. Cocaine muriate 5 to 20 gr. Aqua q. s. Mix the first three ingredients and add just enough water to make the paste the consistency of cream. The paste should always be prepared fresh before each ap- plication. THE METHOD OF APPLYING. I always begin the treatment of cancer by taking a piece of isinglass plaster and placing it over the parts to be removed. I then take a lead pencil and mark a line around the growth about one-quarter of an inch from the diseased margin. I now cut the center out of the isinglass plaster and dampen the piece which has a hole in the center and place it on the healthy parts which surround the growth. We have now outlined the exact tissue to be removed and the plaster will protect the healthy parts. The skin or outer integument should now be removed either by curetting, with the use of a local anaesthetic, or by the use of salicylic acid as mentioned before. Now you have an abraded surface on which to supply your plaster. The paste should now be prepared and spread on the piece of isinglass plaster you cut out, which is the exact size of the cancer to be removed, and applied to the growth, over which you can dress with absorbent cotton and bandages. This should be allowed to remain in situ from twenty-four to forty eight hours, as long as the CANCER. 71 patient can stand the pain. His suffering may be re- lieved, however, by the use of morphine hypodermically. When the time comes to remove the plaster,, you will find a black necrossed mass. You should now apply a flaxseed poultice until the slough separates, and the can- cer comes away in one body. If you have any reason to believe that every particle has not been destroyed, you The above picture illustrates the action of Marsden's Paste in removing cancers. This growth was removed with two appli- cations of the paste. may apply another plaster, but if, in your opinion, the operation has been complete, apply iodoform ointment and a simple dressing and allow it to heal. You will find that the plaster will cause extensive swelling. If on the face, the eyes may be swollen shut, but this will gradually subside and cause no trouble. You should always advise the patient that he may expect some swelling. Much caution must be exercised in ap- plying this treatment around the lips and other mucous surfaces, and the parts must be protected, so that the patient will not swallow any of the paste, resulting in arsenical poisoning. 72 CANCER. This method of treatment may be used in all cases in which the cancerous tumor is not over four inches in diameter. If the growth is larger than that, apply to one side first and after that has been removed, apply the treatment to the other side. Although this is the best and most generally accepted treatment which is used by cancer specialists, I will add several formulas which have also been used with a greater or less degree of success, and have formerly made a reputation for their originators. DR. LANDOLFI'S CANCER PASTE. This practitioner obtained a wide celebrity throughout Italy by the use of a preparation which he claimed to be a specific cure for cancer, providing that the growth was accessible, and that the system was not already too deep- ly implicated in the cancerous cachexia. The formula he usually employed, although it differed somewhat in the relative proportion of the ingredients, was the following : ^ Zinci chloridi i dr. Auri chloridi I dr. Antimonii chloridi I dr. Brominii chloridi I dr. Farinae and acqua..q.s. to seperate form a thick paste. To be applied on small portions of linen to the ulcer- ated surface. The essential element he regarded was the chloride of bromine, the quantity of which he often increased to two or three drachms. The chloride of zinc was used chiefly for its hemostatic qualities, and he increased this in- gredient when there was a marked tendency to hemor- rhage. The pain of the application is considerabie, and must be allayed by opiates. The application need not re- CANCER. 73 main on more than twenty hours, and may then be re- placed by an emollient cataplasm. About the eighth day the eschar should become detached and leave a healthy granulating surface. If any points remain of less satis- factory appearance, or still presenting cancerous ulcera- tions, a little of the caustic paste is again to be applied. Dr. Landolfi believed it best, though not in all cases indispensable, to administer the chloride of bromine in- ternally in doses of one-tenth or one-twelfth of a drop, in pill form, twice a day, for three to six months. BOUGARD'S PASTE. IJ Hydrarg. chlor. cor I part. Acid.arseniosi 2 parts. Hydrarg. sulphuret. rub 10 parts. Ammonium mur 10 parts. Farini trit 120 parts. Amyli 120 parts. Zinc* chlorid. crys 120 parts. CERNY AND TRUNECEK'S TREATMENT. ^ Acid arseniosi 1 part Spts. vini rect 75 parts. Aqua des 75 parts. Mix, spread over the parts each day with a brush, until the entire cancer has sloughed off. COSME'S PASTE. The following is the formula of Cosme's Paste as modified by Herba : 1^ Acid, arseniosi 1 part. Hydrarg. sulphuret rub 1 part. Ungt. aq. rosae 40 parts. 74 CANCER. WHEELER'S PASTE. 9 Acid arseniosi i part. Morph. sulphate i part. Calomel 8 parts. Pulv. acacia 48 parts. HUE'S TREATMENT. Dr. Hue uses the following formula hypodermically : ^ Acid arseniosi 1 part. Cocaine hydro 5 parts. Aqua Des 500 parts. Mix, inject into the substance of the cancer every few days. This treatment he employed in the treatment of internal cancers, where it seemed impossible to apply the plaster. DAVISSON'S CANCER REMEDY. For several years a man named Davisson resided near Lake Zurich, 111., who established quite a reputation as a cancer specialist. The following formula is said to be the correct recipe for his plaster: 3J Rochelle salts 1 oz. Sulphur 1 oz. Sulp. zinc 1 oz. Arsenious acid 1 oz. CANCER. 75 DR. FELL'S CANCER PASTE. This is one of the oldest cancer remedies and was suc- cessfully used three-quarters of a century ago. The '. ... . 1 • *^ The above cancer was removed with Dr. Fell's Cancer Paste, and illustrates before and one month after treatment. author has used this paste several times with excellent success. The formula is as follows : IJ Zinc chloride I dr. Pulv. sanguinar. rad I dr. Flour and aqua q. s. to form paste. KLINE'S PAINLESS CANCER PASTE. IJ White wax I oz. Fir. balsam I oz. Chromic acid I oz. Melt the wax and the balsam together, and add the acid slowly, stirring while cooling. Remove the cuticle 76 CANCER. by blistering if necessary, and apply the plaster, spread upon thin muslin. When a sufficient depth of tissue has been destroyed, slough out with poultices if necessary. OZONE CANCER PLASTER. A physician recently canvassed this country, selling a cancer cure under the above name, for the formula of which he charged from ten dollars up. Out of curiosity, I purchased the formula, which was as follows : 3J Zinc chloride ]/ 2 dr. Arsenious acid. I dr. Powdered sanguinaria I dr. Flour and water q. s. to make paste. In Southern Illinois a cancer cure has been exten- sively sold in a similar way, under the name of THE HOWARD CANCER CLAY. IJ Chloride of zinc I dr. Powdered blood root I dr. Pulv. charcoal i dr. Aqua q. s. to make a paste. While the above formulae possesses a certain degree of merit it only illustrates "what fools we mortals be," who pay from ten to twenty-five or more dollars for a name and receive formulae which are the common prop- ertv of the medical profession. CANCER. 77 FUSCHIUS PASTE. ^ Arsenious acid I oz. Vegetable charcoal i oz. Powd. serpentaria I oz. Mix. Make into a thick paste with water and apply. GUY'S ARCANUM. This formula was held a secret for many years ^ Acid arsenious I dr. Powd. sulphur I dr. Peucedanum off . . , I dr. Ranunculus sylvestris I dr. Mix. Make into paste with water. ESMARCK'S PASTE. IJ Acid arsenious I dr. Morphine sulphate I dr. Mercurous chloride, mild I oz. Powd. acacia 6 dr. Aqua enough to make paste. HEBRA'S PASTE. ^ Acid arsenious . x I dr. Mercuric sulphide, red 3 dr. Vaseline 3 oz. 78 CANCER. SHERMAN'S PASTE. ^ Zinc chloride 5 gr. Alum 5 gr. Acid Tannic 2 gr. Persulphate of iron 3 gr. Glycerine q. s. to make paste. LASSAR'S PASTE. If Acid salicylic 10 gr. Powd. starch 2 dr. Zinc oxide 2 dr. Lard 4 dr. DR. LUTTERLOH'S PASTE. 3J Sanguinaria pulv 1 part. Galangal pulv 3 parts. Zinc chloride q. s. to make paste. There are several other formulae of cancer plasters which could be added, but it would only be a repetition of those already given, somewhat modified, and by pub- lishing them would not offer a means of broadening our knowledge on the subject, as what has been said will al- low you to treat cancers as successfully as any specialist who holds his methods a secret. RECTUM. 79 THE RECTAL SPECIALIST. Most practitioners have greatly neglected the treat- ment of diseases of the rectum, and like many other things, it has been rather a green pasture for the special- ist. Although diseases of this organ have existed for centuries, the medical profession has been slow to recog- nize the different pathological conditions which exist, and until the invention of the speculum this was one of the unexplored parts of our anatomy, but by the use of this instrument, the surgeon may now have full access to different diseased conditions which exist. Until re- cent years rectal operations were considered of so grave a character that they could only he successfully treated by the regular surgeon, and I have no doubt that the treatment of diseases of the rectum would have still re- mained exclusively in the hands of surgeons if it had not been for the much condemned advertising and itinerant rectal specialist, whose visits invited competition and compelled local physicians to investigate his methods and devote more time to the treatment of rectal diseases. The opinions of surgeons differ as to the best method of treatment for hemorrhoids. Allingham's ligature operation seems to be in general favor with most sur- geons, but is considered by Dr. Pratt and others as "un- scientific and a relic of past rectal inquisition." Ailing- ham says that the clamp and cautery is six times as fatal as the ligature. Others speak of it as being a barbarous practice. The Whitehead and American operations ar-: too tedious, difficult and bloody for the general prac- titioner, and few specialists care to undertake them. 80 RECTUM. AVe now come to the injection method, which has seldom met the approval of the regular rectal surgeon; on the other hand, he is ever ready to raise the following objections : First — That it takes too long to effect a cure, owing to the fact that only two or three pile tumors can be treated at a time. It is quite true that this method takes longer, but we find that patients, as a rule, prefer longer and gentler methods of treatment to speedy cutting oper- ations. Second — That the operation is not uniformly success- ful. At this point we differ with him, as this method of treatment may be used with the same degree of success as other operations if the proper fluid is injected and the application made in the right place. Third — That it cannot be used in external piles. This, to a certain extent, is true, although many operators are using it with a degree of success. We shall limit its application to internal piles and the ligature to the ex- ternal. Fourth — That it causes excessive sloughing. This is a great mistake. If the fluid is properly used, it will not cause any more sloughing than the ligature or cautery and it is surprising to note that the surgeon who advo- cates the cautery and ligature will condemn this method because it causes a sloughing of the pile tumor. Tell me how their methods cure, if it is not by sloughing? That is what we make the injections for and the sloughing from this method is no greater than from theirs. Fifth — That the method is more dangerous than other operations. We must admit that when this method of treatment was introduced into this country, unfortunate- ly, it fell into the hands of not only a few unskillful prac- titioners, but also into the hands of some men who were entirely destitute of a sound medical knowledge, and out- side of what they had learned about treating piles, knew nothing of the true and sacred mission of the healing art; hence the mortality which followed the operations of these men, who would buy some secret method and in- discriminately inject their fluids into the walls of the rec- RECTUM. 81 turn, cannot be compared with the careful and judicious way the method is being practiced today ; but even as it was, this method of treatment compares quite favorably with other methods. Dr. Andrews has collected reports of 3,304 cases with thirteen deaths. This was when the method was in its infancy and used by unskilled opera- tors, as just mentioned. Allingham reports six deaths in 5, 863 cases from the use of the ligature. Dr. Matthews after successfully using the ligature in over a thousand cases reports one death from tetanus, also several alarm- ing cases of hemorrhage. I am sure that the injection method is as free from danger as the cautery, for several cases of excessive sloughing and hemorrhage have followed that operation. Furthermore, I am satisfied that the injection method of treating hemorrhoids, where indicated, is fully as success- ful as any operation in use at the present time. With the right fluid, skillfully injected, this method may be used with uniformly curative results, and is free from all danger and practically painless. The diseases of the rectum which the physician is called upon to treat are hemorrhoids, fissure, fistula, rec- tal ulcer, prolapsus and polypus, and in order that these conditions may be successfully treated, it is necessary that the operator should have a thorough knowledge oi the parts. A detailed description of the anatomical hystological and pathological conditions of this organ would be rather out of place in this book, but this in- formation is accessable to every physician in other works, and it will repay him to devote his time in studying them. DIAGNOSIS OF RECTAL DISEASES. When a patient consults you in regard to any form of rectal disease, he will almost invariably tell you that he has piles. This is the extent of his knowledge in the [6] 82 RECTUM. matter. After he has described his ailments as best he can, the physician may often determine the nature of his disease by carefully questioning him. Pain will, no doubt, be the most prominent symptom. The pain from a fissure, fistula or hemorrhoids may often be told by its character. Is there constipation or diarrhoea? How long has his disease been existing? Is there a discharge of blood or mucous? Do the bowels protrude during de- fecation? Does he have an irritable bladder? etc. After you have a history of his case, it is always best to request him to submit to a local examination, as this will allow you to obtain a more thorough knowledge of his The 3rinkerhofiE Speculum. case. No patient with an atom of common sense will object to this, and by placing the patient on a table, either in the Sims or the Lithotomy position, with the aid of a good light and the speculum, you can determine the exact nature of his trouble. This brings us to the point of considering the value of different speculums. For the preliminary examination of the rectum and a few minci operations I prefer a very small Sims speculum. This can be introduced with but little pain and will reveal the condition of affairs. For operating by the injection method, the Brinkerhoff speculum is, beyond a doubt, the best instrument in existence. This speculum is a hollow, conical tube, with a slide which can be with- drawn, exposing the surface you wish to operate on. It RECTUM. 83 also has the advantage of a reflector in the end which throws light on all sides of the tumor. Another good feature of this speculum is, that its tubular shape will act as a basin to catch any superfluous fluid which may es- cape while injecting. In this way you will cauterize only the surface of the rectum which has been punctured. For dilating and other operative work Pratt's bivalve speculum is to be recommended. All speculums should be well oiled with vaseline and heated to the temperature of the body before introducing them. After learning the nature of the diseased condition which exists, we will next consider its treatment. HEMORRHOIDS. These are generally classified as external and internal tumors, resulting from a varicose condition of the hemor- rhoidal veins or other blood vessels, of the rectum. The former have their attachment outside of the external sphincter, while the latter have their attachment inside the grasp of this muscle, but can be forced down by straining if they are of sufficient size. Internal hemor- rhoids are covered with mucous membrane and may be found of almost any shape, size and color. The color will generally indicate whether they are of a venous, capilliary or arterial origin. Venous hemorrhoids are bluish in color unless they are strangulated, when the) become more purple. Capillary hemorrhoids are of dark color. They are not painful, but bleed easily. Arterial hemorrhoids are of. a bright red appearance, are irrita- ble, and also bleed freely. External hemorrhoids are visible to the eye without the use of the speculum, and may assume different shapes and color. The skin and mucous membrane covering external piles is extremely sensitive, while internal piles are nearly devoid of sensibility. All forms of piles seem 84 RECTUM. to have a remarkable erectile power, much resembling the corpus spongiosum of the penis, and, if handled roughly, will become more prominent. This is very ad- vantageous to the operator as it brings them into mor° prominence, where they can be easily treated. TREATMENT OF HEMORRHOIDS. The words knife or surgical operation pierces the ears of most patients almost as keenly as the instrument itself, and if they are assured that they can be cured without pain, detention from business, and cutting operations, without endangering their lives, they are sure to favor such a procedure. Thus we find chat patients will submit to the injection treatment when they would prolong their suffering in silence rather than undergo a surgical operation. The injection treatment has many advantages other than the ones just mentioned, from the physician's point of view. The busy general practitioner can not always devote the time to learning the technique of cutting operations, as it is a well known fact that such operations require much skill and practice, and the practitioner who sends all his rectal patients to the surgeon, is depriving himself of both reputation and revenue which could be retained by the use of this method. Since the injection treatment has been used, nearly every caustic in the vegetable and mineral kingdom has been tested, but it is the universal opinion of physicians who use this method that carbolic acid, either used single or in combination with other remedies, is the best, and that better results can be obtained from a forty per cent, or stronger solution than from the weaker ones. The following formula is the most generally accepted one : ^ Carbolic acid 40 parts. Olive oil 60 parts. EECTUM. 85 Mix. Sig. — Inject enough of the fluid to change the color of the tumor to a grayish white. The amount of the fluid required to accomplish this will depend upon the size of the tumor. Small tumors require only from one to three minims*, while larger ones will require more. The hypodermic syringe for hemorrhoidal work should have a large piston-head and strong finger-brace. The piston stem should be graduated in minims with a set-screw. After you determine the amount of fluid a pile tumor will require, regulate the set-screw on the piston-stem so as to get about the amount of fluid you will require for each injection. In this way you can de- termine the exact amount of fluid used in each operation. The Hypodermic syringe plays quite an important part in the different operations mentioned in this book, and we ^• IIIIIIIIIIII H II I II I IIIIIIIIIIIIIIIIIII ^^^^ *#=-! GUARDED NEEDLE AND CANULA. wish it understood that when we use the term minims we mean minims as regulated by the piston and set-screw of the syringe, and not drops as they are ejected from the point of the needle, as there is quite a difference, for five graduated minims will be equivalent to nearly fifteen drops if a fine needle is used. The hypodermic syringe is more thoroughly discussed in the obtundent system of painless dentistry on another page to which you are re- ferred. The needle used for injecting hemorrhoids should b^ of extra length. I prefer a needle with a finer caliber than most operators use, as the larger needles have a tendency to allow the fluid to escape more freely when it is withdrawn, and thus cauterize the healthy walls of the rectum. Needles for this work should have a set-screw near the point, which will prevent you from puncturing the 86 KECTUM. opposite walls of the tumor and injecting the fluid where it is not required. If you have a plain needle, you can regulate the depth of the injections by putting a very small piece of paper on the needle at the distance you deem necessary from the point. HOW TO OPERATE. After you have examined the patient and located the piles you wish to treat, the BrinkerhofI speculum should be gently introduced and the slide withdrawn, so that the tumor will protrude through this opening. This will give you full view of the tumor. The patient may be placed on either side, or on his back. He should always be placed in such a position as to allow the tumor to point downward if possible. This has two advantages, firs',, you are not so liable to inject the fluid too near the base of the tumor; second, if any fluid should escape when you withdraw the needle, it will be caught by the specu- lum. There will not be an overflow, however, unless you use too large a needle and withdraw it too quickly. After you have exposed the tumor to full view, tell the patient to strain a little, then take a wire snare, such as is used in throat and nose work, and surround the tumor you wish to inject. Do not make sufficient ten sion on the snare to cut the tissues, but just enough to restrict its base. The needle should now be inserted about one-third the distance from the apex. The injec- tion should be made as near the center of the tumor as possible and forced into the pile a drop at a time. This will allow the coagulum to gradually form and avoid forcing any of the contents of the tumor back into the main blood vessels. If the tumor is an extra large one, several injections may be required to thoroughly cauter- ize it. The needle should be gently withdrawn and, if any blood should follow its withdrawal, it indicates tha! - RECTUM. 87 there has not been enough of the fluid used and the opera- tion should be repeated. One who is not accustomed to making these injections might think the operation would be attended with pain, but such is not generally the case, as carbolic acid is a powerful anaesthetic when used in this strength. If there should be pain, it generally comes on a few hours after the operation, and indicates that the 1 injection has been made too near the base of the tumor into the deep structure. This should be avoided, as ex- tensive ulceration has been attributed to this mistake. The tumor should be covered with an ointment com- posed of boric acid, two drachms, and vaseline, six drachms, and the speculum withdrawn. Not more than two small or medium sized, or one large pile tumor should be treated at a time and two or three weeks should elapse before another treatment. It is always best to treat the large tumors first, for as soon as they are re- moved, the smaller ones are thrown into better view. There are several complications to be considered in all rectal operations. Retention of urine may follow an operation. This can be relieved by the catheter or other treatments. Constipation is present in a large majority of people who are suffering with piles and great care should be taken to relieve the patient of this difficulty as it has a decided tendency to retard the progress of your treatment. Secondary hemorrhage is a complication of all rectal operations, but it seldom occurs with the injec- tion treatment. If it should occur, the rectum should be tamponed above the bleeding point and astringent appli- cations made to the bleeding surface. Extensive ulceration will not occur unless the injec- tions have been made too deep. These ulcerations can be treated like other ulcerations of the rectum. One of the dangers which has been pointed out by surgeons opposed to this method is, that the injection fluid might form a thrombus, but I am doubtful if any such complication ever occurs. This can be guarded against, however, by the use of the circular pressure at the base of the tumors with a snare as described before. It might be stated that weaker solutions of carbolic acid RECTUM. would have a tendency to produce this condition more than the stronger ones, as the latter make a complete coagulum and cauterize the tissue as completely as the actual cautery. EXTERNAL HEMORRHOIDS. There are certain forms of external hemorrhoids tha f can be successfully treated by the injection method. These tumors are of recent formation and decidedly vesicular. PHYSICIAN SUPPLY CO'S RECTAL CASE. This makes a very convenient set for the Rectal Specialist. It contains four metal screw-top bottles for holding medicinces, two syringes, one Brinkerhoff speculum, one rectal polypus or dressing forceps, one suppositor for ointments, one silver probe-pointed canula, one guarded and one plain h3'poderinic needle. Pile tumors which are hard and fibrous should be re- moved by excision or the ligature. Many prefer the latter because it is practically bloodless. The minute details of these operations are given in nearly all works on sur- RKCTUM. 89 gery and it will not be necessary to repeat them here, but I will give you a brief outline of the operation, which is very simple. These tumors do not require the use of the speculum as they are already exposed to your view. Anaesthetize the surface to be operated upon by first saturating a piece of absorbent cotton with a ten per cent, solution oi cocaine, and cover the parts. This is applicable only to tumors, that are covered with mucus membrane as the anaeesthetic will have no effect upon the skin. This should be allowed to remain about ten minutes. Then inject a three per "cent, solution of cocaine as given in formula No. 3 in the Obtundent formula on another page. These injections should be made just under the skin or the mucous membrane around the base of the tumor. The snare should now be applied at about the place you have made the injection, or just a little above, and sufficient force used to make circular pressure around the tumor without cutting the surface. Now take a knife or a pair of fine-pointed scissors and sever the outer integument along the line of the snare, being careful not to cut too deep. This incision severs the nerves of sensation and will lessen the suffering and also hasten the sloughing process. The ligature can now be applied to the cut sur- face and the tumor strangulated. I generally use two silk ligatures and tie several knots in each. This will prevent after-hemorrhage. After the tumor has been thoroughly ligated, snip off a little of the summit of the tumor and dust the parts well with antiseptic powder. Apply over this a piece of absorbent cotton and a bandage. If the patient suffer^ much pain after the operation, he can be allowed suffi- cient morphine to quiet him. FISTULA. It is claimed by Allingham that two-thirds of the rectal operations performed at the St. Mark's Hospital, London, were for fistula, but American surgeons fina 90 RECTUM. hemorrhoids the most common affection. There are several varieties of fistula, generally classed as complete, which have an external and an internal opening; internal incomplete, which have an internal opening leading to a blind pouch which may become a receptacle for foreign matter; external incomplete, with an external opening only. The complete and external incomplete are very easily detected by the eye by their openings. The in- ternal incomplete may require the use of the speculum. Fistulas are not always attended with severe *paiii, but they give the patient a feeling of uneasiness, owing to the discharge from them, which may cause a soreness oi itching at the anus. DIAGNOSIS AND TREATMENT. If on examination, we find an external opening, wc can determine whether or not the fistula is complete by inserting a probe into the opening and following the point of the probe with the finger in the rectum. If the internal opening is a little obscure injections of antisep- tic colored water injected into the external opening can be seen oozing through the internal orifice. After determining the nature of the affection, we can apply the treatment we deem required. Most operators prefer to treat these affections upon a surgical basis. For the details of these operations we refer the reader to any text-book on surgery. There are several ways in which this ailment can be cured, however, without re- sorting to surgery. The oldest of these is the ligature, which is said to have been used by Hippocrates. This method consists in passing a ligature through the sinus into the bowel and tying it outside allowing the ligature to gradually cut its way to the external surface. The silk ligature was soon replaced by the rubber liga- ture as the contraction of the rubber would have a tendency to cut through to the surface in less time, gen- KKCTUM. 91 erally requiring from five to ten days. If the rubber should break or become relaxed, the operation should be repeated. Rubber ligatures should never be tied, but the ends placed in a small piece of lead and pinched to- gether so as to avoid slipping. Another way of successfully treating many cases of fistula is to first inject peroxide of hydrogen into the cavity. After this has thoroughly "boiled out," the pus, the interior of the fistulous tract should be scarified by passing a probe or a scarifier up and down the canal several times; then inject carbolic acid through a silver probe, canula, commencing at the internal opening, gradually withdraw the probe and press out a drop at a time. The finger should now follow the canal and press out the excess of acid, if there should be any. This can be followed up by an injection, at least once a week, of eucalyptol, thoroughly saturating the cavity. Brinker- hofl used the following mixture which he called "Ulcer Specific:" I£ Dist. ext. hamamelis 5 dr.. Liq. ferri. subsulph 1 dr. Acid carbol. cryst 2 gr. Glycerine 2 dr. Mix. Sig. Inject ten or fifteen drops deeply into the fistula and press the tract of the fistula with the finger to force the fluid more deeply in. The principal thing to avoid is having the external opening heal before the internal. You should always keep the external orifice open ; this will allow free drain- age for the septic fluids as the healing process should start from within and work towards the surface. FISSURE. Of all diseases of the rectum a fissure is the most pain- ful. To the inexperienced, it would seem almost im- possible that such an innocent-looking little ulcer could 92 RECTUM. cause so much suffering. It is, however, the cause of intolerable pain and gravely disordered reflexes. A fissure is simply an ulcerated abrasion of the muco- cutaneous membrane which lays bare certain nerve fibers which come in contact with foreign matter and produce spasmodic contraction and pain of an intense character. The treatment of a fissure is the simplest known in sur- gery and it can be cured in several ways. Dilating the sphincters to the full extent with a Pratt's bivalve specu- lum will, in nearly every case, effect a cure. If you haven't a speculum at hand, the thumbs of each hand can be inserted into the rectum and the same force applied. Patients can object to this treatment for no other reason except that they should take a general anaesthetic. If patients fear this, you can effect a cure by saturating a piece of absorbent cotton with a ten per cent, solution of cocaine and allow it to remain on the ulcer for five or ten minutes, then scarify the surface and apply a solution containing equal parts of carbolic acid and glycerine. This will convert the ulcer into a simple sore which will rapidly heal by keeping it dressed with antiseptic powders or ointment. RECTAL ULCERS. Situated above the anus are not of uncommon oc- curence and give rise to many reflex troubles. These ulcers may be caused by mechanical injury, as from in- troducing the nozzle of a syringe, or by a seed lying in the folds of the mucous membrane. They may also re- sult from simple inflammatory or specific diseases. Ulcers of the rectum are attended with pain and tenesmus and a feeling of uneasiness in the lower bowel. There may be a discharge of pus, mucous or blood. Morning diarrhcea is nearly always present, although in some cases the bowels are constipated. RECTUM. 93 If ulceration of the rectum is suspected, the speculum should be introduced and the extent and character of the ulceration ascertained. If they should be due to syphilis, constitutional treatment alone is all that will be required, but, if from any other cause, they will require local medi- cation, in the form of antiseptics and astringents. When ulcers can be outlined through a speculum, they may become converted into a simple sore by satur- ating the surface with nitrate of silver, seventy grains to an ounce of water. This can be applied with a cotton pointed applicator or the surface can be anaesthetized with a ten per cent, solution of cocaine, then scarified and touched with a solution containing one drachm of carbolic acid and three drachms of olive oil. These treat- ments should be applied by the physician once or twice a week. The patient should also be supplied with an antiseptic astringent home treatment. The vaginal sup- positories as given on another page in the chapter on diseases of women, form the best treatment to my knowl- edge, and they are used with wonderful curative results in all cases of rectal ulcerations and inflammations. The patient should insert one of these suppositories up the rectum at the ulcerated surface each night before going to bed and after the bowels move in the morning. These suppositories contain a happy combination of remedies which is all that can be desired to promote healing, and extensive ulceration will rapidly yield to their use. PROLAPSUS OF THE RECTUM. This condition is of quite common occurence in chil- dren and is also occasionally found in adults and is fre- quently associated with hemorrhoids. This protrusion of the rectum is generally due to excessive straining at stool, or in patients who are paralyzed. The walls of the rec- tum can easily be placed in their normal position by lu- bricating the fore fingerd with vaseline and inserting it 94 RECTUM. into the rectum and gently pushing the membrane over the finger into the orifice. The patient should be supplied with antiseptic and astringent treatment such as the vaginal suppository just mentioned, and be instructed to avoid straining at stool. If the bowels are constipated, treatment should be di- rected so as to produce free watery stools without strain- ing. If the prolapsus is due to hemorrhoids, they should be removed ; this will also cure this condition. POLYPUS OF THE RECTUM. Polypoid tumors are found in the rectum the same as on other mucous membranes. The treatment is very simple. They may be removed either by injecting tho same hemorrhoidal fluid as that used for piles into the pedicle of the tumor, or they may be ligated at the base of the pedicle and the top cut oft*. They may also be removed by the snare, and the pedicle cauterized. Polyp 1 have a tendency to bleed quite freely at times and the treatment should be directed to avoid this complication. PRURITUS. This is a very common and troublesome ailment. It may be caused from acid, mucous, or purulent discharges from the anus. Some physicians believe many cases are of a purely parasitic origin. The following formula has always been very serviceable in my practice : Ty Acid carbolic 20 gr. Camphor 20 gr. Zinc oxide 15 gr. Vaseline 1 oz. M. Sig. Apply to the surface two or three times a day. RECTUM. 95 The following formulae have been advocated and suc- cessfully used by their originators for the hypodermic treatment of piles : POWELL'S FORMULA. I> Acid carbol. (crystals) 2 dr. Tinct. thuja I dr, Aqua dest q. s. ad. I oz. OVERALL'S FORMULA. 1^ Acid carbol I dr. Fl. ex. ergot I dr. Ol. olive i dr.' BRINKERHOFF'S FORMULA. 1$ Carbolic acid I oz. Oilive oil 5 oz. Chloride of zinc 8 gr. The little pamphlet furnished to the itinerants pur- chasing the "System" directs that the amount of injec- tion inserted into the tumors shall be as follows : Largest piles 8 min. Medium piles 4 to 8 min. Small piles 2 to 3 min. Club-shaped painless piles nearorifice2 min. "BrinkerhofFs System" forbids the injunction of any but internal piles. 96 RECTUM. RORICK'S FORMULA. 5 Carbolic acid 2 dr. Glycerine 2 dr. Fl. ex. ergot 1 dr. Water iV 2 dr. DR. GREEN'S FORMULA. I£ Carbolic acid 1 oz. Creosote 10 min. Acid hydrocyanic 1 min. Olive oil 1 oz. DR. SMITH'S FORMULA. ^ Acid carbolic .35 parts. Fl. ext. ergot 20 parts. Glycerine 30 parts. Distilled water 15 parts. DR. SHUFORD'S FORMULA. ^ Sodium biborate 1 dr. Acid salicylic 1 dr. Glycerine 1 oz. Acid carbolic 3 dr. Mix. Sig. Inject three to five drops in small and eight or ten or more in large ones. DR. HOYT'S FORMULA. ]$ Acid carbolic 80 min. Ext. hamamelis, (Pond's) 6 dr. Distilled water 6 dr. ALCOHOL AND DRUG HABIT 97 THE ALCOHOL AND DRUG HABIT SPECIALIST. What are the factors which predispose certain indi- viduals to the excessive use of liquor, while others do not care to use it at all? This is a question that has never been satisfactorily answered. I believe that certain in- dividuals are born drunkards, just as I believe that others are born thieves, and there are children born every day cursed in their mother's womb by the dissipation of one or both parents. Bad company and poor literature contribute, perhaps, more towards the development of the drink habit than any other cause. A man with a timid disposition often thinks he is better able to combat with the world if he imbibes freely of the amber-colored liquid, while a man with an unevenly balanced mind be- lieves he can be made more worldly if he flushes his stomach with the fiery fluid. A poor man feels rich if he is in a state of semi-intoxication, and especially so if he is in a glittering bar-room with company in a similar state. Finally, the intoxication increases, stupor comes on, and after this has worn off in the morning comes thirst, misery, headache, tremor and nervous irritability. Again he seeks relief by the usual "eye opener," and again he keeps his jaded nervous system stimulated dur- ing the day until outraged nature rebels, and his stomach will no longer retain the poison, and the dis- ordered brain and nervous system are on the border of collapse unless rest or medical aid will restore him to the normal, and compel him to leave alcoholic liquors alone for a few weeks or months. This is the history of the average periodical drinker. There is another class of men whom we generally find in active business who do not intoxicate themselves to the extent just described, but who consume a large [7] 98 AIXOHOL AND DRUG HABIT amount of liquor every day and keep it up for years, without much apparent injury, but by carefully watch- ing these subjects, we find that they finally die from some disease for which alcohol is responsible. Possibly the heart may become exhausted or the liver or the kid- neys give out, or the weakened blood vessels at some point of the brain will yield and apoplexy result. There is another class of men who may properly be called degenerates. These individuals are certainly phy- sically and mentally weak, and, if allowed, will consume as much liquor as they can get their hands on. They wish to keep in a state of intoxication all the time, until they are finally taken to the prison or madhouse or wear out the lives of their most devoted friends. From so high authority as Sir William Roberts we find in his excellent little work on "Diet and Digestion," that tea, coffee, tobacco and alcohol have been bene- ficial in strengthening both the muscles and the brains of Americans. He argues that this is one of the reasons why we have outstripped our eastern brethren in civiliza- tion and intellectual attainments. If such be the case, we have bought our civilization and our intelligence at an enormous expense. There has been much discussion in medical literature as to whether the excessive use of alcohol is a disease or a habit. I am inclined to think that it is both, and that it may be either hereditary or acquired. If a man goes on an occasional spree and has no particular taste or craving for liquors, we may say that he has a habit. If he has an uncontrollable appetite for alcohol and feels that he cannot exist without the stimulant, we must ad- mit that it is a disease, for there are certain pathological changes which take place in his nervous system. Whether or not alcohol may be used without being abused is too broad a question to be discussed here, but we all know that it is a dangerous companion with which to associate, and we may live longer and better lives if we disinherit this king of many crimes. It was Henry W. Grady who said that whisky had wasted more lives, dug more graves and sent more souls ALCOHOL AND DRUG HABIT 99 unshrived to judgment than all the pestilences and wars since God sent the plague into Egypt and Joshua stood before Jericho. HOW TO ADMIT PATIENTS FOR TREATMENT. When a person applies for treatment for alcoholism he is generally in a state of intoxication ; he wants sym- pathy and a friend. Possibly he has been called a drunken brute, which may be true in many instances, for there are many individuals who are correct impersona- tions of Dr. Jekyll and Mr. Hyde when under the influ- ence of liquor. Men who have a kind, lovable and char- itable disposition are transformed into perfect demons by its influence. A person not addicted to the liquor habit might think that it is not a difficult task to stop drinking, and we often find people who subject the drunkard to the most severe criticism, is a habitue of perhaps a milder stimulant or narcotic, i. e., tea, coffee, snuff or tobacco. I have seen as pronounced tea drunkards as I ever have whisky addicts. Although Dr. Keeley and others who were among the first to classify alcoholism as a disease, were ridiculed by the Medical Profession, we are pleased to note at this writing that their views have been generally accepted, and by treating these conditions as disease, patients can be rapidly restored to their former manhood. Any man of ordinary intelligence knows right from wrong, and by explaining to him the evil effects of his habits and how his dissipation has reflected upon himself and family; how he and his have been shunned by so- ciety; how his noble and faithful wife has patiently waited for the time to come when he would abandon the evil habit and become the same kind father, brother or son that he once was. She has, no doubt, many times knelt in prayer, and implored the Divine Giver of Life to shield her loved one from this terrible curse. Have your patient to understand that he is able to live a dif- ferent and a better life and that he has applied to you 100 ALCOHOL AND DRUG HABIT for the purpose of having you cure him of an uncon- trollable disease, alcoholism, and when he has completed his treatment, he will return to his loved ones a much different man. But in order to be successful, he must avoid his former associates and places where liquor is sold, and in order that the treatment may be properly carried out, you must have his fullest co-operation. EQUIPMENT. There has been a diversity of opinion whether or not a physician in general practice, can treat alcoholism and the drug habits as successfully as they could be treated at habitue institutes. The principal and only advantage the institutes have they are generally equipped for treating such cases, and the psychic influence it has on the pa- tient, of "leaving home for a vacation," which is generally their excuse. Alcoholic habitues dislike to admit their weakness and acknowledge that alcohol is their master. You often hear the most profound drunkard remark, "I can drink or let it alone," but they more often drink to show you they can drink than they do to abandon its use for demonstrative purposes. There is rather a fraternity among drinking men, and while at an institute they discuss many experiences re- garding the evil effects of alcohol, which often leads from the cradle to the prison or mad house. If the modern temperance lecturer is deficient for food for argument, his time will be well spent in visiting one of these insti- tutes. There is no special class of men exempt from this evil, and we find inmates at these places who were clergy- men, doctors, lawyers, etc.. holding respective repentance with men of the lower classes, all congregated for one grand purpose of restoring manhood and placing them- selves before the world once more, the same honorable, upright citizen they once were. They leave the institute with new resolutions and a brighter future before them. A well equipped institute should possess everything which will be conducive to entertainment and health. ALCOHOL AND DRUG HABIT 101 For this purpose a small gymnasium is of special value, not only for amusement, but as a strengthening process. Baths of every description offers the same advantages. I feel I cannot say too much regarding baths, as they offer us one of the best means of elimination obtainable, the Turkish bath chairs and folding bath cabinet mentioned on another page will answer the purpose, but the shower and, other baths can be added to a good advantage. Pa- tients should be required to take a Turkish bath, at least every other day throughout the treatment. Although the institutes have a few advantages, a physician in gen- eral practice can treat patients equally as successful as far as actual medication is concerned. The only equip- ment other than medicine is the bath outfit just men- tioned. His first step towards success is to obtain the utmost confidence and co-operation of his patients and keep them under his observation and treatment for at least four weeks. At the end of the first week, he no doubt will abandon the use of liquor and by the judicious use of remedial measures, at the end of the remaining three weeks, he will leave your care with no further de- sire for alcohol beverages. PRELIMINARY TREATMENT. The preliminary treatment for alcoholism depends somewhat upon the condition of the patient when he pre- sents himself for treatment. He may be perfectly sober, or, on the other extreme, he may be brought to you in a state of total collapse, or suffering with delirium tremens, or manifesting symptoms bordering upon this condition, as the result of a recent debauch ; the former condition will require no special treatment, while the latter de- mands the physician's immediate attention. The pa- tient's stomach may be in such a state that he cannot tolerate solid foods; in such cases we find hot broths, milk and invalid foods are the best diet. If the patient is not able to take this nourishment by the mouth, it can be given by the rectum. Many drunkards eat and sleep 102 ALCOHOL AND DRUG HABIT very little while on a debauch, and it is owing to this de- ficiency of rest and diet which have a tendency to induce collapse and delirium tremens, by over-taxing their al- ready shattered nervous system. It has often been observed that alcoholics who eat and sleep well never manifest delirious symptoms. We therefore find that the most important factors as a pre- liminary restorative treatment will be to sustain nourish- ment, quiet the nervous system and induce nature's sweet restorative — sleep — and eliminate all the poisonous ele- ments from the body. The patient should be encouraged to eat, the congested liver and portal system should be relieved by a full dose of calomel followed by a saline purgative or the continuous use of phosphate of soda. The congested kidneys should also be relieved with an active diuretic, through diaphoresis should be obtained by means of the Turkish bath given in the bath cabinet illustrated on another page and followed by a hot plunge bath for a few minutes in water of no degrees F. These baths are indispensable as a means of elimina- tion, and should produce sleep. If the baths should fail to produce sleep, the patient can be given a full dose of bromidia, sulphonal, trional, veronal paraldehyd, or any other suitable hypnotic, which will be discussed later in what is known as the "Rest Cure." Patients have been educated by the former founders of the so-called "gold-cure" institutes to believe they can have all the liquor they desire. Thus we often find it neces-i sary to carry out our treatment on the same plan, or the patient may think our treatment an inferior one. If the patient is very weak he should only be allowed sufficient liquor to support him. There is no remedy in existence which will support an irritable heart or calm the nerves of the whisky habitue as quickly as whisky. This should only be allowed in moderate doses, however, for a few days, until nature has an opportunity of recuperating from other sources. If the patient is a moderate drinker and in a state of intoxication or semi-intoxication, he may be allowed a four ounce bottle of whisky and ad- vised to see how long he can make that last. All patients ALCOHOL AND DRUG HABIT 103 should be emphatically forbidden to enter any place where liquors are sold, or drink any intoxicating liquor other than that which he receives from you. In order that the reader may become familiar with the different methods of treatment, I will first give the treatment I used while in charge of an institute and which I have since used in private practice with excellent results for the treatment of alcoholism and the drug habits. I will also outline many secret cures and sys- tems, sold to the profession at different prices according to territorial right, etc. By the judicious use of these treatments you will be prepared to treat and cure alco- holism and the drug habits as successfully as they can be treated elsewhere. THE REST CURE. Some institutes have what is known as the ''Rest Cure," which in detail is very much like the preliminary treatment just described. This treatment is of special value as a preliminary treatment for patients who are nervous or present themselves in a state bordering on collapse, or manifest symptoms of delirium tremens. The patient is given a hot water bath or a hot blanket bath, which consists of wrapping the patient in woolen blank- ets taken from water with the temperature 140 degrees F. These baths are frequently repeated to keep up free diaphoresis. Nourishment is given in small amounts as the patient awakens. The patient is allowed as little whisky as is necessary to support him and is kept in a hypnotic or semi-hypnotic state from two to four days, until the effect of the alcoholic poison wears off. The remedies used for the purpose of producing "rest" (hypnosis) are hyoscine, trional, veronal and paraldehyd. Dr. J. Collins, in N writing regarding the relative value of the three last named remedies, says : The reliance which we place upon them, apparently, judging from the frequency with which they are used, is indicated by the order in which they are enumerated. 104 ALCOHOL AND DRUG HABIT Although veronal, one of the most recently introduced hypnotics, has something to be said in its favor, and particularly that it produces a hypnosis more profound than that caused by trional, there are disagreeable fea- tures attendant upon its use which compel us to admit that trional is the more suitable hypnotic. My experience with veronal, which I have used upward of a year in a great many cases of insomnia of manifold causation, is that it causes quite the ideal artificial sleep, it sometimes produces motor incoordination, especially of the lower extremities, erythematous eruption, neuralgia, and it di- minishes the solids and urin. Although trional will do all of these, I have not noticed any of them with anything like the frequency that I have after giving veronal. Nevertheless, veronal is an excellent hypnotic, and the sleep-producing effects are greater than those of trional, given in from ten-grain to fifteen-grain doses. It usually produces sleep after the second or third do#e in patients with delirium, whereas trional must be giv^en oftentimes in twice or in three times this quantity before any con- siderable hypnosis results. We have /the best results from the administration of trional when we give it in ten- grain doses every hour and with large draughts of hot water. After from four to six doses have been taken, the patient usually secures a more or less protracted sleep. Paraldehyd is the most reliable of all hypnotics. Every one who has much experience in nervous and men- tal diseases will concede that this is a fact. It is never a pleasant medicine to take, and if given frequently it is sure to disorder the digestion. In delirium tremens the subacute or chronic gastro-duodenal catarrh is almost invariably present, and paraldehyd tends to increase it and exaggerate it ; for this reason we never give it in the City Hospital as a routine measure, but when other hyp- notics fail we rely upon its administration in producing sleep and are rarely disappointed." The rest cure is only given to patients who are deliri- ous or extremely nervous and irritable and have muscular tremor, etc., and require rest. If the patient places him- self in vour charge in a reasonable state of sobrietv, the ALCOHOL AND DRUG HABIT 105 rest treatment is omitted, with the exception of a hyp- notic at bedtime, otherwise the patient is placed at once upon the following general tonic and reconstructive treat- ment : TONIC AND RECONSTRUCTIVE TREATMENT. The first treatment I ever used was that known as the Dunlap Cure, which was approximately the same treatment, somewhat modified, as that used by Dr. Gray, the formulae of which were made public through the efforts of Dr. Andrews, of Chicago ; and it is my belief that this treatment is quite as good as any in use at the present time, if used according to the following revised formulae : I commence giving the patient hypodermically : J£ Gold and sodium chloride 4 gr. Aqua, dis 1 oz. M. Sig. Inject five to ten minims at seven and eleven- thirty a. m., and at five and nine p. m. Each ten minims represents one-twentieth grain of the chloride of gold and sodium. I also give the following internally: Ty Atropine ' %. gr. Strychnine nitrate 1 gr. Tinct. capsicum 2 dr. F. E. erythroxylon coca 1 oz. F. E. avena sativa 1 oz. F. E. chionanthus virg 1 oz. Compound F. E. cinchona 3 oz. Simple elixir 1 oz. Mix. Sig. A teaspoonful every two hours while awake. In briefly resuming the therapeutic value of the above medication, I may add that it is the belief of many phy- sicians that the only important part gold has in the treat- 106 ALCOHOL AND DRUG HABIT ment of alcoholism is the gold coin which passes from the hand of the patient to the pocket of the doctor. This is a great mistake, although the term "gold cure" has been extensively advertised for commercial purposes and sounds well and looks well. The therapeutic value of the chloride of gold and sodium is strongly indicated to antagonize the evil effects of alcohol. By referring to all modern literature upon the subject and accepting the views of the most competent clinicians, we find that the salts of gold are alteratives of the highest order and seem to exercise their best efforts upon organs and tissues de- stroyed by the poisonous effects of alcohol. It is a remedy par-excellence for sclerosis of the in- ternal organs, especially the liver and kidneys, drunkards dyspepsia, characterised by red glazed tongue, relaxation of the bowels, catarrh of the bile-ducts, duodenum, jaundice, etc. It has been highly commended for suicidal mania, melancholia and a tonic for low spirited people, and many other conditions which are associated in a direct or indirect way with chronic alcoholism, thus we find that the use of gold is not as empiric as we are often led to believe, and is one of the principal remedies used at many successful institutes. Atropine has been judi- ciously added to the preparation as a means of relieving cerebral congestion and headache, which is nearly al- ways present after a debauch. It is also especially use- ful as a cardiac and respiratory stimulant. Strychnine is also a valuable adjunct in the treatment of alcoholism and the drug habits as a stomachic tonic and a stimulant to the heart respiratory, muscular and nervous system. Ery- throxylan, avena sativa and the cinchona compound have been added for their respective tonic properties. Chiona- thus in passive doses, as given here, is a cholagogue and mild diuratic and promotes activity of the liver and kid- neys, and assists elimination. There is no remedy which replaces the fiery taste of whisky better than capsicum. Whisky drinkers are accustomed to hot drinks and this remedy supplies this desire. This can be omitted in many cases, however, and should always be gradually reduced within a few days, or it can^be administered separately if desired. ALCOHOL AND DRUG HABIT 107 After the patient has taken this treatment for a few- days, he generally loses his desire for liquor and dis- continues its use, but the treatment should be continued for a period of three or four weeks. On the other hand, we occasionally find a patient who thinks he is overly- wise and can "beat the cure." These patients are gen- erally of the lower classes and will drink, drink, and drink until compelled to stop. They are easily managed, however, and it is rather amusing to see how quickly you can relieve their minds of these erroneous ideas. After a patient has been taking the treatment a few days and you feel that he is fighting the treatment, when the time comes for the hypodermic injection, give him an extra large drink of whisky. Have him secure it at the drug store, if you wish, so that he will not think you have doctored it, and instead of the regular injection, give him one-tenth grain of apomorphine. This, of course, will make him sick at his stomach and vomit. In nine cases out of ten you cannot get him to touch liquor any more, but once in a while a patient will attempt to drink again. I remember once giving a patient seventeen of these in- jections before I could conquer him. Apomorphine and the "sickening process" have al- ways formed one of the "trade secrets" of the different gold-cure institutes, and I believe that apomorphine is one of the most valuable drugs we have as an emergency treatment in the cure of alcoholism, as it makes you master of the situation, and at the same time, impresses the patient with the fact that the treatment you are giv- ing is a complete antidote to alcohol, and that the two can not be taken at the same time. You will also find that some patients before quitting the treatment wish to see if they can take a drink of liquor, to learn whether or not the cure has been complete. In many cases I have requested them to drink and then given them an injec- tion of apomorphine at the same time. This satisfies them in the extreme. This might be condemned by some as an unprincipled and injudicious practice, but, such as it is, it is effective and curative and I believe that there is a larger percentage of cures in those who have under- 108 ALCOHOL AND DRUG HABIT gone the sickening process at least once while taking treatment than in those who have not. The mental im- pression the patient receives (and alcoholism is conceded to be partially a mental disease, hence the term ''dipso- mania") is lasting in its results. After this treatment the patient is thoroughly disgusted with his favorite bever- age. I have often seen patients become sick at their stomach by watching others drink, several days after taking the apomorphine. This is what is known at most gold-cure institutes as the "barber pole shot."' They have three solutions for in- jecting, labeled number one, two and three. Number one is white and contains a solution of nitrate of strych- nine ; number two contains gold and sodium and is col- ored red ; number three contains the apomorphine, which if mixed with water will turn a bluish green, hence, by taking medicine from each bottle, Ave get the red, white and blue. There is no special advantage of treating alcoholism by hypodermic medication, other than you have the pa- tient under your immediate control. You can absolutely compel him to stop drinking by the use of apomorphine and having him report regularly for his hypodermic treat- ment, you can keep him constantly under your observa- tion and control and witness the progress of your treat- ment. The hypodermic injections also have a wonderful psychic effect. Many patients have never received a hy- podermic inje'ction before they imagine that this method of treatment is much more certain and curative in its effects than the ordinary treatment given by the mouth. Although the apomorphine treatment is not required in all cases it would be almost impossible to cure some cases without its use, and this method of producing emesis is far better than to give an emetic in whisky, and is not nearly so easily detected. The combined treatment which I have just outlined is the one I prefer for the general class of patients and it will establish as great a number of cures as any treat- ment in present use. It can be used in either private a sanitarium practice with equal success. ALCOHOL AND DRUG HABIT 109 THE TREATMENT FOR OPIUM, COCAINE AND OTHER DRUG HABITS. There are several different types of drug habitues and several different methods of treatment to cure them, each method having its enthusiastic advocate. The treatment of drug habits differs from alcoholism inasmuch as nearly every case presents different, individual characteristics and requires special attention and skill on the part of the physician to meet the emergencies. While we find al- coholic patients desire companionship and enjoy social functions, opium and other drug habitues are generally secretive in their disposition, and the physician who treats them should loose no time in securing the confi- dence and co-operation of his patients. They are wedded to their drug and believe that it is part of their existence; therefore they should have the assurance that they can have all of the drug their system requires during the treatment, but that they are to take only that which they receive from you. To illustrate the cautiousness of many patients, I re- member one lady who applied for treatment who had three drachm bottles of morphine and a hypodermic syringe secreted in her clothing. She did not tell me this until after she had completed the treatment, when she handed them to me and confessed her actions, stating that she had heard so much about the torture received in curing the morphine habit, that she came prepared not to suffer. She was placed upon the gradual reduction treatment and made a splendid recovery. There are several things to be considered in carrying out a treatment for the drug habits. We have to combat the physical and mental disturbances, which are sure to follow the withdrawal of the drug. We have to relieve the patient from the craving of the drug, that we may enable him to permanently discontinue its use. We have to restore his mental and physical condition so that he will not depend upon the drug for support. These are problems which often confuse the minds of the most skill- ful physicians, but they can be solved by appropriate therapeutic measures. 110 ALCOHOL AND DRUG HABIT Among patients applying to you for treatment, you will find first, the young and vigorous patients, who have not taken the drug long enough to produce any marked pathological changes in their anatomy. Second, the one who has used the drug for several years .without its seem- ingly producing any ill effects. Third, the one who uses the drugs for the relief of pain of some co-existing dis- ease, such as cancer, chronic sores, hepatic and renal calculi, etc. Fourth, the old and feeble who have ex- isted upon the drugs for years and have brought about pathological changes which are beyond repair. As the digestive and assimilative organs are prac- tically paralyzed ; the secretions of the stomach, liver and bowels are checked. They become emaciated and live upon their reserve of former years. The first and second class will generally yield to proper treatment. The third class may also be cured, providing you can establish a cure for the painful dis- ease, but, as a rule, the fourth class is beyond all medical aid and the patients should be allowed to use the drug as long as they live. The preliminary treatment for drug addicts should be very much the same as that for alcohol. If, in your judgment, you think the case is a curable one, for a few days previous to the treatment you adopt, the patient should take hot air and water baths and open the pores of his skin. The alimentary tract should be cleaned out by the use of calomel and phosphate of soda. Acetate of potassium will be found a good remedy to stimulate the secretions of the kidneys. The patient will then be ready for the regular routine treatment. There are sev- eral ways in which the drug habit may be treated, viz : — the gradual reduction method ; the rapid reduction method, and the immediate withdrawal method, etc. THE GRADUAL REDUCTION METHOD. This is one of the most satisfactory methods of treat- ment in present use for curing morphine and other drug habits and has the advantage that it can be used in private practice nearly as well as at a sanitarium or in- ALCOHOL AND DRUG HABIT 111 stitute with the full co-operation of the patient. This method of treatment offers the following advantages, viz : It is not attended with any marked discomfort to the patient, no weakness or profuse perspiration, gener- ally no pain or diarrhcea or extreme nervousness, col- lapse, etc., often accompanying other treatments. With this treatment there is no fixed amount of the drug re- duced each day, but the patient is requested to take as little of the drug as possible, and still remain comfortable. The principal point to be observed is to build up the patient's general constitution and prepare him for the reduction previous to withdrawing his drug supply, and allow him as minimum amount of the drug as is com- pensative with health and comfort, and to withdraw the amount so gradual that it will not be noticeable to the patient. Most patients take much larger amounts of the drug they are using than is generally necessary to keep them comfortable. If a patient is taking 30 grains of morphine a day it can be reduced to at least one-half that amount, or even less the first few days, and hardly be noticed, and the patient always feels better for its re- moval. It is always a good rule to commence the first day's treatment by reducing the amount of the drug at least one-half; if you are satisfied that the patient is ab- solutely in need of more you may allow it. If he has passed the first day successfully and in comparatively a comfortable manner, the drug may be reduced as much as you think he will stand the next day, finally you will reach the minimum amount which will support him with- out distress, and this should be your starting point. Re- member, however, that you should never allow the patient to suffer for the want of the drug; on the other hand, they often imagine they want the drug when they really do not require it; in such instances a hypodermic injec- tion of water will often pacify them. After you have found the minimum amount he can stand, the reduction should be made from now on in such small amounts each day that the patient will not be able to detect the reduc- tion. As soon as you commence to reduce the drug the functions of the body, which have been chained down, 112 ALCOHOL AND DRUG HABIT will awaken to new life and activity, the appetite will usually increase, the secretions will be more profuse, the bowels will become more regular, although the patient may be somewhat restless at night. AY hat sleep he does procure will be more profound and refreshing. If he should suffer too much from insomnia, a suitable hyp- notice may be given when he awakens. The heart may become irritable, Aveak, fast or irregular, requiring a hy- podermic injection of strychnine. With this method there is no stated time promised to effect a cure ; it might require one month, or it may re- quire ten weeks ; this depends somewhat upon the physi- cal condition of the patient, which is always to be sup- ported in advance or in proportion to the amount of the drug withdrawn, always watching the condition of the appetite, bowels, kidneys and heart, and see that the skin is active with hot air and water baths, which assist the eliminative process. If the patient has weak recuperative powers, it will take longer to effect a cure than it will where the functions of the body are more active. During the reduction the patient will require a good thorough tonic and eliminative treatment. The following offers one of the best hypodermic medications to support the heart's action and nervous system : I> Strychnine nitrate J^ gr. Spartein sulp 6 gr. Aqua I oz. Mix. Sig. Inject ten minims with the amount of morphine you find necessary to support the patient ; each ten minims represents strychnine, one ninety-sixth grain, and spartein one-eighth grain. The best time to make the hypodermic injections is about fifteen minutes before meal time and just before going to bed. The stimulating effect allows the patient to eat and sleep better if given at these times, and it is absolutely necessary that he should maintain a good appetite and rest to have the treatment progressive and accomplish results. The pa- tient should also take internal treatment. The following formula has given excellent satisfaction : ALCOHOL AND DRUG HABIT 113 ty F. E. avena sativa I oz. F. E. passiflora incarnata ij4 oz. F. E. Cinchona comp 2 oz. Bromidia 1^2 oz. Spts. ammonia aromatic 2 oz. Syr. lactucarium virosa 2 oz. M. Sig. A teaspoonful every two hours while awake. To illustrate the use of this method of treatment, we will say that the patient is in the habit of taking forty grains of morphine ; we know that he can exist in per- fect comfort with twenty grains, we therefore com- mence our first day's treatment with twenty grains. If the day is passed comfortably, the next day we make a still further reduction of two grains. This reduction is made from one to two grains a day until we have reached the minimum amount which will support him comforta- bly. If this should require twelve grains we will com- mence from this amount as a starting point and from now on we will make the reduction so gradual that the pa- tient will not be aware of it. I have the following solu- tion prepared : ^ Morphine sulphate 96 gr. Aqua 1 oz. Mix. Each five minims of the above solution repre- sents one grain of morphine ; of this he receives four in- jections the first day by taking ten minims (two grains of morphine) of this solution and ten minims of the spartein and strychnine solution at about 6:45 and 11 145 a. m., and 5:45 and 9:30 p. m. He is also allowed two powders of one-half grain each triturated with ten grains of sugar of milk, to be taken if absolutely necessary be- tween the injections, allowing him to have only one powder at a time. We will now attempt to reduce the morphine one grain a day for five days. After about two weeks, under judicious management, we will find we have reduced the drug from forty to about six grains a day without much discomfort to the patient. The reduc- tions from now on will have to be made in much smaller [8J 114 ALCOHOL AND DRUG HABIT amounts. A new solution should be prepared containing one grain to every ten minims and from this solution you can commence by using twelve minims with one-half grain powders if necessary. At the end of another week the patient can be well supported by three grains., By reducing the drug in very small amounts, for about three or four weeks longer it can be gradually withdrawn al- together without the patient's knowledge. During thf last three weeks if you have not abandoned the internal powder, it is well to substitute quinine, which has a sim- ilar bitterness and cannot be detected by the patient. Of course, you will find there are many complications aris- ing from this treatment the same as there are with others, but by carefully watching the patient and with his co- operation, you can effect a cure in fully eighty-five or ninety per cent, of all cases. If the patient is weak and nervous, endeavor to build him up physically and men- tally in proportion to the amount of the drug you with- draw. Do not attempt to be in too great a hurry and cause the patient discomfort, for it is better to have the patient in a peaceful state of mind than otherwise, even if it takes longer. Complete recoveries can be made by this treatment in six weeks in many cases, while in others it will require three months. Although this treatment is condemned by enthusiastic advocates of other treatments, I believe it to be the best medication for the average patient and it is particularly advantageous in the aged and persons with low vitality. If we fail to get the full co-operation of the patient by the gradual reduction method, there is only one alternative, which is the rapid reduction method. THE RAPID REDUCTION METHODS. There are two ways generally practiced of reducing drugs rapidly; one is known as the Intermediate With- drawal Method and the other as the Radical Withdrawal Method ; both require much discipline on the part of the physician, and some distress and will power on the part of the patient, for a few days after the drug has been en- ALCOHOL AND DRUG HABIT 115 tirely abandoned. The latter can be greatly overcome, however, by appropriate medication. Both of these methods have been largely used at institutes where the patient only had a limited time to receive treatment. Many patients start on this treatment and terminate with the Immediate Withdrawal Method, as will be discussed later. INTERMEDIATE WITHDRAWAL METHOD. The drug can be reduced by this method by either hypodermic or internal medication. I prefer the internal treatment in powder form, triturating the drug with sugar of milk. . If you are treating the patient for the morphine habit, duplicate quinine for the morphine as you withdraw the latter. This will give the powder a bitter taste so that it will not be' noticed by the patient that you are using less morphine each day, and at the same time you get the tonic effect from the quinine. The amount by which the morphine is reduced each day will depend upon the amount consumed. To illus- trate, if the patient is in the habit of consuming fifteen grains of morphine in twenty-four hours, it should be prepared with sugar of milk as follows : ^ Morphine sulphate 15 gr. Sugar of milk 45 gr. Triturate and divide in as many powders as the patient wishes. He can take these powders at the same intervals as was his former custom. The next day we will make a reduction of two grains and add quinine as follows : I£ Quinine sulphate 2 gr. Morphine sulphate 13 gr. Sugar of milk 45 gr. Triturate and divide in powders as required. We will attempt to reduce the morphine two grains a day for the first five days and add two grains of quinine each day, then one grain a day for three days, then, half 116 ALCOHOL AND DRUG HABIT a grain a day for four days. After this, the drug should not be given at all, if possible. Now we commence to re- duce the quinine as we did the morphine until the patient requires none of the powders. This is the general plan of treatment by the simple reduction method, but often- times we have to deviate from this, and not reduce the drug so rapidly, also giving an extra dose of morphine to allay the nervousness. But this method of treatment should be adhered to as nearly as possible, and be sure that the patient gets a smaller quantity of the drug eacn day. The tonic treatment may be kept up for some time after the powders are abandoned, but it should be taken in smaller doses each day and withdrawn alto- gether a week or two after the quinine is stopped. THE RADICAL REDUCTION METHOD. The amount of the drug is much more rapidly reduced by this method than it is by the gradual reduction or in- termediate treatments previously given. The patient is allowed the drug which he is addicted for about seven to twelve days and then it is given up altogether. The method of reduction is to reduce the drug by one-half each day. To illustrate, if the patient should take thirty- two grains of morphine each day, the second days treat- ment he receives sixteen grains, the third day eight grains, and so on until the end of the tenth day, when he receives one-sixteenth grain, then it is used no longer. From the time he is allowed less than two grains a day for about ten clays or tivo weeks, he will suffer consider- able mental and physical distress, but by successfully bridging him over this critical period by the use of judi- cious therapeutic measures, he will reach the crisis suc- cessfully. Aside from the hypodermic and tonic treatment he receives during the critical period, a suitable hypnotic and baths should be given to induce sleep. It might be necessary to confine the patient to his bed for a few days and keep him in a semi-hypnotic condition, by alternating hyoscine with other suitable hypnotics. This method of ALCOHOL AND DRUG HABIT 11 7 treatment is rather a severe one and is only a modifica- tion of the Levinstein treatment. It can be used success- fully, however, in many cases where time is limited and the patient has sufficient courage and vitality to with- stand its application. It is this and similar treatments, however, which give institutes a bad reputation, as hav- ing a torture process connected with their treatment. It is best never to use this treatment wihout first ex- plaining the details of the treatment before commencing its use. Patients who have taken this treatment are not liable to give the method a very hearty commendation, which often reacts to a disadvantage to the physician's reputation. IMMEDIATE WITHDRAWAL METHOD. The Three Day Cure. A few months ago there was a Dr. Swain located in this city, who afterwards established a sanitarium in Cleveland and advertised quite extensively what was known as the "Three Day Cure." This and similar quick cure treatments used at institutes are described as the "Immediate Withdrawal Method," which is approximate- ly the treatment I wish to outline here. This treatment can be adopted to a good advantage in the young, vigor- ous, and in new cases. The patient is prepared for this treatment the same as for other treatments, by giving hot air and water baths a few days. Before commencing the treatment remove all foreign matter from the bowels by cathartic remedies ; the kidneys should also have dieuretic treatment. In the meantime the drug should be reduced to a minimum. After giving these prelim- inary measures the attention they require and the day comes to commence the treatment proper, the patient is requested to abstain from the use of the drug to which he is addicted until he can ho longer resist the craving. Then he may be given a hypodermic injection of five minims of the following formula : s 118 ALCOHOD AND DRUG HABIT HYPODERMIC MEDICATION. Formula No. i. .,; I> Hyoscine hydrobromate. . . J4 gr. Tincture rhus tox , . . 5 min. . Tincture apis mellifica 5 min. Solution boracic acid (2 per cent) .... 1 oz. Mix. Sig. Use hypodermically. Maximum dose ten minims, minimum dose five minims; use according to the directions' which follow : At the end of fifteen minutes, give him five minims more, and in a half hour he can take ten minims more. The patient will now tell you that his throat is very dry, and he will fall asleep ; his sleep will probably last four or five hours. If he' should become sleepy after the sec- ond dose, five minims will be sufficient for the last injec- tion. When the patient awakens he will complain of being dizzy; his pupils will be dilated and his face flushed. If he has been asleep four or five hours, he should have another injection of ten. minims. By this time he is getting the characteristic physio- logical effects of the hyoscine. He will imagine and do all sorts of things. He may cry, sing or imagine he sees funny people; he will pick at the bed clothes, etc. This should not cause you to be alarmed, as all these symp- toms are due to the denarcotizing effects of the hyoscine. The patient should be given hypodermic injections at in- tervals of four or five hours until he has been kept in this condition for a period of twenty-four hours; then discontinue their use and allow the patient to resume his normal mind. He may ask for more of his accustomed drug or he may say that he has no desire for it what- ever. If he should still crave the drug, he should be kept under the influence of hyoscine for a period of twelve hours longer ; then stop the treatment again until he is rational. If he still has a craving, you may again pro- duce the semi-intoxicated condition with the hypodermic injections for a few hours longer, but if he states he has ALCOHOi; AND DRUG HABIT 119 no further use for the drug, and is free from the craving, you should discontinue the hypodermic injections and at once commence giving him the following: INTERNAL MEDICATION. Formula No. 2. I> Hyoscine hydrobromate . . .% gr. Strychnine nitrate . ... 1 gr. Nitro-glycerine .%. gr. F. E. avena sativa . . . . . 2 oz. Simple elixir q. s. ad. 6 oz'. Mix. One teaspoonful every four to six hours. During the time you are giving the hypodermic injec- tions, the patient may manifest a variety of symptoms. His heart action generally remains about normal, but if it should become weak, give him a hypodermic injection of 1-40 grain strychnine nitrate or 1-100 grain nitro- glycerine, if his body is cold. The patient will almost always vomit freely and feel much better afterwards. He may also have fetid breath, dry tongue and free saliva- tion. None of these symptoms should cause you alarm. Respiration may be accelerated, but this is of little concern. If it should become labored, one-fourth or one- half grain of morphine may be given, which will give im- mediate relief without retarding the treatment. During the treatment, the patient should have all the. water he wants and nutrition should be kept up as much as pos- sible with milk or with some one of the prepared invalid foods. After the patient tells you he has no desire for his accustomed drug, he should commence taking a tea- spoonful every four hours of formula No. 2. This should be continued for a few days, according to the needs of the patient, when it should be gradually withdrawn. The most common complaint of one who has taken the opium cure is insomnia, and it is always best to omit hypnotics. If possible, try to induce sleep by having the patient take hot or cold baths, but, if it is absolutely necessary, you may give from seven to fifteen grains each of hydrate of chloral and bromide of potassium. 120 ALCOHOL AND DRUG HABIT A patient undergoing this treatment should be un- dressed and confined to his room, and have the constant attention of a nurse, who should watch the patient very closely and see that he has a hot or cold bath every day. This has a remarkable soothing effect. Allow the patient to sit up or lie down as he prefers. The bowels should move at least every other day, but, if diarrhoea should exist, it should be checked by appropriate treatment. This method of treatment may be considered rather heroic, but it is not dangerous in selected cases. The patient should never be told beforehand the effects of the treatment, but you can inform his friends if you wish. This is a very successful treatment and will produce re- markable results in curable cases, but I prefer the grad- ual reduction method when it can be applied. THE MIXED TREATMENT. It becomes necessary at times to change from one treatment to another ; this is particularly so if you do not succeed in getting the full co-operation of the patient. You might commence the gradual reduction method and find the patient is taking his drug on the sly, which, of course, detains the progress of the treatment. In such cases the immediate withdrawal of the drug and the use of hyoscine bears the same relation to the opium habit as the apomorphine does to the alcohol habit ; it rather compels them to abandon the drug. It can also be used to a good advantage in many cases, where for various rea- sons, the patient has only a limited time to complete his treatment. I have seen beautiful results from commenc- ing treatment with either the Gradual, Intermediate or Rapid Withdrawal Treatment, and when the point has been reached where the patient craves more of the drug than you are supplying him, to place him at once upon the Immediate Withdrawal Treatment and terminate the cure. While on the other ■ hand there are a few selected cases where the Immediate Withdrawal Treat- ment has been used first and the Gradual Reduction Treatment completed a cure. ALCOHOL AND DRUG HABIT 12 L GENERAL COMPLICATIONS. As I have previously stated, there can be no stereo- typed rule, treatment or medication which can be applied in all cases alike. Although you will find that there are several complications, idiosyncrasys and personal char- acteristics which may confront you and require your im- mediate attention as they present themselves during the course of any treatment you deem best suited for any par- ticular case. These complications should be readily met with proper therapeutic measures. The condition of the appetite, heart, kidneys, liver and bowels should always be watched. Endeavor to keep them in as normal state as possible. The heart may become weak and require a stimulant, of which we find strychnine, spartein or nitro- glycerin acceptable. The sudden withdrawal of morphine may cause diarrhoea, which may require the use of salol, bismuth, the sulpho-carbolates, etc. Excessive perspira- tion and night sweats may be checked with atropine.. Sickness at the stomach and hyperacidity often require the physician's attention. A morphine addict who has existed upon the drug a long time, pain will be a promi- nent symptom when the drug is withdrawn ; this may be either real or imaginary. Rest, hot air and water baths, accompanied by hypnotics, are the best means of relief. If the patient should manifest symptoms of delirium, some one of the hypnotics mentioned in the "Rest Cure" will be serviceable. The treatment of alcoholism and the drug habits in general require remedies thoroughly class- ed as a heart stimulant, nerve tonics, sedatives, recon- structives, hypnotics, etc. Elimination is the foundation of all curative measures and is well expressed by Dr. Waugh in his favorite quotation "wash up, clean out and keep clean," cannot be used in any disease to a better ad- vantage than in eliminating poisonous drugs, which have found a lodging place in the bodies of habitues for years. Every excessable source we have in promoting elim- ination should be utilized. The most important of these is hot air and water baths ; these baths have as important a relation in the treatment of alcoholism and the druo- habits as quinine does in malaria, or mercury in syphilis. 122 ALCOHOL AND DRUG HABIT Baths are the one indispensable agent in assisting nature to eliminate the poisonous elements. They should be taken at least as often as every other day from the com- mencement of the treatment and continued for several months afterwards. Baths are not only important as an eliminating process, but they will often relieve pain and induce rest and sleep when other treatments fail. When the patient has successfully completed his treatment, it is always a good plan to provide him with remedies which will stimulate the secretions of the kid- neys and liver and regulate the bowels. There are many remedies and emergency treat- ments which might be mentioned here, but every physi- cian is familiar with the therapeutic value of the drugs required, and by, carefully observing the condition of the patient during the progress of the treatment, he will be able to meet the demands of the different complications and successfully bridge him over the critical period to a successful crisis. A CURE FOR THE TOBACCO HABIT. It may seem rather unreasonable to state that the tobacco habit is one of the most difficult to conquer, but such is the case, and in order to effect a cure, the patient has to exercise his will-power to its fullest extent. In this habit we have what may be termed a mechanical as well as a physical and mental condition to overcome. Those who use tobacco are accustomed to having something in their mouth and they miss this as much or more than they do the narcotic effect of the tobacco. I once treated a patient for the tobacco habit, who used at least three ounces of fine-cut every day, and after the cure was completed, he stated that he had no desire for tobacco, but he must have something in his mouth ; he, therefore, chewed wheat. He was still keeping up this practice when' I saw him last, four years after taking the treatment. Others want gum, while cigarette, cigar and pipe smokers often like to hold a lead-pencil in their mouth. ALCOHOL AND DRUG' HABIT 123 The following formula has proved that it meets tht demands in curing the tobacco habit in hiany cases in my practice : IJ Atropine sulphate % g r - Tr. nux vomica Y dr. Tr. humulus I oz. Tr. quassia ••'••• } Y 2 - oz - Tr. gentian ....-, V ... . V/i oz. Tr. cinchona comp . , 2 oz. M. Sig. A teaspoonful every two or three hours while awake. For the chewing tobacco habit the patient should be allowed a small amount for a few days ; he should use fine-cut and use a piece no larger than a bean. This may be used every three hours for the first day ; every five hours the second day; the third day it may be used twice, and the fourth day it should be given up al- together; but every time the patient thinks he wants a chew from this time on he should take a few drops of medicine on his tongue. This will stop his craving. If the patient smokes, he should be instructed to smoke a pipe instead of cigars or cigarettes. He may have a short smoke of not more than a quarter of a pipe full at a time every three hours the first day, and every five hours the second day; twice the third day, and none the fourth day. The same plan of treatment of taking a few drops of medicine on the tongue will apply to smok- ing the same as it does for chewing. From now on he need not take a teaspoonful of the treatment every three hours, as the medicine he takes when he has a desire to use tobacco will be sufficient to cure him. The treatment should be kept up for a month or more. WHAT CONSTITUTES A CURE FOR THE AL- COHOL, MORPHINE AND OTHER HABITS. The physicians in charge of institutes or sanitariums where these habits are exclusively treated, differ greatly as to the percentage of cures, some claiming ninety-five 124 ALCOHOL AND DRUG HABIT per cent., and others as low as fifty per cent. These dif- ferent percentages of success naturally lead us to inquire what may be considered a cure. I believe that if we can succeed by proper treatment in placing a patient in a condition in which he does not require or crave any alcohol, morphine or other drug to which he is addicted, for a period of six months, he may be considered cured, and, if he has any strength of char- acter, he can let it alone from that time on. There are always periods after a patient has taken treatment when he has a feeling of loneliness or absent-mindedness steal over him. This cannot be termed a craving, but he can- not help realizing the delightful sensations that were present when he was full of his once accustomed poison. It is therefore many times beneficial to give a good tonic preparation after the regular treatment is abandoned and to tell him that if he should ever have a desire for his liquor or drug to take this preparation for a day or so. This in many cases will carry him through. Patients of this kind should have their minds oc- cupied either with work, amusement, travel or change of scene, or some other diversion. If we consider a term of six months a sufficient length of time to pronounce' a case cured, the percentage of cures will be much larger than they would if we accept only those cases which are permanently cured. Of the first fourteen cases I treated for alcoholism, the first to relapse was at seven months. From this time up to two years, eight went back to their former habits, one died six months after taking treatment, of pneumonia. Some of these eight took the treatment again, however, and did not drink again for many months. The last time I heard from the remaining five, they were still total abstainers. I have had occasion to note patients who have taken the Keeley and other treatments, and I found that the per- centage of cures are about the same. Owing to the lack of association, I oelieve that the percentage of cures in drug habits is greater. We will always notice that those who drink alcohol want associates, while those who in- dulge in drugs want secretiveness. ALCOHOL AND DRUG HABIT 125 Even if the percentage of permanent cures may be considered small, this treatment has been instrumental in doing more good than any other temperance cause ever instituted. If its only field of importance were to make homes happy for a period of six months or a year, it would be a worthy practice, but we find, on the other hand, a certain percentage of permanent cures, which bring with them new manhood and happy families. In the foregoing pages I have endeavored to give the details of the different methods of treatment generally used at gold cure institutes, private sanitariums and in private practice. Although the treatment may vary in many instances it is practically all founded upon the methods already outlined. There have been several other methods and secret systems used which have come under my observation, and in order that the physician may broaden his knowledge as much as possible upon the sub- ject, I will append the formulae and details of several of these secret and non-secret systems. LEVINSTEIN'S METHOD OF SUDDEN WITH- DRAWAL. This method is also often spoken of as the English Method, due to its first being introduced in England by the above author. This treatment consists of placing the patient in a padded cell and suddenly withdrawing all morphine. He is constantly watched by a medical attendant and provided with stimulants or other medica- tion he may require to meet the emergencies as they pre- sent themselves. The patient raves and fights until he is often in a state of collapse ; at the end of from four to six days his struggle is over, and with appropriate tonic treatment he reaches a successful crisis. This barbarous treatment needs no mention other than its condemnation, as it requires an extra amount of courage for both physician and patient, although it is successful in many cases. There have been many sudden deaths, and the mortality is much greater than the use of other treatments. 126 ALCOHOL AND DRUG HABIT DR. MATTISON'S TREATMENT FOR MORPHINISM. In opposition to the English method, Dr. Mattison, of Brooklyn, has published what he calls the American Method, which is an intervening method of treatment. from the cruel method of sudden withdrawal without supporting the nervous system, as practiced by Levin- stein and avoids the long delay of reaching the crisis by the use of the gradual reduction method. The treatment used by this noted specialist, in brief, is as follows: The morphine is gradually reduced in from ten to twelve days.,' and as the reduction is taking place the nervous system is supported with increasing doses of bromides. The bromide of sodium is preferred, as it is attended with the least cutanious eruption and is more agreeable and ac- ceptable by the stomach. The sodium is administered twice a day, at ten a. m. and ten p. m. To illustrate, the patient states he generally uses about thirty grains of morphine each day; we find this about one-third more of the drug than is necessary 1 1 support him comfortably. We therefore commence the first day's treatment with twenty grains of morphine ; from now on we reduce two or more grains a day until at the end of ten days the drug is entirely withdrawn. To support the nervous system and produce sedation the bromide of sodium is given in increasing doses, as the morphine is withdrawn. The first day the morphine is reduced three grains and the patient receives ten grains of the bromide of sodium twice daily; the next day the morphine is likewise reduced and the sodium increased to twenty grains tAvice a day; the third day another reduc- tion is made with the morphine, and the patient receives thirty grains of the sodium each morning and evening, thus the decrease of morphine and the increase of sodium is kept up until the morphine is entirely withdrawn and the patient is taking the maximum dose of sodium bro- mide, which might reach to seventy-five or one hundred grains daily. The object of this treatment is to produce sedation and conquer all nervous manifestations by large doses of the bromide. ALCOHOL AND DRUG HABIT 127 The length of time required to carry out this treat- ment and the amount of morphine reduced each day and the quantity of bromide required to produce sedation, will depend largely upon the condition of the patient and the judgment of the physician. The patient should not have any stated amount of the bromide, but sufficient to pro- duce complete sedation at all times. After the patient has taken this treatment a few days, he will appear to be drowsy and want to sleep ; he may also manifest symp- toms due to the increased amount of bromides he has taken, i. e., acna, feated breath, etc. All these symptoms may be absent if the bromide of sodium causes an in- creased action of the kidneys, as it often does. After the patient takes his last dose of morphine he may require a few injections of codeine to carry, him through the critical stage. Insomnia is often present and is treated with trional. For pain and restlessness he gives large doses of fluid extract cannabis indica (P., D. & C), thirty to forty minims. Dr. Mattison has devoted many years of his life as a specialist in drug addictions and has been remarkably successful with this method, of which he is the originator. TRIUMPH FORMULAE FOR LIQUOR, MOR- PHINE, COCAINE, CHLORAL AND TOBACCO. Two years ago a gentleman representing a concern from Knoxville, Tenm, canvassed this state, selling the formulae and "system" of the Triumph Cure, for liquor, morphine, cocaine, chloral and tobacco habits. The price charged for the system was from $10.00 up, accord- ing to territorial right; the purchaser pledging himself under a $500.00 contract never to disclose the secrets. This is a fair example of the many things which are of- fered the medical profession, although this system is above the average in merit. I have used some of the formulae with good results, and will give a verbatim copy of the original, which was bought for ten dollars by a physician residing in Indiana. 128 ALCOHOL AND DRUG HABIT WHISKY TREATMENT. Drunkenness is now recognized as a disease. Since it is a disease of the nervous system, or pathological condi- tion which disturbs the mental equilibrium, or as it were, a defect in the will power, termed dipsomania. Being convinced, therefore, that we have a disease of a specific nature to deal with, we must set out to find a specific treatment, using such therapeutic re-agents as will main- tain or bring back the nervous system to its original physiological equilibrium, or normal condition of will- power. This may be accomplished by improving the patient's general tone, by stimulating and strengthening his nervous system and by surrounding him with good moral influences. It has been proved that strychnine is a specific remedy, as it is the most powerful and valuable neurotic which we possess. Atropine has a specific ac- tion in decreasing the appetite for alcohol ; hence, a com- bination of the two remedies with others gives us as nearly a specific as can be wished for. I would advise that you get the full confidence and consent of the pa- tient before commencing treatment and have him stop all work and worry for the first few days. This should always be the case with morphia, cocaine, chloral or cigarette habits. If you follow this rule, you will cure every case. If you do not, your percentage of cures will be smaller. If a patient stubbornly presists in drinking liquor, give him a full drink of whisky, and immediately follow it with apomorphia. This will soon nauseate him so that he will not attempt a repetition while under treat- ment, and he will be fully convinced of the fact that his disgust for the taste or even the smell of liquor is due to the whisky and not to the apomorphia which he has taken. Then push the treatment to its fullest extent, even to the point of toxic effect. The maximum dose must be reached gradually until the drug effect becomes manifest, then gradually de- creased. Should any antidote be needed, give chloral hydrate. It is necessary to use considerable judgment with some patients, as they have physiological idiosyncrasies ALCOHOL AND DRUG HABIT 129 regarding the drug employed. With all patients, es- pecially those who are weak, nervous or worn out, begin the treatment cautiously, with two-thirds of a dose. Pro- long the treatment and do not be in too great a hurry. In all cases it is necessary to give an internal medicine as tonic. When the patient refuses liquor it is well to dis- continue the atropine entirely and substitute picrotoxine, and if perspiration should be copious, discontinue this also. Have all your patients take a warm bath every two or three days, and keep the liver acting and bowels open with calomel in combination with ipecac and soda. If you follow the above treatment and use discretion when needed, studying each individual case, you will meet with no disaster, nor fail to perfect a cure. You may give the patient all the whisky he wishes, having him drink in your presence, but I would not advise it. Stop them immediately, or in a day or two, at most. This can be done by moral persuasion and encouragement. The diet should consist largely of vegetables and fruits. Directions for compounding these medicines and for using them successfully are found on the following pages, classified under their respective diseases. HYPODERMIC INJECTIONS. This is a certified copy of the original formula No. 10041 registered with Sharp & Dohme, pharmacists, of Baltimore, Md,. from whom it may be ordered, at fifty cents a pint. I? Strychnine 85-100 gr. Atropine sulph 40-100 gr. Acid boracic 10 gr. Hydrastis canadensis 10 drops. Aqua destillata q. s. ad. 1 oz. Mix. Sig. According to directions as below. Then I have four empty two-drachm vials, corked; upon one cork I mark No. 1, in ink, and upon another cork I mark No. 2, and so on to 4. Then I put 100 drops of the original formula No. 10041 in each of the four two- [9] 130 ALCOHOL AND DRUG HABIT drachm vials. Understand, now, all four vials arc like the original formula. Yial Xo. I leave as the original formula, without adding any tablets of strychnine nitrate as it is the weakest proportion used. Vials Xos. 2, 3 and 4 I will make each so many points stronger than the other, as shown below : To vial Xo. 2 I add 5 1-40 gr.- tablets of strychnia nitrate. To vial X'o. 3 I add 10 1-40 gr. tablets of strychnia nitrate, To vial X'o. 4 I add 20 1-40 gr. tablets of strychnia nitrate. Five drops is a dose from any of the vials Xos. 1 to 4. Give this hypodermically or by the mouth at 8 a. m., 12 m., 4 p. m., 8 p. m. Always commence hypodermic injection 'with one dose from vial X'o. 1 ; then one dose of vial X'o. 3 ; then one dose of vial X^o. 2; then one close of vial X~o. 1, skip- ping backward and forward this Avay. If you need a stronger dose, work in vial Xo. 4 in the same manner as stated above. Use picrotoxin 1-40 grain, by adding to a dose from any of the vials (1 to 4) hypodermically or by the mouth, enough to make the patient sweat the poison out of the system and to bring- back the natural color. If you want to treat a patient entirely by the mouth, instead of treating him hypodermically, use vial X T o. 3 through the whole course of treatment ; use the same sized dose, with alcoholic tonic, as if you were treating hypodermically ; and you should know the patient gets the medicine regularly to make a cure. I advise you in all cases to treat hypodermically if possible ; then you know that the patient gets the medicine regularly, and you are sure of success. Don't expect physiological effect before five or six days, viz., twitching of muscles, dryness of mouth, etc., and as soon as you get the toxic effect, go back to vial No. 1 and stay after it is obtained. You may now hold the effect with the weakest vial, No. 1. As the least medicine given to any patient is always the best, give always the smallest dose that will produce the desired effect. After you have reached the maximum dose vou may decrease the amount and still hold the physiological ALCOHOL AND DRUG HABIT 131 effect, which is best. Then the fourth clay always ask your patients if they still want whisky or beer. Of course some of them will say yes. Don't be alarmed at this. Then tell them you don't see how it is, as you are sure the medicine is taking effect, or is about to, at any rate, as now is the time to make it take effect, etc. As the patient has entire confidence in you by this time, since he is feeling so much better, eating and sleeping well, and the thirst and desire is leaving him, tell him you want to see him drink in your presence. This may be done on the fourth day after you have commenced treating the patient ; then tell him to go and get some whisky or beer, as you don't want to furnish it to him, for he would say you had "drugged" it ' and would lose con- fidence in you. In this way he sees you had no chance to touch the whisky or beer, and he is perfectly satisfied you have not tampered with either. This must be done at one of the regular times of the hypodermics % Then, in place of giving the regular dose, skip one and give instead i-io grain of apomorphia immediately after he has taken the whisky or beer. Of course, you know the result. Repeat this once or twice a day, until whisky is disgusting to him in sight, smell or taste. Then keep up the regular treatment three weeks, or longer if the case should demand it. Never increase the size of the hypodermic or dose. If you want a stronger dose, go from vial to vial, as you see each vial is marked so many points stronger than the other, as tabulated. Cases of delirium tremens are best treated by giving hypodermic from vial No. I, and by adding to each injection 1-250 grain of hydrobromate of hyoscyamine. By using the drug in this way you see that there can be no bad re- sults obtained, as by using morphine to quiet the patient, to make him sleep, and taking the chances of adding to the whisky or beer habit the morphine desire. Keep the dispensing vials clean, rinsing them well before refilling, being careful not to inject sediment or deposit in solution in the arm, as it will produce an ab- cess. All air must be excluded from the syringe before injecting. Wipe off the needle after using on one patient and before using on another. 132 ALCOHOL AND DRUG HABIT As a tonic for whisky patients I use a private formula which you will find below, No. 10043, registered with Sharp & Dohme, Pharmacists , Baltimore, Md., from whom it may be ordered at $3.25 per gal. : ALCOHOLIC TONIC. R Acid muriatic, C. P. free 2048 gr. Powdered phosphate of lime 768 gr. Powdered phosphate magnesia 1024 gr. Fl. ext. hydrastis canadensis 256 gr. Powdered quinine muriate 256 gr. Crystal strychnine nitrate io}4 g r - Fl. ext. Pulsatilla .- 255 gr. Simple syrup q. s. ad 1 gal. Mix. Sig. As directed below. Teaspoonful every four hours in a little water, and taken between hypodermic injections or doses. In case this tonic cannot be had, you will find a good substitute in Phillips' Phospho-Muriate of Quinine Compound, ad- ministered as above. This is considered by all physicians the best tonic. It is sold by druggists. Ours is better and less expensive. Compare the formulae and prices. This is given at 6 a. m., 10 a. m., 2 p. m., 6 p. m. and 10 p. m., when the patient is up at the first and last hour. After stopping the use of hypodermics it is necessary to give the tonic twice a day for a week or so, with one tablet of 1-60 grain of strychnine nitrate added to every teaspoonful contained in the bottle. A FEW WORDS OF CAUTION. Examine each case thoroughly before treatment, es- pecially the action of the heart and the nervous system, that you may note with benefit to yourself the changes that will be produced by the action of the remedies used. Question patients particularly as to why they drink ; whether from the love or the taste of whisky or beer or the effect produced. If a patient drinks from love of the taste of whisky or beer, vou need not hesitate to take ALCOHOL AND DRUG HABIT 133 him and guarantee a cure, for you can make the taste or smell of whisky or beer disgusting- to him, and he will not drink it again when the fascinating taste is gone. This is accomplished by giving the treatment with one dose of apomorphia. If the patient drinks for the effect of whisky or beer, don't fail to give hypodermic of apo- morphia on the fourth day, just after giving him a drink of whisky or beer in your presence, repeating the dose once or twice a day until whisky or beer becomes nause- ating to him in sight, smell and taste. If the patient who drinks for the love of whisky or beer persists in drinking, or it is difficult to turn him against it, give apo- morphia in manner as stated above until you do obtain the desired results. \~ MORPHINE, OPIUM, LAUDANUM, COCAINE AND CHLORAL TREATMENT. The most perfect antidote for these poisons is per- manganate of potash. For all cases give one injection of the antidote, and let one grain of permanganate of potash be the maximum dose to be given at the beginning of treatment, hypodermically. It matters not what amount of morphine taken in 24 hours. If they take less than one grain of morphine in 24 hours let the dose of the perman- ganate of potash be governed accordingly. Usually you can get your patient off morphine at once by the addition of 1-200 grain of hydrobromate of hyoscyamine to the hypodermic injection from vials No. 1 to 4. Use in the same way as in whisky cases, whatever strength you deem sufficient. Don't give the hydrobromate of hyoscyamine oftener than is necessary to control the patient, viz., Nos. 1 to 4, given every four hours and continued from one to five weeks or longer as the case demands. The tonic I use for the above mentioned diseases is No. 10042, which you will find below. Then I have two four-ounce bottles filled with the tonic. To one bottle add about three-fourths the amount of morphine taken by the patient each day. You must multiply three- 134 ALCOHOL AND DRUG HABIT fourths of the morphine taken by the patient for one day by eight, as four-ounce bottle, Xo. 2, has thirty-two doses ; four doses per day will last eight days. This bot- tle we mark Xo. 2; the other bottle, without the mor- phine, as No. 1. Have the patient take a teaspoonful out of the bottle with morphine. No. 2, four times a day, adding to this bottle with morphine, viz., X^o. 2, a tea- spoonful from the bottle without morphine, No. I, after each dose taken. These doses are to be taken betw r een the hypodermic injections. By treating this way you see bottle Xo. 2 will last sixteen days. The patient has been taken off morphine in this way so easily and quickly that he is not aware of it, and you can hold him. After taking these two bottles, continue the hypodermic injec- tion three Aveeks or longer, as in whisky cases, and also the tonic from private formula X"o. 10042, which you will find below, without adding any morphine, registered with Sharp & Dohme, Pharmacists, Baltimore, Md., who sell it at $4.00 per gallon : MORPHINE, OPIUM, LAUDANUM, COCAINE AND CHLORAL TONIC. Ty Powd. red cinchona 1 lb. Podw. hydrastis canadensis y 2 lb. Powd. Pulsatilla ]/ 2 lb. Powd. mix vomica 2 oz. Pow T d. xanthoxylum berries 2 oz. Powd. capsicum y 2 oz. Powd. avena sativa 8 oz. Dilute alcohol. , q. s. ad. 1 gal. Mix. Sig. Teaspoonful every four hours of the above tonic. The morphine patient cannot be trusted, and you must examine him thoroughly for any morphine, opium, or hypodermic that he may have in his possession, de- manding that they be given up. An attendant should be with patients for some time and the physician with them should always be on the alert, examining the pupils ALCOHOL AND DRUG HABIT 135 of the eye constantly, for the drug will first show its effect there. If you can keep them from using morphine or opium for a week you may be certain of a cure. The bowels are at first likely to be affected, and patients may have cramps in their limbs. For this condition use 10 per cent solution veratrum album in four or five drop doses, which will greatly benefit and relieve them. You may tell them that you will reduce the quantity of the drug gradually, but do not let them know at what time you cease to give them morphine. Should these cases at anytime need something to make them sleep, give them whisky. Do not labor under any delusion that you must increase the size of the dose and the strength of the hypodermic injection, if you fail to obtain the physio- logical effects of the remedies used within a few days, and under no circumstances add any additional strychnia nitrate tablets to the doses or vials as tabulated under hypodermic injections. Increase doses by using solutions from vial to vial. CIGARETTE TREATMENT. Begin this treatment with hypodermic injections of picrotoxine in 1-40 grain dose added to one of the hypo- dermic injections from vials Nos. 1 to 4, treat in the same way as for whisky cases until copious perspiration ensues ; then have an attendant give the patient a hot sponge or steam bath, cooling him off gradually with a shower, at first warm, then cold, rubbing until dry. The cigarette habit in time will cause the user to be effected with a mental condition resembling insanity more than any of the foregoing habits. It particularly affects the will-power, and is similar to insanity, pitiable, yet harm- less. Iy Formula No. 10041 . .2 dr. Tr. cannabis indica 5 drops Mix. Sig. As directed below. Inject hypodermically from five to ten drops, from two to four times a clay, using your judgment in indi- 136 ALCOHOL AND DRUG HABIT vidualizing your case and the dose to be used, as in whisky cases ; continue treatment, however, from three to five weeks hypodermically, and the tonic, as mentioned below, for a week or ten days longer. CIGARETTE TONIC. IjS Phillips' phospho muriate of quinine compound 5 oz. Commercial avena sativa I oz. Mix. Sig. As directed below. Teaspoonful at a dose, from three to four times per day. If the patient becomes nervous you have to use the following prescription, viz. : ^ Thein Merck's) 8 gr. Acid boracic 2 gr. Aqua destillata q. s. ad. I oz. Mix. Sig. As directed below. Inject from five to ten drops hypodermically, re- peating the dose as your discretion dictates. Treat cases in the following manner: Giving injections hypo- dermically at 8 a. m., 4 p. m. and 8 p. m., giving a tonic at 6 a. m., if the patient is up at the first and last hours; then at 10 a. m., 2 p. m., 6 p. m. and 10 p. m. The cigarette habit is about the most difficult of all we have to contend with and requires from three to five weeks to perfect a cure. It is about as good a plan as any in the treatment of these cases to cut them short. If you do not adopt this plan, have them decrease the number of cigarettes each day by one-third or one-half and in four or five days you may stop them entirely. Patients will get very nervous and weak, but encourage them in every way you can. If the patient stubbornly persists in smoking, after the first nine days ,give him 1-10 grain apomorphia hypo- dermically, just after you have given him a cigarette to smoke in your presence, and keep this up until the sight, smell and taste is disgusting to him. Give this at one of the regular hours of treatment, instead of the regular hypodermic at that hour. ALCOHOL AND DRUG HABIT 137 TOBACCO TREATMENT. I£ Formula No. 10041 y 2 dr. Tr. plantago Major ^4 dr. Tr. avena sativa . . Y\ dr. Mix. Sig. As directed below. Give the patient three drops by turning the bottle on the cork and touching it to the tongue each time he feels like taking a chew or a smoke, especially a dose after each meal, asking the patient to assist you by lessening the number of chews of tobacco or cigars each day. Give the patient treatment hypodermically, in the same manner as for whisky patients, from vials Nos. 1 to 4, five drops at a dose, three times a day. In from nine to fourteen days' treatment, tobacco will be disgusting to his sight, smell and taste. Then stop the tobacco en- tirely and continue the prescription for tobacco cure by touching it to his lips or tongue when he feels like using tobacco. If necessary give alcoholic tonic No. 10043, a teaspoonful three times a day. If the patient becomes very weak and nervous for the first few days give ten per cent solution veratrum album in four and five drops at a dose. If the patient is stubborn and persists in smoking or chewing tobacco after the ninth day, give him 1-10 grain apomorphia hypodermically, just after taking a chew or smoke, in your presence, and keep this up once or twice a day until the sight, smell and taste of tobacco is disgusting to him. Give this at one of the regular hours of treatment instead of regular hypodermic at that hour. You will find many things to worry and disappoint you in the treatment of patients for these diseases, but do not lose your temper and do not get disheartened, but hang on to them as long as there is any hope of reclaiming a wreck to his friends, family and society. The foregoing treatment is the best known for dipso- mainia, morphia, cocaine, chloral, tobacco and cigarette habits that is today endorsed by the medical profession as can be verified by the experience of numerous physi- cians throughout the United States. 138 ALCOHOL AND DRUG HABIT THE KEELEY TREATMENT. A physician who was in charge of one of the Keeley Institutes and who afterwards conducted a sanitarium of his own, for the cure of alcohol, drug habits and nervous and mental diseases, published a little booklet giving the methods of treatment which he used, which he claims were identical with the methods used at the Keeley In- stitute. This booklet was sold to physicians for $25.00, and had many purchasers, and I believe the treatment he gh'es is reasonably correct, as I have met several physi- cians who had charge of similar institutes and are will- ing to vouch for its accuracy. Space will not allow me to publish the entire article, which to a certain extent would be only a repetition of Avhat has been said, but I will give the formulae of some of the preparations used, and the reader can judge for himself as to their value. HYPODERMIC SOLUTIONS. Solution "S." I> Boracic acid 4 gr. Strychnine nitrate y 2 gr. Aqua des 1 oz. Tr. cudbear. . . . q. s. color Sig. Dose five to ten minims, four times a day. Solution "A." 1^ Atrophine sulphate T / 2 gr. Boracic acid 20 gr. Aqua des 1 oz. Mix. Sig. Dose five to eight minims. Solution "A P." I> Apomorphine 4 gr. Boracic acid 20 gr. Aqua des 1 oz. Mix. Sig. Dose six to ten minims. ALCOHOL AND DRUG HABIT 139 Solution "T." I> Thein. mur 8 gr. Boracic acid 20 gr. Aqua des 1 oz. Sig. Dose five to ten minims. Solution "P." Iy Pilocarpine mur 8 gr. Boracic acid 20 gr. Aqua des '. 1 oz. Mix. Sig. Dose five to six minims. Solution "M." I£ Morphine sulph .8 gr. Aqua des T oz. Mix. Sig. Dose fifteen to thirty minims. It will be noticed that the name of the solution is an abbreviation of the active ingredient contained. To illus- trate, Solution "A" is atrophine, "S" is strychnine, etc. TREATMENT FOR ALCOHOLISM. When the patient enters the institute he is given a mixture containing the following : J$ Gold and sodium chloride 30 gr. Strychnine nitrate 4 gr. Atropine sulphate 1 gr. I Glycerine 2 oz. Fl. ext. cinchona comp q. s. ad. 16 oz. Mix. Sig. One teaspoonful in water three times a day. In addition to the internal remedy, the patient is also given hypodermic injections from the solutions that the physician deems the patient requires. The atropine solu- tion is generally pushed, until patients get the full physiological effect of the drug. The apomorphine is used when it is desired to produce the ''sickening pro- 140 ALCOHOL AND DRUG HABIT cess." You will notice that the solutions are colored conveniently for the ''barber pole shot." After the desire for liquor has been conquered the patient is given hypo- dermic injections from Solution "S," and the following internal remedies throughout the balance of the treat- ment : I£ Ext. cinchona solid 40 gr. Grd. gentian root 2 oz. Powd. capsium 20 gr. Grd. bitter orange peel y 2 oz. Glycerine 3 oz. Aqua 2 quarts. Caramel q. s. to Color. Mix the first four drugs in the water and boil twenty minutes ; remove and filter ; then add the glycerine and caramel. Sig. One teaspoonful every two hours in water. FOR ALCOHOLIC GASTRITIS. 5 Pepsin sacch 1 dr. Bismuth sub-nit I dr. Powd. capsicum 20 gr. Mix. Ft. powders XXX. Sig. A powder every three or four hours. FOR NEURASTHENIA. Iy Tr. cinchona rub 2 oz. F. E. kola 2 oz. F. E. Scutellaria 1 oz. Elix. aromatic q. s. ad. 6 oz. Mix. Sig. One teaspoonful in water four times a day. THE TOBACCO TREATMENT. 1^ F. E. calumba T /i oz. Tr. quassia ^2 oz. Alcohol y 2 oz. Aqua q. s. ad. 4 oz. ALCOHOL AND DRUG HABIT 141 The hypodermic treatment consists of injections from Solution "T" four times a day, and an occasional injection from Solution "P," or if the "sickening process" is re- quired, from Solution "A P." DR. GRAY'S TREATMENT. Dr. J. L. Gray, of Indiana, was among the first to use the so-called "Gold cure" for the alcohol habit, and his method was made publicly known through Prof. Edmond Andrews, of Chicago, who published an article on it in one of the Chicago papers. The treatment given was as follows : On entering the institute the patient was given a hypodermic injection four times a day, containing one- tenth grain of chloride of gold and sodium, and one- fortieth of a grain of nitrate of strychnine. He also re- ceived a mixture to be taken by the mouth composed as follows : ^ Chloride of gold and sodium 12 gr. Muriate of ammonium 6 gr. Nitrate of strychnine 1 gr. Atropine T /\. gr. Comp. fl. ex. of cinchona 8 oz. Fl. ex. of cocoa I oz. Glycerine 1 oz. Aqua des 1 oz. Mix. Sig. Take a teaspoonful every two hours when awake. I have used this treatment on several cases and find it is an excellent one, but do not believe that it is necessary to give such large doses of gold and sodium and strychnine, as they cause the muscles to twitch and an eruption to break out on the skin in many cases. THE ANTI-NARCOTIN CURE. Since the first edition of this publication I have re- ceived many letters from physicians wishing to sell secret formulae, of which this is an illustration : This 142 ALCOHOL AND DRUG HABIT treatment came from Dr. J. E. Clark of Hiattsville, Kan- sas, who claims it was formerly obtained from a Dr. Williamson, who was the attending physician at the Anti-Xarcotin Institute, of St. Louis, Mo. Although it offers no special advantage over other treatments already given, it illustrates the simplicity of another "great cure," for which I gave approximately $10.50. 5 Hyocine hydrobromate 1-100 gr. Pilocarpine 1-100 gr. Strychnine nitrate 1-100 gr. Atropine 1-600 gr. The above medication is given hypodermically every three hours, missing the treatment at twelve and three at night, during which time the patient generally sleeps. The directions for using, which came with the treatment are as follows : On the evening before commencing the treatment the patient should be given a full cathartic and remove all foreign substance from the bowels ; on the morning of the first day's treatment, the patient is al- lowed his usual quantity of morphine, and about two hours afterwards the above treatment is commenced and given at regular intervals. Thou sparkling bowl ; thou sparkling bowl ; Though lips of bards thj r brim ma3 r press, And eyes of beauty o'er thee roll, And songs and dance thy power confess— I will not touch thee ; for there clings A scorpion to thy side that stings. JOHN PIERPONT. HERNIA 143 THE HERNIA SPECIALIST. The treatment of hernia by the subcutaneous injection method was first practised by Joseph Pancoast, M. D., of Philadelphia, and a report of his success was published by Dr. Warren, of Boston, in 1867. Afterwards Dr. Heaton, also a Boston surgeon, proposed a radical cure for hernia, which had been successfully used by himself in a number of cases, by what he called tendinous irrita- tion. It is also stated that Dr. Heaton was assisted by Dr. Warren in perfecting his method of treatment. This method differed somewhat from that of Dr. Pancoast in points of detail and the irritant employed. Although these surgeons made some remarkable cures, they met several cases where disastrous results followed the in- jections and the system was finally abandoned and lay dormant for several years. It was afterwards revived, however, and today it is receiving the attention it justly merits. At the present time, this method of treatment is placed upon a sound therapeutical foundation. With the ad- vantages of antiseptics, and the present enlightenment upon the subject, will allow the general practitioner to treat these afflictions with a more marked degree of suc- cess than other means of surgical interfernece, and avoids the dangers which are always connected with surgical operations. \ The injection method for the radical cure of hernia has only one object in view, which is, to close the canal, and thus prevent the descent of the bowels and mem- branes. That the injection method offers many advantages superior to surgical interference, is beyond a doubt, as it is perfectly safe, and nearly free from pain. It will not detain the patient from business, and a permanent cure can be obtained in fully eighty-five per cent of all cases in which it is applicable. 144 HERNIA This method of treatment can be adopted in any case of hernia which may be reduced and retained by a suit- able truss. This is absolutely necessary to insure good lesults. There are several good trusses on the market. 1'he accompanying cuts illustrate the ones which aic most generally used. If the patient should fail to have a proper fitting truss, he should be supplied with another. The physi- cian should take the measurements and also superintend its first application. The patient should wear the truss for several days previous to the first operation to make sure that it holds the hernia perfectly. In selecting a truss, the following rules are to be observed: Never ac- cept a truss until you get one which fits properly ; try it by putting it on and stooping down and rising up sud- denly; cough violently and persistently; separate the limbs when sitting down and go through various mo- tions. Of course the truss is not a proper fitting one if it allows the hernia to slip while going through these experiments. HERNIA 145 In wearing a truss, the following precautions must always be taken : Never take off a truss unless you are in a recumbent position ; rub the parts thoroughly when putting the truss on.. .The truss should be removed the last thing before retiring, and put on the first thing in the morning. In many cases, it is best to wear the truss Testing the Truss. night and day while you are giving the treatment. After you are satisfied that the truss is a perfect fit, and it has been thoroughly tested, the patient is ready for treat- ment. THE INJECTION FLUID. This is a very important thing to be considered, and should consist of such remedies as will create a mild irritation without excessive inflammation, and throw out sufficient plastic and adhesive material to unite the parts, and close the canal. Since the discovery of the injection method of treat- ing hernia, many remedies have been tried with a view of accomplishing this result. Dr. Pancoast commenced the treatment by injecting tincture of iodine and cantharides. This was followed by Heaton and Warren, by the use [10] 146 HKRNIA of quercus alba, which is one of the principal drugs in use at the present time. The following formula is an excellent one and was sold to an Ohio physician with the exclusive right of use for that state for eighteen hundred dollars. This offers us another illustration, of what can be done by the professional promotor, who has a secret system and territorial rights for sale. EXCELSIOR HERNIA FLUID. I> Zinc sulphate 10 gr. Carbolic acid 6 min. Guaiacol (pure) 15 min. Thuja (Lloyd's specific tinct.) 1 dr. F. E. quercus alba (P. D. & Co.) ... 2 dr. Oil of cinnamon 2 min. Glycerine 2 dr. Aqua q. s. ad. 1 oz. Mix. Dissolve the sulphate of zinc in the water, add the glycerine, carbolic acid, oil of cinnamon and guaiacol, then, when thoroughly mixed, add the other drugs. This should stand for a few days and be shaken frequently and finely filtered through absorbent cotton. In resuming the therapeutic effects of this formula, we have a mild astringent antiseptic and an irritant which will abstract from the surrounding tissues sufficient plastic material to unite the walls and close the inguinal canal. DIRECTIONS FOR USING THE FLUID. After you are satisfied that the patient has a well- fitting truss and one that will hold the rupture under all circumstances, you may commence treatment with every assurance of success, but if the truss allows the hernia to protrude occasionally, you cannot expect to receive the results from the treatment which you otherwise would. This is a very important thing to be observed, for after the treatment has been commenced, the hernia should never be allowed to descend, even if the patient has to wear the truss day and night. HERNIA 147 The injections should be made when the patient is in a reclining position. The parts should be thoroughly washed with some antiseptic solution. The needle and syringe should also be clean and aseptic. The best place to make the injection is on a surgical chair or table, with the head slightly lowered so that the bowels will have a tendency to gravitate away from the canal. The hypo- dermic needle for this work should be a little longer than the ordinary needle. A hypodermic syringe with a glass cylinder is all that is required. After drawing the fluid The above illustrates the method of making the injections. into the syringe, the needle should be pointed upward and sufficient pressure made to force all the air out of the syringe. The set screw on the piston should be ad- justed to regulate the amount of fluid used at each injec- tion, which will vary from two to ten or more minims. I generally commence by using two minims and increase each injection as the case requires. After the patient has been prepared for the operation, the operator,, if right handed, should take a position at the left side of the pa- tient, and with the fore finger of the left hand, invaginate- the canal to the point of the internal opening. He should now grasp the integument with the finger in the canal and the thumb on the external surface, and elevate the tissues somewhat. This draws the tissues away from the cord and avoids any danger of puncturing the contents. The needle should now be passed through the tissues directly over the end of the inside finder until it has reached the 148 HERNIA canal. The canal can be determined by the inside finger, which only has the covering of the thin scrotal wall. You can generally determine when you have entered the canal as the needle meets with little or no resistance and can be moved around quite freely. The fluid should now be in- jected slowly and deposited at several different places at the highest points of the opening. You should always avoid making the injection too low in the canal, for if it should close the canal too low down, it will prevent in- vagination and the application of the treatment at the point it is required. After the needle has been with- drawn, the point of injection should be gently massaged. This will have a tendency to scatter the fluid and cause it to cover a greater area. The truss may now be re- placed, which gives constant pressure on the parts and the patient allowed to go about his business. The treatment will cause him but little annoyance. The parts treated will have a somewhat uneasy feeling, which is due to the mild inflammatory action the injec- tion has caused. This will subside in a few days, when the treatment should be repeated. The succeeding treat- ment should not be applied until the soreness from the last treatment has abated. I commence the treatment by injecting one or two minims and request the patient to call at the office in a few days, or as soon as the soreness leaves. At the next treatment the injection is increased one or two minims. I always govern the amount of the injection by the condition of the patient. The injection should never be made as long as there is any inflam- matory action existing. As soon as you have determined the amount of fluid each case requires to produce the de- sired amount of irritation, the following treatments may «be given in the required amounts, which will vary from three to ten minims. The average dose, however, will be four or five minims. The length of time required to effect a cure depends upon the condition of the patient and the size of the open- ing. Young and vigorous patients, whose tissues are firm, can be cured more rapidly than older people whose tissues are flabbv and relaxed. HERNIA 149 After the patient has had several injections, you may make a test to find out if the treatment has been success- ful. This test should be made in your presence. The patient should first be in the recumbent position and be instructed to cough. If the hernia has a tendency to come down, the treatment should be continued, but if sufficient adhesions have taken place to retain the bowels, the patient may try the same experiment by standing up, hand over the parts where the injections were made when he was testing the truss. The physician should place his hand over the parts where the injections were made when he is testing the results of his treatment, for if there should still be a weakness, the physician can detect the vibration. If you are satisfied that the cure has been complete, the patient should be instructed to wear the truss for another month or so and another test made. If all is well, the patient can remove the truss unless he is a laboring man and does heavy lifting. If such is the case, it is well that he should wear the truss for a while when engaged at such work, but finally it may be given up altogether. Physicians have been rather timid in applying this method of treatment for fear they would produce some of the bad results that were formerly witnessed before the days of antiseptic surgery, but I wish to state that this method of treatment is perfecly safe, if a reasonable amount of skill is exercised in carrying out the details of the operation. I have never seen a case of peritonitis, orchitis, abscess or injury to the cord occur. If the in- flammation should be a little more extensive than you expected, it is due to the use of too much of the fluid. This will subside, however, in a few days, and may be treated the same as inflammations elsewhere, but rest for a day or two is generally all that is required. DR. LANGDON'S OPERATION. Dr. R. K. Langdon of Nebraska has devised a new method of making injections within the inquinal canal with which he claims originality and greater success than 150 HERNIA by injecting fluids through the external surface, as des- cribed in the foregoing pages. With his method the scrotum is invaginated within the canal and the fluid deposited through the walls of the scrotum in order to guide the course of the needle. He has had a special instrument devised, which clasps on the little finger by means of two adjustable flanges or bands; as you pass the finger up the canal you can guide the course of the needle to any point desired (see cut). The needle has a blind point with openings on each side about four lines from the point. DR. LANGPON'S NEEDLE AND CANULA. In making injections the scrotum is invaginated and the point of the canula is directed to the point where you wish to deposit the fluid. The needle is now introduced through the canula into the canal or ring, and the fluid deposited. It is claimed that this method has the ad- vantage of always depositing the fluid into the canal, and not in the adjacent tissues as often occurs with the ex- ternal method. If desired the complete canal may be obliterated by depositing the fluid along the track as you withdraw the needle. The internal opening should al- ways be closed first, however. By closing the external canal you will not be allowed access to the internal open- ing, which is the most important point. Although Dr. Langdon met with many failures when he first adopted this method, he later reports no failures by using this method constantly for five years, and he firmly believes today that with very few exceptions, he HERNIA 151 can cure every case regardless of age when the tissues are not too thin from the long use of a truss. He also states that he has used almost every known method and at least one hundred different ingredients and combina- tions. He prefers for a child up to nine years of age, fluid extract quercus-alba boiled down in a test tube tu one-half, of which two to ten minims are injected. Al- ways commencing with the minimum amount and in- creasing if necessary. The injections are made once a week for five or six weeks. For cases from nine to Dr. L,angdon's Hernia Set, in Case. — Contains one Special Hypodermic Syringe for treating hernia ; an Aspirating Needle, Hypodermic Needle, a Flex- ible Silver Probe-pointed Needle, a Hemorrhoid Needle with screw slide, two Vials, one Cauula with adjustable metal flange, etc. twenty years of age, he uses quercus alba in combination with zinc sulphate. The fluid extract quercus alba is reduced by heat in a test tube to about four-tenths, and to each minim used, he adds one-tenth grain of zinc sul- phate. Older patients from twenty-five to sixty he uses the same fluid he does for children, and to each three minims of quercus alba, he adds one-half minim of beech wood creasote. 152 HERNIA In conclusion. the Dr. says: "I have no doubt that others have just as good results with other formula, but assuredly in later years my record is almost perfect, so that today I feel confident to cure nearly every case. THE OLSTRUM METHOD. Dr. Olstrum who has devoted several years of his life to the rupture specialty, and although a very en- thusiastic advocate of the injection method, says he can cure fully fifty per cent of all cases which are curable with other methods by scarifying the surface of the canal or ring. He uses for this purpose the ordinary large hemorrhoidal needle and endeavors to scarify the open- ing so thoroughly at one treatment that he will get im- mediate union. After the surfaces of the opening have been thoroughly scarified the abraided surfaces are kept together by the pressure of the truss, union takes place immediately, and one operation is often all that is neces- sary. This operation, skillfully and painlessly performed by the use of a local anaesthetic, certainly deserves to be recognized as an advanced treatment to other radical cutting operations. It accomplishes the same results by the same process of inviting union of two abraided sur- faces and has the advantage of overcoming the fear of the knife. The patient should be kept in bed for a few days until all soreness has disappeared ; he is also in- structed to wear a truss for a few months afterwards. This method of treatment illustrates what one of the simplest operations in the category of surgery can ac- complish in curing a condition which is attended with a certain amount of danger to life, if not interfered with, and also avoiding the dangers of the radical cutting operations. I once asked the doctor if he could devise a special knife or instrument which would be better suited for the operation that the point of a hypodermic needle to scarify the surface. He remarked : "I am used to a hypodermic needle and have no desire to change it for other instru- ments." While there are manv cases in which this treat- HERNIA 153 ment cannot be applied, it will often close the doors of the canal more quickly and with greater certainty than injecting fluids and cutting operations. PARAFFIN INJECTIONS FOR HERNIA. Paraffin has been used with a greater or less degree ot success in the treatment of hernia and is frequently re- ferred to as the "supportive treatment." The paraffin is used at about the same melting point as injected for the saddle back nose, and with the regular paraffin syringe. The object of the treatment is to fill the canal with the paraffin and thus prevent the descent of the bowel. Alhough many favorable reports have been recorded, it is not as practical a way to treat hernia as the other methods already^ described. THE IDEAL HERNIA CURE. The Ideal Hernia Cure Company of St. Paul, Minn., formerly used large space in Medical Journals, offering to sell a formula for the cure of hernia, and a hypodermic syringe for $10.00. The syringe was of the regular $1.50 variety, and this places the value of the formula at 58.50. The following is the formula they sold : ^ Glycerole of tannic acid (90 gr. to the oz 1 ) ... 2 dr. Alcohol , 1 dr. Tinct. cantharides . . 1 dr. Mix. Sig. Five to fifteen drops should be injected at each treatment. The patient must remain in bed at absolute rest two days after each treatment. HEATON'S FLUID. This is one of the oldest fluids in use and the original way of preparing it is as follows : IJ F. Ex. quercus alba (Thayer's prepared in vacuo) ]/ 2 oz. Alcoholic solid Ex. quercus alba 14 gr. Morphine ^4 gr. 154 HERNIA Mix. Triturate with the aid of gentle heat for a long time in a mortar until the solution is as perfect as pos- sible. It is well not to exceed this amount of the solid extract, else the mixture will be too irritating. Dr. Heaton usually prepared a quantity of this mixture sufficient for a six month's supply, and was very cautious in using it at first, adding a little more of the solid or fluid extract, ac- cordingly as he observed that it produced too little or too great an effect. The amount of this fluid used at each operation is about ten minims. DR. FIELD'S FLUID. T£ Zinc sulphate 15 gr. Alcohol 2 dr. Acid carbolic 30 gr. Aqua q. s. ad. 1 oz. Mix. Inject from five to ten drops at each operation. DR. PROVOST'S FLUID. I> Guaiacol 30 min. Zinc sulpho-carbolate 10 gr. Creasote beechwood 30 min. Tannin-glycerite q. s. ad. 1 oz. Mix. Reduce from ten to fifty per cent, with alcohol, and inject four or five drops, which can gradually be in- creased as the case requires. DR. SAUNDER'S FLUID. IJ Zinc sulphate 2 gr. Creasote 2 min. Guaiacol 2 min. F. E. hamamelis 30 min. Glycerine 30 min. Mix. Inject two to four minims. HERNIA 155 DR. WALLING'S FLUID. This fluid is sold at $2.50 for a two-drachm vial. He publishes the following formula, which is so complicated that it would require further instructions to properly pre- pare it : If Complex salts of aldehyde 30 per cent Iodo-ethylate of guaiacol 30 per cent Sulpho-tannate of zinc 20 per cent. Free guaiacol 5 per cent. Beechwood creasote 15 per cent. The above formula is a fair example of many of the so- called non-secret remedies (?) which are offered physi- cians with every intention to deceive them. THE FIDELITY FLUID. The following formula has been published as the exact formula of the fluid used by this company : If Carbolic acid 95 per cent. Glycerine Alcohol a. a. p. e. Tinct. iodine. q. s. color. THE MILLER TREATMENT FOR HERNIA. This company used both the hypodermic method of treatment and an external astringent. The injection fluid was the same as that proposed by Dr. Hearon. The external astringent, which was to be applied by the patient, was as follows : If Tinct. iodine comp Soap liniment a. a. p. e. 156 GENITOURINARY THE GENITO-URINARY SPECIALIST. Before giving the treatment for Genito-Urinary and female diseases I wish to direct your attention to two instruments, for making local applications, which are indispensable to any physician who treats these affec- tions. Applications to the urethra and inter-uterine cav- UNIVERSAL APPLICATORS WITH ATTACHMENTS. For Applying Liquid Treatments and Medicated Bougies to the Urethal and Intra-Uteriue Surfaces, also Medicated Gauze, etc. ity can be made in either liquid or solid form. Most phy- sicians prefer the liquid applications as they are more easily applied, but often-times the solid applications are preferable. With this end in view it has become neces- sary to devise the two instruments illustrated here. The first is known as the Universal Applicator and is designed from what was formerly known as Woods' gause packer. This instrument has such a wide range of usefulness, that its name scarcely describes it. It may be used to apply treatment in powder or bougie form to any cavity or canal and is equally useful in applying treat- GENITOURINARY 157 ment to the nose and throat, rectum, male or female urethra or the intra-uterine surface. It offers a means of applying treatment to the, pros- tatic and other parts of the male urethra, and well nils the capacity of a catheter, or it may be used to give a re- current douche to the bladder or the intra-uterine sur- face. It may also be used as a gauze packer, to apply antiseptic dressings or to check hemorrhage in the nose or the uterus. In fact its scope of adaptability is greater than that of any instrument I have any knowledge of, as the illustration will demonstrate. The second is called the Intra-uterine Applicator, but it is also indispensable in making liquid applications at any part of the urethral or other surfaces. DISEASES OF THE PROSTRATE GLAND. Enlargement and hyperesthesia of the prostate gland are extremely common affections and our best authors have asserted that fully one-third of all men between the ages of thirty-five and sixty have disease or weakness of this organ. I will not attempt to give the pathology and symptoms of the different diseased conditions which exist, as they are familiar to most physicians. I wish to describe a special method of treatment, however, which has been uniformly successful as a palliative and curative treatment in a great number of cases, and will yield as good results as many surgical and electro-thera- peutic measures. In treating diseases of glandular organs the process of cure is naturally slow. This is especially so with the prostate gland ,the location of which is so relatively in- fluenced by external and internal disturbing elements as to render an impediment in restoring the diseased organ to the normal. Its anatomical situation is such that bicycle or horse- back riding or sitting in cold, damp places exposes it to external detrimental influences, while inflammatory con- ditions of the bladder, hyperacidity of the urine and ex- cessive sexual indulgence deter the process of cure. 158 GENITOURINARY The treatment for enlarged prostate should consist of both local and internal medication. The internal treatment should consist of such remedies as will render the urine somewhat alkaline, allay Yesical irritability and also have a special effect in controlling the vascular sup- ply to the prostate. For such conditions saw palmetto, The above cuts illustrate the method of making Ijquid or Bougie Applications to the Urethral Tract. buchu, triticum repens, pichi, oil of sandal-wood, uva ursi and eucalyptus may be used with good results. The following in tablet form has been particularly service- able in my hands. Each tablet contains : 5 Boracic acid 2 gr. Potassium bicarb 2 gr. Ext. buchu i gr. Ext. triticum I gr. Ext. corn silk ^ gr. Ext. hydrangea ^ gr. Atropine sul 1-500 gr. Sig. A tablet six times a day. A combination of bromide of potassium, ergot and tincture of gelsemium may be indicated if there is an in- creased vascular supply and hyperactivity of the sexual system. Local treatment can be applied to the prostatic part of the urethra, either in liquid form or by medicated bougies with the instrument previously described. The following medication either way once a week will often prove very gratifying to both the physician and patient : GENITOURINARY 159 I£ Eletarium 1-60 gr. Hydrastine Y\ ' gr. Cocaine 1-10 gr. Ichthyol 2 gr. The above remedies act as a sedative and anti- phlogistic and although we usually expect only palliative results, in many cases of long standing, in other patients all symptoms of hypertrophy seem to leave and the dif- ficulty of expelling the urine and clearing the urethral canal are permanently overcome. SPERMATORRHOEA. There is no other subject in medical literature which has been more misused than that of spermatorrhoea. The medical profession at large have almost ignored the sub- ject, this being perhaps due to the obnoxious literature which is supplied to the layman by the advertising physi- cian, who attempts to make a large majority of his patients believe that they are afflicted with the disease and are rapidly going into a decline. This subject has so many good talking points regarding the "sapping of vitality," etc., that any patient who has a slight discharge of mucous from the urethra when straining at stool or otherwise, is advised of the horrors of premature decay, associated with this disease. This is the state of mind which the so-called quack desires, for the more his patient broods over his imaginary spermatorrhoea, the more compensatory the case will be and the greater the praise when finally cured. The facts are that spermatorrhoea is not a very com- mon disease, but when it does exist will often require the utmost skill of the physician to effect a cure. The anaphrodisiac remedies are the most popular routine methods of treatment. The following in tablet form taken before retiring has produced good results in de- pressing sexual excitability in many cases : I£ Sodium bromide 5 gr. Acetanilid 2 gr. Hyoscyamine 1-400 gr. Digitalin 1-400 gr. 160 GENITOURINARY As a single internal remedy for nocturnal emissions and spermatorrhoea salix nigra heads the list. It should be given in thirty-drop doses of the fluid extract before going to bed. This remedy acts like magic in many cases and should be one of the first to be considered. Direct medication to the prostatic urethra and the ejaculatory ducts when judiciously applied offers one of the best methods of treatment. The following remedies incorporated in a gelatin bougie or applied in liquid form, make an excellent application and this form of treatment has cured many cases where other treatments have failed. Each treatment contains : I£ Ichthyol 2 gr. Sulphate of zinc 54 g r - Creasote i-io gr. Fluid Hydrastis 2 gr. Ext. hyoscyamus i-io gr. Apply by the use of the applicator to the prostatic part of the urethra once or twice a week. A CURE FOR NOCTURNAL EMISSIONS. A number of mechanical appliances have been de- vised to prevent nocturnal emissions, but one of the best is called the "spermatorrhoea ring,'' which was invented by an advertising specialist. This consists of a ring SPERMATORRHOEA RING. which can be applied to the circumference of the penis when flaccid. This ring is so arranged that when an erection takes place it will inflict punishment by mod- erately pricking the organ. The device is applied to the organ before going to bed and if an erection takes place during the night it will awaken the patient. He should GENITOURINARY 161 be instructed to temporarily remove the appliance and urinate before going asleep again. This instrument has a tendency to produce such good results that it is seldom given the patient until after the advertising specialist has received large revenues from other treatments, for he knows very well if he supplies this appliance at first his remuneration will be cut short, therefore this is given as "the last resort." IMPOTENCY. It is this disease in particular which has offered both the local and mail-order specialist a Mecca to which the afflicted may journey, either in person or by letter, more than any other. The amount of money spent in adver- tising cures for "lost manhood," "premature decay," and "general debility," reaches into the millions every year. Although many local specialists have made fortunes, the mail order medical companies have taken the lead as far as financial success is concerned. One of the principal reasons why this, like all other sexual diseases, has brought them such a golden harvest is the same old story — the fear that their family physician will expose their weakness. The following formula combines six of the best known aphrodisiacs and, after thoroughly testing the merits of this combination of drugs, I can unhesitat- ingly recommend it as being a superior treatment. Each tablet contains : R Ext. damiana 2 gr. Ext. nux vomica % g r - Zinc phosphide 1-10 gr. Cannabin 1-10 gr. Cantharides 1-25 gr. Avenine 1-200 gr. GONORRHOEA AND GLEET. These are among the diseases which these specialists are most frequently called upon to treat. The cleanest and most efficient way to treat these affections is by the 162 GENITOURINARY use of a medicated urethral bougie. These bougies may be inserted by the patient where they will come in con- tact with the inflamed surface and gradually melt at the URETHRAL MEDICATED BOUGIE To be used with Universal Applicator. temperature of the body and thus offer continuous medi- cation. The following formula has always been a favorite with me. Each bougie contains : I£ Zinc sulphate J / 2 gr. Antipyrine I gr. Boric acid 2 gr. Carbolic acid % gr. Fluid hydrastis 3 gr. Morphine sulphate 1-10 gr. Insert a bougie three or four times a day after urinat- ing. THE SOLVENT METHOD OF TREATING STRIC- TURE. This is another method of treatment which originated from the irregular practitioner and is extensively used by both local and mail-order specialists. I believe that the treatment is an exceptionally good one in a large number of cases. The following drugs are to be applied to the constricted part of the urethra either in the form of a powder or emulsion : I£ Ext. hyoscyamus Yi gr. Ext. calendula 1 gr. Carica papaya 1 gr. Powd. slippery elm 5 gr. The stricture should first be dilated with a sound, which can be more easily admitted by first injecting a few drops of the fluid extract of hyoscyamus and forcing it back to the constricted part with the finger. The treatment can now be applied to the parts by the use of the applicator. GENITOURINARY 163 This treatment has received the name of solvent from the fact that the papaya has to a certain degree the power of dissolving or loosening the tissues of the stricture in very much the same way that it dissolves a diphtheric membrane. The treatment when combined with the other remedies is an excellent one and has the indorse- ment of the leading members of the medical profession, although many of them have attempted to shield the formula and sell it for a large consideration. VEGETABLE TREATMENT OF SYPHILIS. My attention was first called to the vegetable treat- ment of this disease by an article written by Dr. J. Marion Sims, which contained many astonishing asser- tions and, after using this vegetable alterative in my practice in many cases, I am convinced that the pre- scription he gave might almost be called a specific, if such a thing were possible in the treatment of the dis- ease. Although many physicians are familiar with this prescription, I think it will be of sufficient interest to give you a history of it which dates back from its dis- covery among the great medicine men of the Creek In- dians, who in early times inhabited middle Georgia. The negroes in that vi'cinity finally adopted the preparation and prepared it as given to them by the Indians. Dr. Sims' article would be too long to insert here, but Dr. B. Rush Jones, brother-in-law of Dr. Sims, gives the fol- lowing: "A few years before the civil war there were many obstinate cases of secondary syphilis around Montgom- ery, which had resisted the efforts of the best physicians. They went the round of the doctors, and could not be cured. One of these was advised to consult an obscure negro, by the name of Lawson, who worked on a cotton plantation, and after being under his treatment for a few weeks was perfectly cured. His recovery was so great an event that others applied to this same Lawson, and were also cured." Dr. G. W. McDade, hearing of these cases, took a great interest in the subject, and visited Lawson and ob- 164 GENITOURINARY tained from him the formula used so successfully. It seems that the formula had come down from a mulatto slave, by the name of Horace King, who resided among the Creek Indians for several years before they removed west of the Mississippi river (1837). and had learned while with them their method of treating syphilis. Dr. McDade says that instead of adopting the so- called Indian remedy as he found it, he began by elimin- ating those roots and herbs and inert substances which he knew were absolutely of no value. He selected the few known to possess medicinal properties, and instead of making a decoction, as had been done before, and which had to be made in large quantities every day or two, he had them prepared in the form of fluid extracts, which placed the remedy on a scientific basis and insured uniformity of action. He then gives the formula as fol- lows : ^ Fluid ext. of smilax sarsaparilla. . 16 parts, fluid ext. of stillingia sylvatica. . 16 parts. Fluid ext. of lappa minor 16 parts. Fluid ext. of phytolacca decandra.. 16 parts. Tine, of xanthoxylum carolinianium 8 parts. Dr. Sims in his article gives many cases which were treated by the negro Lawson on the plantation ; he also mentions the success Dr. McDade has had with it. Dr. B. Rush Jones, of Montgomery, who has been treating syphilis for more than 40 years, now says he has but little dread of undertaking the worst case since adopting this formula. He has repudiated mercury and iodide of potash entirely, as he says they are unnecessary when this formula is used. From the odor and general properties of this com- bination we are led to believe it identical in formula with the much advertised and secret preparation called S. S. S. The printed matter on this latter preparation, which states that it has been in use in domestic practice in cer- tain parts of middle Georgia ever since the retirement of the Creek Indians in that section of the state, does much to strengthen our belief. DISEASES OF WOMEN 165 THE GYNECOLOGICAL SPECIALIST. NON-SURGICAL TREATMENT FOR THE DIS- EASES OF WOMEN. The treatment of the diseases of women has always contributed largely towards the yearly income of the general practitioner, while the gynaecologist continues to fatten upon the revenue he receives from operations. Ovariotomies and we might add operations for appendi- citis and laparotomies in general have become an epi- demic in some localities to the extent that many sur- geons think they will be branded as being unskillful if they allow their patients to get well without operative procedures. When the fashionable period of ovariotomies and other operations wear off, and physicians learn to apply rational, therapeutic measures there will be a revo- lution in gynaecological practice. I do not wish to be understood in condemning the progress of surgery or its application in many cases, but every physician who is familiar with hospital and sanitarium practice will attest that many organs are removed which might have been restored to health by non-surgical means. Owing to the prevalence of female diseases, a large territory is also opened for proprietary remedies, and we find lady agents everywhere who are extolling the virtues of some secret remedy for the diseases peculiar to their sex. Among the most prominent preparations may be mentioned: Viavi, Mountain Rose, Neuvita, Orange Blossom, Olive Branch, etc. On the other hand we find many physicians who use preparations like Micajah's Uterine Wafers, without knowing the ingredients they contain. Regarding the success obtained from the use of these preparations I am not able to say, but I do believe that every physician is aware of the fact that a large percent- age of these cases eventually drift into his hands for a more thorough and scientific course of treatment. 166 DISEASES OF WOMEN From peculiarities of constitution and the duties as- signed by nature, woman is subject to a class of diseases, which entitles her to all that is humane, delicate and skillful on the part of the physician, whose duty it be- comes to advise and treat her. The degree of suffering, physical and mental ; the pain and discomfort endured; the disturbing elements in social life ; the severing of domestic ties, and the propagation of weakness and disease, often have their origin in the dis- eased organs and the preverted use of feelings and facul- ties designed for the creation of the race, and the happi- ness and well being of mankind. The cause of the prevalence of ill-health among wo- men may be attributed probably to the various acute and chronic diseases, to which all mankind are alike liable, but in a greater degree to the numerous class of ailments peculiar only to the female sex; and also to the fact that women are timid about broaching these subjects, and from a false modesty often conceal their disease, instead of seeking for a means of recovery. Thousands of women, from a mistaken sense of womanly delicacy, are passing the springtime and summer of their lives in silent suffering from disorders they do not understand, and know not how to alleviate. A modest, sensitive woman often shrinks from con- sulting a physician regarding sexual subjects in general, and especially so concerning the private and special ail- ments of her own generative organs, prefering to suffer in silence rather than to expose her weakness; and the most serious results are often attributed to this cause. It is owing to this delicacy on her part that has open- ed a large field for the various preparations mentioned above. I have given the medical treatment of the diseases of women much thought, and after thoroughly investigating many of the secret and non-secret reme- dies used by physicians, I have formulated a system of intra-uterine, extra-uterine and internal treatment, which associate physicians and myself have used in thonsands of cases with remarkable success, and I believe the con- stituents of same will appeal to the judgment of every DISEASES OF WOMEN 167 physician in cases where surgical interference is not re- quired. The conditions in which this method of treatment is particularly indicated are amenorrhoea, dysmenorrhcea, menorrhagia, leucorrhcea, ulcerations, erosions, vaginitis, metritis, endometritis, backache, bearing down pains, irritation of the ovaries and bladder, frequent and painful urination, in fact all forms of congestion, inflammation or pain in the pelvic cavity. In devising a treatment for the above conditions there are several things which need the physician's attention. Upon examination, you will find the uterus enlarged and possibly either hard or sleazy in texture. The cir- culation is torpid and requires new activity. Such con- ditions require the combination of an astringent, an anti- septic, a sedative, an analgesic and absorbent. These are all provided in the following formula, which may be called the EXTRA-UTERINE APPLICATION. 1^ Elaterium \y gr. Powd. jequirity T /\. gr. S. E. belladonna y 2 gr. S. E. hyoscyamus y 2 gr. S. E. hydrastis y 2 gr. S. E. hamamelis I gr. S. E. calendula I gr. S. E. thuja i gr. Zinc sulphate 2 gr. Boric acid 4 gr. I have had some difficulty in finding a suitable base in which to incorporate the above medication in order that it would rapidly disintegrate ; this is a very essential point in order to receive the desired results. The affin- ity elaterium has for serum, seem so great that the latter has a tendency to coagulate around the application, thus preventing it from dissolving. I formerly depended ex- clusively upon this application prepared in tablet form, and although the treatment was reasonably successful, I 168 DISEASES OF WOMEN was often disappointed in cases where I expected the greatest success. I afterwards learned that the more pelvic congestion or inflammation present, the more serum there would be exudated, and the more serum exuv dated the less liable for the tablet to dissolve, owing to the tendency of the serum to accumulate around the ap- plication. Oftentimes the tablet would be removed thoroughly encapsuled, with coagulated serum, which of course prevented the complete medicinal effect of the treatment. After much experimenting my chemist now prepares this treatment in two forms, one in a tablet, resembling in shape the ordinary suppository, with a rapidly disin- tegrating base. The other in a base composed of cocoa- butter, Slippery Elm and Thymol as suggested by Dr. Hall, of Chicago. The tablet is generally dispensed in chronic diseases where slow, continuous medication is desired ; the latter in all acute diseases, where pain is present in the pelvic cavity, via dysmenorrhea, painful urination, hemorrhoids, cancer, etc., where rapid action of the treatment is required. In fact I prefer this medi- cation in a cocoa butter and slippery elm base as a gen- eral treatment in 95 per cent of all cases. This can also be used in the rectum with equal success. Since Dr. J. Marion Sims recognized the affinity glycerine has for serum and advocated tampons applied to the cervix as a depilatory, for the relief of congestion, etc., within the pelvic cavity. Physicians have been in search of a remedy to replace this treatment, which could be applied by the patient herself. My attention was first called to elaterium, as a uter- ine depilatory and antiphlogistic by Dr. Gentry, who stated that he had used the remedy in his practice for twenty years, and argued that if this remedy when taken by the stomach will extract serum from the alimentary tract and produce profuse watery stools, it would extract serum from other mucous surfaces if applied locally, and there is no other place where it can be applied to a greater advantage than in the vagina or uterine canal, where it seems to have its greatest curative influence in DISEASES OF WOMEN 169 removing congestion, engorgements and impurities from the 'female pelvic cavity, that the organs may resume their normal condition. Elaterium alone, is rather drastic in its effects, and we have, therefore, combined it with other remedies to control its action, each of which has its specific therapeutic value. Jequirity resembles somewhat the action of elaterium, but is more. mild. However, it is a valuable adjuvant. Belladonna and hyoscyamus have their anti-spasmodic and anodyne ef- fects, while hydrastis, hamamelis, calendula and thuja each have their respective actions as local alteratives, antiseptics, styptics and sedatives. The zinc sulphate and boric acid are added for their astringent and anti- septic properties. This formula might be open to criticism as containing too many remedies, but I wish to assure you that each of them has been added from time to time with a marked improvement, and it seems to me that it would be im- possible to dispense with any one of them. There is great satisfaction in recommending and us- ing this preparation, for every time it is applied, good results are seen and felt, although I do not offer this preparation as a panacea, I am convinced that it is far superior to any general extra-uterine treatment with which I am familiar, and its practical application will convince the most skeptical that it has extraordinary merit when judiciously applied. This treatment has a wide range of usefulness, and has always found a place in my medicine case, to be used in emergency cases. By inserting a suppository at the mouth of the womb it will immediately suppress pain and ill feelings of every character in the pelvic cavity, often times with nearly the same rapidity as an injection of morphine, and thus cure dysmenorrhea, ovarian irri- tation and neuralgia. Although it is not curative in can- cer, it will abate the odor and alleviate the burning and gnawing pains. It is almost a specific for irritation of the bladder, frequent and painful urination and vaginitis, gonorrhoea, etc. 170 DISEASES OF WOMEN It is also an excellent treatment for piles if inserteci in the rectum, where it soothes the congested and in- flamed surface and heals the ulcers. This application may also be depended upon to re- lieve engorgements, erosions and ulcerations, and its continuous use will control menorrhagia and metorr- hagia. It is likewise used to a great advantage at the Method of Applying Extra-Uterine Application. menopause, as it will draw from the uterus the accumu- lation of diseased matter so that it will not enter the cir- culation and cause "hot flashes," etc. Its antiphlogistic and contractile power will readily contract the flaccid and loose walls of the vagina, at the same time it exerts a contractile influence upon the tissues which support the womb and retain the organ in its natural position. DISEASES OF WOMEN 171 METHOD OF APPLICATION. In chronic diseases the patient should use a douche of warm water before retiring, and insert a suppository as far as possible up the vagina. This should be allowed to remain until the next evening, when the douche should be repeated, and another suppository applied. This treatment should continue for several months in ob- stinate cases to obtain the desired results. With some patients where pain is present and im- mediate results are wanted, as in dysmenorrhea, piles, frequent and painful urination, cancer, etc., the treatment 1 2 3 4 5 may be applied several times a day if required, but the patient should be instructed to use a douche of warm or rather hot water, before each application. For the class of patients which every physician meets, women and young ladies who are over-modest, bashful, timid and diffident, who fear exposure, examination, ex- pense and dread the local treatments, this treatment has many advantages, for it is always attended with good results, and it may be used by the patient herself at home. With many patients it is absolutely necessary that they should submit to an examination and local treat- 172 DISEASES OF WOMEN ment, in order that you may treat them intelligently, and with a degree of success that you could not other- wise obtain without observing the progress of your treat- ment. In order to make examinations, and successfully threat these diseases, requires the use of several wejl selected instruments. The accompanying cut illustrates those of my choice. Xo. i, the combined bivalve and Sims speculum. Xo. 2, fine pointed dressing forceps, which may be used in making intra-uterine applications if necessary. X'o. 3, dilator used for rapid dilation of the uterine canal. Xo. 4, intra-uterine douche for cleansing the uterine cavity and bladder ; its use in miscarriages and other purulent conditions are indispensable. X T o. 5, intra-uterine appli- cator for liquid medication in the cervical and uterine cavity. These instruments, together with the universal applicator, a douche curette and sound offers quite a complete outfit and are indispensable to the physician for the medical treatment of the diseases of women. INTRA-UTERINE MEDICATION. Intra-uterine treatments are indispensable for the cure of many diseases. This is particularly so in metritis and endometritis, deep-seated erosions, etc., where more fav- orable results may be obtained by direct medication, to the lining membranes of the uterus or cervical canal. In these conditions, examination will disclose ulcerations and erosions of the cervix, and large quantities of mucous oozing from the uterine canal ; menstruation is often pro- fuse and appears too often. Whenever this condition exists, I apply an intra-uterine application, composed of the following remedies, either in liquid or bougie form, each treatment containing the following medication in its maximum quantity: I£ Elaterium 1-16 gr. Hydrastine (P. D. & C.) / 2 gr. Resorcin 1 gr. Oil of thuja 2 min. Ichthyol 8 min. DISEASES OF WOMEN 173 I regret to say that I have to differ in opinion with the "old healing masters" regarding local applications to the cervical canal and uterine cavity. I was taught and it is the general treatment given in many text books to- day, that caustic acids, nitrate of silver, carbolic acid and tincture of iodine, and the fashionable cautery elec- tricity are about the only remedies of any value as local applications to the cervical canal and the uterine cavity. After using these treatments for years I was compelled to abandon their use, as my efforts were never marked with any great success. After giving the subject much thought I wondered why physicians who stand at the head of the ranks of the profession, and gynaecologists of more than a national reputation, should advocate such treatment. Would they apply this continuous caustic treatment to ulcerations of the mouth or other mucous surfaces in less isolated parts of the body, and expect to encourage the healing process? No. Then why should this heroic treatment be applied to erosions and inflamed conditions of the uterus. These are the problems which confront the physician. Dr. Skene, in making reference to this point, says: "I am satisfied that in times past, and even at present, much of the treatment of uterine diseases, while it arrests the inflammatory trouble, proves so destructive to the normal structure of the organs as to render the last condition of the patient worse than the first." The facts are that erosions of the os and cervical canal, or other parts of the uterus, require the same gentle treatment that ulcerations in general do. Ac- companying cervical ulcerations, however, we often find chronic inflammatory conditions involving other parts of the organ, metritis and endometritis, which require treatment at the same time. If I were to select only one remedy for the local treatment of these conditions, my first choice would be Ichthyol. This remedy is in no way a caustic, but it penetrates deeply into the tissues and its contractile action upon the vascular system is so great that it rapidly relieves the chronic congestion and inflammation and encourages the healing process. It is 174 DISEASES OF WOMEN also a marked antiseptic and anodyne. Several months ago I learned the value of the oil of thuja in ulcerated conditions of the eye, and argued if this remedy was of value in the treatment of the delicate structures of the eye, it would be of equal service in treating erosions of the cervix and elsewhere, and decided to use it in com- bination with ichthyol, and the results were the most pleasing. This remedy seems to be a solvent of the high- est order. These remedies combined with hydrastis and the antiphlogistic effect of elaterium, and the antiseptic properties of resorcine, gives us a treatment which does not act as a caustic irritant, but as a healing agent in the broadest sense of the term. I have been using this treat- ment constantly for about fifteen months with greater satisfaction and success than any treatment I have pre- viously applied. It will be found particularly service- able in all erosions, congestions and chronic inflam- matory conditions of the uterus. METHOD OF TREATMENT. Dr. Henry Mills is supposed to be the first physician in this country to apply medication within the uterine cavity. Since this time gynaecologists have seemed to differ somewhat in opinion regarding the practicability and utility of intra-uterine medications. They all agree, however, that medication to the cervical canal is of much benefit to diseased conditions of the entire organ. No doubt, the reason why intra-uterine medications of for- mer years has been a failure is due to the use of too strong applications* of caustic compounds. Nearly every caustic remedy in the Materia Medica has been used for this purpose, often doing much injury. There is another point to be observed in applying intra-uterine medica- tions. With some women there seems to exist an idio- syncrasy regarding the application of medicine to the in- terior uterine walls, and they cannot withstand the mild- est form of medication, while others can endure the most heroic measures. I have observed that where the inner os was sufficiently large to allow the escape of any excess DISEASES OF WOMEN 175 of the fluid, uterine applications could be made with greater success than where the inner orifice was small or contracted. When the latter condition exists, the inner os should always be .previously dilated; for this purpose I use a strong pair of narrow-pointed dressing forceps. This allows the escape of any superfluous medication. These facts are constantly before my mind, and when a patient presents herself for treatment, I make several ap- plications to the cervical canal before entering the cavity of the uterus, and I always satisfy myself that the os is well dilated before making each application. The first Method of Applying Intra-Uterine Applications. treatment should consist of only about one or two minims which can be increased in amount as the treatment pro- gresses. There are only a very few cases where medica- tion will be required in the uterine cavity. Fully 90 per cent of the diseases of women can be cured by making applications to the cervical canal, where there is ab- solutely no danger. The instruments should always be at least of an equal temperature to that of the body, and after each application a tampon of glycerine combined with some suitable antiseptic be applied. There has been several instruments devised and many different forms of medication used for applying treat- 176 DISEASES OF WOMEN ments within the uterine canal and uterus. The most practical of these consists of the remedies in liquid form or incorporated in bougies in a base of either cocoa butter or glycerine and gelatine. These bougies should be ap- plied with the universal applicator (see cut). The old way of making medicated applications to the endomet- rium by means of cotton saturated with the medicated solution applied with a probe or applicator, is fast falling into disuse as being unpractical. Dr. P. F. Mundy says : "In the vast majority of cases with normal canals I really believe that the effect of the medication (when applied with cotton) is expended entirely on the mucous lining of the cervical canal and external os, and the en- dometrium improper is touched merely by the albumin- ous coating of the applicator." The bougie treatments have the disadvantage of being expensive to manufacture and somewhat difficult to apply. The liquid medication is therefore the. more practical for all general purposes and is much more easily applied. For several years I used a glass pipette which con- sisted of a glass tube with a rubber bulb on one end re- sembling the ordinary medicine droper, but I found this instrument had many disadvantages. There was no way of determining the amount of medicine used at each ap- plication, and by making pressure upon the rubber bulb you would often force air into the inter-uterine cavity, which would often produce uterine colic. A few years ago I had a special instrument made, which resembled the ordinary hypodermic syringe, with a flexible metallic tube attached, the size and shape of the ordinary uterine sound. This has many advantages, as it allows you to accurately guage the amount of medicine used, as the piston is graduated in minims, and by adjusting the point upwards you can force all the air out of the syringe before each application. The point can be adjusted to any shape which will best enter the uterine cavity. In mak- ing applications to the cervical canal or inter-uterine cav- ity, I always regulate the amount of medicine used by the graduate on the piston stem. The amount of medi- cine used at each treatment is usually from five to fifteen minims. DISEASES OF WOMEN 177 By carefully observing these rules and judiciously ap- plying this treatment you will meet with phenomenal success, and find it far superior to the caustic treatment so much in vogue. This treatment is particularly ser- viceable in all erosions and ulcerated conditions at the external os and cervical canal ; and in cervical or cor- poreal endometritis and chronic inflammations of these organs. INTERNAL TREATMENT. Internal treatment is always of great importance and should consist of such therapeutic measures as may be required in each individual case. I believe in dispensing all internal medication in as palatable a form as possible, and when no specific treatment is required, the following tablet, chocolate coated, has rendered me much service as a uterine tonic : IJ Ext. Viburnum prun I gr. Ext. Viburnum opul I gr. Ext. Star grass Y* gr. Ext. Squaw vine Y* gr. Ext. Helonias Y* gr. Caulophyllin Y\ & r - Hydrastis, represented by white alkaloid 7^ gr. THE COMBINED TREATMENT. When a physician becomes too enthusiastic regarding a special treatment he is often branded as a "crank." If this caption applies to my case it will be accepted very gracefully, and I only wish I could be as "successfully cranky" with many other treatments in the practice of medicine. I consider this treatment, either used in part or combined, as the case may require, one of the most successful treatments in present use for the diseases of women commonly met with, and far superior to the caus- tic remedies or the fashionable cautery, electricity. As a rule I do not believe in "stereotyped therapeutics" and occasionally I modify this treatment to meet the require- rt2i 178 DISEASES OF WOMEN ments of some individual case, but in a large majority of cases I know of no means of improvement, and use it as given here. With a large number of patients I find the The above illustrates the way all Exterior Erosions or Ulcerations of the External Os should be "Painted" with the Intra-Uterine Application. best results are obtained from the combined treatment, and usually I have a patient visit my office once or twice a week, that I may apply the intra-uterine application DISEASES OF WOMEN 179 and watch the progress of the treatment. During the intervals she is instructed to take a douche of warm or rather hot water each night before retiring, and apply the extra-uterine application ; throughout the treatment she also takes a tablet of the Viburnum tonic compound six times a day, or whatever other internal treatment her case may demand. By the judicious use of these remed- ial measures I am convinced that they will effect a care in many cases where other methods of treatment have failed to be of benefit, and it will excel the numerous routine treatments, proprietary preparations and nostrums often used by physicians. To demonstrate its wide range of usefulness, I will point out its value in the following il- lustrated cases : Irritation of the Bladder. Miss G., an actress appearing at one of the theaters in this city, consulted me regarding this troublesome and painful condition with which she had been suffering at different times for about two years. She stated that it was almost impossible for her to fulfill her engagement, as she was in such distress ; between each act she would attempt to urinate, but there would be only little urine and such unbearable, spasmodic pains afterwards. This was about 5 130 p. m. ; I instructed her to take a vaginal douche of two quarts of hot water, as hot as she could comfortably endure, and apply an extra-uterine applica- tion (in cocoa butter and slippery elm base) and to re- peat the operation at 7:30, just before the performance. She followed my advice and reported the next day that in about twenty minutes after she made the first appli- cation all of her distressing symptoms left her and she passed the evening in perfect comfort. The following- day I washed out the bladder and instructed her to use the extra-uterine application three times a day. She con- tinued the treatment during her week's stay in this city and took sufficient medicine with her to last two months, making one application each night before retiring. I did not hear from her again until the following season, when she visited my office and informed me that she had never 180 DISEASES OF WOMEN been troubled since. She wished me to prepare some more medicine, however, to be used in case of emergency as she was in constant fear of the old trouble returning. I relieved her mind, however, by telling her that in all probability she would never be troubled that way again. Amenorrhoea. Miss H., age 16, applied for treatment for irregular menstruation. The menstrual periods were established when 13 years of age. At this time she thought she "took cold" from bathing; at least, the periods did not return again for four months ; since this time they have always been irregular, appearing at intervals from two to three months. The patient was anaemic and complained oi having much backache. Her anaemic condition was, no doubt, one of the primary causes of her condition. I prescribed the "Viburnum compound" three times a day, and after each meal she was given a five grain Blaud's pill combined with arsenic and strychnine. I instructed her to use a hot water douche each night before retiring and insert an extra-uterine application. She continued this treatment nearly five months ; at the end of this time she was menstruating regularly; her complexion became florid, and her general health was seemingly good. She continued the internal treatment for several months, omiting the iron tablets at intervals. She has been con- stantly under my observation, and at this writing is per- fectly well, strong and healthy. Congestive Dysmenorrhoea. Mrs. H. consulted me regarding her daughter, 19 years of age, who had always suffered with dysmenorrhoea. Menstruation was not established in her case until 16 years of age, and during the menstrual period she was confined to her bed the greater part of the time. She was a very plethoric girl and appeared rather timid in disposition, although she frankly informed me she ''hated doctors." If I had suggested examination in her case she no doubt would have been out of the office before DISEASES OF WOMEN 181 the words left my lips. After briefly discussing her case with her mother, I pronounced it congestive dysmen- orrhea, and prescribed a douche of two quarts of hot water each night before retiring, and instructed her how to use the extra-uterine application (in a cocoa butter and slippery elm base). After the douche I also gave her a tablet of the "Viburnum tonic compound" six times a day. She promised to carry out the treatment pei- sistently and report after the next menstruation ; in aue time her mother called and informed me she had suffered some pain, but it was not so severe as at former periods. She continued the treatment as above, ana the next period was passed with still less pain ; the next period was passed in perfect comfort. She continued the treatment altogether about five months, and has never suffered since. It is now a year since she has abandoned all medication. This is only one of many cases which have come under my observation which has demonstrated the curative value of this treatment. Had I prescribed the application during the first two periods she no doubt would have suf- fered at all, as will be illustrated in the following case : Dysmenorrhoea. Miss B. I was called at the bedside of this lady, wno was suffering intensely. She informed me that she al- ways suffered this way, but the pain was less severe af- ter the appearance of the menstrual discharge. I im- mediately gave her a douche of hot water and she in- serted an extra-uterine application ; in less than half an hour nearly all the pain had left her. She repeated the operation twice during the night; in the morning the menstrual flow had made its appearance, but she con- tinued the application twice a day throughout the period, with but very little pain. This lady continued the treatment for about four months, with the aid of the "Viburnum compound,'' and occasionally dilating the cervical canal, and she was dis- charged and pronounced cured. 182 DISEASES OF WOMEN Cancer of the Cervix. I was called to see Mrs. P., aged 47, who w r as flowing excessively. She had been advised by another physician that her condition was due to the change of life, although he had never examined her. Speculum examination re- vealed the fact that she was suffering with a cancer of the cervix, involving the lower third of the fundus and the upper w r alls of the vagina. I informed the husband re- garding her serious condition and also told them that I believed operative proceedures would be of no value, as the destruction of tissues was so great, and the only treat- ment would be to offer her as much comfort as possible until the end. She was suffering much pain, which was very severe at times. I gently curetted the sloughing surface and applied the intra-uterine application to the abraded surface, and advised her to take a douche of warm water and apply the extra-uterine application every two or three hours as her case required. It was surprising to note how rapidly this treatment relieved the pain and seemed to control the hemorrhage and abate the odor. This treatment w r as continued until the very last, when morphine had to be resorted to. Although the treat- ment in this case w r as only palliative, it offered all that can be accomplished in such cases. DISEASES OF WOMEN 183 Endometritis of the Cervical Canal. This lady was 29 years old ; was married and had never become pregnant, very much contrary to her wishes. Her general health seemed excellent, but she said she had been troubled with leucorrhoea for years. After reading some domestic medical book she became alarmed at her condition, thinking the discharge was a sure means of destroying her life. I made a speculum examination and, with the aid of the sound, I found the diameters of the uterus and the internal os about normal. The external os, however, was ulcerated, everted and en larged. By passing the sound the mucous surface would bleed very easily, showing the mucous membrane was very much congested. It was easily determined that she had endometritis limited to the cervical canal. I applied ten minims of the intra-uterine application to the entire length of the canal, and also thoroughly covering the ex- ternal ulcerated surface with the medicine, after which 1 inserted a tampon saturated with glycerine and thymol at the external os before removing the speculum. These local treatments were continued twice a week ; during the intervals she used the extra-uterine application, with warm water injections each night before retiring, and the Viburnum compound. This treatment was continued about four months. At the end of this time the mucous membrane of the canal seemed to be perfectly healthy, and the external erosions entirely healed. In order that I could watch her condition I had her visit my office once a month for several months, but the old condition never returned. Corporeal Endometritis. Mrs. D., 41 years of age., came to my office, stating that "It seems as though beavers are building a dam in my womb, there is such a constant gnawing." By exam- ining her with a speculum I found the external os and cervical canal in apparently a healthy condition, but on entering the uterus with a sound she complained of some pain, and said "that is the very place which is causing 184 DISEASES OF WOMEN me so much discomfort." The surface would bleed easily at the most gentle manipulation. Menstruation was ir- regular, but when it did appear it was too profuse and lasted longer than it should. She also had leucorrhcea, which at times was offensive. I decided that she had endometritis limited to the uterine cavity, which is not of common occurrence. I treated her twice a week with the intra-uterine application, and curretted the surface occasionally, and also had her use the extra-uterine ap- plication and "Viburnum compound." At the end of three months all symptoms of the disease had left her, and she Avas discharged as being cured. A Complicated Case. Airs. J.— This was one of those complicated cases not unfrequently met with, where the inflammatory condition seemed to involve the entire pelvic cavity, and had she fallen into the hands of the modern gynaecological sur- geon, she no doubt would have parted with much of her anatomy. Congestion and hyperthesia was manifest everywhere within the pelvis ; the ovaries were sensitive, and at times she would have frequent and painful urina- tion, backache and constant pain in the pelvic region. Speculum examination revealed an enlargement of the cervix, which was fairly purple in color, showing retard- ed circulation. There was a large erosion on the external os, the lining membrane of the cervical canal and uterine DISEASES OF WOMEN 185 cavity were sensitive and bled very easily when touched with the sound. There was large quantities of mucous oozing from the canal, which was often streaked with blood. Menstruation appeared too often and was too profuse ; her general health was very much impaired ; she was weak and anaemic, had disturbances of the stom- ach, and was extremely constipated and nervous. It was not difficult to see she was suffering with metritis and endometritis, involving the entire membranes of the uterus. She was placed upon a thorough course of re- constructive and tonic internal medication, and the intra- uterine application was applied to the entire uterine cavity and cervical canal, by gradually increasing the amount of medicine at each application until ten or fifteen minims were used, which was sufficient to cover the entire surface. She was also instructed to use the extra-uterine application and a hot water douche each morning and evening, as an intermediate treatment. The extra-uterine application seemed to have a wonderful effect in her case ; at the end of one week she declared she had not a pain or discomfort in the pelvic region. Often when she would take a douche there would be large pieces, amounting sometimes to entire casts of the vagi- na, of coagulated serum, come away, which demonstrated the value of the application as a depilatory in curing these conditions by exosmosis. After she had continued the treatment for several months, she had gained about 25 pounds in flesn, tilt size of the uterus was gradually diminished and the en- dometrium was apparently in a healthy condition, when an accident occurred which ended in her death, by falling down an elevator shaft in one of the large department stores in this city. Specific Vaginitis. Mrs. C, a refined lady, 32 years of age, contracted gonorrhoea from her husband, who was "rather sporty inclined." I did not inform her the cause of her condi- tion, as I did not wish to take an active part in a family disturbance, as I was treating the husband for the same 186 DISEASES OF WOMEN disease. (I think St. Peter will pardon a few prevarica- tions under such circumstances.) She was suffering in- tensely with vesical and rectal tenasmus, had a profuse discharge and all the accompanying symptoms of the disease. She was instructed to use a douche of two quarts of warm water in which 2 drachms of borax had been dissolved, 5 or 6 times a day. After each douche she inserted an extra-uterine application. She experi- enced great relief from the first, and at the end of ten days the symptoms of the disease had left her and she was practically well. She continued the local treatment, however, once or twice a day for about three weeks. STERILITY. Among other problems confronting the physician is a successful treatment for sterility. Barreness may be either congenital or acquired ; or it may exist for years and a seemingly spontaneous cure result from the action of unknown causes. This is illustrated with Anne., of Austria, who was sterile for twenty-two years before she became a mother. Catalina de Medicis, wife of Henry the Second, was unfruitful for the first ten years of her marriage, after which time she became so prolific that she had ten successive children. The cause of sterility has been attributed to several different sources ; chronic inflammation of the vagina, giving rise to excessive acid secretions which destroy the life of the spermatozoa, as will also the excessive secre- tions from the uterus. Inflammatory conditions of the uterine cavity and canal has also been pointed out as one of the principal conditions preventing conception. Phy- siologists lay much stress on the proper time for coition as reacting favorably to produce conception, and the fruitful period is given from three days before to ten days after the monthly period every physician is familiar with the fact, however, that there is no stated time when a woman can be considered unpregnable. The Mosiac laws forbid women from accepting visits from their husbands for fourteen days after the menstrual period, and still the Jews are a very fruitful people. DISEASES OF WOMEN 187 Many persons who desire to prevent conception ab- stain from intercourse during the supposed fruitful period, but while it may lesson the probability of the oc- currence of conception, it is by no means sure. It has been demonstrated that some women are more suscepti- ble to conception immediately before the menstrual period, others during the period and others immediately after. In suming up my own observations regarding the subject, I am convinced that the cause of sterility in the majority of cases has been due to diseased conditions of the cervical canal and inner uterus and stenosis of the canal, which has often been traced to the use of too strong caustic local applications. When a patient asks, "What can I do to become a mother," I advise an examination, which will generally DR. OUTERBRIDGE'S DILATORS AND APPLICATORS. reveal the condition described above. The treatment for sterility depends largely upon three things, viz. : Cure any existing disease of the endometrium, remove all ob- structions from the cervical canal and advise copulation at the time when physiological conditions are the most favorable to conception, which is just before, during or after the menstrual period. The diseased condition will usually yield to the extra-uterine and intra-uterine medi- cations already given, and now we wish to keep the canal open and allow the spermatozoa to enter the uterine cav- ity. This is best done by the use of the Outerbridge stems, or dilators. These instruments consist of a set of stems and an introducer to apply them with ; when once introduced into the cervical canal and adjusted to the 1S8 DISEASES OF WOMEN right position, they will keep the canal open, and while they are indespensable in the treatment of sterility, they can also be nsed to a good advantage in the treatment of certain forms of dysmenorrhcea and endometritis. The shape of this instrument adapts itself to the anatomical position of the uterine canal and is so constructed that it is self-retaining without changing position. There are several different styles of these stems de- signed to meet the requirements of different canals ; these dilators can be introduced from either the Sims or dorsal position. The dilator is placed within the grasp of the instrument made especially for the purpose, and after examining the position and length of the canal with a uterine sound, the stem is selected to correspond with the canal, "which is previously dilated with an ordinary dilator, and the Outerbridge dilator introduced, where it may be left for several days. The time selected to cure sterility and dysmenorrhcea is from three days before the menstrual period until five days after, then the instru- ment can be removed. The instrument should not be used at the next period unless you are satisfied that con- ception has not taken place. In dilating the cervical canal with this instrument you should be very careful not to injure the mucuous membrane, as this may pre- vent the emigration of the spermatozoa and thus prevent the process of conception. These instruments are made of several different ma- terials, but the only dilators of any value are made from some non-corrosive metal, of which aluminum is prefer- able, owing to its lightness, strength and elasticity as a treatment for sterility and obstructive dysmenorrhcea. This method is without a doubt the most successful and will not disappoint reasonable expectations. IMPOTENCY IN THE FEMALE. SEXUAL INDIFFERENCE. Although there have been many volumes written on impotency in the male, this condition, which is often termed sexual anaesthesia, sexual indifference and sexual DISEASES OF WOMEN 189 apathy, in the female has received little or no attention by the general practitioner, and like many other things, opens the door for a specialist, although this may seem an unusual subject of which to make a single specialty. I recently met a physician who was enjoying an income of several thousand dollars a year by operating upon women afflicted with this unfortunate condition. There is no doubt that our Creator designed the organs and functions of women to be as highly and sensitively developed as those of men, and the sexual embrace should be conducted in a manner mutually agreeable to both husband and wife, but it is a well- recognized fact that fully ten per cent, of women are entirely devoid of sexual passions, and in such women, intercourse is conducted for the sole gratification of the husband. It is also unnecessary to state that this is one of the elements which help to fill our courts with divorce suits. Women thus affected almost invariably state that their sexual condition has caused more shadows and domestic disturbances than any other one thing in their marital union. Every physician recognizes the fact that the happiest homes are those in which husband and wife are sexually mated, and we must also admit that the healthy performance of these functions are not only conducive to good health, but largely to the development of much that is lovable and affectionate in a woman's nature. There are two varieties of this condition : First, one in which there is no sexual desire whatever, and, second, where there is a mild desire, but without gratification. The cause of this dormant condition of the female sexual organs can be traced to a number of sources. Functional diseases of the ovaries and uterus often cause a depression in the sexual instinct, while at the change of life and during pregnancy and lactation, this function may be suppressed. In other cases, this function may have been fully developed and the organ fully or partly paralyzed in child-birth or by accident. It may also be due to spinal trouble or sexual excess. Such cases often experience excitation without gratifica- tion or relief. This often leads to mental depression and 190 DISEASES OF WOMEN melancholy. The most frequent cause, however, is an elongation of the hood and its adherence to the walls of the clitoris, completely obliterating that organ. It is this condition, principally, that I wish to discuss. My attention was first called to this point by the spe- cialist mentioned above, who, I have every reason to be- lieve, has operated upon thousands of cases. My experi- ence will vouch for his success, for I have restored this function in fully ninety per cent, of all the cases upon which I have operated. The operation is very easy and consists of simply removing the foreskin from the clitoris as follows : Pinch up the foreskin with the thumb and finger and inject a few drops of the cocaine solution as given in the obtundent formulae on another page, and also saturate a piece of absorbent cotton and allow it to cover the clitoris for a few minutes until it is thoroughly anaesthetized ; insert a tenaculum through the foreskin and lift is upwards, then take the handle of a scalpel and break up all adhesions between the clitoris and covering membrane and cut away a V-shaped piece of the fore- skin, entirely denuding the clitoris. Unite the two layers of membrane by applying a suture on each side of it, and one at the apex. Keep the parts separate by placing absorbent cotton between them and use the usual anti- sptic dressings. The sutures may be removed in two or three days. The doctor should always provide the patient with an antiseptic ointment, containing sufficient tincture of cap- sicum to furnish warmth to the parts, as follows : Jy Tinct. capsicum 20 min. Boracic acid 1 dr. Vaseline 1 oz. Sig. Apply to the parts four times a day. Although this is one of the most simple minor opera- tions in the whole category of surgery, it is one of the most remunerative, as the patient will not hesitate to pay from $25 to $50, and one patient is always likely to send another. The physician also gives the patient a two months' supply of aphrodisiac tablets, as given on another page. PAINLESS DENTISTRY 191 THE PAINLESS DENTAL SPECIALIST. THE ODTUNDENT SYSTEM OF PAINLESS DENTISTRY. Whoever procures exemption from physical suffering may be considered a public benefactor and in no other field of labor has there been a better chance of earning such a title than in that of extracting teeth, as the pain- less operator is the one whom people praise and patron- ize, but as a general rule a large percentage of operators have made a failure of local anaesthetics, (nostrums) and have discarded them altogether, as being worthless. They do not understand why some can make a success of their use and others can not. While this chapter will not be an exhaustive treatise on the subject, I will en- deavor to make it as plain and practical as possible, and give all the information that will be required to handle local anaeesthetics successfully. W r hat will be said has been taken from the experience of myself and other operators under my observation, who have used this method successfully in over sixty thousand different operations ; and I believe that every operator of ordinary skill and intelligence, who will faithfully follow the di- rections given will be equally successful. In the year 1874 Dr. Oliver Wendell Holmes created the words, "Artificial Anaesthesia," and wrote : "Nature herself is working out the primal curse which doomed the tenderest of her creatures to the sharpest of her trials ; but the fierce extremity of suffering has been steeped in the waters of forgetfulness, and the deepest furrows in the knotted brow of agony has been smoothed forever." The diminution of the cutaneous sensibility by the application of ice and freezing mixtures has long been 192 PAINLESS DENTISTRY practiced. It was not, however, until Richardson's method by the hand-ball spray apparatus had been pro- posed that there had been much use made of local anaesthesia ; this method consists in directing a current of atomized ether against the part to be anaesthetized. The ether employed for this purpose should have a specific gravity not to exceed 0.723. Rhigolene, the lightest liquid known, a product of the fractional distilla- tion of petroleum, is more effective than ether, but great difficulty attends its use, owing to its extreme volatility. When a current of atomized ether, or Rhigolene, is di- rected against the skin, the rapid evaporation produces an intense degree of cold, in consequence of which the nerves lose their power of transmiting impressions to the sensorium. A serious drawback to this process of producing local anaesthesia is the unpleasant burning which follows in the part when it recovers from the freezing, and also the great pain which attends the application of the ether spray to certain parts. Shortly after the spray apparatus fell into disuse, local anaesthesia was introduced by hypodermic medica- tion, and while there has been an abundance of good energy wasted by some of our best authors (who have made a failure of it) in condemning the method, we find on the other hand a larger percentage of admirers who have discarded every other system of anaesthesia believ- ing this to be superior to all. COCAINE. Careful research in the study and chemical analysis of the many local anaesthetics (nostrums) which have flooded the market, prove that all local anaesthetics used successfully by hypodermic medication have from one and one-half to five per cent, cocaine basis, and this work would be incomplete, without giving the reader a com- prehensive knowledge of the physiological action of this valuable drug. PAINLESS DENTISTRY 193 Although erythroxylon (cocaine) has been the subject of investigation, and its powers to suspend the functions of the sensory nervous system recognized, the character of its local action was not suspected. It was reserved for Dr. Roller, of Vienna, to discover its analgestic effects when applied directly to the mucous membrane, and this great fact he demonsrated before the ophthalmological congress at Heidelberg. It happened that the dis- tinguished ophthalmologist of New York, Prof. Dr. Noyes, was in attendance on the congress and he sent to the New York Medical Record, a letter giving facts of the discovery, and this proved to be the first statement in the English language of Roller's demonstration. As the possibilities of the future utility of cocaine as a local anaesthetic was then recognized, it created a profound impression, and in an incredibly short time this remark- able discovery became of common interest and in com- mon possession. Everywhere cocaine was investigated by physiological and clinical methods, and the results confirmed the statements of Roller. To no one this side of the ocean, was the investigation of the properties and, powers of cocaine of as much interest as to the medical and dental professions. The character of the action of cocaine is much in- fluenced by the amount administered, and the several stages of its action differ because the immediate and primary effect is necessarily opposed to the condition of reaction which seeks to restore the normal. When a sufficiently active (or toxic) dose is given, the first effect is stimulation ; the heartbeats are accelerated ; the respiration becomes more frequent ; the reflexes respond to a distant irritation more promptly ; the mind experi- ences a grateful sense of well-being and of activity, and ideation is ready, acute and comprehensive. The stage of excitement continues for an hour or two, and is succeeded by depression, which is at the same time physical, mental and moral. The pulse may con- tinue quick, but its force declines, and some irregularity of its rhythm may occur ; the skin grows moist or pro- fuse sweating comes on ; the bodily temperature declines [13] 194 PAINLESS DENTISTRY a little, possibly; the appetite is lost, and nausea and vomiting increase the feeling of physical wretchedness and mental distress. Although cocaine is not actively toxic, and may be taken in enormous doses, we find some persons who are susceptible to its action, and are some- what depressed by a smaller quantity. On the other hand, we find in an interesting article written by Dr. William A. Hammond and read at the eighteenth annual session of the Medical Society of Virginia, at Richmond, in which he reports taking eighteen grains at a dose, which I think will be of sufficient interest to quote in full, for it fully explains the true physiological action of the drug better than any article ever written, to my knowl- edge. The doctor said : "About two years ago I undertook a series of experi- ments with this agent on myself, with the object of ob- taining more satisfactory information relative to its ac- tion than it seemed possible for me to get otherwise. I began by injecting a grain of the substance under the skin of the forearm, the operation being performed at 8 o'clock p. m. ' "The first effect ensued in about five minutes, and consisted of a pleasant thrill which seemed to pass through my whole body. This lasted about ten minutes and shortly after its appearance, was accompanied by a sensation of fullness in the head and heat of the face. There was also noticed a decided acceleration of the pulse with increase of force. This latter symptom was probably, judging from subsequent experiments, the very first to ensue, but my attention being otherwise en- gaged, it was overlooked. On feeling the pulse five min- utes after making the injection, it was found to be ninety- four, while immediately before the operation it was only eighty-two. "With these physical phenomena, there was a sense of exhilaration and an increase of mental activity that were well marked, and not unlike in character those that ordinarily follow a glass or two of champagne. I was writing at the time, and I found that my thoughts flowed with increased freedom, and were unusually well ex- PAINLESS DENTISTRY 195 pressed. The influence was felt for two hours, when it gradually began to fade. At 12 o'clock, four hours after the injection, I went to bed, feeling, however, no dispo- sition to sleep. I lay awake till daylight, my mind actively going over all the events of the previous day. When I at last fell asleep, it was only for two or three hours, and then I awoke with a severe frontal headache. This passed off after breakfast. "On the second night following, at 7 o'clock, I injected two grains of the hydrochlorate of cocaine into the skin of the forearm. At that time the pulse was eighty-four full and soft. In four minutes and a half it had increased to ninety-two, was decidedly stronger than before, and somewhat irregular in rhythm. The peculiar thrill previ- ously mentioned was again experienced. All the phe- nomena attendant on the first experiment were present in this, and to an increased degree. In addition there was twitching of the muscles of the face, and a slight tremor of the hands, noticed especially in writing. In regard to the mental manifestations there was a similar exhilaration as in the last experiment, but much more intense in character. I felt a great desire to write, and did so with a freedom and apparent clearness that as- tonished me. I was quite sure, however, at the time that on the following morning, when I came to read it over, I would find my lucubrations to be of no value ; I was therefore greatly disappointed when I came to peruse it, after the effects of the drug had passed off, that it was entirely coherent, logical and as good, if not better, in character than anything I had previously written. "The effects of this dose did not disappear till the mid- dle of next day, nor until I had drank two or three cups of strong coffee. I slept little or none at all, the night being passed in tossing from side to side of the bed, and in thinking of the most preposterous subjects. I was, however, at no time unconscious, but it seemed as though my mind was, to some extent, prevented from its usual course of action. The heat of the head was greatest at about 12 o'clock, and at that time my pulse was 112, the highest point reached. I had no headache until after 196 PAINLESS DENTISTRY rising, and the pain disappeared in the course of the morning. "Four nights subsequently I injected four grains of the hydrochlorate of cocaine into the skin of the left fore- arm. The effects were similar in almost every respect with those of the other experiments except that they were much more intense. The mental activity was ex- ceedingly great, and in writing, my thoughts, as before, appeared to be lucidly and logically expressed. I wrote page after page, throwing the sheets on the floor with- out stopping to gather them together. When, however, I came to look them over the following morning, I found that I had written a series of high-flown sentences alto- gether different from my usual style, and bearing upon matters in which I was not in the least interested. The result was very striking as showing the difference be- tween a large and excessive dose of the drug, and yet it appeared to me at the time that what I was writing con- sisted of ideas of a very superior character, and expressed with a beauty of diction of which I was, in my normal condition, altogether incapable. "The disturbance of the action of the heart was also exceedingly well marked, and may be described best by the word "tumultuous." At times beginning within three minutes after the injection, and continuing with more or less intensity all through the night, the heart beat so rapidly that its pulsations could not be counted ; and then its action would suddenly fall to a rate not exceeding 60 in a minute, every now and then dropping a beat. This irregularity was accomplished by a disturbance of respiration of a similar character, and by a sense of op- presion in the chest which added greatly to my discom- fort. "On subsequent nights I took six, eight, ten and twelve grains of the cocaine at a dose, but I will not detain the society with a detailed account of the effects produced. It will be sufficient to say that they were similar in general characteristics, though of gradually in- creasing intensity in accordance with the dose taken, to that in which four grains were injected. PAINLESS DENTISTRY 197 "In all there was great mental excitement, increased fluency of thought, and exaggerated disposition to write: the matter written being disconnected and at times, al- most incoherent, though it appeared to me at the moment to be wonderfully logical and profound. In one, that in which twelve grains were taken, I was conscious of a tendency to talk, and as far as my recollection extends, I believe I did make a long speech on some subject of which I had no remembrance the next day. In all the action of the heart was increased, was irregular in rhythm and force to such an extent that I was appre- hensive of serious results. Insomnia was a marked characteristic, and there was invariably a headache the following morning. "In all cases the effects passed off about midday, and by evening I was as well as ever. "Up to this time I certainly had not taken a poisonous dose of cocaine, or one that had produced inconvenience. My experience had satisfied me that a much larger dose than any I had up to that time injected might in my case, at leafst, be taken with impunity. A consideration of the phenomena observed appeared to show that the effects produced by twelve grains were not very much more pronounced than those following six grains. I determined therefore to make one more experiment, and to inject eighteen grains. I knew that in a case of attempted suicide twenty-three grains had been taken into the stomach without seemingly injurious effect, and that in another case thirty-two grains were taken within the space of three hours without symptoms following of greater intensity than those I had experienced. "I had taken the dose of eight, ten and twelve grains in divided quantities, and this dose of eighteen grains I took in four portions, within five minutes of each other. At once an effect was produced upon the heart, and be- fore I had taken the last injection the pulsations were 140 to the minute and characteristically irregular. In all the former experiments, although there was great mental exaltation, amounting at times almost to delirium, it was nevertheless distinctly under my control, and I am sure 198 PAINLESS DENTISTRY that at any time under the influence of a sufficiently powerful incentive I could have obtained entire mastery over myself, and have acted after my normal manner. But in this instance, within five minutes after taking the last injection, I felt that my mind was passing beyond my control, and that I was becoming an irresponsible agent. I did not feel exactly in a reckless mood, but I was in such a frame of mind as to be utterly regardless of any calamity or danger that might be impending over me. I do not think I was in a particularly combative con- dition, but I was elated and possessed of a feeling as though exempt from the operation of deleterious in- fluences. I do not know how long- this state of mind continued, for I lost consciousness of all my acts within, I think, half an hour after finishing the administration of the dose. Probably, however, other moods supervened, for the next day when I came down stairs three hours after my usual time, I found the floor of my library strewn with encyclopedias, dictionaries and other books of reference, and one or two chairs overturned. I cer- tainly was possessed of the power of mental and physical action in accordance with the ideas by which I was gov- erned, for I had turned out the gas in the room and gone up stairs to my bed chamber and lighted the gas, and put the match used in a safe place, and undressed, laying my clothes in their usual place, had cleaned my teeth and gone to bed. Doubtless these acts were all automatic, for I had done them all in pretty much the same way for a number of years. During the night the condition which existed, was, judging from the previous experiments, certainly not sleep, and yet I remained en- tirely unconscious until 9 o'clock the following morning, when I found myself in bed with a splitting headache and a good deal of cardaic and respiratory disturbance. For several days afterwards I felt the effects of this extreme dose in a certain degree of languor and indisposi- tion to mental or physical exertion ; there was also a difficulty in concentrating the attention, but I slept soundly every night without any notable disturbance from dreams. PAINLESS DENTISTRY 199 "Certainly in this instance I came very near taking a fatal dose, and I would not advise anybody to repeat the experiment. I suppose if I had taken the whole quantity in one single injection, instead of in four, over a period of twenty minutes the result might have been disastrous. Eighteen grains of cocaine are equivalent to about 3,630 grains of coca leaves, and of course, owing to its con- centration, capable of acting with very much greater in- tensity. "I am not aware that a fatal dose of cocaine has yet been indicated by actual fact. Probably eighteen grains would kill some people, and perhaps very smaller quan- tities might, with certain individuals, be fatal. But these are inferences and not facts ; but so far as I know, there is not an instance on record of a person dying from the administration of cocaine. So far as my experiments ex- tend (and I think it will be admitted that they have gone as far as is safe), I am inclined to think that a dose suf- ficient to produce death would do so by action on the heart. Certainly it was there that, in my case, the most dangerous symptoms were perceived. The rapidity, force, and marked irregularity of the pulse all showed that the innervation of the heart was seriously affected. "It is surprising that no marked influence appeared to be exercised upon the spinal cord, or upon the ganglia of the base of the brain. Thus there were no disturb- ances of sensibility (no anaesthesia, no hyperasthesia) and no interference with motility, except that some of the muscles, especially those of the face, were subjected to slight twitchings. In regard to sight and hearing, I noticed that both were affected, but that while the sharpness of vision were decidedly lessened, the hearing was increased in acuteness. At no time were there any hallucinations." \ Cocaine is eliminated by the kidneys, and may be de- tected in the urine ; the excretion takes place in a few hours and hence, any effect it has on the organism is not persistent. An impression has prevailed that it is especially hurtful, but this conception of its character has developed out of a misconception, and unless an 200 PAINLESS DENTISTRY idiosyncrasy exists (which is easily detected), the proper use of cocaine, seems to be not incompatible with a normal degree of bodily and mental vigor. In formulating a local anaesthetic to be used in dental or minor surgery, there are several objects to be obtained, viz. : First, to have one that will be safe at all times ; second, one that can be used in all pathological conditions of the gums ; third, one that will have no bad after effects; fourth, one that will not decompose, within a reasonable length of time. In the following formulae I think we have overcome all these obstacles and have an anaesthetic that is safe and can be used in all pathological conditions of the gums without any bad after effects, if used with anti- septic precautions and ordinary skill. OBTUNDENT FORMULAE. No. i. I> Cocaine hydrochlorate (Merck's) ... .20 gr. Atropine sulphate 3-10 gr. Chloral hydrate 20 gr. Phenoresorcine ^2 dr. Aqua cinnamon 4 oz. No. 2. 9 Cocaine hydrochlorate (Merck's) ... .40 gr. Atropine sulphate 3-10 gr. Chloral hydrate 20 gr. Phenoresorcine ^2 dr. Aqua cinnamon 4 oz. No. 3. I£ Cocaine hydrochlorate (Merck's) .... 1 dr. Atropine sulphate 3-10 gr. Chloral hydrate 20 gr. Phenoresorcine ]/i dr. Aqua cinnamon 4 oz. PAINLESS DENTISTRY 201 No. 4. ^ Cocaine hydrochlorate (Merck's) ... .80 gr. Atropine sulphate 3-10 gr. Chloral hydrate 20 gr. Phenoresorcine /4 dr. Aqua cinnamon 4 oz. Mix and filter through absorbent cotton until clear. The above formulae represent a one, two, three and four per cent, solution. For all general purposes, I use formula No. 3. In having these formulae compounded you should be sure and have it done by some one who is careful and competent and will see that the drugs are fresh and pure, and from a reputable house, of which Merck's is preferable. The question naturally arises, why the above formulae have any advantage over a common cocaine solution? Atropine given in small doses, as in this formula, is a cardiac, respiratory and spinal stimulant, and tends to counteract the effects of the cocaine more than any other remedy we possess. By the term phenoresorcine is meant by Riverdine, a mixture of carbolic acid and resorcine, sixty-seven parts of the former and thirty-three of the latter. This mixture crystallizes on cooling and by the addition of ten per cent, of water (which is always used in the above formulae as follows) : J} Carbolic acid 67 parts. Resorcine 33 parts. Aqua 10 parts. The above formula mixes with water in all propor- tions, combining the virtues of both remedies. Phenoresorcine is not only an efficient and valuable antiseptic and local anaesthetic, but is indispensable in localizing the anaesthesia, and preventing its constitu- tional absorption, it was also discovered by laryngologists if used in conjunction with cocaine, it alleviated the nausea which sometimes follows the use of that drug. Phenoresorcine is also one of the most valuable remedies we could select to preserve the preparation. While a 202 PAINLESS DENTISTRY common cocaine solution is almost worthless at the end of a week, this preserves the preparations for months. Chloral hydrate, like phenoresorcine has a marked anti- septic and local anaesthetic effect, and also assists the other remedies in localizing the anaesthesia and prevents its absorption into the general circulation. Aqua cin- namon as used in these formulae is composed as follows : ^ Oil of cinnamon 6 drops. Glycerine I dr. Aqua distilled 4 oz. Mix and filter through absorbent cotton until clear. This makes an aromatic solution which disguises the odor of the phenoresorcine. It also assists in preserving the preparation. HYPODERMIC SYRINGE AND NEEDLES. The syringe for this kind of work should have a strong broad cross bar, or finger brace, also a large flat piston head so that by continual use it will not make the fingers sore. The piston stem should have a minim graduate, or scale. SYRINGE AND CASE DESIGNED FOR DENTAL OPERATIONS. and an easy working nut on the same (for we can best regulate the use of our medicine with this nut). The diameter of the glass cylinder should be quite small, so that you may run up a high pressure when required. PAINLESS DENTISTRY 203 Never use a syringe that holds over thirty minims, as larger ones take up too much room when operating. The metal frame work holding the glass cylinder should be open on both sides so that you can have a clear view of the contents of the syringe, and know that it contains no air or floating matter when operating. The needle should be of medium size, about twenty- two, twenty-three or twenty-four standard wire gauge is the proper size. When the syringe is not in use, put a wire previously dipped in olive oil through the needle, and screw the cap on the syringe tight; this keeps the needle from rusting and getting stopped up and the pack- ing of the syringe from drying out. If you are not using the syringe continually, you should oil the cylinder occa- REGULAR DENTAL SYRINGE — TWO-THIRDS SIZE, sionally and always keep it in working order, and ready for use. Before using the syringe again, be sure that it has been disinfected and is in a thoroughly antiseptic condition. Never use a rusty needle, or one that has a blunt, or rough edge. They always cause more or less irritation. One of the best things to sharpen a needle on, is a common honing stone. The accompanying cut represents the kind of syring-e to be used when operating with local anaesthetics : i. Piston head. 2. A 30 minim graduated piston stem with scale. 3. Nut which is set for about two minims, sufficient to inject one side of a molar. 4. Finger brace. 5. Metal frame work supporting glass cylinder. 6. Glass cylinder. 7. Plunger with oil chamber. 8. Needle. 9. Cap to be applied when syringe is not in use. If your needle should get stopped up, so that you cannot get a 204 PAINLESS DENTISTRY wire through, but can force water through, put a drop of sulphuric or hydrochloric acid in the funnel end of the needle, and blow until it shows at the point, allow it to remain this way a little while, then try to get the wire through ; should you fail, try the acid preparation again until you succeed and then rinse the needle and syringe thoroughly. TO FILL THE SYRINGE. With the medicine screw the needle on tightly (never remove the needle to fill the syringe). Insert the needle in the anaesthetic until it has been thoroughly immersed, then slowly draw the piston back until you get all the medicine you can in the syringe. Adjust the needle up- wards and make sufficient pressure on the piston to force all the air out of the syringe and needle; in this way you obviate the danger of injecting air into the tissues. Be- fore operating make a swab by winding some absorbent ANTISEPTIC SWAB— ONE-HALF SIZE. cotton around the point of a pair of pliers. (See cut.) Dip this into an antiseptic solution of which listerine is one of the best for this purpose, and bathe the gums thoroughly around the teeth to be operated on. This makes the operation thoroughly antiseptic, providing you have kept your syringe aseptic. THE GUMS. To be operated on by the use of local anaesthetics can be divided in three classes, viz. : Firm, spongy and dis- eased. The firm gums are the most favorable of all for the use of local anaesthetics, inasmuch as they retain the medicine in place a greater length of time, and lessen the constitutional absorption. You will find it requires a greater degree of pressure to force the medicine in firm gums than it does where they are spongy, and gen- erally a sac will form where the medicine has been in- PAINLESS DENTISTRY 205 jected which should always be spread by the antiseptic swab. Spongy gums are much more treacherous than firm gums, and if you do not watch them carefully after withdrawing the needle the medicine will escape, and you will not get the desired effect. Hence, after with- drawing the needle, apply the antiseptic swab and scatter the medicine immediately. Ulcerated and diseased gums are almost invariably spongy and should always be treated as such, and carry out the antiseptic method of treatment more thoroughly by. using listerine freely. Should there be an abscess I always open it freely and inject peroxide of hydrogen. Swelling of the gums will follow the use of local anaesthetics in a certain per cent, of operations, which seems unavoidable, especially if the gums -are diseased. The difficulty subsides in a few days, and leaves the gums in a perfectly healthy condition. TO INSERT THE NEEDLE. Insert the needle about one-tenth of an inch above or below the gum margin, as the case may be. Do not try to insert the needle between the gum and the tooth at its margin (a mistake made by many operators), as you are quite sure to insert some debris which generally accumulates at the margin, along with the needle, which always causes more or less irritation. To insert the needle with but little pain, put the flat side of the needle on the gums and just make sufficient pressure to catch the needle under the gum tissue, and as you push the needle in on a line with the roots, force the medicine ahead of the needle until you have reached a depth cor- responding with the length of the roots ; withdraw the needle and make sufficient pressure on the outside sur- face with the antiseptic swab to scatter the medicine and hasten its absorption by the alveolus. A similar treat- ment should then be made on the opposite side of the tooth and extract immediately. I never exceed waiting over one minute after rubbing the gums with the anti- septic swab. In this way you liberate a large portion 206 PAINLESS DENTISTRY of the medicine, hence more can be used for this pur- pose than where it gets access to the general circulation. Regulate the amount of medicine used at each injection by the nut on the graduated piston stem. In this way METHOD OF INSERTING THE NEEDLE. you do not have to watch the syringe to see how. much medicine you are using at each injection, but you know when the nut on the piston stem comes in contact with the syringe, just how much medicine has been used. THE AMOUNT OF MEDICINE USED In preparing teeth varies according to the teeth being prepared for operation. Molars and canines require more medicine than incisors and bicuspides. It also requires more medicine to prepare a single tooth than it would a number located together. For instance, if I were to pre- pare a single molar I would use from two to two and one-half minims on each side of the tooth, where if I was to prepare a number of molars located together I would use from one and one-half to two minims on each side. In preparing the four incisors at once, I make five PAINLESS DENTISTRY 207 injections, two on the lingual and three on the labial side, using about one and one-half or two minims at each in- jection. In preparing any single tooth, all molars and canines always inject on each side of the tooth. The reason it does not take as many injections on the lingual side as it does on the labial is, the space is more com- pact and the tissues more dense, and you can spread trie medicine at your will with the antiseptic swab, which I always hold in my left hand when preparing the teeth. The accompanying cut will show about where to insert the medicine for a complete operation. The dots representing about where the needle should be The dots in the above cut represents where the needle should be inserted for a complete operation. inserted. It will require a little experience to become skilled in manipulating the syringe and needle, and the more you operate, the less medicine you will use, as it requires a little practice to learn where the medicine will do the most good. While I claim that the use of these anaesthetics when carefully administered are per- fectly harmless, at the same time I insist that they be properly used. Dentists generally think if they cannot inject a whole mouth full of a local anaesthetic into a patient's gums at once, the anaesthetic is at fault. Ex- perience with the use of these formulae in over sixty thousand different operations by myself and others under 208 PAINLESS DENTISTRY my observation, convinces me, that they are the safest and best in use, and, if handled with one-fourth the skill other anaesthetics are, you would never hear of any bad effects resulting from their use. It is not the use of a medicine but the abuse of it, that makes people con- demn it. In carefully looking up the records of the use of local anaesthetics, I am not able to report a single death caused by their use. If a patient presented himself for you to administer chloroform, you wouldn't com- mence by pouring one or two ounces of the drug on a napkin for inhalation, but would begin gradually, the same method should be observed in using local anaes- thetics. Instead of injecting a patient's gum full of the anaesthetic the first thing, carefully prepare one or two teeth, and operate in this way. If the operation is pain- less and successful, you get the patient's confidence, and he loses all fear of proceeding farther. Always allow a few minutes (from five to fifteen) after each operation for the patient to rinse his mouth and the gums, to stop bleeding. Then prepare three or four more, allow- ing sufficient time after each operation for the patient to rinse his mouth, and his gums stop bleeding. If your patient gets impatient, tell him you cannot operate while his gums are bleeding; for the secret of safety and success is to allow sufficient time to intervene after each operation. I will admit I am a hundred times more reckless than the instructions given above, as I frequently prepare from ten to sixteen teeth at a time, but I am so accustomed to its use, and can judge the temperament of a patient so well that I am perfectly safe in doing so, and the above instructions are laid down for operators with less experience and it is always best to be on the safe side. Should you ever make such a mistake as to inject the gums full of the medicine at once and the patient should complain of feeling faint, sick at his stomach, etc., extract immediately, and this will liberate a large portion of the anaesthetic, also give the patient a liberal supply of good liquor (preferably brandy), and they will generally feel all right in a few minutes ; but do not PAINLESS DENTISTRY 209 continue the operation until the patient tells you he feels better and is ready to proceed. If stronger stimulants are required, aromatic spirits of ammonia and amyl nitrate may be used to good ad- YOUR SUCCESS. There has been much said of late in current literature regarding sloughing gums and disastrous after effects fol- lowing the use of local anaesthetics, and they do not understand why one dentist can handle a local anaesthetic successfully and another cannot. Many dentists will secure some nostrum, allow it to stand around the office for three or four months exposed to the heat and light until it decomposes and loses its strength, throw their syringe into a box, allow it to corrode, dry up, and the needle get rusty, and when a patient presents himself he gets the benefit by having some decomposed medicine in- jected in his gums through a corroded and rusty syringe and needle. The patient complains that the operation has been painful (and he ought to). He will probably return in a few days with his face swollen badly and you might find an abscess where the needle was inserted to add to the patient's misery. There is always a right and a wrong way for every- thing, and if the operator will follow the instructions given and observe the following "pointers" I will assure him that he will be successful while his competitors are not: First — Always operate under antiseptic precautions by using listerine or some other antiseptic freely. Sec- ond-Never allow your syringe and needle to corrode, dry up and become rusty, but always keep it aseptic and in working order. Third — Never get in a hurry, but give the patient plenty of time to rinse his mouth, etc. Fourth — Always operate more slowly on weak, nervous and sickly people, than you would on the robust. Fifth — Be sure that the medicine has been inserted in the gum and not squirted in the mouth, as the medicine that gets into the mouth is what causes the patient to complain 210 PAINEEES DENTISTRY of sore throat, stiff tongue, faint, sick at stomach, etc. Never operate without having liquor at hand that no needed stimulation may be delayed. SECRET NOSTRUMS AND NEW PREPARATIONS. It has seemed to be the sole ambition of the nostrum venders to formulate a local anaesthetic without the use of cocaine, and with this aim in view, some of them have extolled the virtues of many familiar preparations, such as Aristol, Listerine, etc. While others who have wished to make their ''wonderful discoveries" more mysterious, have attributed them to some foreign country, and now we have offered us "The Hindoo Ansesthetio" and the "Brazilian Anaesthetic" (Dorsenia), and many others, all of which are claimed to be a reliable substitute for cocaine, and free from its disadvantages. On the other hand, there has been many legitimate products offered which are entitled to all the credit given them by their manufacturers. Most prominent among these may be mentioned eucaine, tropo-cocaine and chloretone. I have used these remedies quite ex- tensively, but do not believe that their action can be compared with cocaine, which in my opinion is par ex- cellence as a local anaesthetic. There has been several secret preparations analyzed to determine the percentage of cocaine, which I will give and also the published formulae of several advertised dentifrices. ODONTUNDER. A. W. Diack, D. D. S., in the Medical World, gives the following for the above named much advertised local anaesthetic. He says the following has been given me as (approximately) the correct analysis of the com- pound : 5 Carbolic acid Yi dr. Tinct. iodine Yz dr. Potassium iodide I dr. Glycerine 2 oz, Aqua 2.y 2 oz. Cocaine, about 34 gr. PAINLESS DENTISTRY 211 Charles M* Kerr, M. D., writes that he made an analysis of a similar compound called ANiESTHETINE. With the following results: If Cocaine 4 per cent, solution. Boracic acid quantity not estimated. Creasote quantity not estimated. Glycerine quantity not estimated. DENS ANTI POENA. The following is the result of an analysis of the above named compound made in Frederick Sterns & Co. laboratory. The examination was made to find the per cent, of cocaine with the following results : If Cocaine about 2 per cent. Chloral .per cent, not estimated. Carbolic acid per cent, not estimated. Cinnamon per cent, not estimated. PARSONS' LOCAL ANAESTHETIC. If Chloroform 12 parts. Tinct. aconite 12 parts. Tinct. capsicum 4 parts. Tinct. pyrethrum 2 parts. Oil cloves 2 parts. Camphor 2 parts. Dissolve the camphor in the chloroform, then add the oil of cloves, and then the tinctures. The venerable Dr. Parsons, in sending this formula for publication says : "I cannot expect to remain much longer in this world, and I want the profession to know the value of this local anaesthetic. " ODONTODOL. If Cocaine hydrochlorate 1 part. Oil of cherry laurel 1 part. Tincture of arnica 10 parts. Solution of ammonia acetate 30 parts. 212 PAINLESS DENTISTRY JESSOP'S ANAESTHETIC ly Cocaine hydrochlorate 2.63 per cent. Carbolic acid per cent, not estimated. Oil of rose per cent, not estimated. Aqua . q. s. DICKSON'S ANAESTHETIC. 3J Cocaine hydrochlorate 3.90 per cent. Carbolic acid per cent, not estimated. Chloral hydrate per cent, not estimated. Aqua distilled q. s. DORSENIA. 3J Cocaine hydrochlorate 0.20 per cent. Carbolic acid per cent, not estimated. Camphor per cent, not estimated. Alcohol per cent, not estimated. Aqua q. s. WEINMANN'S ANESTHETIC. I? Cocaine hydrochlorate 5.68 per cent. Aristol per cent, not estimated. Oil of peppermint. ...per cent not estimated. Br. coloring matter.. .per cent, not estimated. Alcohol per cent, not estimated. Aqua q. s. DENTAL SURPRISE. 3J Cocaine hydrochlorate 1.46 per cent. Carbolic acid per cent, not estimated. Aqua q. s. AN/ESTHETO OBTUNDENT. 3J Cocaine hydrochlorate 3.39 per cent. Carbolic acid per cent, not estimated. Camphor per cent, not estimated. Glycerine per cent, not estimated. Oil of cinnamon per cent, not estimated. Oil of citranella per cent.not estimated. Alcohol per cent.not estimated. Aqua q. s. PAINLESS DENTISTRY 213 ODOLGINE. ^ Cocaine 21 gr. Tincture of iodine 9 min. Potassium iodide 2 gr. Carbolic acid 6 min. Witch hazel : . . 1 oz. Glycerine 1 oz. Aqua 3 oz. BARR'S ANAESTHETIC. ^ Alcohol per cent, not estimated. Oil of peppermint. . .per cent, not estimated. Oil of cloves per cent, not estimated. EUREKA ANAESTHETIC. ]^ Cocaine hydrochlorate 3.26 per cent. Carbolic acid per cent, not estimated. Oil Rose per cent, not estimated. Aqua q. s. AROPHENE. 3^ Cocaine hydrochlorate 1.46 per cent. Carbolic acid per cent, not estimated. Chloral hydrate . . . .per cent, not estimated. Glycerine per cent, not estimated. Oil of rose per cent.not estimated. Alcohol per cent.not estimated. Aqua distilled q. s. DENTIFRICES. REID'S ANTISEPTIC LIQUID DENTIFRICE. 3J Thymol 2 gr. Carbolic acid 5 drops. Oil sassafras 8 drops. Oil wintergreen 8 drops. Oil rose geranium (Turk) 8 drops. Oil eucalyptus 3 drops. Oil calamus 5 drops. 214 PAINLESS DENTISTRY Oil pinus pumilio 20 drops. Glycerine 2 oz. Alcohol 43/2 oz. White castile soap 2 dr. Dist. water q. s. to 16 oz. Calcium phosphate q. s. Caramel Tinct. cudbear aa. q. s. to color Dissolve the soap in five ounces of warm water. Dis- solve the acid and oils in the alcohol and add to the soap solution. Filter through paper containing a small quantity of calcium phosphate. Add glycerine. VAN BUSKIRK'S SOZODONT. IJ White soap (powdered) y 2 dr. Alcohol 1 oz. Aqua 6 dr. Glycerine 2 dr. Oil of peppermint Oil of cloves Oil of wintergreen q. s. Powdered cochineal q. s. to color FRAGRANT SOZODONT POWDER. IJ Calcis precipitate 1 oz. Magnesii carbonatis 1 oz. Iridis florent radicis I oz. Triturate. RUSHMERE LIQUID DENTIFRICE. 5 Soap bark ground 2 oz. Glycerine 1^2 oz. Salicylate sodium 2 dr. Oil bergamot J / 2 dr. Oil wintergreen }£ dr. Oil cloves 10 drops. Alcohol 1 oz. Solution carmine (N. F.) q. s. Dilute alcohol, to make 16 fl. oz. PAINLESS DENTISTRY 215 Macerate the soap bark with the diluted alcohol and glycerine, then percolate. To the percolate add the oils dissolved in the alcohol. To this add the salicylate of sodium and sufficient solution of carmine to color. Shake thoroughly and filter through wetted talcum, returning first portion to the filtrate until it runs clear and add enough dilute alcohol through the filter to make the measure one pint. CALDER'S SAPONACEOUS DENTINE. J£ Calcium carbonate 59 per cent. Soap 44 per cent. Oil of wintergreen sufficient to flavor. ROSE DENTOLINE. 3J Quillaja, coarse powder 2 oz. Glycerine 2 oz. Cologne spirits 8 oz. Rose water 2 pts. Solution carmine 3 dr. Essence vanilla ^2 oz. Oil wintergreen 30 drops. Oil cloves 10 drops. Dissolve the oils and essence in the spirits, add the rose water, and in the whole digest the quillaja for two weeks, shaking occasionally. Finally add the glycerine and coloring solution and filter. The carmine solution is made by rubbing one dram carmine with one-half ounce aqua ammonia till dissolved, then add three and one-half ounces water. BROWN'S CAMPHORATED SAPONACEOUS DENTINE. 3^ Calcium carbonate 71 per cent. Soap Camphor aa. 29 per cent. 216 HYPNOTISM THE HYPNOTIC SPECIALIST The medical profession of this country have never seemed to study the phenomena of hypnotism as our medical brothers across the water have. Although it is a subject that interests the statesman, the scientist, the professional man and the layman alike, it is discussed by a few only, and is marveled at by the many. Showmen and charlatans have endeavored to hold the world at bay regarding its secrets by teaching the people that they were in possession of a gifted mystic power. While the phenomena of hypnotism are beyond the scope of this book, I feel that I would be neglecting a very important subject if I did not divert it of the super- natural and explain how it is done. If there is any class of people who should acquire a knowledge of hypnotism, it is the medical profession, for in their hands, it will find its greatest field of usefulness as a healing agent and sociological factor. In the following pages, I will endeavor to give, in brief, the history of hypnotism ; the different methods of producing the hypnotic state; hypnotism as a curative agent, etc. This may seem very simple to you. It is simple and by following the instructions, and with a little practice, you can produce all the different phe- nomena of hypnotism, as well as other operators. Every physician should at least be familiar with the subject, if he does not practice it. THE HISTORY OF HYPNOTISM. It is almost impossible to realize what an important part hypnotism has played in the political and religious histories of the world. It has made prophets and seers of old, witches and wizards at the beginning of the last HYPNOTISM 217 century, and all kinds and conditions of religious fanatics of our present day. The laying on of hands, the absent treatment and other methods used by the modern divine healers (?) were practiced by the Egyptians be- fore the year 1552 B. C. It is also known that Francis L, of France, and other French kings up to Charles X., practiced the art of healing by the imposition of hands. Another system was presented at the end of the middle ages, which developed out of the doctrine of the influence the moon and stars had upon men, which is well known to be practiced by astrologers at the present day. In the beginning of the eighteenth century, we find Santanelli in Italy, recognizing the great influence of imagination and advancing the theory that every thing material possesses a radiating atmosphere which operates magnetically. Although the foundation of "animal mag- netism was thus laid, universal attention was first drawn to it by Mesmer (from whom the name mes- merism developed), a Viennese doctor (1734-1815). Mesmer used animal magnetism in the treatment of dis- eases. He cured, at first, by contact, but believed later that different objects of wood, glass, iron, etc., were capable of receiving the magnetism, consequently he made use of them as a means of conveying his mag- netism. Mesmer made many disciples. His pupils and succes- sors were generally called Mesmerists,, and the doctrine of animal magnetism was also called mesmerism, vital magnetism, bio-magnetism. These practices flourished and gained a strong foothold all through Europe. Mesmerism was introduced in Manchester, England, in 1841, when Dr. Braid, of that city, became interested in the subject and showed with much method that the phenomena were of a subjective nature. By carefully fixing the eyes upon a given object, it induced a condi- tion of sleep which he called "hypnotism," which was the origin of that term. A few years later, Dr. Braid came to America and introduced hypnotism in New Orleans, which was its chief center for many years. 218 HYPNOTISM In the year 1878 Dr. Charcot, of Paris, France, began his public classes, in which he directed attention to the physical states of hystero-epileptics during hypnosis. Later hypnotism was introduced by Prof. Bernheim, in the second Medical College of France, at Nancy. This created a contest between the school of Charcot, and that of Xancy, which is not yet entirely settled. The latter, however, has gained ground more and more. At the present time hypnotism has gained its entrance into the lecture rooms of several universities and medical CHARCOT S CLINIC, PARIS, FRANCE. colleges, both in Europe and America ; therefore it must be mentioned that animal magnetism, out of which hypnotism has developed, has retained many adherents in the scientific world, and today, we can recognize three great schools with many points of transition : First, the school of Charcot ; second, the school of Xancy, and third, the school of Mesmerists. METHOD OF INDUCING HYPNOTISM. There are several ways of producing the hypnotic condition, but for convenience, I will divide them into HYPNOTISM 219 only three ways : First, the mesmeric method, which is the system used at most public exhibitions, and I be- lieve the easiest way to induce hypnosis ; second, the so-called mental method, and third, the fascination method. It is these methods, used either singly or com- bined, that Charcot, Bernheim, Fere, Braid, Regnard, Preyer, Dumont and all others used. Hypnotists of international reputation are using the mesmeric method. I consider this method the easiest and most practical way of producing hypnosis. The first thing to accomplish, is the concentration of thought in the subject. Require him to sit down; give him a coin or some other article, tell him to look steadfastly at it and not take his eye from it, and think of nothing else except the article you hand him. By watching the sub- ject carefully, you can tell whether or not his mind is upon the object. If you think his mind is not wandering, approach him and suggest that his eyelids are growing heavy, that it is impossible for him to keep his eyes open. Have him close his eyes and make passes from the head to the knees (the mesmeric passes). Now suggest that his eyelids have grown together, and it is impossible for him to open his eyes. Have him try hard (he will try, but in vain). Place his hands upon his knees and tell him that he cannot remove them. He will try, but fail to do so. Keep up the passes and suggest that he is now going to sleep, sound asleep ; that his mind is a blank ; he can no longer think of anything, but will remain sound asleep until you tell him to wake up. If your subject is susceptible to the hypnotic influence, he will sit before you in a complete state of hypnosis, and ready for any suggestions you may offer. You may tell him he is a horse, broom, or thrashing machine, and he will believe it and act his part well. In order that I may give you a clearer idea of the phenomena of this mystic power, I will tell you my first experience as a hypnotist. I was attending a medical convention in Cincinnati, and some of the physicians, with whom I was stopping, requested me to join them in a theatre party, to attend a performance given by a 220 HYPNOTISM lady hypnotist. I consented to do so, and watched her perform very attentively. She used the same method as described above. On arriving at our hotel, after the performance, we entered into a discussion regarding hypnotism, and I stated that I believed that if that lady could produce the hypnotic condition, I could, for I could see nothing supernatural about her, and I really had more confidence in my own ability than in hers. This self-confidence and positiveness, I afterwards learned, is one of the chief requisits for a successful hypnotist. To be brief, the physicians present volunteered to supply me with the subjects if I would hypnotize them. This was agreed to, and they presented me with three per- sons, two ladies and a young man. I seated them and handed each a coin, requesting them to concentrate their thoughts on that one thing and to think of nothing else. They took the matter seriously and followed my instruc- tions. Presently, I approached one of the ladies and told her that her eyes were getting tired and advised her to close them. I then commenced to make passes from her head to her knees. I suggested that her eyelids had grown fast and she could not open them. I told her to try hard, and she did, but in vain. She was perfectly conscious, but could not get her eyes open. I then assured her that she had grown fast to the chair and could not get up. She tried, but failed. I then told her that I was going to give her a magnetic treatment, and make a few passes over her body and she would go fast asleep. I commenced to make the passes and at the same time to suggest "You are going to sleep now, fast asleep," etc., and in a few moments she sat before me in as complete a state of hypnosis as one would wish for. You may imagine my surprise. To tell the truth, I was somewhat confused, for I had never studied hypnotism, and did not know the first principle of it; in fact, I did not know whether or not I could awaken her, but I slapped my hands loudly in front of her face, and said "Wide awake," and she immediately opened her eyes and smiled, which was, I assure you, a great relief to me. HYPNOTISM 221 I next tried the young man. I could place him in a condition in which he could not open his eyes, but could go no farther. The other young lady I could do nothing with. I cite this experience to show you how simple the subject is, and when you make your first efforts in that line, you will, no doubt, be as much surprised at your success as I was. I had never read an article on the subject, and knew very little about it, except what I had seen the lady do that evening. The mental method of inducing hypnosis is the method used at the school of Nancy, and is frequently referred to as the Nancy method. This is the most popular method in use throughout Europe. By its use the subject is thrown into a hypnotic state by arousing in his mind the image of sleep. This is more easily practiced on subjects who have previously been hypnotized. The following is the exact method proposed by Dr. Bernheim, and used at the college in Nancy, France: The person is advised to be seated and close his eyes. Then tell him : "You must try and go to sleep ;" "think of nothing, but that you are to go to sleep." Leave him in this condition for a few seconds and then continue : "You are commencing to feel tired and sleepy all over your body;" "your arms and legs feel heavy;" "a feeling of drowsiness is now taking pos- session of your body;" "your head feels dull;" "your thoughts grow more confused ;" "you can no longer re- sist, you are now sound asleep ;" "you cannot open your eyes ;" "your mind is a blank," etc. These mental sug- gestions are often all that is required to produce a com- plete state of hypnosis, and it is a very convenient way with some subjects. You can now ask him if he is asleep, and he will answer, "Yes." Ask him if he hears the band playing; he will say, "Yes." Tell him to open his eyes, and he will see a beautiful white horse. Place a chair in front of him for a horse. Tell him to get on the horse and take a ride. He will straddle the chair and attempt to ride. You can ask him what he sees while riding through this beautiful forest and he will describe 222 HYPNOTISM very accurately some scene he has viewed in his life. You now have completely robbed the subject of his will by simply suggesting sleep. He is en rapport with you and you only. The fascination method is induced by looking the sub- ject straight in the eye. After you have done this for some time, take him by the arm and draw him away with you. Still keep your eyes fixed upon each other; then raise your arm and he will do the same ; in fact, you can have him imitate any movement or position that you make as long as you keep your eyes fixed upon his, but as soon as you cease to look at him, the charm is broken. This method is demonstrated in lower animals. We have often seen snakes and cats charm birds. For all practical purposes it is used less than the other methods. THINGS THAT PREVENT AND ENCOURAGE THE PRODUCTION OF HYPNOTISM. When you are attempting to hypnotize a subject, you must insist that the place shall be kept quiet; disturbing noises of all kinds have a tendency to distract the atten- tion and interfere with the mental condition required to induce the hypnotic -state. Have those who are present assume rather a serious mood and avoid all ac- tions, either by word or gesture that will give any evi- dence of mistrust. Gain the confidence of those upon whom you operate. Endeavor to have perfect harmony in your presence. This, together with soft, sweet music and quietness, will assist you in establishing the results you desire from your efforts. HOW TO AWAKEN FROM THE HYPNOTIC STATE. There are as many ways of awakening a subject from the hypnotic state as there are of putting him into it. Crying out "Wide awake," or "All right," "Open your eyes," and spatting your hands loudly, or snapping your fingers in front of the subject's face is generally all that HYPNOTISM 223 is required. They will also awaken if left alone, but this will take some time if they are in a deep state of hypno- sis. If passes have been made downward, reverse them. You will never have any trouble in bringing your subject out of, the hypnotic state. HYPNOTISM AS A THERAPEUTIC AGENT. In the foregoing paragraphs you were told how to induce the hypnotic state, and now we wish to know how its influence can be used as a curative agent, but before discussing its various applications, we wish to call your attention to the importance of the way in which you make suggestions. A hypnotist must always be positive and firm, yet kind and gentle. Your subject must feel that you under- stand your business, and that you are master of the situation. You should make your suggestions in as con- cise and impressive a manner as possible. For instance, do not say, "Try to open your eyes ; they are closed fast and it is impossible for you to open them," but say, "Your eyes are closed fast, you cannot open them, try hard." The first suggestion you give is the first to be re- ceived by the subject, that is, in the first sentence, you told him to open his eyes, which he might do before you finish the balance of your suggestion. In the latter sen- tence you told him that his eyes were closed. This he receives and his efforts to open his eyes will fail. There are a great many ways in which hypnotism can be applied to good advantage. It can produce either local or complete anaesthesia. Under its influence, Jules Cloquet removed a breast, and Dr. Loysel amputated a leg painlessly in the year 1845. Its influence is also used at the present time by hundreds of physicians in America and Europe for the treatment of certain diseases and in minor surgery. Teeth have been extracted, small tumors removed, the pain of neuralgia relieved, and it is applied to good advantage in various diseased conditions, which I will illustrate in the following cases : 224 HYPNOTISM Case i — Mr. H., aged 23, applied to me to have an upper molar tooth extracted, and requested me to hypnotize him for the operation, as he was prejudiced against the use of local anaesthetics. I directed him to be seated ; I had hypnotized him before and it was very easy to place him in a state of hypnosis, which I did. I torn* him, "I wish to extract a tooth for you which will be done without pain. You must open your mouth wide," which he did without any hesitation. I then added, "Your mouth is now wide open, and it will be impossible for you to close it." I took this precaution to prevent his closing his jaws upon my fingers or the instruments. I now placed my thumb and finger on each side of the tooth and made heavy pressure, and said, "This tooth is perfectly dead now. The nerve has been killed and there will be no pain." I now loosened the gums from the alveolar process and removed the tooth. The patient still sat in the chair with his mouth open and face motionless. I now told him., "The tooth is out, close your mouth and spit out the blood." He did as I suggested, after which I slapped my hands in front of his face and added, "All right, wake up." He opened his eyes and said, "Did you get it, doctor?" He seemed sur- prised to find his mouth full of blood. This is the usual method of producing all forms of local anaesthesia through hypnotism. If I were to re- move a small tumor, I would carry out nearly the same method of suggestion, and stroke the part to be removed before operating upon it, and never forget to suggest that it will be done without pain. SIMPLE SUGGESTION. I do not wish to associate hypnotism with Christian science, but their modern operations are very much alike at times. Their principal therapeutic agent is sugges- tion, which will be illustrated in the following case: In the early days of my medical career, I was treat- ing a patient who had a fever. Her temperature was 1043^. She was delirious and I had much difficulty in HYPNOTISM 225 getting her to sleep. Various remedies were used, but with little effect. I invited an older brother practitioner to visit the case with me. On entering the room, we found that she had had very little sleep in the last twenty-four hours, and was very nervous. The doctor was a kindly magnetic old soul, and after discussing the case briefly, he sat down beside the patient and gently stroked her forehead, and said, "I guess you can go to sleep now. Try hard. Think you are going to sleep and you will sleep. " He continued stroking her head for a few minutes and she fell into a beautiful sleep, which lasted four and one-half hours, and awakened feeling much refreshed. This patient was not hypnotized, but she took the suggestion favorably. This demonstrates what simple suggestion will often do as a restorative agent if properly applied. It is by this simple method of suggestive therapeutics, that the modern Christian scientists, faith cures, and divine healers, have claimed to achieve their great suc- cess, and, although its field of usefulness is limited, it is worthy of consideration in many cases, and can often be applied in the general practice of medicine. It might be well for me to add, however, that if I had told the good old doctor he was practicing hypnotism oi ^Christian science in that case, he would have ceased to be my friend, for he was very skeptical on such subjects. The following case is reported by Dr. Bernheim, and will illustrate the way hypnotism is applied at the school of Nancy, and the power it has over muscular rheu- matism. The doctor says : "A child was brought to me with a pain like muscular rheumatism in the right arm, which dated back four or five days. The arm was painful to pressure ; the child could not lift it to its head. I said to him, 'Shut your eyes and go to sleep.' I held his eye- lids closed and went on talking to him, 'You are asleep and you will keep on sleeping until I awaken you. You are sleeping very well, as if you* were in bed. You are perfectly well and comfortable. Your arms and legs and whole body are asleep, and you cannot move.' I took my [15J 226 HYPNOTISM fingers off his eyelids and they remained closed. I put his arms up and they remained so. Then touching the painful arm, I said ; 'The pain has gone away ; you will have no more pain ; it will not come back any more.' In order to increase the force of suggestion by embodying it, so to speak, in a material sensation, I suggested a feel- ing of warmth. The heat took the place of pain. I said to the child, 'You feel that your arm is warm; the warmth increases and you have no pain.' I awakened the child in a few minutes ; he remembered nothing. The sleep had been profound. The pain had almost com- pletely disappeared. The child lifted the arm easily to his head. I saw the father on the day following, and he told me that the pain had disappeared completely, and that there was no return of it." The above case is interesting, for it illustrates the way in which painful disorders of every description will often yield like magic to the influence of hypnotism. Tooth-ache, neuralgia, dysmenorrhea, headache and other affections of a nervous origin, may often be cured by placing the patient in a hypnotic state and stroking the parts, and suggesting that the pain has left, never to return. There, are thousands of victims of the alcohol and drug habits that have been cured by hypnotism, while' the great Charcot and his followers have used it with wonderful success in all diseases of the mind and the nervous system. In conclusion, I will say that wherever hypnotism can be applied, it has a large field of usefulness. It is simple in practice and deep in theory. As yet no en- tirely satisfactory explanation has been made why this phenomenon exists, but we know that it does exist, be- yond a doubt, and today hypnotism holds a respected place in the scientific world. But its nature, like the nature of most other mental phenomena, is not under- stood, and to the medical practitioner who is wedded to drugs, a statement of the result obtained from the hypnotic influences may seem like the miracles of some ancient Oriental work. HYPNOTISM 227 I do not wish it understood as my belief that hyp- notism will ever be the universal curative agent, the panacea for all ills, or that it will ever supplant the use of cocaine, chloroform, ether or gas as an anaesthetic for surgical purposes. My experience with hypnotism has been very limited, but I must confess that it has been rather satisfactory. It is practical when it can be used, but on the other hand, it is impractical when we stop to consider that only about one in three can be hypnotized, and a smaller percentage cured by its use. I really believe that hyp- notism has a bright future, and if this chapter has suc- ceeded in merely throwing a small ray of light upon the subject and robbing it of its mysteries, I will feel that I have not wasted my efforts. " God bless the man who first invented sleep ! So Sancho Panza said and so say I ; And bless him, also, that he didn't keep His great discovery, to himself, nor try To make it— as the lucky fellow might — A close monopoly by patent right. j. G. SAXE. 228 FEATURAT SPECIALIST AND DERMATOLOGIST THE FEATURAL SPECIALIST AND DERMATOLOGIST. For many years the John H. Woodbury institutes seemed to monopolize this specialty. In late years, how- ever, several members of the medical profession have entered this special field of practice and find it a very re- munerative branch of the medical and surgical art. This specialty differs largely from the methods practiced by the so-called beauty specialists, inasmuch as it incorpor- ates surgery of very minute detail, and many of the op- erations are of a very delicate nature, requiring extraor- dinary skill in their performance, as it will be remem- bered that all operations upon the face are performed with a view of removing the deformity, blemish or dis- ease without leaving any mark, scar or trace of your work, and the surgeon who can accomplish results with the least detection is the one generally sought for. The face being the most conspicuous part of the body, it is also the most subject to accident, leaving deformities and unsightly scars, which are of the most embarrass- ing nature. What defects cannot be traced to accident, Nature has seemed to select the face as the favorite place for disease and blemishes,, thus we will see the face the favorite seat for moles, birthmarks, cancers, pimples, etc., while other parts of the body are by far less exempt. Physicians have greatly neglected the treatment of these deformities and blemishes, many thinking this part of medical or surgical practice beneath their dignity ; others have given it so little thought that they are ignorant of the many simple methods of treatment used by the ad- vertising Dermatologists. There is no special branch of medicine or surgery where patients are more grateful FEATURAL SPECIALIST AND DERMATOLOGIST 229 for skillful service than in the correction of deformities, or the removal of blemishes or diseases from the face. By successfully treating these defects the physician not only receives the credit for his skill, but he will re- ceive the life-long gratitude of his patients. DEFORMITIES OF THE NOSE. The nose is the most prominent part of the face and is likewise the more often subjected to injury and de- formity. So universally recognized are the disadvant- ages of the crooked, ill shaped or deformed nose, in both a social and business way, that it becomes one of the most important duties of the featural specialist to main- tain its conformity. It has been stated that ancient Per- sions will allow no man to sit upon the throne, who had a crooked or deformed nose, and children of the royal blood were accustomed to have their noses molded into perfect shape by eunuchs, who had charge of the royal offsprings. From a surgical point of view nasal deformities may be divided into deformities which effect the bony struct- ure, and deformities which effect the cartilagenous por- tions. These deformities may be congenital or acquired through accident or disease. The accompanying cut illus- trates the deformities commonly met with, which vary in a greater or less degree. These deformities have been described as the convex, or Roman nose, concaved or saddle back nose, and the bulbous nose; we also find a nose with a depressed tip, due to destruction of the sep- 230 FEATURAL SPECIALIST AND DERMATOLOGIST turn by disease, the too broad or narrow nose, etc. Each deformity presents characteristics which may require in- dividual attention. One of the most common nasal de- formities is the concaved or saddle back nose ; the cause of these deformities are usually traced to accidents, from falls or blows, breaking down the body structure. There has been several methods of treatment devised for cor- recting these deformities. Some surgeons prefer to break up the old adhesion and replace the bony frame work; others have been treated with metallic plates. The easiest arid I believe the most practical way in most cases, is to build out the concaved surface with paraffin, or as some specialists choose to call it, ''neoplastic treatment." Neo- plasine is another coined name for paraffin and consists of paraffin and sufficient white petrolatum to bring the melting point down to no degrees. Ordinary commer- cial paraffin generally has a melting point from 120 to 170 degrees, and in order to have the paraffin the right con- sistency, the white petrolatum is added and we have what the manufacturers call "an independent product" (neoplasine), which sells for a fancy price. The com- bination makes- a perfectly inert substance, which, if thoroughly sterilized, can be injected into any living tissue, even the peritoneal cavity, without injury. After the paraffin has been injected and allowed to remain some time, it becomes incapsulated and there seems to be an inter-woven network of fibrous tissue which pro- tects it in holding its conformity. Neoplasine has a wide range of usefulness to the fea- tural specialist other than the treatment of deformed nose. It has been found useful in building out a receding chin (see cut) and in filling in scars and indentures, as the result of alveolar and other abscesses. Some opera- tors have even filled out hollow cheeks and neck with this injection. In order to use neoplasine successfully re- quires a special syringe, as illustrated: this syringe is made of metal with a screw piston, which allows more force and an even distribution of the neoplasine; this is a very important point as neoplasine injected with the FEATURAL SPECIALIST AND DERMATOLOGIST 231 ordinary hypodermic syringe is a very treacherous sub- stance to handle, for it is impossible to regulate the force on the piston, and if you make a heavy pressure it will take a sudden spurt and you will inject too much and not in the place you intended to deposit it. When once de- posited there is no way of removing it, other than dissect- ing it out, therefore in making the injection great cau- tion should be exercised in not injecting too much, or you may cause a greater deformity than the one you were treating. Another thing I have always observed with neoplasine injections is that the tissues injected are in- NEOPLASTIC SYRINGE AND NEEDLES. clined to expand somewhat, therefore I never inject the full amount to level up the depressed surface, allowing from one-sixteenth to one-twentieth inch to be filled in, by expansion of tissue. If it is necessary to make another injection to complete the operation this can be done later. In this way you will always avoid duplicating one de- formity for the one you are treating. The only value neoplasine has in the treatment of deformities is to sub- stitute neoplasine for destroyed or deficient tissue, thus we find it indispensable in adding contour to the face in many ways. It can be used successfully in building out a concaved nose or a receding chin, and to fill in depres- sions and indentures at any point desired. For this pur- 232 FEATURAL SPECIALIST AND DERMATOLOGIST pose it has the following advantages : It can be used without a general anaesthetic or any resulting scar; it will not detain the patient from business pursuits, and is easily applied with ordinary skill and under purely antiseptic surgical procedures ; there will be no abscess or sloughing and the most gratifying results are ob- tained. TECHNIQUE OF NEOPLASTIC OPERATIONS. In order to successfully use neoplasine in subcutan- eous operations it is absolutely necessary that both the syringe and neoplasine be rendered sterile and surgical- ly clean. The neoplasine should be placed in a glass or- The above cuts illustrate the method of Inserting the Needle, the Neoplasine Sterilizer and Syringe and the Application of a Metallic Form after Operation for Convex Nose. metal receptacle, surrounded by water, and boiled. The syringe should also be boiled and devoid of all grease, as is sometimes found in ordinary syringes. While the neoplasine is still in a liquid state, the syringe should be filled; the point of the needle is pointed upwards and sufficient force applied to force all the air out of the needle. When you operate you can place the syringe, charged with neoplasine, into warm water at about 120 degrees F. for a few minutes, or it can be injected in a semi-solid state at a temperature of about in° degrees F. The latter method is preferred by many, as it avoids the danger of embolism, although I have never heard of this FEATURAL SPECIALIST AND DERMATOLOGIST 233 complication. A brief resume of the operation for a con- caved nose is as follows : After thoroughly sterilizing the neoplasine and syringe, as just described, the surface to be operated upon can be anaesthized with the obtund- ant solution No. 3, given on another page, but as a rule, I prefer to operate without an anaesthetic, as the anaes- thetic injection has a tendency to distend the tissues somewhat, and not allow you to judge as accurately the amount of neoplasine required to fill out the surface. RESULTS OBTAINED FROM NEOPLASINE INJECTION FOR CONCAVE NOSE. Injecting neoplasine without an anaesthetic is not painful, and is well borne by most patients. The needle is now inserted at a point of the nose to the furthest point of the deformity, and as the needle is withdrawn the screw on the piston stem is turned sufficiently to deposit the neoplasine required to fill in the concaved surface ; as the needle is withdrawn the fingers of the left hand molds the neoplasine to the proper shape and prevents it from entering places where it is not desired, and also smooths the surface to a normal contour. After the needle has been removed the point of entrance should be sealed with collodion, and cold applications of ice water may be applied for a few hours. There may be some swelling, but this will subside in a few days ; the nose may also 234 FEATURAL SPECIALIST AND DERMATOLOGIST continue to be red for a week after the operation, but it will gradually resume its normal color. Operations for a receding chin and other depressions are performed in a similar manner. In several cases RESULTS OBTAINED FROM NEOPLASINE INJECTION FOR RECEDING CHIN. scrawny necks and even female breasts have been built out by this means. Although this treatment has been somewhat abused by over enthusiastic operators, it is practical when carefully and judiciously used, and offers us one of the best means of treatment for many de- formities. OPERATION FOR ROMAN OR CONVEX NOSE. RESULTS OBTAINED FROM NEOPLASINE INJECTION FOR CONVEX NOSE. The operation for this deformity is somewhat more difficult, and requires considerable surgical skill to obtain success. In some cases the nose has been built out with FEATURAT, SPECIALIST AND DERMATOLOGIST 235 neoplasine at different points to produce a straight bridge, as illustrated in the accompanying cut. This is not a very practical operation, however, most cases re- quire a complete and thorough removal of the projecting bony framework, and in order that you leave no mark or scar, the operation performed by Dr. J. O. Roe, of Rochester, N. Y., is the most desirable. As described by him the operation is as follows : "The skin is first raised from the projecting portion by incising the wall of the nose from the inside of the nostrils through to the inner side of the skin, great care being exercised not to wound RESULTS OBTAINED FROM DR. ROE'S SUB-CUTANEOUS OPERATION FOR CONVEX NOSB. the skin. The opening is then enlarged sufficiently to admit the instruments required, which may consist of bone scissors, Rongier forceps, a slender saw and such other instruments aS/inay be necessary, according to the condition present. In removing the projecting portion great care must be exercised not to remove too much of the redundant tissue, lest a depression be left on the top of the nose, which may be more unsightly than the orig- inal deformity. This mistake more readily happens in those cases in which the upper portion of the nasal pas- sage extends all the way up into the projecting portion. In these cases the nasal passage is very easily opened on removing the projecting angular portion. After this 236 FEATURAL SPECIALIST AND DERMATOLOGIST operation a compress is made by placing a piece of ad- hesive plaster under a metallic form, so as to maintain symmetry throughout until healing takes place. This operation can be performed with less difficulty by mak- ing a lineal incision along the field of the operation and removing the tissues desired, but has the disadvantage of leaving a small scar. The scar tissue can be removed, however, by the different methods explained on another page. THE BULBOUS NOSE. The bulbous nose is generally found in drinking men in the form of a lipoma, and consists of an enlargement and thickening of the cartilaginous and cutanious tis- sues. The operation required is to make a V-shaped in- cision at the point splitting the septum, and removing as much tissue on each side as is desired to make tne nose the proper contour. Redundant tissue on the alaei nasi may be either dissected out or destroyed by elec- tricity. This is also done with the operation for ex- panded nostrils. There are other nasal deformities, each requiring special mechanical surgery; the nose may be too narrow or too broad, or the tip tilted to one side, etc., which requires special mechanical devises to retain the nose in its normal position or the replacing or transfor- mation of tissue. These conditions are not difficult to manage, if the surgeon is somewhat of a mechanical genius. RESULTS OBTAINED FROM OPERATION FOR PROTRUDING EARS. PROTRUDING EARS. Protruding ears are pictured out by many featural specialists, as convincing evidence that Darwin's theory FEATURAL, SPECIALIST AND DERMATOLOGIST 237 is correct, regarding the evolution of man, and argu- ments to this effect are used as a persuasive means of in- ducing the patient to have the "deformity corrected/' Protruding ears can be corrected in two ways, first, by removing the skin from the back surface of the ear and mastoid process, and uniting the denuded surfaces by means of sutures, after which an adhesive bandage is placed around the head, until healing takes place. An- other way of operating is to remove cartilaginous por- tions of the ear. The incisions are made from behind, where the scar will be less noticeable, and the adhesive bandage placed around the head, as in the former opera- tions. RESULTS OBTAINED FROM ENCORCHMENT TREATMENT FOR BAGGY SKIN AND WRINKLES. THE ENCORCHMENT TREATMENT. There has never been a treatment devised which has found such a universal field of usefulness in the treat- ment of facial blemishes as that described in the above caption ; on the other hand, this treatment has been greatly misused by ignorant beauty specialists, who possess little or no knowledge of the physiology of the skin, and the therapeutic application of this preparation, which they have endeavored to use as a sort of a pan- acea. This treatment has always been held in the great- 238 FEATURAL SPECIALIST AND DERMATOLOGIST est secrecy, and the "process" has changed hands sev- eral times, for many thousand dollars. If the applicant did not have sufficient cash to secure the working for- mula, he was supplied with the medicine only at a fancy price. This treatment, it has been said, originated with a French surgeon, and at the present time is very exten- sively used in Paris, where beauty culture is in great demand. This treatment is far superior to the iodine plaster treatment used in this country, and is much more easily and painlessly applied. The original formula of this treatment was a paste containing equal parts of resorcin and zinc oxide, which was used as a treatment for acne rosacea; it was later discovered that the treat- ment was of exceptional value in many other skin dis- eases and blemishes. The formula, as used today by some of the most successful Dermatologists, is as fol- lows : E Salicylic acid 4 gr. Ichthyol 8 min. Zinc oxide c. p 20 gr. Resorcin 80 gr. Lard 2 scr. Olive oil 16 min. Triturate the Resorcin, Salicylic Acid and Zinc Ox- ide into a fine powder, then add and mix the other in- gredients. This preparation is applied to the diseased surface morning and night for about four or five days, when the epidermis becomes like parchment; the surface is now thoroughly cleansed with soap and warm water and the skin wipped dry in order to remove the superficial layer of skin. The surface is now painted with the following mixture : ^ Zinc oxide, c. p.i 2 dr. White gelatin 4 oz. Glycerine 15 min. Aqua bullient q. s. FEATURAL, SPECIALIST AND DERMATOLOGIST 239 Dissolve the gelatin with sufficient hot water and stir in the other ingredients while in a water bath. This should be applied while hot to the surface you wish to remove, and covered with surgeon's gauze, and another coat applied over this. It is best to cut the gauze in small pieces, about one and one-half inches square, and apply one at a time. If you have a large surface to cover; in a few days the little pieces of gauze will work lose from the edges and can be picked off, leaving the new under skin exposed, taking the blemish or disease with the outer cuticle on the plaster you have removed. r M~a RESULTS OBTAINED FROM ENCORCHMENT TREATMENT FOR SMALLPOX PITS. One of the greatest mistakes made by ignorant operators is they leave the plaster on too long. I was recently visited by a lady who had this treat- ment applied in Buffalo, the face being left in a mask for one month before removing, and the result was that large abscesses had formed and made her last condition much worse than the first. While this is an exceptionally val- uable treatment it should be used with much caution and it is best to have the patient confined to the house and constantly under your observation. The object of the treatment is to remove the outer cuticle and take with it any diseases, discoloration or blemish it may con- 240 FEATURAL SPECIALIST AND DERMATOLOGIST tain. It is almost a specific for acna and certain forms of eczema, chloasma, or liver spots, tan, freckles and black heads, while small-pox pits and scars have been treated with a greater or less degree of success. * ELECTRICITY. Electricity plays a very important and useful part in the treatment of facial diseases and blemishes, therefore before discussing the different treatments used in the re- moval of these diseased conditions, it is well to briefly outline the electrical equipment required. Nearly every physician is familiar with the use and technique of elec- tricity and it will not be necessary to give the minute details of the construction of the electrical apparatus which produces this mystic therapeutic agent. Suffice to say that Dermatologists prefer for convenience a portable battery, containing from six to twelve cells, which is all the current required for their work. This simple equipment is all that is required to master the electrical treatments in facial blemishes. The method of application will be briefly described when discussing the treatment for different diseases. Before giving the application of electrolysis as a means of removing certain blemishes, I wish to make some general remarks regarding its practical use and limitations : The galvanic current is the only one to be employed. Electrolysis only offers us a means of cauterization and its only means of cure is to cauterize, the same as the use of other acids or alkaline caustics. If we insert the needle attached to the negative pole into living tissue, hydrogen gas, caustic soda and potassa are formed ; if the needle is inserted, attached to the positive pole, oxy- gen, chlorine and the acid radicals of the inorganic acids appear. The amount of caustic liberated and consequent- ly the amount of tissue cauterized and destroyed depends upon the strength of the current and the amount of sur- face the needle covers. It will thus be seen we have at our service an acid of alkali caustic which may be regu- FEATURAL SPECIALIST AND DERMATOLOGIST 241 lated and dispensed to any strength desired. If we at- tach the needle to the negative pole we liberate an alkali, caustic, which is generally preferable and nearly always used in Dermatological operations, as it does not create as much cicatricial tissue as the acid caustics eliminated from the postive pole. There is always some scar tissue following the use of the electrical needle, but this is not nearly so great when the negative pole is used. A gold or iridio-platinum needle also lessens the formation of ci- catrical tissue or inflammatory tendency. THE TREATMENT OF WARTS, MOLES AND BIRTHMARKS. There are several methods of treatment for the re- moval of these blemishes. They can be treated purely upon a surgical basis and carefully dissected out and FAVORITE LOCATIONS FOR BIRTHMARKS. unite the surface by making as close union as possible, as described in the treatment for scars. If the surface is a large one, as it usually is, in naevi, it may require sev- eral operations. Electrolysis is one of the most popular and successful treatments and leaves very little scar tis- sue. The patient should hold the positive electrode in her hand, and the needle connected to the negative pole is inserted in a vertical direction, through the base of the wart or mole, on a level with the skin, severa times at different points and allowed to remain about one-half minute. If the current from four to six cells has been used, bubbles of hydrogen gas will be observed around the entrance of the needle and the mole will appear [-16] 242 FEATURAL SPECIALIST AND DERMATOLOGIST blanched and in a few* days entirely disappear. A most excellent way to remove warts and moles is to cut a piece of isin-glass plaster to fit tightly around the healthy skin, allowing the mole or wart to protrude, thus protecting the healthy skin from being cauterized. The patient is given a small vial of pure glacial acetic acid and instruct- ed to thoroughly bathe the surface of the growth by dipping one end of a match in the acid and applying it to the surface three or four times a day. If this should cause much inflammation, the application can be omitted for a day or so before applying again. By continuing this treatment for a few days the growth will entirely disap- pear. Birthmarks can be removed by electrolysis in two ways, viz., by inserting the platinum needle attached to the negative pole into the center of the growth, and then make several punctures in the tiny capillaries which radiate from this source. If the growth is large a neeale disc may be used covering the entire area at one treat- ment. The principle object of electrical treatment is to de- stroy the nourishment of the growth and allow it to re- trograde. Dr. Neiswanger recommends the following treatment as preferable to electricity in many cases of naevi. He says, "If the mark is not elevated it is best to employ the following method : I? Antim tart I dr. Soap plaster 3 dr. Green soap i dr. This is thickly spread about 1-12 inch on adhe- sive plaster, leaving an adhesive edge to facilitate hold- ing it in place. Being placed upon the mark it is pressed down firmly to insure good and even contact; it must then be frequently examined and just as soon as active escharotic effect is evident, which is from three to five days, the plaster must be removed and the surface dress- ed with ^ Zinc oxide 20 gr. Cold cream 4 dr. FEATURAT, SPECIALIST AND DERMATOLOGIST 243 When the surface is healed the mother mark will have disappeared. Dr. Beck successfully treats naevi by transforming the vascular bulk of a navus into connective tissue by subcutanious sutures introduced at several sittings. A thread of cat gut is passed in a zig zag manner first be- low the skin, then underneath the base of the tumor, then again underneath the skin and tumor, and so on, until the tumor mass is included in this continuous suture. The suture is drawn tight and closed at the point of en- trance. In this manner the circulation is shut off within the tumor and at the end of a week the size of the tumor will be reduced and another ligature inserted. This op- eration is repeated until the tumor is reduced to the smallest possible size, when it may be excised and the borders united by lineal union. RESULTS OF TREATMENT FOR GUN POWDER MARKS. ( Only one side of Face Treated— Illustration nsed by Featural Specialist.) TO REMOVE GUN POWDER AND TATTOO MARKS. Powder marks can be removed by the electrical needle, but the process is very tedious and painful. 244 FEATURAL SPECIALIST AND DERMATOLOGIST Dr. Watson uses a small trephine designed for this purpose. The trephine is placed over the mark and given a slight rotary motion, going sufficiently deep to take out the little disc of skin containing the powder, which is clipped off; the cavity is filled with a healing powder or ointment, and leaves a very little scar, which in time is hardly detected. One of the most rapid and practical ways is to pierce each mark with a sharp lance, exposing the imbeded powder and apply a saturated compress of peroxide of hydrogen. The operation may be repeated in a few days, if necessary, until all the marks disappear. Tattoo marks may be removed by tattooing the same surface 'with papaya solvent. UNSIGHTLY SCARS. Scars caused by burns, cuts, wounds, etc., are best removed by carefully dissecting away the cicatricial tis- sue. The bordering skin is very elastic and can be stretched quite a distance. If the scar is not over one- half inches wide it can be removed in one operation. Should it cover a surface of more than one or two inches square it may require several operations. The object of the operation is to remove the scar tissue and unite the sound borders of the healthy skin ~by lineal union and without leaving any more mark than is possible ; the closer the union the smaller the scar. After union has taken place the remaining scar tissue can be reduced by the electric needle. Birthmarks are often removed in this way. BAGGY SKIN, WRINKLES, ETC. The method of removing baggy skin and wrinkles, as used by the featural specialist is purely surgical, and con- sists of what is known as ''wrinkle tucks," which means to remove pieces of skin under the hair and chin where it will not be observed. These tucks may follow the en- tire border of the scalp, about one-fourth inch from the FKATURAL SPECIALIST AND DERMATOLOGIST 245 hair margin. In this % way the skin is stretched to its former smoothness and makes the face devoid of wrinkles or puffiness. REMOVAL OF SUPERFLUOUS HAIR. There has been several depilatories introduced from time to time for the purpose of removing superfluous REMOVING SUPEFLTJOTJS HAIR WITH A DEPILATORY. hair, which have been sold under "a positive guaran- tee (?) that the result would be permanent." The com- mercial end of this business has been well taken care of by the mail order specialist. I have secured several of 246 FEATURAL SPECIALIST AND DERMATOLOGIST their preparations, and have never,found any agent other than electricity, which will accomplish this purpose. As a depilatory application for the temporary removal of superfluous hair, barium and strontium sulphide heads the list. I prefer strontium, as it is less toxic, and differs from other depilatory agents in not evolving hydrogen sulphide. My favorite formula is as follows : If Strontium Sulphide 30 gr. Zinc Oxide 15 gr. Starch 15 gr. Triturate thoroughly and mix sufficient water to make a paste. This is applied over the surface containing the superfluous hair and allowed to remain five or ten min- utes, when it can be removed by scraping the surface with some blunt knife similar to a paper knife, or it may be rubbed off with absorbent cotton ; the face should be washed, cleaned and some bland oil applied. This will give excellent results, but will not permanently destroy the hair follicle. The only sure means of removing super- fluous hair is by electrolysis. ELECTROLYSIS. The patient should be placed in a comfortable chair with a head rest, and before a strong light. The positive electrode is laid on the patient's lap or attached to the arm of the chair; the needle is attached to the negative pole and a current from two to six cells are thrown into circuit. The needle is then introduced along the hair shaft to the root and the patient is requested to place the palm of her hand over the sponge electrode of the posi- tive pole and thus complete the circuit. If the current is strong enough in a few seconds a little froth will appear about the entrance of the needle. The hair can now be removed with the depilatory forceps without much force. If you should meet with some resistence, it indi- cates that the electrolysis has not been complete and may require a stronger current or another operation. This re- PAINLESS SURGERY 247 quires a delicate sense of touch on the part of the oper- ator. There are two very important things to be con- sidered in removing superfluous hair by electrolysis. Never operate at the same sitting on hairs located too close together, for fear of a resulting scar, and to be suc- cessful at each operation the needle should follow the hair follicle as close as possible to the terminus of the hair root. The small depression around the hair at the exter- nal surface should be your point and the direction the hair takes will be your guide. The accompanying cut illustrates the needle which has not entered at the depression at the surface of the skin, but accidently penetrated the sheath and gain ac- cess to the papilla. Of course such hair will be perma- nently destroyed, but it illustrates that more caution should be exercised in the point of entering the needle. PAINLESS, BLOODLESS, AND SUTURELESS SURGERY. It is doubtful if surgical science has ever made a greater achievement in minor surgery than that described in the above title. This is not only one of the interesting accomplishments in modern surgery, but also one of the most practical. When a surgeon can make an incision without the appearance of blood, or any indication of pain, and unite the surfaces without applying sutures through the living tissues, we have certainly reached the 248 PAINLESS SURGERY highest goal of success. Although this method of surgi- cal practice has a limited field, it can be successfully used in part or in whole in 90 per cent, of all external minor operations. Operations can be made painless to the ex- tent and limitation of the use of a local anaesthetic, can be made practically bloodless wherever a local anaesthetic can be applied, can be made sutureless on any cutanious surface where tention is not to great. This method has a large field of usefulness in minor operations, upon the eye, ear, throat and nose, exterpating small tumors and growths upon the skin. The parts to be operated upon should be anaesthized with the Obtundent formula No. 3, with the addition of adnephrin according to the follow- ing formula : R Obtundent formula (No. 3) 20 min. Adnephrin 10 min. This offers one of the happiest combinations of rem- edies in the Materia Medica, as each remedy seems to have a controling influence over the other. The ad- nephrin, through its contractile influence on the capillar- ies controls the absorption of the cocaine and also in- creases the anaesthesia by lessening the blood pressure. A few. drops of this solution can be installed into the eye for the removal of cataract, or the operation for strabis- mus, or injected into any tissue to be operated upon, with the advantage of not only having the operation painless, but also nearly bloodless, thus allowing you full view of the operation with very little use for the surgical sponge. To illustrate the advantage of this hemostatic anaesthetic, and union without sutures, I will give a case which re- cently came under my observation : Mr. H., aged 41, came to me with a fatty tumor on the back of his neck about the size and shape of a hen's egg. This solution was injected at several points along the line of incision ; the tumor was then carefully dissected out, the edges of the wound trimmed in the usual way to PAINLESS SURGERY 249 secure as close a union as possible, the edges were drawn together and Luken's wound clips were used to unite the surfaces as illustrated below, these clips have the ad- vantage of making even pressure on all parts of the de- nuded surface, and it also makes a very close union, avoiding the formation of much cicatricial tissue and eventually leaving the surface free from any perceptible mark or scar, which is a great advantage, especially in facial surgery. The solution used as a hemostatic an- aesthetic should be made fresh each time, as it deterior- ates with age and the results are not as satisfactory. To one who has never witnessed an operation with the use of this solution the results will be surprisely marvelous, at the calm and composed condition of the average pa- tient. One can readily see the field of usefulness of tnis solution. I have used it in circumcision, male and female, ingrown toe nails, for the removal of tumors of all kinds, large as could be successfully operated upon by the use of local anaesthetics, in fact when you become acquainted with its true merits, you will find it one of the most re- liable preparations in your possession. 250 GOITER THE GOITER SPECIALIST. Goiter, or "big neck," as it is popularly advertised, has been isolated as a specialty by some physicians, and there is one Medical Co. in Cincinnati who claim to have the names of two-thirds of the goiter patients in the United States. This list has been secured by persistent adver- tising for several years. The treatment used by this company is an ointment composed of iodosyl incorporated in a base of lard and lanoline, applied three times a day. The internal treat- ment consists of iodide of potassium. Some years ago Dr. Hale devised a treatment by hypodermic injection, which has been used by several physicians with excellent success. The treatment is as follows : Injection No. i. If Carbolic acid J^ dr. Tinct. iodine 2 dr. Glycerine Yi oz. Aqua des 1 oz. Mix the carbolic acid and water, add the tinct. of iodine and glycerine and filter through absorbent cotton. Injection No. 2. 3$ Iodoform 40 gr. Glycerine 3 dr. Mix by triturating in a glass motar and keep the so- lution in a colored bottle. LOCAL APPLICATION. I> Tartar emetic y 2 dr. Tinct. benzoin comp 2 dr. Tinct. iodine 3 oz. Aqua Yz oz. Dissolve the tartic emetic in the water and add the tincture of benzoin and iodine, and filter. GOITER 251 Injections No. I and 2 should be alternated by first injecting from 1 to 5 minims of No. I, and in three days inject from 2 to 10 minims of No. 2. In this way a pa- tient receives about two hypodermic treatments a week. The amount of medicine used will depend somewhat upon the extent of the growth and the age of the patient. It is always best to commence with a minimum amount and increase the amount of medicine used as the treat- ment progresses. It is not necessary to inject deeply into the tissues, as you are dealing with a glandular substance and the medicine is readily diffused. The patient is also requested to apply the local application two or three times a day. If you wish to remove the discoloration caused by the iodine, you can readily do so by applying a concentrated solution of hyposulphate of soda. DR. CHAVETTE'S GOITER CURE. ^ Zinc sulphate 2 dr. Salicylic acid • 2 dr. Boracic acid 3 dr. Iodoform 3 dr. Oleic acid 8 oz. Mix and keep at boiling heat for four hours, then pour off the liquid, and after cooling, bottle and cork and keep in a dark colored bottle. This preparation should be applied to the enlarged gland by using slight friction twice a day until slight desquamation occurs, then it may be applied only once a day until the enlargement has been entirely reduced. It has been stated that this is a permanent cure for goiter. 252 HAIR THE HAIR SPECIALIST. A physician in general practice would hardly think that the treatment of the disease of the scalp, falling hair and baldness would offer a large enough field for a spe- cialty, but we find many regular physicians and many irregular "professors" entering this specialty and con- ducting "Bald Head Institutes" on a profitable basis. Many of these specialists limit their work to the treat- HIRSUTE MONSTROSITIES— LIONELL THE " DOG-FACED " RUSSIAN AND THE BEARDED LADY. ment of falling hair and baldness, while other treat all conditions pertaining to the hair, give scalp massage, electric treatments, shampoo, bleach and dye the hair, etc. The average person, especially men, pay very little at tention to their hair in a way of grooming, until he finds his hair is falling out and he is fast becoming bald. This excites his vanity and he seeks relief by consulting a spe- cialist. In this chapter we will give the treatments used by these specialists, and the different views regarding baldness. There are four varieties of hair; first and most HAIR 253 important of these is the long and pliant hair of the head ; second, the shorter and coarser hair on the face of man, and on the pubies and under the arm pits of both sexes; third, the shorter and coarser hair found on the eyebrows, eyelids, nostrils, etc. ; the fourth is called lenugo, which is the fine hair which covers nearly the entire body. Although there is no race on earth whose bodies are entirely covered with heavy hair, there are many mon- strosities in the way of hirsute growths, as is well illus- trated in the accompanying cuts, of Lionell, the dog-faced Russian boy, whose ancestors possessed a similar growth, and the bearded lady, who was born in the northern part of Michigan, whose ancestors did not possess an abnor- mal growth of hair. There has also been several individ- uals, whose entire bodies were covered with hair, which represented nothing more than their own individuality. These freaks are not of as great interest, however, to the hair specialist as the gold and silver taken in exchange for the treatment of restoring silver hair to its natural color, and producing the golden shade in others and curing baldness. ALOPECIA. There has been a diversity of opinion as to the cause of baldness, but it is the general belief of most investi- gators that it is of microbic origin. Prof. Unna, in the year 1887, was among the first to publish a paper advancing the theory that dandruff and subsequent baldness was of parasitic origin, and although his theory was not kindly accepted by many at first, his statements were afterwards verified by Morrell, who claimed he succeeded in isolating the dandruff germ — diplococus. Since his report there has been much in- vestigation along that line, which prove that dandruff and premature baldness is of parasitic origin. It has been noticed by many careful observers that seborrhoea often attacks several members of one family, who used the same hair brush and comb. It has also been demonstrated that mice placed in the combings of hair become bald rapidly, and that dandruff rubbed into the 254 HAIR hair of a rabbit will cause their hair to come out. I am of the same opinion as Dr. Bernheim, that much contam- ination originates at the barber shop. The less hair a man has on his head the more frequent he visits the bar- ber shop and exposes others to the same contagion, by- coming in contact with his own falling hair and dandruff left upon the comb and brush. We also notice many men who lead public lives and use public toilet utencils, brushes and combs, in hotels, DIPLOCOCUS AS IDENTIFIED BY MuRRELL, offices, etc., are also encouraging baldness. Another and one of the most convincing proofs that dandruff and fall- ing hair is of parasitic origin is that the only successful treatment is based purely upon cleanliness, antiseptic and parasitic medications. Among other things which have been attributed to the cause of falling hair and baldness may be mentioned, excluding the top of the head from light, air and sunshine, which is nature's greatest hair grower. Did you ever see a bald-headed Indian? Much credit is given as a cause of baldness to wearing too tight hat bands, thereby obstructing the circulation in the top of the head. The loss of hair is also associated with all debilitating diseases, etc. HAIR 255 TREATMENT OF ALOPECIA. The essential requirements to successfully treat dand- ruff, falling hair and premature baldness, are cleanliness, antiseptics, and stimulants, also the untiring patience on the part of the patient and physician. With this object in view there has been hundreds of hair restoratives placed on the market and many devises invented to pro- mote the growth of hair. DECOMPOSITION" OF HAIR FOLLICLE CAUSED BY DANDRUFF. In considering the requirements for treatment as enu- merated above, the following simple formula is one of the best preparations, to my knowledge, to quickly and thor- oughly remove dandruff, and is what is known as PEERLESS SEAFOAM : ]J Aqua ammonia 2 dr. Cologne . . 1 dr. Alcohol 8 oz. Aqua 8 oz. Mix. Sig. Apply about a tablespoonful at a time to the hair when dry and rub briskly. This makes a profuse foam which is very refreshing and cleansing to the scalp. After this has been repeated several times, the hair should be 256 HAIR washed thoroughly with a good tar soap. Owing to the poor quality of tar soap on the market, it is best to superintend the compounding yourself by using forty parts of beechwood or birchwood tar to sixty parts of castile soap. After using these shampoos the head should be thoroughly rinsed with hot water, gradually cooled. The bath water will contain many hairs, which may give the patient the impression that the treatment is doing more harm than good ; you should explain to them that the hairs which have come away are diseased hairs and would have fallen out in a few days of their own accord. These shampoos should be repeated at least as often as once or twice a week. Some specialists use what they call "scalp foods," which is used after the shampoo; these foods are mixtures of olive oil, lanoline, resorcin and mer- cury bichloride, and can be applied to a good advantage in many cases. It is applied with a tooth brush, rubbed in to the scalp, in the same way hair tonics are used. The next treatment used are what is popularly known as "hair tonics or restoratives," (see nortrums), and there is no end to the different combination of remedies used for this purpose. The principal thing to be considered is the combination of a mild stimulant, antiseptic, germicide and tonic. The remedies incorporated in these com- pounds are mercury bichloride and resorcin, for their antiseptic and germicide properties, quinine and nux vomica for their tonic effect, jaborandi or capsicum for their stimulating effect. The following formula will be found an excellent combination for promoting the growth of hair: I£ Quinine sulphate 20 gr. Tinct. nux vomica 2 dr. Tinct. cantharides 2 dr. F. E. jaborandi 2 dr. Resorcin 1 dr. Alcohol 2 oz. Glycerine 2 oz. Bay rum 6 oz. Rose water q. s. 16 oz. HAIR 257 Mix and filter. The best way to apply this and other hair tonics is to part the hair about one-half inch apart, lengthwise the scalp and dip a stifl tooth brush in to the solution and rub it into the scalp two or three times a week. Another form of hair restorative contains a prepara- tion of sulphur and lead. It not only acts as an alleged curative for baldness, but as a coloring agent in dying and deepening the color of the hair. The following formula is a very popular preparation for this purpose : (The reader is also referred to the for- mula given in the chapter on the mail order specialist, and other parts of the book for vegetable and other hair dyes.) IJ Lead acetate 6 dr. Sulphur precipitated . I oz. Tinct. cantharides 4 dr. Glycerine 8 oz. Alcohol 4 oz. Oil of citronella 1 dr. Oil of bergamot y 2 dr. Water enough to make 64 oz. Dissolve the oils in the alcohol, add the glycerine and tincture of catharides and mix with the water, then add the sulphur and lead. Preparations containing sulphur and lead, when exposed to the light, form black lead sulphide, therefore they should be kept in dark bottles. Patients using sulphur and lead hair restoratives should be cau- tioned that they are not entirely free from danger. To recapitulate : the treatment of seborrhoea, alopecia or falling hair, should consist of thorough cleanliness, antiseptics and stimulants, which may be obtained by the first two preparations ; the latter formula is not to be used unless you wish to darken the hair. The secret of success in promoting the growth of hair and treating scalp diseases lies in untiring perseverance. This should be explained to the patient and no case should be admitted for treatment unless he is willing to continue the medication for two or more months. [17] 258 HAIR ADVANCED ALOPECIA. The treatment of advanced baldness will depend upon the condition of the scalp ; if the scalp is shiney and the glands entirely atrophied, there is absolutely no help ex- cept the topee. If there are a few hairs left it offers the specialist a chance for argument and encouragement, and the physician's favorite quotation is often given : "where there is life there is hope." * All treatments for advanced baldness point towards one thing, viz., to improve the circulation of the scalp. This has been attempted by blistering, electricity and the vacuum treatment ; of these treatments the vacuum THE EVAN'S CAP FOR GIVING THE VACUUM TREATMENT. treatment is to be preferred, as it has many advantages in its favor. It is not claimed by specialists who use the vacuum treatment that it will create live hairs when there is none, but it provides every possible means of promoting hair growth under the most adverse circum- stances ; however, in no case will it restore hair to a per- fectly bald or shiney scalp when the life of the hair folli- cile has been extinct. The object of the treatment is to loosen the scalp and improve the circulation, which is of much benefit in all cases of alopecia. HAIR 259 HAIR DYES. The people of the Occident have to a certain extent, followed the universal custom of those of the orient in dyeing and bleaching- the hair to hide its grayness or to give it a preferred color. Hair dyes are of two classes, those containing the dye already formed, and those in which it is produced in the hair by some chemical pro- cess. Some hair-dyes contain substances which in their nature are very injurious to the hair, and cause baldness. Before dyeing the hair, the oil should be removed by washing thoroughly with soap and water, and the dye applied when nearly dry. The scalp should also be pro- tected from staining by a broad, fine-tooth comb. PERMANGANATE OF POTASSIUM DYE. ^ Permanganate of potassium 5^ oz. Distilled water 2 qt. The above combination forms a dark violet solution. When this is brought in contact with any organic sub- stance like the hair, it rapidly discolors it and imparts a brown tint, due to the hydrated oxide of magnesia. The hair is washed as stated above, and the dilute solution applied with a soft brush. The color is pro- duced at once. According to the degree of dilution, this innocuous preparation can be made to give any desired color from blonde to very dark brown. It is this prepara- tion which has recently been extensively used by ladies in their latest fad of coloring the hair auburn. Of course this preparation and other hair dyes may be used for the beard as well as the hair. TESIAN AUBURN HAIR DYE. "Zaza Shade." ^ Dioxide of hydrogen 2 oz. Nitric acid . 3 min. Aqua ammonia 5 min. Resorcine 15 gr. 260 HAIR SILVER HAIR DYES. This, and similar hair dyes, consists of two prepara- tions, preserved in bottles labeled Nos. I and 2 ; the latter, containing the silver solution, should be kept in a dark, amber-colored bottle, as the silver salts are decomposed by light. For use, some of the liquid from bottle No. I is poured into a cup, and the hair is moistened with it by means of a soft brush. The liquid from bottle No. 2 is now poured into another cup and applied with another brush. These dyes are prepared in different strengths in order to color the hair brown or black. TO DYE THE HAIR BROWN. No. i (in white bottle). If* Sulphide of potassium 7 oz. Alcohol 1 qt. No. 2 (in dark bottle). IJ Silver nitrate . .4^ oz. Distilled water 1 qt. TO DYE THE HAIR BLACK. No. 1 (in white bottle). I£ Sulphide of potassium y 2 lb. Alcohol 1 qt. No. 2 (in dark bottle). R Silver nitrate 5^ oz. Distilled water 1 qt. The sulphide of potassium appears in fragments of a liver-brown mass, which readily dissolves in water. The solution must be filtered before being poured into the bottle as it becomes turbid in the air. Keep in well corked bottles. When the two solutions are brought to- gether, black sulphide of silver results and darkens the hair. After the use of this preparation, a disagreeable odor adheres to the hair, which may be readily removed by washing. HAIR 261 CHRISTADORO'S HAIR DYE. No. i contains sixty grains of pyro-gallic acid dis- solved in one dram of alcohol and 4 ounces of distilled water ; No. 2 consists of 1 ounce of nitrate of silver dis- solved in 1 ounce of distilled water and 1 ounce of con- centrated ammonia, to which is added y 2 ounce of gum arabic dissolved in 3 ounces of distilled water. WALNUT HAIR DYE. 1^ Green walnut shells 2 oz. Alum % oz. Olive oil 4 oz. Heat together in a water bath until the water has been completely expelled, then express, filter and perfume. TO BLEACH THE HAIR. There are several preparations on the market, under different names, as Goldine, Auricome, Golden Hair Water, etc. These preparations are nothing but per- oxide of hydrogen, perfumed. When this is applied to the hair as a bleaching agent, it should be diluted and the hair deprived of its oil by first washing it with soap and water. HAIR RESTORATIVES AND GROWERS. NOSTRUMS. The following formulae will allow you to become familiar with many of the extensively advertised hair preparations : SEVEN SUTHERLAND SISTERS' HAIR GROWER. IJ Bay rum 7 oz. Distilled extract of witch hazel 9 oz. Common salt , 1 dr. Hydrochloric acid (5 per cent.) 1 dr. Magnesia q. s. Mix the bay rum and distilled extract of witch hazel, and shake with a little magnesia ; filter and in the filtrate dissolve the salt and add the hydrochloric acid. The 262 HAIR agitation with magnesia causes the preparation to assume a yellow color, but by rendering it very slightly acid, with the hydrochloric acid, this color all disappears. — (New Idea.) ALLEN'S WORLDS HAIR RESTORER. If Sulphur 6 parts. Acetate of lead 8 parts. Glycerine ioo parts. Perfumed water 200 parts. Dissolve the acetate of lead in the water, then add the glycerine and sulphur. Any aromatic water may be used for making the water. — (American Pharmacist.) HALL'S HAIR RENEWER. 1$ Sulphur 1 dr. Lead acetate 1 dr. Salt 2 dr. Glycerine 8 02. Bay rum 2 oz. Jamaica rum 4 oz. Water 16 oz. BORDET'S HAIR TONIC. The American Druggist gives the following for this preparation, and it is my opinion that it is much better than the lead and sulphur mixtures: If Carbolic acid 30 min. Tincture of cardamon 30 min. Tincture of nux vomica 2 dr. Compound tincture cinchona I dr. Cologne water 1 dr. Cocoanut oil q. s. ad 4 oz. AYER'S HAIR VIGOR. ^ Acetate of lead 3 parts. Flowers of sulphur 2 j)arts. Glycerine 14 parts. Water 80 parts. — (Formula d'Hygiene Populaire.) BEAUTY 263 THE BEAUTY SPECIALIST. The above title describes another type of specialist with which every city is familiar. These specialists are generally of the feminine gender, and their finely fur- nished parlors are found on every fashionable thorough- fare. As most women are ambitious to become hand- some, we find these specialists well patronized, and "for ways that are dark and tricks that are vain" they are, unapproachable. Georgine Champbaron, of Paris, was among the first to establish a reputation with her famous rejuvenating treatment. Afterwards Mrs. Harriet Hubbard Ayer opened an establishment on Fifth avenue, New York, for the purpose of beautifying the complexion of patients. From a financial standpoint, her success must have been phenomenal, for at the present time, we find temples of beauty everywhere, with a presiding princess, who is usually a woman past her first youth, hard in feature, illiterate to a degree, but seductive in manner and fluent in argument. These "ladies" generally claim to be philanthropists, pure and simple, animated solely by a desire to help their less beautiful sisters (at a trifling charge of from fifty to three hundred dollars for each case). Their primary training as beauty specialists is often obtained at some fashionable manicure or hair-dressing establishment, where they have acted as an apprentice and learned to listen to and sympathize with women who are not blessed with good complexions by nature. A clever woman at once finds the field a large and profitable one, and enters into business on her own re- sponsibility, with a few pretty young ladies as her as- sistants. By consulting some recipe book, she finds the formu- lae for the preparations required in her practice, places 264 BEAUTY them in fancy bottles and labels them "Creme de Beaute of the French Court," "Helen of Troy Skin Rejuvenator,'* "Circle's Bloom/' or "Elixir of Youth." They also have wrinkle-eradicators, hair dyes and bleaches, plasters, etc. They have steaming and other appliances which impress their patrons favorably. , A young lady once delivered herself into the hands of one of these philanthropic "ladies," for the purpose of learning their methods, and under her treatment, was FACE STEAMING APPARATUS. kneaded, pinched, massaged, greased, steamed, lotioned, powdered, painted and elixired during six weary days. She claims that she got along with the treatment more easily than many others, for as soon as she had retired from their apartments, she washed their stuff off, and was not self-sacrificing enough to undergo the rejuvenat- ing process, for she did not care to submit to the torture, and be flayed alive. She describes the process of beauti- fying as divided into three departments, bleaching, steaming and plastering. The almost invariable basis of the complexion bleach is corrosive sublimate, the BEAUTY 265 action of which is to remove the outer cuticle, leaving the smooth, pink underskin exposed. The pain con- nected with the use of this preparation varies according to the strength in which it is applied, and the delicacy of thcskin. The face-steaming treatment used at these institu- tions is too well known to require much description. The face is thoroughly greased, and then bathed with medi- cated steam. This opens the pores and allows all secre- tions to escape, including the natural oil which is abso- lutely essential for the nourishment of the skin. The great argument in favor of the face-steaming treatment is, that it removes all impurities, which is quite true, but experience has demonstrated that the continual and ex- cessive use of these steaming treatments will weaken the secretory glands of the skin, and have a tendency to leave it dry by extracting its oil. This, of course, is the cause of wrinkles, which no amount of their creams or flesh food will repair. The most horrible and barbarous of all the com- plexion processes is known by the alluring title of '*fe- juvenating treatment," and is guaranteed to make a per- son look twenty years younger in a few weeks. This is practically a revival of the torture process in vogue in France in the fifteenth century, and the suffering which it entails varies only in degree. Unlike the other treatments given, the skin, in this process, is peeled off in strips. The face is first bathed with a mixture of iodine some use the pure tincture. Plasters are then applied, which not only loosen the skin, but draw out a thick, milky pus. The outer skin is finally torn off with the plaster, leaving the half-raw and agonizingly sensitive under-cuticle exposed. When the surface has entirely healed, the shortest time being from four to eight days, the complexion in many cases is really marvelously beautiful, although all. the lines of character have disappeared, leaving the face as expres- sionless as that of a doll. 266 BEAUTY For weeks afterward, the faintest breath of wind or the touch of the softest cloth in bathing the face, causes the most excruciating pain. In a few months after tak- ing this treatment, the sensitive skin commences to show thousands of criss-cross lines almost imperceptible at first, but gradually deeping until the face, when viewed closely, shows a shrivelled surface somewhat re- sembling that of a peach which has been plucked too soon. In connection with the above treatment, these specialists often give massage treatments ; bleach, dye APPLYING AND REMOVING THE PLASTERS IN THE REJUVENATING SYSTEM. and shampoo the hair, treat baldness, and remove super- fluous hair, have remedies for pimples on the face and other skin diseases, advertise flesh foods to develop the bust and to round out the neck. They also have complex- ion tablets and other beautifying articles. Although physicians, as a rule, do not care to assume the dignified title of "Beauty Specialists," they are often requested to compound toilet preparations for some of the above conditions. I, therefore, append some of the formulas of their secret preparations, which may be of service to them. BEAUTY 267 THE SKIN. It is this part of the anatomy that offers the "beauty specialists" their greatest opportunity to hold high car- nival, and we find their preparations extensively adver- tised to cure every thing from a pimple to a "mother mark." Among the remedies used for beautifying the skin, glycerine, no doubt, heads the list. Pure glycerine should never be used, however, in concentrated form, as it abstracts water from the skin and produces a sensation of heat and burning, but when it is combined with an equal part of rose water, we find it a very valuable agent FAKE PICTURES USED BY BEAUTY SPECIALISTS TO DEMONSTRATE THE VALUE OF THE REJUVENATING TREATMENT. in rendering the skin white, supple, soft and glossy. No other remedy will clear a sun-burned skin in so short a time as this preparation. Owing to the penetrating properties of lanoline, we find it also a valuable preparation, in which other reme- dies may be incorporated to convey them to the under cuticle. Corrosive sublimate is the remedy most gener- ally used as a bleaching agent. To remove freckles, moth patches, liver spots, etc. 1 subjoin several formulae which are used extensively in treating these different conditions of the skin: 268 BEAUTY ALBADERMINE TREATMENT. Under the title of Albadermine, a foreign specialist has devised a method of treatment for the removal of "tan" and the milder varieties of "freckles," which is as follows : SOLUTION A. ]J Potass : iodide 2 dr. Iodini pur 6 gr. Glycerine 3 dr. Infus. rosae 4 oz. Dissolve the iodide of potassium in a small quantity of the infusion and a drachm of the glycerine ; with this fluid moisten the iodine in a glass mortar and rub it down, gradually adding more liquid until complete solu- tion has been obtained ; then stir in the remainder of the ingredients, and bottle the mixture. SOLUTION B. Tfy Sodii hyposulph. (Thiosulphate) . . . .J4 oz. Aqua rose I pt. Dissolve and filter. With a small camel's hair pencil or piece of fine sponge apply a little of "Albadermine A" to the tanned or freckled surface, until a slight but tolerably uniform brownish-yellow skin has been produced. At the expira- tion of fifteen or twenty minutes moisten a piece of cam- bric, linen or soft rag with "B," and lay it upon the af- fected part, removing, squeezing away the liquid, soak- ing it afresh, and again applying until the iodide stain has disappeared. Repeat the entire process thrice daily but diminish the frequency of the application if tender- ness is produced. In the course of from three or four days to as many weeks the freckles will either have dis- appeared entirely or their intensity will be greatly di- minished. "Summer freckles" yield very speedily to this treatment. BEAUTY 269 GLYCERINE CREAM. ^ Glycerine Yz lb. Almond oil 14 oz. Rose water 12^4 oz. Spermaceti 3^ oz. Wax 480 gr. Oil of rose 60 gr. Melt the wax and spermaceti by gentle heat, then add the almond oil, next the glycerine mixed with rose water and the oil of rose. This makes a splendid preparation for sun-burn, chapped hands, etc. MELVINA CREAM. The following formula will make a preparation closely resembling the original: 5 Saxoline 265 gr. White wax 50 gr. Spermaceti 30 gr. Bismuth oxychloride 40 gr. Mercuric chloride ]/2 gr. Spirit of rose (4 drachms of oil to one pint) 20 min. Oil of bitter almonds 1-8 min. Warm the saxoline, white wax and spermaceti to- gether until melted. While cooling incorporate the bis- muth oxychloride and the mercuric chloride; this last previously dissolved in a little alcohol, and when nearly cold, stir in the perfume. MELVINA LOTION. This lotion is used in connection with the Melvina Cream, and is recommended by the manufacturers to re- move freckles, pimples, moth-patches, liver moles, ring- worm and salt rheum, and also to straighten wrinkles in the face, and cleanse and soften the skin to youthful freshness. The following formula will make a prepara- tion similar to this remedy: 270 BEAUTY IJ Mercuric chloride 2 gr. Zinc oxide 3 dr. Almonds 2 dr. Rose water i pt. Make an emulsion of the almonds and rose water; dis- solve the mercuric chloride and add this with the zinc oxide. — -(New Idea.) ROSALIND. This is a cosmetic for tinting the fingers, face and lips, which preserves the skin, cures chapped hands, etc. The New Idea gives the following formula as approx- imately replacing the original : 3J Eosine io gr. White wax 30 gr. Spermaceti 30 gr. Amber saxoline 410 gr. MADAM RUPPERT'S FACE BLEACH. Recent analysis assigns the following composition to this highly lauded cosmetic : IJ Corrosive sublimate 1 gr. Tincture of benzoin 7 gr. Water 500 gr. Mix. — (Western Druggist.) COMEDONE LOTION. T? Sulphuric ether 1 oz. Carbonate ammonia 1 dr. Boracic acid 20 gr. Water, to make 16 dr. Mix, and apply twice a day. The ammonia carbonate forms a soap with the grease. The borocic acid acts as an antiseptic and the ether as a solvent. — (Analytic.) BEAUTY 271 HAGAN'S MAGNOLIA BALM. Said to resemble the genuine. 3J Pure oxide of zinc I oz. Rose water 4 oz. Glycerine I dr. Perfume 25 drops. — (Lillard's Prac. Hints and Formulae.) LAC VIRGINS. Cosmetic for the skin : IJ Tinct. of benzoin 10 parts. Rose water 150 parts. Mix. A teaspoonful of this mixture, added to an ordinary hand-basin of water, makes an admirable cosmetic for the skin of the face and hands. FUNK'S CREAM OF ROSES. 3J Tragacanth I dr. Glycerine 1 oz. Triple extract of white rose 1 oz. Water .8 oz. Carmine q. s. to color DELIGHT OF THE HAREM. This name sounds quite Oriental enough to enable one to conjure up a vision of some dusky beauty. This cream is used to whiten the skin of the neck and arms temporarily and is especially useful for the purpose of disguising a bad skin in the evening. I£ Oxide of zinc 1 oz. Spermaceti 1 oz. White wax 1 oz. Paraffin 1 oz. Orange blossom oil. 20 min. Almond oil 6 oz. LA DIAPHANE. This preparation is also known as Sarah Bernhardt's face powder, and has had a wonderful sale in some lo- calities. 272 BEAUTY IJ Talcum powder 10 oz. Rice flour 10 oz. Zinc oxide (Hubbuck's-) 5 oz. Mix well and perfume with a mixture of oils of berga- mot, ylang ylang and neroli. RED LIP SALVE. ^ Expressed oil of almonds 2 lbs. Wax 4^ oz. Spermaceti A^/2 oz. Oil of geranium 150 gr. Oil of santal 90 gr. Alkanet root 4^4 oz. The beautiful red color which distinguishes this preparation is produced with alkanet root ; the mass, be- fore the essential oils are added, is macerated for from six to eight hours under frequent stirring with the com- minuted root and then decanted from the sediment. FINGER NAIL POLISH. The finger nail being an appendage to the skin, we give the following formula for imparting smoothness and gloss to the nails : ^ Oxide of tin 4 lbs. Carmine ^4 oz - Oil of lavender 150 gr. Oil of bergamot 150 gr. The oxide of tin must be an impalpable powder and is mixed with the other substances in a mortar. ECCHYMOSIS. The following formula is the very best treatment known for discolored skin due to a bruise, especially the so-called "black eye :" I£ Tincture of Capsicum 1 dr. Gum arabic 1 dr. Glycerine 10 drops. Paint this over the affected parts, allow it to dry and then apply again, until the surface has three or four coats. The formulae for other toilet preparations will be found in the chapter on Secret Nostrums. BEAUTY 273 THE NEW REJUVENATING OR TREATMENT. ENAMELING One of the most amusing incidents the writer has ever had in investigating beauty culture, was to visit the parlors of an itinerant beauty specialist, who had adver- r ; RESULTS OBTAINED FROM THE NEW REJUVENATING TREATMENT— ONE SIDE OF FACE TREATED. ILLUSTRATION USED BY BEAUTY SPECIALISTS. tised quite extensively, and given several lectures regard- ing her rejuvenating treatment for the removal of wrin- kles, etc. Her parlors were always crowded and she did a flourishing business during her stay in the city. By allowing her to understand that I wished to secure an interest in the business, she was extremely willing to [18] 274 BEAUTY enlighten me as much as possible regarding her method of treatment. The specialist occupied three rooms in one of the leading hotels; one was used as a reception room, one as a consultation and treatment room and the other for what she called the "retiring room." Patients were required to take a course of ten treatments for $15.00 in advance. At this nominal price she found many victims from all walks of life, but old maid school teachers seemed to predominate. The treatment, or enameling process, consisted of painting the entire face, using a common half-inch round paint brush, with the following formula, which I learned afterwards : I£ Mercury bichloride 2 gr. Boracic acid 2 dr. White of eggs 1 pt. Mix by beating and trituration. The entire face was given a heavy coat of this sub- stance and allowed to dry, when another coat was ap- plied. This was repeated several times. With the assist- ance of a fan this process took about fifteen minutes and several ladies were treated at the same time. After the last coat they were placed in the retiring room and re- quested to stay there three hours ; they were not allowed to talk or open their mouth, for fear they would break the enamel. Imagine yourself placed in a room full of ladies, where all is silence and their faces as expression- less as a doll's ; it reminds one of a visit to some ancient Egyptian, incarnated mummery. The process removes the wrinkles, however, but of course, the results are only temporary, and many of the ladies abandon the treatment before the course is com- pleted. This illustrates one of the many ridiculous things which a fluent and persuasive tongue can accomplish in inducing the gentler sex to improve their complexion and restore their youthfulness. BEAUTY 275 TO DEVELOP THE BUST. It is very doubtful if there is any one thing other than a beautiful complexion that a woman admires more than a full, symmetrical bust. This has caused the inventor and the specialist to contrive all kinds of devices to assist nature in the development of the mammary glands in flat-chested women, and we find bust foods and vacuum treatments advertised very extensively. THE ABOVE ILLUSTRATES THE VACUUM INSTRUMENT AND THE METHOD OF APPLYING. The vacuum treatment consists of a cup-shaped glass (see cut) which will fit around the gland, and when suc- tion is made at the apex, either with a rubber bulb or pump, it will draw the breast into the cup, where it is allowed to remain in this expanded condition during the night. Bust foods are nothing more or less than lanoline,. which may be adulterated with lard or cheap oils and perfumed. This is rubbed into the breast by a course of massage treatment, which occupies from one or two hours each evening before retiring. I have never had any experience in the use of either of these treatments, but the accompanying cut is supposed to represent the results obtained from their use. 276 BEAUTY The Medical World has the following to say regard- ing the development of the bust: If woman's "crowning glory" be her hair, it is certain that a well-developed bust is a more attractive feature to most people. Many women go through life with scrawny figures which are a source of constant mortification to them, when a little advice and proper exercise would modify matters materially. The quack advertisements in the yellowest of lay papers are matched by the better worded advertisements in the highest class of ladies' magazines in bidding for the money of the credulous. The proof is evident that there is a demand for some method of developing the figure, and the family physician should know what advice to give ; in fact he should frequently have the tact to give advice unasked. The average physician would ridicule a lady patient who asked such advice, when he should encourage and aid. Of course one must ridicule any drug which has the merit (?) of "developing the bust four to six inches in a few days," but we can instruct our patients in the use of inunctions, massage, bathing, and breathing so as to obtain for them appreciable results. The following; ! xtract is taken from Ostrom's Massage and Swedish Movements : "Massage and exercise are the only means by which the bust may be properly de- veloped. The patient should be taught how to breathe properly, and for the quick development of the mammary glands, use in massage the following preparation : I£ Cocoa butter 2 oz. Lanolin 2 oz. Extract saw palmetto 2 oz. Oil cajuput 1 oz. Oil sassafras ^2 oz. This preparation has not a fine odor, but produces a pleasant sensation in the skin. It is a valuable compound wherever we wish to develop a part, but it should not be used on the face." A few deep breaths taken on rising each morning will work wonders in the course of a few months. The grow- BEAUTY 277 ing girl should be taught to stand and walk with the abdomen drawn back, the chest thrown well forward, shoulders well thrown back and on a line with the hips. Bathing with alcohol or cold water on rising or retiring is not only grateful, but beneficial. If your flat chested girl patients do not speak to you on such matters, it is your duty to speak to them (probably through their mothers), thus not only earning their gratitude, but ben- efiting their health. y^^l If 1 ,' wkf* Pi *w; «n : » ?#* rm^S! w /, °'l~ i/ > r THE RESULTS OBTAINED FROM VACUUM MASSAGE AND FLESH FOOD TREATMENTS. GALEGA. Galega is the internal remedy used by most mail order specialists and at local institutes for bust develop- ment, and it is claimed that wonderful results have been obtained in many cases, not only as a bust developer, but as an aphrodisiac for women. The discovery of this drug was due to its extensive use in the central parts of Eu- rope, where it is given to cows to increase the quantity of their milk from thirty to fifty per cent. 278 HYDROPHOBIA PASTEUR'S METHOD FOR TREATING HYDROPHOBIA One of the most successful of the toxin treatments is Pasteur's treatment for rabies. From the years 1886 to 1893 inclusive there were 14,430 cases treated at the Pasteur Institute in Paris, with only 72 deaths. This leaves a mortality of one-half of one per cent. The institute in New York treated 424 cases with but two deaths. As yet there has never been a microbe discovered which is associated with rabies, yet proof is abundant that the disease is due to a micro-organism. Pasteur found the virus most abundant in the spinal cord of the rabid animal and showed that its inoculation upon a healthy animal will produce the characteristic symptoms of the disease, also that the virus may be attenuated in virulence by drying the spinal cord containing it. He also found by inoculating on each successive day the virus from a cord dried during a shorter period than that used on the previous day the animal so treated may be gradually made almost certainly secure against rabies, either from the bite of a rabid animal or from any method of subcutaneous inoculation. Upon these facts he founded the preventative treatment of this disease, commenced by him in Paris in 1885, which consists in the daily inoculation of the bitten person with emulsions of gradually increasing virulence, made from the dried spinal cord of rabbits that have died from rabies. By this procedure chemical substances (toxins) HYDROPHOBIA 279 produced during the life of some specific organism and known to be inhibitory of its growth, are introduced into the system of the patient (V. Horsley). Dr. Horwitz gives the following as his mode of con- ducting the treatment of a case of hydrophobia: The substance used for inoculation is perfectly pure veal broth, free from microbes, in which has been dis- solved a little of the spinal marrow of a rabid rabbit. The broth is carefully prepared and put into a glass re- ceiver of spherical form with a long neck, hermetically sealed. It is then submitted for half an hour, under pressure, to a heat of 239 degrees F. This boiling is for the purpose of destroying all germs. When per- fectly clear it is decanted in one of Pasteur's receptacles. To obtain the infected marrow, a rabbit is chloroformed and trepanned, the infected broth is injected under the dura mater, then the edges of the wound are stitched to- gether, and the rabbit is left to recover. After the inocculation, rabies declares itself in the rabbit at the end of six days. Two or three days later the animal dies. The spinal cord is carefully extracted and then hung up in a flask containing caustic potash. It is placed in a room kept at a heat of 68 degrees F. When the infected substance is to be used, a piece about a centimetre in length is cut off and mixed with pure broth. The first day the patient receives half a hypo- dermic syringeful of broth, with marrow of thirteen days' strength. The following day the patient receives a hypo- dermic injection of twelve days' strength. Each day the marrow is one day younger, the operation being repeated daily for twelve days. Rabies may be considered a very rare disease and many old practitioners have never seen a case. It is therefore best for the physician to send the patient who has been bitten by a rabid animal to one of the Pasteur institutes. He should be accompanied by a piece of the medulla oblongata of the rabid animal if possible. This will allow the physicians in charge to determine whether or not the animal was rabid. 280 TAPE-WORM THE . TAPE-WORM SPECIALIST. These gentlemen are, as a rule, not graduates of medicine, and often prefix the title "professor" instead of doctor to their names. They are either permanently located in cities or travel through the country, lectur- ing on worms, from a buggy on the street corners of small towns, where they display large bottles of the •different specimens of worms, which they claim to have removed. They cure all kinds of worms and, by their persuasive oratory, make a large portion of their audiences believe that they have worms whether they have or not. The fact that physicians often overlook the symptoms of worms, gives them an opportunity to sway their audi- ence by their convincing arguments. The treatment of tape-worms is very simple and spe- cific. The best remedy, without a doubt, is the tannate of pelletierine. This is best administered in the form of Tanrat's solution of pelletierine, which is sold in bottles containing one adult dose, for two dollars each. I have used this in several cases without a single failure. I regret that I cannot give the formula of this preparation, but it -is a preparation like many others used by physi- cians, of which the manufacturers hold the vehicle a secret, and charge many times the price it is worth. If a physician wished to prepare a similar prepara- tion, from crude drugs, the following formula comes from high authority, and is said to be used with equal suc- cess: 5 Granati 2 oz. Pepinis 1 oz. Aspidii oleoresin Yi dr. Aqua acacia and syrup q. s. ad 9 oz. TAPE-WORM 281 The granati should be mixed with a pint and a half of water and boiled down to seven ounces. The pepinis should be deprived of their outer coats and beaten to a paste with fine powdered sugar. The aspidii should now be made into a emulsion with acacia and the decoction of granati, then added to the paste of pepinis and add sufficient flavored syrup to bring the mixture up to nine ounces. One-third of this mixture should be taken in the morning after a light diet and laxative the previous day. If the first dose is not successful, the second and third portions can be taken at intervals of every three hours. When the worm comes away the patient should be sit- ting on a vessel partly filled with warm water to pre- vent the weight of the expelled portion tearing off the head. The patient should be instructed never to attempt to pull on the worm, for he will always break it and the treatment will have to be repeated. Another way is to cover a vessel with a piece of mosquito netting so that the cloth bags somewhat into the vessel. The faeces will readily pass through and leave the worm on top, where it can be easily examined. In the large cities we find German specialists who have established a reputation among their countrymen for removing tape-worms. They are usually successful and their method is worthy of mention. Their procedure is as follows : The patient is requested to omit two meals and during that time a brisk saline cathartic is given until the bowels are emptied, after which, they are given a teaspoonful of the ethereal oil of male-fern (Merck) in a teaspoonful of warm milk. The patient can now lie down and suck a lemon. If the dose nause- ates him at the end of two or three hours, the patient is given an ounce of castor oil with ten drops of oil of turpentine and one drop of croton oil. After a short in- terval the bowels will move copiously and the worm will be expelled. As soon as the worm is expelled it should be examined to ascertain if the head is present. 282 STAMMERING THE STAMMERING SPECIALIST The treatment of stuttering and stammering does not properly belong to the physician, as they are habits, not diseases, and no medicine will have any effect upon them ; but as he is often consulted in regard to these impediments of speech, a statement of the manner of curing them will not be out of place in this work. They differ very slightly, one being an inability to pronounce certain words, the other to give certain sounds, and by persistent effort both are easily overcome. A New York professor, who is a graduate of a German college for the study of the vocal organs, says : "The whole thing is very simple, so simple that you will smile when I tell you the sole and only cause of stuttering and stammering is careless respiration. People who suffer from the impediment have only to pause, take in a long breath, and then, opening the mouth in the manner laid down in the charts used by elocu- tionists, pronounce the word sharply. Have you ever noticed the remarkable fact that people who are inveter- ate stammerers are often accomplished vocalists? That is because in the act of singing respiration is done in a proper way. "A novel fact is that the troubles of stammerers or stutterers lie entirely with the vowel sounds. Patients do not seem to understand this. In describing their cases they will tell me that they have difficulty in sound- ing 'p' or 'd.' That is where they are wrong. They STAMMERING 283 sound the consonant all right, but stagger at the vowel. A patient comes to me, and I say to him, 'Say papa.' He will commence, T-p-p-p-p, oh, professor, I c-c-c-c-c-can't say p-p-p-p-p-papa.' "It is at once apparent that his trouble lies with the vowel 'a.' Then the treatment commences. Standing before him, I suggest that he take a long breath through the partially closed mouth until the lungs are well filled, and then, at the moment of exhalation, following my direction, he opens the mouth in the proper manner, as indicated by a chart, and pronounces with me in a high, mechanical voice, 'pawpaw.' This is often repeated, the vowels being changed. "From words we pass on to sentences and so on to introduce in close connection all the vowel sounds. The respiration before each vowel sound is necessary. The treatment therefore consisis in forming this habit. As the patient pupil progresses, the length of this respira- tion is reduced, the pronunciation is made in a lower pitch and in a few weeks, rarely over five, the most in- veterate stutterer can talk fluently and rapidly with no sign of his former affliction. But eternal vigilance is necessary. "Should the apparently cured patient become care- less and forget the necessity of respiration as taught him, he may relapse into his former state, and then his train- ing must be done all over again. A boy of sixteen years of age was brought to me. His was a stubborn case, but in six weeks I had him talking all right. Time passed on for two years. I frequently saw the boy at his father's house and was delighted with the cure. Last summer he came to my institute. He was as badly off as when I first saw him. "It seems that his father had sent him on a short business trip to Europe, away from the restraining in- 284 STAMMERING fluence of the father, whose ears were always alert for any return of his son's affliction, and, much disturbed by the noise of the vessel's machinery, he became care- less, and having once relapsed he became worse every day, and was really forced to shorten his stay abroad and return to New York for treatment. "He was a bright lad, who readily applied himself to my rules, and in a week he was all right again. As a matter of fact, he need not have come back to me, but could have applied his old lessons with success. "The German government has long recognized the importance of rational treatment of vocal impediments, and school children afflicted in this manner are put through a regular course by graduates of the college at Frankfort, where this specialty is taught in the govern- ment employ. The German treatment is that of ele- mentary training in elocution. "The habit of imperfect respiration is generally found in connection with some diseases of childhood like the measles, but a most frequent cause is unconscious imita- tion. One stuttering child in a family will set all the others to struggling with the vowel sound. An adult in conversation with a stuttering person finds it difficult to speak without stammering." In this city there is an institute for the cure of stam- mering and stuttering, and I have an acquaintance who took the course and was at the institute for about three weeks. Through this gentleman I received the follow- ing information, although the professor is very careful to keep his methods a secret, and I believe each student is required to sign an agreement not to teach or expose his methods. A synopsis of the treatment is as follows * The first day or so the student is "put in silence," that is, he is STAMMERING 285 not allowed to speak a word to anyone. After this, he is taught to pronounce each word in syllables and at the same time mark each syllable by waving his ringers in very much the same way as a director of a band or orchestra marks the time of music. To illustrate, have the person take a full breath and repeat the following sentence and words : "Breathes-there-a-man-with-soul- so-dead, who-nev-er-to-him-self-hath-said, this-is-my- own-my-nat-ive-land. Con-stan-ti-no-ple ; Phil-a-del- phi-a." You will see that each syllable should be pro- nounced separately and each word and each syllable marked by a right angular wave of the finger or hand, the same as a musician marks time. As the pupil progresses, he can combine the syllables of words and pronounce them as one. This is what he called "the method," and it is sur- prising to notice how well many extreme stammerers can speak after following this method for a few days. The method was, no doubt, founded upon the knowledge that stutterers could sing with as free flow of words as others, and by using this method, he is practically sing- ing his conversation without any tune. He gradually overcomes the sing-song conversation and talks as freely as others. In connection with the method the student is given exercises in breathing and pronouncing different vowels, reading sentences, etc. This is a very simple method and I believe one of the best, f or it will cure a large percentage of cases, if patients will be persevering and persistent. 286 hall's hygienic treatment HALL'S HYGIENIC TREATMENT. Several years ago Dr. Wilford Hall attempted to startle the medical world by announcing he had made a wonderful discovery of a treatment which would cure almost every known form of disease, as well as preserve health and prolong life, without the use of medicine. The pamphlet which unfolds the secrets of this new discovery he sold for $4.00, the purchaser agreeing by "pledge of honor" not to divluge the treatment outside of his or her family. Physicians were allowed, in addition, the right of using the treatment on their patients. His theory was this : "Disease depends upon the absorption of poisonous materials from the colon and rectum. Wash this out thoroughly with hot water once or twice a day and dis- ease is robbed of its power, death of its terror and the doctor of his occupation. Use a large quantity of water, one or two gallons ; retain it as long as possible and that which is not absorbed can finally be expelled, taking with it accumulations which have a tendency to create disease." He claims this to be a sure cure for con- sumption and Bright's disease, while all minor ailments vanish like mist before the sun. This subject has recently been revived by several New York Medical concerns under the name of the "Internal HAIR'S HYGIENIC TREATMENT 287 Bath," and several devises in the way of rectal irrigators have been offered the Medical Profession. There is no question regarding the value of large injections of water, used as a rectal irrigation, thus we find the "Internal Bath" will relieve and cure many conditions with greater dispatch than medicine. The principle condition where this treatment will be found beneficial is in extreme cases of constipation, where the fecal accumulations have been allowed to remain in the bowels for a long time and a systemic absorption of the decomposed matter takes place. With this we get all kinds of reflex disturbances, sallow skin, chloasma flatulence, anaemia, anorexia, func- tional eye diseases, dizziness and blind spells, insomnia, fetid breath, sick headache, pyrosis, nausea, low spirited- ness, capricious appetite, etc. This is one of the most harmless treatments in ex- istence, and by washing out and keeping clean, the phy- sician will be surprised at the results obtained in many cases. It will not be necessary, however, for him to in- vest several dollars for "Hall's" or any other system of "Internal Bath," as this treatment can be instituted with an ordinary one gallon fountain syringe. Although this method of "flushing the colon" has been severely criti- cised by several members of the Medical Profession, it is far from being entirely destitute of merit. If physicians will question their patients carefully, they will find many of them allow the fecal matter to ac- cumulate several days before attempting to expel it and these large injections will afford him a valuable adjunct in curing these extreme cases of constipation with its various reflex detrimental influences. 288 SECRET PRESCRIPTION WRITING SECRET PRESCRIPTION WRITING. Very often we find physicians who wish to have their prescriptions filled at a certain drug store, either because they think they have better drugs or else be- cause they receive a percentage on prescriptions or per- haps they have an interest in the store. This has caused different secret systems of prescription writing to be introduced. The following very simple method has been used in some places and is a very convenient way to write prescriptions. By the use of this system all medical ingredients are divided into grains, minims, and drachms. If the drug is a solid, it is designated either as grains or drachms, if a liquid, either minims or drachms. Grains and minims are distinguished from drachms by the position of the period. If the period appears at the right of the number, it either means grains or minims (i. one grain or minim) ; if at the left of the number, it signifies drachms (.1 one drachm). To illustrate, the following prescription will give the symbols of both ways of writing the same prescription : 5 Strychnine nitrate y 2 . equals J£ gr. Tinct. capsicum 20. equals 20 min. F. E. cinchona com 6 equals 6 dr. Simple elixir q. s. ad. .32 equals 4 oz. M. Sig. A teaspoonful every hour as a "bracer" for debauch. For writing prescriptions in this way you should have special printed prescription blanks directing the patient to the pharmacy where it is to be filled or tell the patient that he can get it filled only at that certain store. To the pharmacist who is not familiar with this way of writing prescriptions it is rather puzzling and some will refuse to fill the prescriptions altogether, while others will attempt to guess it out, which might act to the disadvantage of the prescriber. NOSTRUMS 289 THE NOSTRUM SPECIALIST Xostrum venders should not be classed under the title of specialists, but most nostrums have a specialist at their helm, who is exercising great energy for the sale of his preparations. The amount of money spent in advertising the so-called patent medicines will reach into the millions every year, and the methods of ad- vertisers has created quite a rivalry, and we often see one attack another through printer's ink. There has been hundreds and hundreds of nostrums offered for sale, and while many of them have only be- come popular in certain localities, others have gained a national or international reputation, depending some- what upon the amount of money, energy and cleverness displayed in advertising them. It is the author's belief that any preparation with a reasonable degree of merit can be sold if it is placed before the public in the right light, and the amount of popularity gained will depend altogether upon the "man behind the gun." To illustrate the great and small, I will give some instances which have come .to my notice. ESTABLISHING THE SALE OF NOSTRUMS IN SMALL COMMUNITIES. Several years ago I had a friend who was conducting a drug store in a small city. One day we entered into a discussion regarding the profit made in patent medi- cines. I argued that any meritorious preparation could be manufactured at about one-third the cost of nostrums and would find a ready sale, if the same amount of money was expended in advertising; he decided to test the project and made up a quantity of King's Consumption Cure, after the formula given on another page. The preparation was identical with King's Consumption Cure, [19] 290 NOSTRUMS except that he added more caramel to give it a deeper color. This was cartooned and labeled nicely and placed upon the market under the name of Halwood's Cough Cure. By keeping his advertisement persistently before the public, he has created a great demand for the prepara- tion, which today is bringing him a greater profit than all the rest of his drug business. Although the prepara- tion is only known in one county, there is no doubt that if he would exercise more energy and use more capital, he would create a demand for the preparation through- out the state, or perhaps the United States, and it would gain the same popularity as the original ; but he is con- tented with his lot. One county satisfied his ambition. This is given to show how the sale of a nostrum can be limited or expanded according to the ambition of the pro- prietor. There are several other ways in which patent med- icines have been brought before the public. Most of the Indian remedies have been introduced through Indian medicine companies, who travel from town to town ; pitch their tents on some public thoroughfare and give an Indian show. The presiding professor tells the story of the skill the Indians possess in selecting remedies for the sick and suffering (?). The New Idea gives the following regarding a company that visited this city a few years ago for the introduction and sale of HARTLEY'S SOUTH AMERICA CURE. "During the summer of the present year a man calling himself Prof. Hartley occupied a vacant lot in Detroit, with a large tent, lighted by electric light, wherein he had immense audiences every evening during his stay, which lasted some two months. The professor gave a short lecture upon a South American cure, which he stated to be composed of roots, herbs, seeds, barks, and flowers growing exclusively in South America, and used for centuries by the Araucanians, a tribe of people who inhabit the western slope of the Andes, in the southern part of Chili. During his lecture the professor managed NOSTRUMS 291 to give the audience to understand that this wonderful medicine performed more cures of indigestion, dyspepsia, catarrh, rheumatism, liver complaints, and kidney dis- eases, than any other medicine on the face of the earth. Being curious to know something more concerning the internal constitution of this South America Cure, we pur- chased a bottle, and subjected it to an analysis, according to which we find that it consists of fluid extract of rhu- barb, 8 parts ; fluid licorice and anise, each 2 parts ; fluid .capsicum, Yz part; fluid aloes, y& part; alcohol, 6 parts; water enough to make 32 parts, to which a small per- centage of sodium bicarbonate is added, about ten grains to the ounce. How is this for a South American cure, which country -does not furnish to commence one in- gredient in the nostrum? It is asserted that nearly 60,000 bottles were sold in Detroit in a few weeks that this so- called professor held forth." Other medicine firms depend exclusively upon news- papers, circulars, and sampling, free prescriptions, etc. The following will give you an idea of the way the free prescription fake schemes are worked : DR. CHURCHILL'S PRESCRIPTIONS. The "Churchill Prescriptions" are still being sent out "free." As this particular form of the "sands of life" kind of philanthropy will be new to some readers, we will copy literally, as a sample, one of the prescriptions, which is for "nervous debility," etc. : I? Pareira brava % oz. Hydrastis C y 2 oz. Peruvian bark calisaya % oz. Bromide potassium . .y 2 oz. Carbonate lithia 1 dr. The "mode of preparing" is given as follows : "Put one-quarter ounce pareira brava to one ounce of boiling water ; let it stand for two hours ; then add of finely powdered hydrastis C, one ounce ; mix well and reduce to the consistency of syrup by evaporation. Put one ounce peruvian bark calisaya to two ounces of boil- 292 NOSTRUMS ing water; let it boil five minutes; then filter and add one and one-half ounces bromide potassium. Wash two drachms in the salts of carbonate lithia in proper vessels, and add all the ingredients together, and heat on a slow fire in a close covered vessel to ioo degrees specific gravity; remove it to a mortar, pulverize well, and triturate. Divide the whole mixture into fifteen powders." The reader is warned in the customary fashion against "unprincipled druggists" who undertake to pre- pare the "prescriptions" as "best they can,' and is invited to send to the advertiser for the "remedies." The difference between these prescriptions and the "Blodgetti" and "Arabian sea-grass" operation is, that the former direct nothing but medicines that really exist, but cannot be "compounded" according to the absurd directions, which appear very learned to the average reader. The only course left open to a conscientious pharma- cist who is asked to prepare such a prescription, is to inform the customer of its exact nature, and to "back up" his statements by the Circular, in which he will find all such schemes explained as they arise. As people seem to take more kindly to what they see in print than to what is told them by a familiar acquaintance, this plan has been found to work well ; the pharmacist sustaining his reputation for knowledge and ability. CORRASSA COMPOUND. Another free recipe for the permanent cure of spermatorrhoea, seminal weakness, involuntary emis- sions, impotence, etc. : 1$ Extract of corrassa apimis 8 dr. Extract of salarmo umbellifera 4 dr. Powdered alkermes latifolia 3 dr. Extract of carsadoc herbalis 6 dr. Mix well together in a mortar, then put the mixture in a box and keep it covered, or wrap it in paper and cover with tinfoil to exclude the air. For a dose, take about one-half a tea-spoonful of the mixture, and moisten NOSTRUMS 293 it with a little cold water in a glass or cup, then add about two table-spoonfuls of cold water, or just enough to en- able you to take it down easily. Take the medicine at night before going to bed, and in the morning before eating. If you wish to sweeten it you may add as much sugar or syrup to each dose as may suit your taste. The circular continues as follows: "The above named herbs, so remarkable for their heal- ing qualities, are found in the great valleys of the Am- azon and through most of the valleys of the South American mountains. Their wonderful medicinal prop- erties are known to the Indian medicine men, and also to some of the learned missionaries from Europe, who reside in South America. This particular combination of remedies is called the Corrassa Compound, taking its name from the first of the four medicines which compose the recipe when it is ready for use. The Corrassa Compound acts particularly on the membranes which line the urinary and genital organs, allaying irritation, curing the unhealthy discharges, and imparting a healthy tone to the nerves and tissues which compose these parts. Its tonic properties give strength to the weak and incompetent, while its soothing prop- erties keep down over-excitement of the sexual organs. In gonorrhoea or gleet this medicine cures almost like magic. It is also highly beneficial for females who suf- fer from leucorrhoea or whites. This remedy from South America (the land of medi- cines) is entirely a product of the vegetable world. No deleterious ingredients enter into its composition ; no injury to the constitution can possibly occur from its use, and no other remedy will so effectually eradicate mercury arid other mineral poisons from the body. On the human system it acts like a charm. It improves the digestion, purifies the blood, gives tone to the nerves, prevents the tendency to consumption, imparts to the skin a fresh bloom, and gives to the countenance an ani- mated and brilliant expression. The good effects of this medicine in my own case you will find related in the 294 NOSTRUMS following circular, which you will please read." (Extract from accompanying circular.) "Following this the Rev. Jos. T. Inman tells a plaintive story of how he suffered from the effects of his youthful indiscretions; how he tried all the best physicians in America and Europe; how at last his friends managed to transport him in the good ship Rein- deer, R. I. Marsh, captain, to Para, South America, to spend his last hours as a missionary among the heathen. While there he devoted his "spare time to the study of medicinal plants," and while doing so, "first learned the virtues of the Corrassa Compound," and also made the acquaintance of a "learned and venerable physician named Ferandez Colina, a native of Spain, who had studied in Paris, and had traveled extensively through South America." All of this is intended to frighten and obtain money from the hoped-for victim. No such drugs as are given above being in existence, the dupe is expected to pur- chase them from the "Reverend" Inman. This wonderful ( ?) preparation having been analyzed by Dr. A. B. Lyons, of Detroit, was found to consist of: I£ Gentian 15 per cent. Licorice 15 per cent. Sugar 50 per cent. Sodium bicarb 17^ per cent. Cochineal 2^/2 per cent. All in fine powder. — (New Idea.) THE RAPID METHOD OF CREATING A LARGE DEMAND FOR NOSTRUMS. One of the most novel and profitable ways of intro- ducing patent medicines was told me by a druggist, who Avas formerly proprietor of a drug store in northern Michigan, and I think the story will be sufficiently in- teresting to repeat here, from the fact that the company is now located in Columbus, Ohio, and is among the largest of patent medicine advertisers, as it spends sev- eral hundred thousand dollars every year in advertising. NOSTRUMS 295 This company had three preparations for which it wished to create a rapid demand, and its method was to send an advance agent to various given points, to contract with some local druggist to place so many gross of each kind of medicine in his store for sale. The drug- gist was not to pay for the medicines until they were entirely disposed of, when he was expected to pay the regular wholesale price. After making the contract with only one store in each place, the advance agent immedi- ately commenced to circularize the entire population not only of the city, but of the country for many miles around. The circulars conveyed the information that a certain specialist of wonderful skill and ability would visit that city for the purpose of healing the afflicted. The physician was billed as a philanthropist of the highest character, and under no consideration would he accept any remuneration for his services, his skill being absolutely free and at the command of the sick and suffering. THE SPECIALIST ARRIVED. As early as six o'clock in the morning the hotel parlors were packed to their fullest capacity. Each patient was handed a card giving instructions how to ap- proach the doctor, a part of the advice being to "ask the doctor no questions, as he can tell your ailments better than you can describe them yourself. Each patient will be allowed only five minutes' consultation," etc. When the. patient was admitted to the consultation room he was given a seat and the doctor then proceeded to describe his ailments in very much the same manner outlined in the chapter on the Observing Specialist. The doctor then dictated a prescription to his stenographer, which consisted principally of fictitious names of pharma- ceutical products, handed it to the patient and dis- missed him. THE DOCTOR'S UNDERSTANDING WITH THE DRUGGIST. It was understood between the physician and drug- gist that any prescription he sent him, containing a six- 296 NOSTRUMS teen-ounce mixture would be the preparation he left at the store, containing the same amount of medicine (which is supposed to be a mild cinchona tonic). The twelve and fourteen-ounce mixtures were also identified in the same way. The physician did not always confine his prescribing to the stereotyped preparations at the store, but often added a little nux vomica or other medi- cines he thought the patient required. The druggist supplied the doctor with prescription blanks, with the name and address of his store, which was supposed to be the only store in the city where the prescription could be compounded. The physician instructed the druggist to remove the original labels the preparation contained, and replace them with the regular druggist label with Sig. The gentleman who conducted the store told me that the financial receipts for the prescriptions that day amounted to several hundred dollars, but they did not end there, they continued to fill the same pre- scriptions for several years afterwards, and thus created a demand for the nostrums which I suppose are still sup- plied by the same company. This method has proven to be one of the most suc- cessful methods of introducing nostrums that the author has any knowledge of, for today the company is rated at over a million dollars, and it did not take the doctor and his staff over two years to visit most of the prin- cipal cities of the United States, and thus cover the en- tire country. THE COST OF NOSTRUMS. In the preceding paragraphs we have outlined some of the ways of promoting the sale of nostrums. We will now discuss the cost of nostrums. My attention was first called to this subject by an article which appeared in the Indiana Pharmacist, in which it said : "Why should you pay $1.90 a dozen for Bull's Cough Syrup, when you can put up a better article containing no opium, giving three times the quantity for the same money, at a cost of but 46 cents a dozen? NOSTRUMS 297 Here is a formula for a most excellent cough syrup : 1^ Fl. ext. ipecac 2 oz. 38 cents. Chloroform ^ oz. 2 cents. Tinct. white pine 8 oz. 14 cents. Water 28 oz Sugar 56 oz. 25 cents. Magnesia carb 2 oz. 3 cents. Tinct. gelsemium 1 oz. 2 cents. Total 84 cents. This makes five pints of the finished product, which put up in three ounce ball-neck panels, holding 234 ounces, would make 3^ dozen bottles. The cost of the bottles would be 50 cents, and the labels, wrappers, etc., would cost not more than 10 cents, making a total cost of $1.44 for three and one-sixth dozen syrup, or about 46 cents a dozen, as against $1.90 a dozen for Bull's. Take the subject of bitters. None of the patents can be bought for less than $7.00 a dozen, and from that up to $8.50. They retail for $1.00 where "cutting" is not known. Take the following formula: ^ Cinchona bark, red 8 oz. 30 cents. Qentian root. 8 oz. 5 cents. Columbo root 8 oz. 10 cents. Juniper berries .8 oz. 3 cents. Glycerine 8 oz. 9 cents. Alcohol : .... .1 part. Water 3 parts. To make one gallon of finished product. Have the drugs ground to a coarse powder, pack in a percolator, pour on menstrum until the top of the drug is evenly covered. When the percolate begins to drop, insert a cork in the percolate, cover the top, and allow the contents to macerate 48 hours. Then proceed to ob- tain yy 2 pints of percolate, to which add the glycerine. Flavor with oil of wintergreen. This makes eight pints of finished product, which put up in pint bottles, sells for $1.00 a bottle. The 298 NOSTRUMS bottles cost 25 cents, and the labels and wrappers not Lo exceed 10 cents, making a total cost of $1.50 for eight bottles, or $2.25 for a dozen, as against $7.00 to $8.00 for the regular nostrum. For a blood purifier that will 'do the work every time :" ^ Fl. ext. sarsaparilla 8 oz. 50 cents. Fl. ext. stillingia 8 oz. 25 cents. FL ext. yellow dock 8 oz. 25 cents. Podophyllin 24 gr. 3 cents. Aqua 2 pt. Elix. simplex 2 pt. 23 cents. Alcohol 2 pt. 55 cents. Iodide potash 1 oz. 18 cents. Mix and filter. Put up in paneled 14-ounce bottles. This will give nine bottles to the gallon. The bottles will cost 26 cents, label and wrappers 10 cents, making a total cost of $2.35 for nine bottles, or $3.13 a dozen, as against $7.00 to $8.50 a dozen for the much-vaunted nostrums that are generally only a solution of epsom salts, colored and flavored. For a kidney cure, one that invariably brings back the customer, recommends itself and makes business brisk : I£ Fl. ext. buchu 8 oz. 35 cents. Fl. ext. pareira brava 4 oz. 20 cents. Fl. ext. stone-root 4 oz. 20 cents. Acetate potass 4 oz. 15 cents. Holland gin, best 8 oz. 20 cents. Simple elixir, to make 1 gal. J2 cents. Mix. Filter and put up in bottles holding eight ounces, plain or paneled, as best suits. The bottles will cost 44 cents, and the labels and wrappers 10 cents, mak- ing a total cost of $2.35 for 16 bottles, or $1.77 a dozen. This can be sold for 50 cents a bottle, and will afford a much better per cent, and larger profits than Warner's nostrum and do the patient some good. NOSTRUMS 299 For a liniment for general purposes, that will relieve pain and soreness, giving much better satisfaction than St. Jacob's oil : 1^ Soap liniment 5 pt. $1.10 Aqua ammonia 2 pt. .12 Tinct. opium I pt. .60 After reading the above article it occurred to me that, physicians might need a little of the same advice, when we stop to consider the number of pharmaceutical prep- arations, which are offered to the medical profession at an enormous advance in price, and the only defense their manufacturers can offer, is that their products are "chem- ically pure," which is no doubt true, but when we have access to products from the laboratories of Parke, Davis & Co., Merck's and many others, why should we pay many times the original cost to have some pharma- ceutical manufacturing company place these chemical products in an aromatic vehicle? This is well illustrated in the preparation Bromidia, Peacock's Bromides, San- metto, and others. I would suggest why pay one dollar for a four-ounce bottle of Bromidia when you can get the identical preparation in purity and therapeutical value in the following formula : BROMIDIA. ^ Chloral hydrate (Merck's) .. 1 oz. 11 cents. Potassium brom. (Merck's) . 1 oz. 5 cents. Fl. ext. cannabis ind. (P. D. & Co.) 4 min. Fl. ext. hyoscyamus (P D. & Co.) 4 min. Caramel jq. s. color. Aromatic elix q. s. 4 oz. 4 cents. The above makes an excellent preparation and only represents one of the many stock preparations which a physician could prepare and have in his dispensing case at little expense. Perhaps no greater illustration can be made in the way chemical products have been sold to physicians, at 300 NOSTEUMS fancy prices, than in the different ways acetanilid has been introduced. The cheapness of this remedy (fifty cents a pound) makes it a very profitable preparation to compound with other remedies, and dispose of under a "coined name." Dr. Potter's Materia Medica gives the following regarding some of the preparations this drug is supposed to largely enter : AMMONOL. A proprietary antipyretic and analgesic, claimed to possess unusual stimulating and expectorant properties due to the loosely combined ammonia in its composition. Beringer concludes that it is merely an admixture of : 3J Acetanilid 2 parts. Sodium bicarbonate 1 part. Ammonium carbonate 1 part. With a minute quantity of the dye mentanil — yellow. A similar mixture is used at the Philadelphia Hospital under the name ammoniated acetanilid, which con- sists of: ^ Acetanilid 2.y 2 gr. Sodium bicarbonate 1^2 gr. Ammonium carbonate 1 gr. This for a minimum dose. Dose of ammonol or am- monol salicylate gr. v-xx. ANTIKAMNIA. Is a proprietary preparation widely advertised as an antipyretic and analgesic. Analysis of several samples have been made by different chemists, all of which agree in finding the chief ingredients to be acetanilid and sodium bicarbonate in varying proportions. By some observers caffeine was detected, also tartaric acid, etc. The preparation is formulated by the latest analysis as a mixture of: 5 Acetanilid 70 parts. Sodium bicarbonate 20 parts. Caffeine 10 parts. Dose, gr. v-xv, in powder or tablets. NOSTRUMS 301 ANTIKOL. ^ Acetanilid 75 parts. Sodium bicarbonate 17J4 parts. Tartaric acid 7J4 parts. Dose, gr. v-xv. — (Squibb.) ANTINERVIN. If Acetanilid . 2 parts. Salicylic acid 1 part. Ammonium bromide 1 part. Dose, gr. v-xv. — (Ritsert.) EXODYNE. If Acetanilid 90 parts. Sodium salicylate 5 parts. Sodium bicarbonate 5 parts. The name sufficiently states its claim to medicinal virtue. Dose, gr. iij-x. FEBRINOL. So-called by its proprietors, is a mixture of acetanilid and other inert substances, advertised at one half the price of similar coal-tar preparations. PHENOLID. If Acetanilid 58 parts. Sodium salicylate 43 parts. And competes with the above as a panacea. Dose, gr. v-xv. I am not aiming to do an injustice to the manufac- turers of the different non-secret preparations, which are offered the medical profession, but I only wish to point out the large revenues they receive for adding an aromatic vehicle and favorably impressing the profession that their preparations offer special advantages, because they are chemically pure and pharmaceutically correct. PHYSICIANS AND NOSTRUMS. Many physicians are, generally speaking, no different from the laity, and often entertain some of the mysteries which hover around the healing art, and place more value upon a remedy of which they know little of the contents, than they do on their own knowledge of medicine. The 302 NOSTRUMS principal thing they are seeking is results,'' and with this end in view prescribe nostrums, with the same grace and dignity that a grandmother will goose-oil. I have seen many physicians prescribe such nostrums as Hive Syrup, Castoria, Trask's Ointment and others of a similar character, when superior treatments were at their command. This practice has become as profound a habit with some physicians as tobacco has with others' on the other hand the medical journals contain advertise- ments of several preparations which are nostrums in the broadest sense of the term. To illustrate, Micajah's Uterine Wafers, which are sold at fancy prices, do not compare, in results, with those which can be obtained from the use of the extra-uterine application, given on another page. If the practice of medicine is the exercise of medical art, and embraces all that pertains to the knowledge ot medicine, my plea is to broaden our knowledge to the extent that we may prescribe knowingly, intelligently and specifically in each case, and abandon as far as pos- sible "shot gun therapeutics." THE FORMULAE OF NOSTRUMS. It is the author's belief that most physicians will ap- preciate a collection of the formulae of the most prom- inent secret nostrums, and for several years I have been extracting these formulae from medical journals, books, newspapers, etc., and in addition to the formulae already given throughout this volume, I will add several more. Preserving these formulae in a convenient form for ready reference, affords many advantages, as patients will often ask physicians regarding the contents of a cer- tain patent medicine, and by referring to this collection, he can not only supply them with the information, but encourage them to abandon their use for a more thor- ough course of treatment, as their case may require. In cases of poisoning from patent medicines, which is not of infrequent occurrence, this allows the physician to select the antidote. It also gives your patient to NOSTRUMS 303 understand that you are familiar with the ingredients these preparations contain, and you cannot recommend their use, because you can furnish a more specific course of treatment. Although some of these medicines have a certain degree of merit, many of them are of little or no value, as their formulae will indicate. Out of curiosity I have had several of these formulae compounded and compared them with the original, to ascertain whether or not there was a resemblance, and if they could be prescribed with equal therapeutical results, and I have been surprised at the success obtained in many cases. I, in no way wish to be held responsible for the cor- rectness of all these formulae. The author's name is ap- pended in each case, when known. ACTINA. Prof. Flavel B. Tiffany, of the University Medical College, this city, says the extensively adver- tised "Actina" has this composi- tion: B Menthol crystals 1 dr. Alcohol Vz dr. Ether sulph 1 dr. Oil mustard 2 dr. Sponge sufficient to make..l oz. ALLEN'S LUNG BALSAM. B Tinct. sanguinaria 8 oz. Tinct. lobelia 8 oz. Tinct. opium 4 oz. Tinct. capsicum V/ z oz. Essence sassafras 1 oz. Essence anise 1 oz. New Orleans molasses % gal. Bring the syrup to a boil, and add cautiously the other ingredi- ents. — (Kilner.) AMICK'S CONSUMPTION CURE. The Amick advertisements ap- peared shortly after the publica- tion of Dr. N. B. Shade's paper in this and other journals. Amick copied Shade's language, speaking of the "chemical" cure, etc., and I believe adopted Shade's method of treatment. These are fully de- scribed by Shade, and consist of the use of calomel, iodoform, gua- iacol, etc.— (Dr. Waugh in Times and Register.) ARABIAN BALSAM. B Oleum gossypium 16 oz. Oleum origani 1 oz. Oleum terebinth 4 dr! Mix. — (S. W. Rogers.) ASEPTIN. B Borax 2 parts Alum 1 part Mix. —(National Druggist.) ATHLOPHOROS. B Acetate of potash 1 dr. Salicylate of soda 490 gr. Sugar 4 oz. Caramel 3 drops Water 14 fl. oz. Mix. —(New Idea.) ATKINSON'S INFANT PRE- SERVATIVE. B Carbonate magnesia 6 dr. White sugar 2% oz. Oil anise 20 drops Comp. spirits ammonia.. 2 x / 2 dr. Rectified spirits 2V 2 dr. Tinct. opium 1 dr. Syrup saffron 1 oz. Caraway water enough to make , 1 pint Mix. Used as an antiacid, anodyne and hypnotic. — (Pharm. Record.) AUGSBURG ESSENCE OP LIFE. B Rad. rhei 1 oz. Myrrhae 2 oz. Rad. gentian 2 oz. Croci opt y 2 oz. Camphor y 2 oz. Rad. zedoar 1 oz. Rad. angelica 2% oz. Castor y 2 oz. Aloes, socot 2 oz. Sp. vini. rect 2 pts. Aqua 2 pts. Mix. Digest five days and filter. Dose— Teaspoonful twice a day. —(Medical World.) 304 NOSTRUMS AYER'S AGUE CURE. This is said to be a syrupy tinc- ture of cinchona with aromatics. Each bottle holds 6 fluid ounces, and each fluid ounce was found to contain 3.2 grains of amorphous cinchona alkaloids. 3 grains cinch- onine, 0.9 cinchonidine, 0.8 quinine, and 1 grain quinidine. AYER'S VITA NUOVA. Dr. R. G. Eccles published in the Druggists' Circular a lengthy ar- ticle on the Hubbard-Ayer prepar- ations, and calls attention partic- ularly to the presence of cocaine in the "Vita Nuova. We have recently examined this preparation also and find it to contain notable quantities cocaine easily detected by the organo-leptic test, and also about 19% per cent., by volume, of al- cohol.— (Boston Herald. AYER'S CHERRY PECTORAL. R Acetate of morphia 3 gr. Tincture of bloodroot 2 dr. Wine antimony 3 dr. Wine ipecac 3 dr. Syrup wild cherry 3 oz. Mix. — (Pac. Med. and Surg. Journal.) AYER'S PILLS. Consist of Colocynth. Gamboge and Aloes, coated with Starch and Sugar. AYER'S SARSAPARILLA. B Fluid extract sarsapariila ..3 oz. Fluid extract stillingia 3 oz. Fluid extract yellow dock.. 2 oz. Fluid extract may apple 2 oz. Sugar 1 oz. Iodide potassium 90 gr. Iodide iron 10 gr. Mix. —(Chicago Druggist.) BAREEL'S INDIAN LINIMENT. B Tr. capsicum 1 dr. Oil origanum y 2 oz. Oil sassafras y 2 oz. Oil pennyroyal y 2 oz. Oil hemlock y 2 oz. Alcohol 1 qt. Mix. —(New Idea.) BARKER'S BONE AND NERVE LINIMENT. For man or beast. B Camphor 70 gr. Oil of tar y 2 dr. Oil of thyme 1 dr. Oil of turpentine 2 dr. Franklin oil (black oil, lu- bricating oil) sufficient to make 2 oz. Mix. —(New Idea.) BATEMAN'S PECTORAL DROPS RTinct. of opium If/2 oz. Tinct. of opium-benzoated.20 oz. Tinct. of Canada castor — 5 oz. Cochineal, ground 1 oz. Mix. Dose, for adults, 20 to 30 drops, morning and evening. Not to be given to children under 10 years of age. — (Hager.) BECKER'S EYE SALVE. B Calmine V& dr. Tutty 1% dr. Red oxide of mercury 6 dr. Camphor in powder 1 dr. Almond oil 1 dr. .. White wax 1% oz. Fresh butter 8 oz. Reduce the mineral substances to a very fine powder and incor- porate with the oil ; in which the camphor has been dissolved with the wax and butter, previously melted together. — (Kilner's Modern Pharmacy.) BENSON'S SKIN CURE. This secret nostrum consists of two preparations, one for internal use and one for external applica- tion. A— Internal.— It consists, accord- ing to our examination, of clover blossoms 720 grains, yellow-dock root 90 grains, gentian root 120 grains, boiled (one hour) with one pint of water. Cool, transfer to a closed vessel, and add one ounce of alcohol in which has previously been dissolved oil of rosemary, oil of thyme each one minim; let it stand over night, strain next morn- ing; make up to one pint with water sufficient. B— External Application— This so- lution consists, according to our examination, of acetate of lead 2 grains, acetate of copper 1 grain, acetate of zinc 15 grains, benzoat- ed water 12 fluid ounces; mix. The benzoated water is readily prepared by agitating half an ounce of tincture of benzoin with 12 ounces of warm water, allowing it to cool and settle; then filter. It is warranted to cure all the skin diseases described in the medical dictionaries. —(New Idea.) BEGG'S FEVER AND AGUE PILLS. Each pill contains one grain of quinia sulphate, one-half grain cinchona sulphate, rhubarb one grain, with a little flavoring. These pills are put up in a half- ounce plain flint vial; they are un- coated, 32 pills in a bottle, balance of space filled with powdered lie- NOSTRUMS 305 orice root. A small slip with title, uses, and directions surrounds the bottle, and a red lead wrapper, type set, surrounds the whole. This is an excellent ague cure. —(New Idea.) BIG G INJECTION. An examination made in our la- boratory shows the presence of boric acid, or borax and berberine, the yellow alkaloid of hydrastis. No zinc sulphate or other astrin- gent was found. No quantitative estimates were made. BLAIR'S GOUT AND RHEUMA- TIC PILLS. Are composed of acetic extract of colchicum and extract of hyo- scyamus. —(New Idea). BOERHAVER'S BITTERS. B Alcohol, 90 per cent — 140 parts Sugar 76 parts Aloes 10 parts Cinnamon 23 parts Galangal 23 parts Zedoary 23 parts Angelica 23 parts Cloves 23 parts Gentian 23 parts Quassia, cut 23 parts Water 200 parts Mix. — (Hager.) BOSCHEE'S GERMAN SYRUP. B Oil of tar 1 dr. Fluid extract ipecac 4 dr. Fluid extract wild cherry.. 6 dr. Tincture of opium 4 dr. Carbonate of magnesia 3 dr. Water 6 oz. White sugar 10 oz. Triturate the magnesia, first, with the oil of tar; then with a mixture of the fluid extracts and water; filter and form a solution with the sugar, by agitation, with- out heat. —(Medical World.) BRADYCROTINE. A compound closely resembling it may be made by the following formula: B Caffeine (alkaloid) 5 gr. Potassium bromide 20 gr. Sodium bromide 20 gr. Simple syrup 2 dr. Alcohol 2 dr. Port wine sufficient to make 2 oz. Caramel sufficient to color. Mix. — (Druggists' Circular.) BROWN'S MALE-FERN VERMI- FUGE. B Fl. ext. male fern 3 oz. Oil wintergreen 1 .min. Simple syrup 5 oz.' Mix. —(New Idea.) [20] BRANDRBTH'S PILLS. B Extract colocynth 20 gr. Aloes, Socotrine 2 dr. Gamboge 1 dr. Castile soap V 2 dr. Oil peppermint 2 min. Oil cinnamon 1 min. Powdered arabic and al- cohol, of each q. s. Mix and make 80 pills. Dose: 1 to 3, as directed. —(Dr. D. S. Clark.) BROMO-CHLORALUM. Kilner gives the following: B Alum, coarse powder lib. Boiling water 2 pts. Aqua ammonia q. s. Muriatic acid q. s. Bromine V 2 oz. Water q. s. y 2 gal. BARNES' FROST BALSAM. B Copaiba V 2 oz. Oil turpentine y 2 oz. BROWN'S BRONCHIAL TROCHES. Said to be like the original for- mula: B Powdered ext. of licorice 1 lb. Powdered sugar V/ 2 lb. Powdered cubebs % lb. Powdered gum arabic 14 lb. Ext. conium 1 oz. Mix. —(New Idea.) BROWN'S IRON BITTERS. Are said to contain in each fluid drachm: B Iron 1 gr. Calisaya bark ', 2 gr. Phosphorus 1-200 gr. Coca 1 gr. "Viburnum prunif olium 1 gr. BRODIE'S LINIMENT FOR ASTHMA. B Oil of stillingia 4 dr. Oil of cajeput 2 dr. Oil of lobelia 1 dr. . Alcohol 1 oz. Mix. Bathe the chest and throat three times a day. BRONCHILLINE. B Mullein 64 gr. Hoarhound 64 gr. Senega 64 gr. Ipecac 64 gr. Sanguinaria 64 gr. White pine 64 gr. Wild cherry 256 gr. Chloroform 64 min. Sugar 14 oz. av. Alcohol 8 oz. Tar water (U. S. P.) 8 oz. Mix. —(New Idea.) 306 NOSTRUMS BRODIE'S LINIMENT. B Sulphuric acid 1 dr. Olive oil 1 oz. Turpentine 1 oz. Add the acid gradually to the oil, stirring in a mortar; afterward add the turpentine. BUCKLEN'S ARNICA SALVE. B Extract arnica 1 oz. Resin cerate 8 oz. Vaseline 2 oz. Raisins, seedless 8 oz. Fine cut tobacco y 2 oz. Water q. s. Boil the raisins and tobacco in one pint of water until the strength is extracted; express the liquid and evaporate to four ounces. Soften the extract of ar- nica with a little hot water and mix the liquid with it; add this to the resin cerate and vaseline pre- viously warmed and mix thorough- ly — (Kilner's Modern Pharmacy.) BUCKLER'S CROUP MIXTURE. B Tartar emetic. 2 gr. Pluv. ipecac 40 gr. Syrup of squills 2 oz. Mix. Dose: Teaspoonful every 10 minutes until emesis occurs. BULL'S BLOOD SYRUP. B Iodide of potash 12 dr. Red iodide of mercury 2 gr. Tinct. of poke root 3 dr. Comp. syrup of stillingia. .6 oz. Simple syrup, to make 1 pt. Mix. —(National Druggist.) BULL'S COUGH SYRUP. We have no reason to believe that it contains anything else of medicinal consequence than the morphia and sugar-house syrup. —(New Idea.) ISTRY ,.Sa..m mbmbmb— CALIFORNIA LINIMENT. B Tinct. myrrh 1 oz. Tinct. capsicum 1 oz. Sweet spirits nitre 1 oz. Sulph. ether 1 oz. Chloroform V2 oz. Tmct arnica 1 oz. Oil spearmint 2 dr. Oil wintergreen 2 dr. Oil lobelia 1 dr. Aqua ammonia V2 oz. Alcohol 1 qt. CARTER'S LITTLE LIVER PILLS. B Podophyllin 1% gr. Aloes ty 2 gr. Mucilage of acacia q. s. Mix; divide into 12 pills and coat with sugar. —(New Idea.) CARBOLIC SMOKE BALLS. Upon examination, made in our laboratory by H. W. Snow, it was found to consist of glycyrrhiza and flour (identified by microscopical examination and physicial proper- ties) and one of the veratrums, probably white hellebore identified (by means of the alkaloid jervine, which was separated and identi- fied.) The smoky body is some tar product, not easy to say just which. It is this latter and the white hellebore which it contains that cause it to yield a temporary relief; permanent relief we do not believe can afford. No quantita- tive estimates were attempted. —(New Idea.) CARBOLATE OF IODINE IN- HALANT. B Comp. tinct. of iodine.. 180 min. Carbolic acid. No. 1 48 min. Glycerine 1 dr. Water 5 dr. Mix and expose to the sunlight until the mixture is entirely color- less. —(National Druggist.) CASTORIA. The following formula, from the Indiana Pharmacist, is given as approximating this preparation: B Senna 4 dr. Manna 1 oz. Rochelle salts 1 oz. Fennel, bruised V/ 2 dr. Boiling water 8 oz. Sugar 8 oz. Oil of wintergreen q. s. Pour the water on the ingredi- ents Cover and macerate until cool; strain and add the sugar, dissolve by agitation and add oil of wintergreen to flavor. CATANI'S SPECIFIC. Catani's specific for uric acid is a mixture of: B Carbonate of lithium 1 part Carbonate of sodium 2 parts Citrate of potassium 4 parts All in powdered form. — (Pharm. Post.) CAZEAUX'S NIPPLE OINT- MENT. B White wax W2 oz. Oil sweet almonds % oz. Clarified honey Y2 oz. Balsam Peru 2y 2 dr. Mix. — (Kilner.) CHAMBERLAIN'S RELIEF. B Tinct. capsicum (about) — 1 oz. Spts. camphor (about) % oz. Tinct. guaiac (about) % oz. Color tinct. to make 2 oz. Mix. —(The Drug Mill.) NOSTRUMS 307 CENTAUR LINIMENT. This widely advertised nostrum comes in two forms, "For Man" and "For Beast." For Man. B Oil pennyroyal V 2 oz. Oil thyme & oz. Oil turpentine % oz. Soap 130 gr. Caustic soda 10 gr. Water to make 1 pt. For Beast. B Oil spearmint 1 dr. Oil mustard 15 : min. Oil turpentine V± oz. Oil amber (crude) Vz oz. Black oil % oz. Soap 130 gr. Caustic soda 10 gr. Water to make 1 pt. Mix. —(New Idea.) CHAMBERLAIN'S COLIC, CHOL- ERA AND' DIARRHOEA REMEDY. B Tinct. capsicum 20 dr. Tinct. camphor 16 dr. Tinct guaicum 12 dr. Mix. —(Medical World.) CHILD'S COUGH MIXTURE. B Syr. squills 2 dr. Wine ipecac 1 dr. Tinct. camphor comp 1 dr. Simple syrup 4 dr. Water * ... .3 oz. CHLORODTNE, The following- is a mixture re- sembling Brown's, and I think fully as good: B Chloroform 1 dr. Morphia 5 gr. Ether y 2 dr. Oil peppermint 4 min. Dil. hydrocyanic acid 1 dr. Tinct. capsicum 1 dr. Molasses 10 dr. Ext. licorice 15 gr. Mix. CHLORALUM B Aluminum chloride 20 oz. Sulphate of lime — 1-3 oz. per gal. Mix. —(New Idea.) CLARK'S BLOOD MIXTURE. B Iodide 01 potassium 64 gr. Chloric ether 4 dr. Liquor potash 30 min. Water iy 2 oz. Caramel to color. The chloric ether is made by dissolving one part by weight of chloroform in 19 parts by volume of alcohol. CLE ART'S ASTHMA POWDER. B Pulv. stramonium leaves 30 parts Pulv. belladonna leaves. 30 parts Pulv. saltpetre 5 parts Pulv opium 2 parts Mix. A little to be burned and fumes inhaled. —(Chemist and Druggist.) COALINE HEADACHE POW- DERS. We would suggest antipyrine, 3 grains, cane sugar in powdered form, 15 grains, to each powder. One powder to be dissolved in a teaspoonful of water and taken as a dose, to be repeated in three- quarters of an hour. —(New Idea.) COE'S DYSPEPSIA CURE. B Powdered rhubarb 2 dr. Fluid ext. of gentian 3 dr. Peppermint water iy 2 oz. Bicarbonate of sodium 6 dr. Mix. Dose: A teaspoonful half hour before meals. —(The Drug Mill.) COKE'S DANDRUFF CURE. This preparation is said to be a solution containing large quantities of resorcin, which renders it a valuable antiseptic in parasitic conditions of the scalp. COMBE'S ASPERIENT. B Sulphate of magnes 35 parts Roasted coffee 40 parts Boiling water 500 parts Mix. Boil for two minutes, sweet- en to taste with white sugar. Dose: One wine-glassful in the morning. COOK'S ELECTRO-MAGNETIC LINIMENT. B Alcohol 1 gal. Oil amber 8 oz. Gum camphor 8 oz. Castile soap (fine) ...2 oz. Beef's gall 4 oz. Aqua ammonia 12 oz. Mdx. — (Kilner.) COBB'S PILLS. B Extract of hyoscyamus y 2 dr. Extract of conium V 2 dr. Extract of colocynth 11 gr. Extract of nux vomica 4 gr. Mix. Divide into 30 pills. CRAM'S FLUID LIGHTNING. Mr. I. L. Fulton (Western Drug- gist) gives the following formula, which was represented to him as being the original from which Cram's Fluid Lightning is pre- pared: 308 NOSTRUMS B Oil mustard 2 dr. Oil cajeput 2 dr. Oil cloves 2 dr. Sassafras 2 dr. Ether 1 oz. Tinct. cpium V/ 2 oz. Alcohol 20 oz. Mix and filter. CUTICURA OINTMENT. The much advertised "Cuticura Ointment" has been found to con- sist of a base of petroleum jelly, colored green, perfumed with oil of bergamot and containing two per cent, of carbolic acid. —(Northwestern Lancet.) CUTICURA RESOLVENT. B Aloes, Socot 1 dr. Rhubarb powdered 1 dr. Iodide potass 36 gr. Whisky 1 pt. Macerate over night and filter. —(St. Louis Druggist.) DELLENBAUGH'S COUGH CURE. B Picrate of ammon 2 gr. Chloride of ammon 1 dr. Extract of licorice 1 dr. Water 3 oz. DERBY'S LINIMENT. B Linseed oil 1 gal. Aqua ammonia 4 oz. Tinct. capsicum 1 oz. Oil origanum 1 oz. Mix. — (Kilner.) DESHLER'S SALVE. B Resin 12 oz. Suet 12 oz! Yellow wax ! 12 oz. Turpentine 6 oz. Linseed oil 7 oz. DOW'S WHITE LIQUID PHYSIC. B Sodium sulphate 8 oz. Dissolve in water 24 oz. Then add nitro-muriate acid 2 oz. Powdered alum 68 gr. Mix. The dose is a table-spoonful in water. A cooling purgative. ECLECTIC STILLINGIA LINI- MENT FOR CROUP. B Oil stillingia 8 dr. Oil cajeput 4 dr. Oil lobelia 2 dr. Alcohol 16 dr. Mix. In addition it is sometimes given internally in one drop doses. EDISON'S POLYFORM. B Chloroform 2 oz. Chloral hydrate 2 oz. Alcohol iy 2 oz. Gum camphor 1 oz. Ether 1 oz. Morphine sulphate 6 gr. Oil of peppermint 2 dr. Mix. —(Druggists' Circular.) EDWARD'S ALTERATIVE AND TONIC BITTERS. B Fluid extract of hops 16 oz. Fluid extract of red cin- chona 8 oz. Fluid extract sarsaparilla, 6 oz. Fluid extract hydrastis 6 oz. Fluid extract podophyllum 4 oz. Oil of wintergreen 6 dr. Oil of sassafras 3 dr. Oil of peppermint 2 dr. Oil of lemon 2 dr. Sugar 6 lb. Alcohol 2 gal. Water, enough to make.. 12 gal. Mix. —(Myers Bros.' Druggist.) EGYPTIAN EYE SALVE. B White rosin 6 dr. Burgundy pitch 30 gr. Beeswax 30 gr. Mutton tallow 30 gr. Venice turpentine 30 gr. Balsam fir 30 gr. Spread on thin leather or cloth and apply to affected part. ELEPIZONE. B Magnesii bromidi 3 dr. Sodii bromidi. 3 dr. Aquae Y2 oz. 01. cassiae 2 min. Syr. simplex sufficient to make 4 oz. Ammonical sol. carmine to col- or. —(New Idea.) ELIXIR IODO-BROMIDE OF CALCIUM COMPOUND. B Bromide of calcium 256 gr. Iodide of sodium 256 gr. Chloride of magnesium... 256 gr. Iodide of potassium 256 gr. Comp. fl. ext. of sarsa- parilla 2 oz. Comp. fl. ext. of stillingia.. 2 oz. Elixir of orange 4 oz. Sugar 4 oz. Water to make 16 oz. Dissolve the salts in the water, add the sugar and to this syrup add the fluid extracts, previously mixed with the elixir of orange. After standing two days, filter, miding water to make the measure 16 fluid ounces. NOSTRUMS 309 ELIXIR PINUS COMP. It is evident that this elixir is modeled on the Syrup of White Pine Comp. (White Pine Expect- orant), introduced some years ago by Mr. C. S. Hallberg. On the basis of the claimed formula of the elixir we would offer the fol- lowing formula: B Fl. ext. white pine bark 6 dr. Fl. ext. balm gilead buds... 5 dr. Fl. ext. spikenard 5 dr. Fl. ext. wild cherry V/ 2 oz. Fl. ext. ipecac 40 min. Sanguinaria nitrate 2 gr. Chloroform 64 min. Morphia acetate 8 gr. Ammonium chloride 64 gr. Spirits of orange (1 in 8) 30 min. Spirits coriander (1 in 8).. 10 min. Spirits of anise 10 min. Alcohol 3 oz. Simple syrup 4 oz. Water to make 1 pt. This elixir should be allowed to stand four or five days before fil- tering. —(New Idea.) ELIXIR THION COMPOUND. B Powdered rhubarb 5 oz. Powdered golden seal 5 oz. Sodium hypophosphite — 100 gr. Sodium sulpho-carbolate...40 gr. Alcohol 5 pts. Water 40 pts. Dissolve the salts in the water and alcohol and with this men- struum percolate the powdered rhubarb and golden seal. Flavor with peppermint. —(Indiana Medical Journal.) ELLIMAN'S ROYAL EMBROCA- TION. B Oil turpentine V 2 oz. Oil thyme 1-3 oz. Oil amber (crude) Vs oz. Soap 130 gr. Caustic soda 10 gr. Water sufficient 1 pt. To be prepared in the same man- ner as Mexican Mustang Liniment. —(New Idea.) ELY'S CREAM BALM. B Vaseline 1 oz. Thymol 3 gr. Carb. bismuth 15 gr. Oil wintergreen 2 min. Mix. — (Kilner's Mod. Pharm.) ENO'S FRUIT SALT." B Soda bicarbonate 168 parts Tartaric acid 150 parts Rochelle salt 110 parts Mix. —(New Idea.) ESPEY'S CREAM. B Cydonium V/ 2 dr. Ac. boric 4 gr. Glycerine 2 oz. Alcohol 3 oz. Carbolic acid 10 gr. Cologne water 2 dr. Rose water q. s. ad 1 pt. Dissolve the boric acid in four ounces of rose water, macerate cydonium in solution for three hours, press through straining cloth, add glycerine, alcohol, co- logne and sufficient rose water to make one pint. Lastly add the carbolic acid and shake well. — (Druggist Circular). FAHNESTOCK'S VERMIFUGE. B Castor oil 48 parts Oil worm-seed 48 parts Oil anise 24 parts Oil turpentine 1 part Tinct. myrrh 3 parts Mix. —(National Druggist.) FALKE'S SULPHOLINE CREAM. B Very thick mucilage of quince seeds 300 parts Glycerine 40 parts Sulpho-carbolate of so- dium 20 parts Mix. _(New Idea.) LINDSEY'S PAIN CURE, This is said to be an excellent application for pain of -any kind; or in any place, and especially for neuralgia and inflammatory rheu- matism. B Alcohol 4 oz Ethereal oil of wine 4 dr.' No. six 4 oz. Spirits of camphor 4 oz. Oil hemlock 2 oz. Oil cinnamon 1 dr. Oil sassafras 1 oz. Oil cloves 4 dr. Ether 2 oz. Chloroform 2 oz. Sweet spirits of nitre 4 oz. Chloral hydrate 2 oz. Lard oil 4 oz. Oil cedar 4 oz. Oil origanum 1 oz. Oil wintergreen 2 dr. Mix. It may be taken internal- ly in doses of 5 to 60 drops. The number six is tincture of capsi- cum and myrrh, made double strength. The spirits of camphor is also made double strength by the aid of chloroform. —(Dr. McCann.) FEBRILINE. Dr. R. G. Eccles declares in the Druggists' Circular, May, 1889, that he has investigated a preparation sold under the name "Febriline or 310 NOSTRUMS Tasteless Syrup of Amorphous Quinine (Lyons), "by the Paris Medicine Co., of Paris, Tenn., and finds that it contains no quinine at all. Instead of quinine, quini- dine is used, another alkaloid of cinchona bark. Its lack of bitter- ness renders it convenient for ad- ministration to children, and its imperfect solubility is not disad- vantageous when a slow or tonic action is alone required. FELLOW'S HYPOPHOSPHITES. R Glucose 1 lb. Simple syrup 1 pt. Hypophosphite calcium... 128 gr. Hypophosphite potassium.. 48 gr. Sulphate iron ,...48 gr. Sulphate magnese 32 gr. Sulphate quinine 14 gr. Sulphate strychnine 2 gr. Water q. s. ad. 2 pt. Mix. u B. Lyons, Therapeutic Gazette.) FIRWEIN. Dr. Lewis, of Belvidere, gives the following formula for Firwein: R Solution bromine, iodine, and phosphorus 1 oz. Fir bark (in coarse pow- — der 1 oz. White pine bark (coarse — powder) y 2 oz. Tamarac bark (coarse pow- der) y 2 oz. Dilute alcohol 16 oz. Sugar 4 oz. Percolate the barks with the dil- ute alcohol until 13 fluid ounces are obtained; remove the tannin; add the solution bromine, iodine, and phosphorus. Dissolve the sugar; allow to stand 24 hours and filter. The solution of bromine, iodine and phosphorus is made thus: R Phosphorus 10 gr. Iodine 170 gr. Bromine 170 gr. Alcohol 1 oz. Glycerine sufficient to make 8 oz. Dissolve the iodine in the alcohol, then add glycerine, then bromine and lastly the phosphorus gradual- ly in fine shavings. Use great care in adding the phosphorus. One ounce of this for the above Firwein. —(New Idea.) FLEURY'S TASTELESS CAS- CARINE. Examination proves it to be sub- nitrate of bismuth and calomel, triturated through powdered cane sugar. —(New Idea). FLAGG'S RELIEF. R Oil of cloves, about 1 dr. Oil of sassafras, about. 2 dr. Spirits of camphor, about V/ 2 dr. Mix —(J. J. Pierson, Ph. C.) FORD'S BALSAM OF HOAR- HOUND. R Hoarhound herb 3% lb. Licorice root sy 2 lb. Water 8 pt. Infuse for 12 hours, then strain off six points. To these add: Camphor 10 dr. Opium l oz. Benzoin l oz. Dried squills 2 oz. Oil of anise-seed 1 oz. Alcohol 12 pt. Macerate for one week and then add Z x / 2 pounds of honey. —(New Idea.) FOSGATE'S ANODYNE COR- DIAL. R Fluid extract rhubarb 5 dr. Fluid extract rhatany 2 dr. Fluid extract ginger 6 min. Paregoric l dr. Simple syrup l dr Dilute alcohol 5 dr! —(New Idea.) FROSTILLA. R Quince seeds 60 gr. Hot water 21 oz. Glycerine 6 oz. Deodorized alcohol 5 oz. Mix. —(Druggist Circular). FREEMAN'S VERMIFUGE OIL. R Oil of worm-seed % oz. Oil of turpentine 2 dr. Castor oil 1% oz. Pink root y 2 oz. Hydrastin 10 gr. Syrup of peppermint y 2 oz. Dose for a child 10 years old, a teaspoonful three times a day, one hour after each meal. If it purges too rroely, give it less often. GADBERRY'S MIXTURE. Gadberry's Mixture is used to a great extent in the Mississippi val- ley to control malaria. R Liquor tersulphate iron 3 dr. Liquor arseniate potash.. 90 min. Saltpetre 2 dr. Sulph. quinine 2 dr. Water to make 2 oz. Mix. —(Bulletin of Pharmacy.) GARGLING OIL. R Crude petroleum 13 oz. Ammonia water 6 oz. Soft soap 16 oz. Benzine 16 oz. Crude oil amber 2 oz. Tincture iodine 1 oz. Water 5 pts. Mix the petroleum and soap, add the ammonia water, oil of amber, and tincture of iodine, and mix thoroughly. Then add the ben- zine and finally the water. —(Salmon's Pharmaceutical Com- pendium. NOSTRUMS 311 GARFIELD TEA. Our examination showed it to contain chiefly senna leaves and crushed couch-grass. There are perhaps small amounts of other drugs present; but if so they are relatively of little importance. —(New Idea.) GILE'S IODIDE OP AMMONIA LINIMENT. B Iodine 1 dr. Camphor 1 oz. Oil of rosemary l / 2 oz. Oil of lavender % oz. Aqua ammonia 4 oz. Alcohol 2 pts. Dissolve the iodine in the alcohol; add the camphor and then the oils; then add water of ammonia enough to remove the dark color of the mixture. — (Kilner.) GOLDEN EYE WATER. B Sulphate of hydrastia 2 gr. Distilled water 1 oz. GENUINE WHITE OIL LINI- MENT. B Ammonia carbonate 19 parts Camphor 20 parts Oil turpentine 21 parts Oil origanum 20 parts Castile soap 19 parts Water to make (by weight) 300 parts GOOCHE'S MEXICAN COUGH SYRUP. B Fluid extract wild cherry.. 2 dr. Glycerine 6 dr. Simple syrup 2 dr. Syrup of tar, sufficient to make 3 oz. Mix. — (New Idea.) GOOD SAMARITAN COUGH SYRUP. B Morphia muriat 1 gr. Aq. lauro-cerasi 1 dr. Syrupi 2 oz.' Mix. One dr. to two drs., once or twice daily. GOOD SAMARITAN LINIMENT. B Oil of sassafras 1 oz. Oil of hemlock 1 oz Spirits of turpentine 1 oz'. Tinct. of capsicum 1 oz. Tinct. of opium l oz. Tinct. of myrrh 4 oz. Oil of origanum 2 oz. Oil of wintergreen 4 dr. Gum camphor 2 oz. Chloroform v/ 2 oz. Alcohol 4 pts Mix. —(Kilner.) ' GOMBAULT'S CAUSTIC BAL- SAM. B Croton oil 4 dr. Cotton-seed oil 2 oz. Oil of camphor 1 dr. Oil of turpentine 2 dr. Oil of thyme % dr. Kerosene 4 dr. Sulphuric acid 20 min. To the mixture of croton and cot- ton-seed oils add the sulphuric acid, stirring continually, then add the other constituents. After standing a few days it resembles the original preparation fairly well. —(Western Druggist.) GUNN'S RHEUMATIC LINI- MENT. B Linseed oil 1 oz. Oil cedar 1 oz. Oil amber 1 oz. Take gum camphor y 2 ounce; rub in a mortar Willi alcohol or sul- phuric ether till pulverized, and while still damp add Olive oil % qz. Turpentine V 2 oz. Laudanum y 2 oz. After which add the first three GRANDMOTHER'S OWN COUGH REMEDY. B Liquid tar 5 gr. Fluid ext. hemlock 1 dr. Powdered white sugar 2 oz. And add Alcohol y 2 oz. WaLer 1% oz. Molasses 3 oz. Fluid ext. ipecac 8 min. Mix well and add finally Chloroform 1 dr. Mix. _(New Idea.) GRAY'S SPECIFIC PILLS. B Asafoetida 2 gr. Camphor 1 gr. Lupuline % gr. The specific action is in the di- rection of an aphrodisiac. —(Western Druggist.) GREEN'S AUGUST FLOWER. B Rhubarb 360 gr. Golden seal 90 gr Cape aloes 16 gr.' Peppermint leaves 120- gr. Carb. of potash 120 gr. Capsicum 5 gr Sugar 5 oz.' Alcohol 3 oz. Water 10 oz. Ess. of peppermint 20 min. Powder the drugs and macerate with the mixed alcohol and water for several days; filter and add enough alcohol to make the prod- uct measure one pint. —(New Idea.) 312 NOSTRUMS GREEN MOUNTAIN SALVE. B Resin 5 lb. Burgundy pitch ^ lb. Beeswax V± lb. Mutton tallow % lb. Oil of hemlock.., 1 oz. Balsam fir 1 oz. Oil origanum 1 oz. Oil of red cedar 1 oz. Venice turpentine 1 oz. Oil wormwood % oz. Verdigris (powdered) 1 oz. Melt the first articles together, -and add the oils; having rubbed up the verdigris -with a little oil, put it in with the other articles, stir- ring weii; tncn put into cold water and work until cold enough to roll. GREEN WONDER OIL. B Terebinth venet 4 oz. Zinci sulphat 15 gr. Cupri acetat 1% oz. Bals. Peru 1 dr. Ol. olivae 1 lb. Ol. lini 1 lb. Boil the oils; when warm add the turpentine and zinc; when almost cold add the other ingredi- ents and stir well. For scalds, burns, wounds and piles. GREAT LONDON LINIMENT. B Acetate of morphia 10 gr. Chlproform 1 oz. Olive oil 1 oz. Water of ammonia 1 oz. GRIMAULT'S INJECTION OF MATICO. A satisfactory and valuable sub- stitute could be made by distilling about y 2 to 1 fluid drachm of fluid extract of eucalyptus globulus, with water sufficient to obtain 5 fluid ounces of distillate, and then in this dissolve 4 grains of sul- phate of copper. —(New Idea.) HAINE'S GOLDEN SPECIFIC FOR OPIUM HABIT. B Bayberry-root bark, pow- dered 16 oz. Ginger, powdered 8 oz. Capsicum, powdered 1 oz. Mix. —(Western Druggist.) DR. B. W. HAIR'S ASTHMA CURE. B Wine of tar 14 oz. Iodide of potassium 220 gr. Make a solution. Shake well be- fore taking. The wine of tar to be used in the above must be made as follows : B Common pine tar 2 dr. Sherry wine 2 pts. Pine sawdust y 2 oz. Mix the tar with the sawdust so as to form a sort of powder; then macerate it for a week with the wine and filter through paper. —(Dr. Palmer.) HALLO WAT'S PILLS. B Aloes 2 dr. Rhubarb 1 dr. Capsicum 20 gr. Saffron 5 gr. Sulphate of soda 5 gr. Make one hundred pills. HALL'S CATARRH CURE. B Gentian root 1*4 oz. Bitter orange peel 5 dr. Cardamon seeds 100 gr. Potassium iodide 1 oz. Dilute alcohol Sufficient. Macerate the crude drugs in 12 ounces of dilute alcohol for 48 hours, then transfer to a perco lator and allow to percolate slowly, when the liquid has ceased to per- colate, pass enough menstruum through the percolator to make the finished product measure 16 ounces. In this dissolve the potassium iod ide. —(New Idea) HAMLET'S AGUE PILLS. B Sulph. quinine 2 dr Powd. myrrh 1 dr. Powd. capsicum 1 dr. Mix and make sixty pills. HAMLIN'S WIZARD OIL. B Alcohol 1 pt. .. Gum camphor 1 oz. Oil sassafras y 2 oz. Tinct. myrrh y 2 oz. Tinct capsicum y 2 oz. Chloroform *& oz. —(Dr. Douglas in Medical World.) HAMBURG BREAST TEA. It is said that a preparation simi- lar to this may be made by mix- ing: B Marshmallow flowers 8 oz. Licorice root 3 oz Orris root 1 oz. Coltsfoot 4 oz Mullein flowers 2 oz Anise seed 2 oz. HAMBURG DROPS. B Powdered socotrine-aloes..l% oz. American saffron % oz. Tincture of myrrh 16 oz. Macerate for fourteen days and filter through paper. HANSON'S MAGIC CORN CURE. B Simple cerate 1 oz. Salicylic acid 1 dr. Mix intimately. —(Indiana Pharmacist.) NOSTRUMS 313 HUNTER'S RED DROPS. B Corrosive sublimate 10 gr. Muriatic acid 12 drops. Rub in a glass mortal and grad- ually add: Compound spirits of laven- der 1 oz. Dose— Five to twenty drops in wine, or spirits and water. A powerful alterative in syphilitic diseases. KOHLER'S ONE NIGHT CORN CURE. This is claimed to consist of lard containing 25 per cent of salicylic acid. —(Western Druggist.) HARLEM OIL, B Flowers of sulphur 2 oz. Linseed oil 1 lb. Oil of amber 2 oz. Oil of turpentine sufficient. Boil the sulphur and linseed oil on a gentle fire until the sulphur is dissolved; then withdraw from the fire, and when the mixture has somewhat cooled, add the oil of amber and enough oil of turpentine to bring the preparation to the consistence of molasses. —(National Druggist.) HARDY'S OINTMENT. B Beef tallow 17 dr. Castor oil 6 dr. Gallic acid 30 gr. Essence vanilla sufficient to flavor. HARTER'S WILD CHERRY BIT- TERS. B Wild cherry bark 8 oz. Yellow cinchona bark 1 oz. Orange peel 2 oz. Cardamom seed 1 oz. Asarum canadense % oz. Alcohol dilute 6 pts. Honey 1 pt. Syrup 1 pt. Percolate the drugs, in moderate- ly fine powder, with the dilute al- cohol, and when six pints are ob- tained add the honey and syrup. HELMBOLD'S JELLY OF GLYC- ERINE AND ROSES. Our examination shows the fol- lowing to be the formula for the above: B Tragacanth 1 dr. Triple ext. of rose 6 drops. Glycerine ~. 2 oz. Water 4 oz. —(New Idea.) HEISKELL'S TETTER OINT- MENT. Heiskell's Tetter Ointment, ac- cording to the Western Druggist, is said to be simply cerate of subacetate of lead. HIND'S HONEY AND ALMOND CREAM. According to Mr. Geo. H. Rose, this preparation may be prac- tically duplicated by the following formula: B Ointment of rose-water 5 parts Oil of sweet almonds 5 parts Glycerine o parts Boric acid 5 parts Solution of soda, U. S. P 12 parts Mucilage of quince seed (2 drs. to 1 pt.) 25 parts Water sufficient to make .- 200 parts Oil of bitte^ almond, and oil of rose, of each sufficient to per- fume. HINKLEY'S BONE LINIMENT. B Oil of wormwood 40 min. Oil of hemlock 2 dr. Oil of thyme 2 dr. Oil of turpentine 4 dr. Fl. ext. of capsicum 1 dr. Alcohol to make 4 oz. HIMROD'S ASTHMA CURE, Dr. Geo. Covert, of Clinton, Wis., in a recent article, says in regard to this preparation: "A one-time school-mate and friend of mine cured himself of asthma with his own remedy. He went to Europe, introduced his asthma remedy to the notice of Kaiser William, who used it with benefit and gave it his royal commendation. Our friend's fortune was made, and Himrod's Asthma Remedy is still on the market." B Powdered lobelia 2 oz. Powdered stramonium leaves 2 oz. Powdered nitrate potash... 2 oz. Powdered black tea 2 oz. Sift well and mix. HOLMES' LIVER PILLS. B Colocynth pulp 1 oz. Gamboge 1 oz. Scammony 1 oz. Barb, aloes 2 oz. Castile soap y 2 oz. Oil peppermint 2 fl. dr. Water Sufficient. Make into three-grain pills, of which from two to three are an average cathartic. These pills for- merly had a big reputation in the city of Pittsburg, Pa. HOLLO WAY'S OINTMENT. The formula for this preparation is said to be: B Yellow wax 10 parts White wax 10 parts Turpentine 25 parts Lard 50 parts Sweet oil , 75 parts J 314 NOSTRUMS HELMBOLD'S BUCHU. B Short buchu 9 oz. Uva ursi W2 oz. Licorice root 10 dr. Macerate in 9 pints of boiling water, strain, and add: Caramel 2 oz. Molasses 8 oz. Mix well, and add: Fluid extract cubeb 5 oz Alcohol 2 pt. Oil peppermint 1 oz. Water sufficient to make. .12 pt. — (Lillard's Prac. Hints and For- mulas.) HOP BITTERS. The following is said to be the formula: B Tinct. of hops % oz. Tinct. of buchu 3 dr. Tinct. of senega 3 dr. Podophyllin (dis. in spirits of wine) 10 gr. Tinct. of cochineal 20 drops Distilled water sufficient to make 1 pint Mix. —(Medical World). HOSTETTER'S BITTERS. B Sugar 2 lb. Calamus root 2 lb. Orange peel 2 lb. Peruvian bark 2 lb. Gentian root •. 2 1b. Columbo root 2 lb. Rhubarb 8 oz. Cinnamon 4 oz. Cloves 2 oz. Diluted alcohol 4 gal. Mix. —(The Medical Bulletin). INJECTION BROU. A preparation which is substan- tially the same, may be made by the following formula: B Tinct. catechu (1 in 16) 1 dr. Cocaine muriate 10 gr. Lead acetate 10 gr. Zinc, sulphate 10 gr. Water 6% oz. Alcohol y 2 oz. Dissolve the mineral salts each in V 2 ounce of water and mix them. Dilute the tinct. catechu with 4 fluid ounces of water; add the min- erals and then the solution of co- caine muriate in an ounce of wa- ter; lastly the alcohol and water to make 7% fluid ounces. The color of Injection Brou may be fairly well simulated by using a small amount of magenta. —(New Idea). JACKSON'S COUGH SYRUP. The following is the formula rec- ommended by Prof. J. U. Lloyd to be followed as a standard for the above preparation, which also goes by the name of "Compound Syrup of Morphine:" B Fl. ext. ipecac y 2 dr. Fl. ext. senega 3 oz. Fl. ext. rhubarb 4 dr. Sulphate morphine 8 gr. Oil sassafras 22 min. Syrup, to make 32 oz. Mix. —(American Druggist). JAYNE'S ALTERATIVE. B Tartar emetic 4 gr. Spirits of camphor 1 dr. Fluid extract of ipecac — 4 min. Laudanum 2 dr. Tinct. of lobelia 1 dr. Syrup of tolu 12 dr. Tinct. of digitalis 1 dr. Syrup of squills 2 oz. Mix. —(National Druggist). JAYNE'S EXPECTORANT. The following is given in New Idea as approximating this prep- aration: B Svrup squills 2 oz. Tinct. tolu V/2 oz. Tinct. camphor 1 dr. Tinct. digitalis 1 dr. Tinct. opium 2 dr. Wine ipecac 2 dr. Antimon. and pot. tart 2 gr. KEATING' S COUGH LOZENGES. B Lactucarium 7% gr. Ipecac 3% gr. Squills 3 gr. Ext licorice 3 dr. Mucil tragacanth q. s. Mix and divide into lozenges each containing 19 gr. KENDALL'S SPAVIN CURE. The following formula makes a preparation substantially the same as the proprietary liniment: B Turpentine 1 oz. Alcohol 2 oz. Camphor 240 gr ' Iodine 25 gr. Petroleum oil (heavy) y 2 dr.* Oil of rosemary 1 dr. In the mixed oils (without filter- ing (dissolve the camphor and the iodine. —(New Idea). KENNEDY'S MEDICAL DISCOV- ERY. B Sneezewort 1 oz. Bitter root 4 dr. Mix and add: Boiling water 8 oz. Proof spirits 10 oz. Licorice root 4 dr. Macerate for 48 hours, then add: White sugar 4 oz. Tinct. gaultheria 1 oz. -(King's American Dispensatory). NOSTRUMS 315 KELLOGG' S RED DROPS. B Spirit of camphor 2 oz. Spirits of origanum % oz. Oil of sassafras y± oz. Oil of turpentine y 2 oz. Color tincture (about) 4 oz. Mix. —(Pharmacist and Chemist). KENNKLE'S VEGETABLE ' WORM SYRUP: According to our examination each bottle contains: B Santonine 27 gr. Oil sassafras 1 min. Alcohol 2 oz. Fl. ext. pink-root 2 oz. Fl. ext. dandelion V 2 oz. Fl. ext. golden seal ^4 oz. Molasses V2 oz. The santonine in a finely tritur- ated condition. —(New Idea). KEFHALGINE. This remedy for headache, con- sists of: B Antipyrine 5 parts Roasted coffee 5 parts Caffeine 2 parts Salicylate of sodium 2 parts Mix. -(American Journal of Pharmacy). KICKAPOO INDIAN OIL. B Camphor V2 oz. Oil turpentine 1 dr. Oil peppermint V 2 dr. Oil wintergreen y 2 dr. Tinct. capsicum y 2 oz. Alcohol, sufficient to make 1 pt. Mix. —(New Idea). KING'S NEW DISCOVERY. The following is said to repre- sent its composition: BSulp. morphia 8 gr. Fl. ext. ipecac y 2 dr Chloroform 60 min. Tinct. white pine 2 oz. Water 7 oz. Carbonate of magnesia — y± oz. Sugar 14 oz. Rub the magnesia with one ounce of the sugar in a mortar, and triturate with the tincture of white pine and the fluid extract of ipecac; gradually add the water, and triturate with the mixture in the mortar. Filter and dissolve the morphia sulphate in the fil- trate; mix the chloroform with the rest of the sugar in a bottle and add the liquid above. Keep in a tight vessel. —(New Idea). KITCHELL'S LINIMENT. B Water ammonia 1 part Water 3 parts Caramel q. s. color Mix. —(Western Druggist). KING'S ROYAL GERMETEUR. B Sulphuric acid 2 oz. Water (saturated with sul- phureted hydrogen) 1 oz. Hydrant or well water to make 1 gal. Mix. —(Dixie Doctor). KLINE'S NERVE RESTORER. B Bromide of ammonia 3 dr. Bromide of potassium 3 dr. Bicarb, of potassium 80 gr. Tinct. columbo 6 dr. Water 6 oz. Mix. Dose: Teaspoonful thrice daily in water. —(Dr. Wade in Med. World.) KREYDER'S AGUE PILLS. Sulph. quinia 20 gr. Dover's powder 10 gr. Sub. carb. iron 10 gr. Mix with mucilage of acacia and form 20 pills Dose: Two each hour, commencing five hours be- fore the chill should set in. Then take one night and morning until all are taken. DALLEMAND'S SPECIFIC. B Sulph. quinia 1 dr. Sulph. cinchona 1 dr. Ex. colocynth 4 dr. Wine colchicum seeds 8 oz. Tinct. verat. viride 1 oz. Dilute alcohol 8 oz. Sherry wine 31 oz. Mix. Dose: One teaspoonful. —(National Druggist). LANGELL'S ASTHMA REMEDY. B Powd. belladonna leaves.. 1 part Powd. nitrate of potash. 10 parts LAUBACH'S ECLECTIC LINI- MENT. B Oil of turpentine 60 parts Tine, arnica flowers — 120 parts Stronger water of am- monia 120 parts Soap liniment 900 parts Oil of sassafras 6 parts Oil of thyme 2 parts Alcohol 240 parts Total parts (by measure). 1448 — (New Idea). LAVARRE'S SURE CURE. B Fl. ext. poke berries 80 min. Fl. ext. sassafras 40 min. Liquid ammonia, caustic. 5 min. Sodium bromide 20 gr. Alcohol :y 2 oz. Oil of peppermint 1 min. Powdered cochineal 4 gr. White sugar 3 dr. Water (enough to make) — 4 oz. Mix. —(New Idea). 316 NOSTRUMS LAVILLE'S GOUT CURE. This patent prearation is said to have the following composition: B Quinine 7.7 gr. Cinchonine 9.3 gr. Colocynthin : ...3.8 gr. Lime salts 7.6 gr. Coloring matter 4.6 gr. Alcohol 3 1-3 dr. Water 2 1-3 dr. Port Wine 1234.0 dr. .ix. —(National Druggist). LEE'S LITHONTRIPTIC. B Powdered castile soap 2 oz. Carbonate of potassium 4 dr. Nitrate of potassium 2 dr. Powdered gum arabic 5 dr. Oil of juniper 2 dr. Mix. —(Druggists' Circular). LEE'S GRAVEL REMEDY. B Sapo. Venet 4 oz. Sal. nitre pulv 4 oz. Oil juniper 4 oz. Gum arabic pulv 1 oz. Sal. absynth 1 oz. LEE'S ANTI-BILIOUS PILLS. B Calomel 30 gr. Jalap '.GO gr. Gamboge ....12 gr. Tartar emetic 3 gr. Beat into a mass and make into 24 pills, mix with gum arabic or extract of dandelion. Dose: 3 to 5 pills as a purgative. By substituting podophyllin in the place of calomel (same quan- tity) it makes a safer and better pill for common use. Dose: 2 to 3 pills. LIEBIG'S CORN CURE. The following formula for Lie- big's Corn Cure is said to be very effective: B Ext. of cannabis indica..5 parts Salicylic acid 30 parts Collodion 240 parts Mix until dissolved. Apply with a camel-hair pencil four consecu- tive nights and mornings to form a thick coating. The collodion protects the corn from irritation and rubbing, while the extract of cannabis indica acts as an ano- dyne, and the salicylic acid dis- solves and disintegrates the corn. LITTLE HOP PILLS. B Podophyllin : 3 gr. Ext. colocynth 6 gr. Oil of peppermint 1 min. Ext. rhubarb Sufficient Mix, divide into 12 pills and coat heavily with sugar. —(New Idea.) LINIMENT FOR MAN AND BEAST. B Powdered myrrh 1 oz. Powdered aloes 1 oz. Balsam fir 1 oz. Alcohol 8 oz. Mix. —(National Druggist). LIQUID CARBONIS DETER- GENS. B Quillaya saponari (soap bark) 4 lb. Alcohol (65 per cent.) 2 gal. Macerate and filter. Tinct. (as above) 100 parts Coal tar 50 parts Mix. After eight days, filter. Used externally in skin diseases. LIQUID COURT PLASTER. If soluble gun cotton is dissolved in acetone in the proportion of about 1 dram by weight of the former to 35 or 40 drams by volume of the latter, and half a dram each of castor oil and glycerine be added, a colorless, elastic and flex- ible film will form on the skin wherever it is appied. Unlike or- dinary collodion it will not be likely to dry and peel off. LOCOCK'S PULMONIC WAFERS. B Sugar 10 dr. Starch 10 dr. Gum arabic 5 dr. Lactucarium 75 gr. Equal parts each of vinegar of squills, Oxymel of squills, Wine of ipecac. The last three are to be mixed and evaporated to one-sixth the original bulk and added to the powders in quantity sufficient to make a mass of proper consist- ance. This is to be divided into lozenges of seven and one-half grains each. LOWNDES' MAGIC CREAM. B Hydrarg. ammoniat 1 part Zinc oxide 3 parts Must be thoroughly incorporated in powder; sufficient glycerine and lard then added to make a stiff cream. For application to venereal ulcers. LYDIA PINKHAM'S VEGE- TABLE COMPOUND. B Cramp bark 4 ox Partridge berry vine 4 oz. Popular bark 2 oz. Unicorn root 2 oz. Cassia 2 oz. Beth root Wz oz. Sugar iy 2 lb. Alcohol 1 pt. Water, a sufficient quantity. NOSTRUMS 317 The drugs should all be reduced to a moderately coarse powder; pour on boiling: water, let stand until cold, then percolate with wa- ter until the percolate measures one pint, add the sugar, bring to a boil, remove from the fire, and when cold add the alcohol and strain. Dose: One or two teaspoonfuls of this may be taken three or four times a day. LOW'S MAGNETIC LINIMENT. The following formula furnishes a liniment nearly identical in con- tents, character, and color: B Oil of turpentine 90 parts Tinct. of capsicum 120 parts Spirits of camphor 960 parts Stronger water of am- monia 90 parts Alcohol (sp. gr. 820) . . . .180 parts Oil of sassafras 6 parts Fluid ext. of sassafras.. 40 parts Total (parts by weight).. 1486 —(New Idea). LYON'S KATHAIRON. The following formula will ex- actly duplicate the original: B Castor oil 1 oz. Tinct. cantharides 1 dr. Oil of bergamot 20 min. Stronger water of am- monia 1 min. Alcohol sufficient to make 3 oz. Mix. —(New Idea). MARSHALL'S PILLS. B Compound ext. colocynth..60 gr. Mass mercury 60 gr. Powd. aloes 60 gr. Powd. soap 60 gr. Powd. rhubarb 60 gr. Mix and make into 60 pills. —(Pharmaceutical Record). MATER'S OINTMENT. B Olive oil 2% lb. White turpentine % lb. Beeswax 4 oz. Unsalted butter 4 oz. iix. —(Pharmaceutical Era). MCLEAN'S STRENGTHENING CORDIAL. B Gentian root 8 oz. Columbo root 8 oz. Orange peel 2 oz. Coriander seed 1 oz. Cardamom seed % oz. Serpen taria 1 oz. Whisky 7 pts. Glycerine 1 pt. Grind the drugs to coarse pow- der, moisten with wnisky, pack in the percolator, percolate with the whisky, forcing out the last with water, and in the percolate mix the glycerine. MEIBOM'S PECTORIAL BAL- SAM. B Benzoin 10 parts Dragon's blood 10 parts Opium 10 parts Bals. Peru 10 parts Spermaceti 5 parts Butter 10 parts Sweet oil of almonds.... 50 parts Oil of turpentine 100 parts Acetic acid 2 parts Digest for some days, frequently shaking, and strain through linen. To be rubbed on the breast once daily and taken internally once or twice daily, in doses of 10 to 15 drops, for coughs and catarrh. METZ'S BALSAM. Metz's Balsam, which is quite popular in some sections of the country, it is said is prepared as follows: B Linseed oil 180 parts Olive oil 180 parts Oil of laurel berries 30 parts Turpentine (oleo-resin)..60 parts Melt by a gentle heat and add: Powdered aloes 8 parts Powdered verdigris 12 parts Powdered white vitrol 6 parts Pour into a bottle and add: Oil of juniper 15 parts Oil of cloves 4 parts Mix by shaking. It is used as a dressing for ulcers, boils, wounds, etc. —(National Druggist). MEXICAN MUSTANG LINI- MENT. B Oil turpentine y 2 dr. Oil thyme % dr. Oil amber, crude y 2 dr. Black oil 1 dr. Kerosene oil 3 dr. Water 3 oz. 2 dr. Soap 35 gr. Caustic potash 3 gr. Mix. —(New Idea). MILLER'S GOLDEN OIL. According to New Idea, this con- sists mainly of: B Essential oil of lavender. 30 min. Essential oil eucalyptus 20 min. Essential oil sassafras.. 20 min. Oil of turpentine 1 min. Cotton-seed oil 7 dr. MITCHELL'S EYE- SALVE. B Saxoline, snow white v 350 gr. White wax 130 gr. Oxide of zinc 45 gr. Oxide of mercury 5 gr. Oil of lavender 10 min. Melt the wax and saxoline to- gether, and stir constantly while cooling. As soon as the mass be- gins to solidify incorporate the ox- ides and oil of lavender. —(New Idea). 318 NOSTRUMS MORRISON'S PILLS. B Powdered colocynth 3 gr. Powdered gamboge 6 gr. Powdered aloes 9 gr. Cream of tartar 12 gr. Also syrup enough for 12 pills. Serious results are often produced by large do=es of these pills. MICAJAH'S MEDICATED UTER- INE WAFERS. The Medical Summary gives the following formula as one practical- ly duplicating this preparation, which is so extensively used by the medical profession: B Mercury bichloride 1-16 gr. Zinc sulphate 5 gr. Bismuth subnitrate 15 gr. Acacia 5 gr. Carbolic acid 3 gr. Water q. s. MOREHEAD'S MAGNETIC PLASTER. Is said to be composed of tar and extract of belladonna, of each equal parts. MOUNTAIN ROSE. This remedy is similar to Viavi and is said to have been invented by the same Dr. Springsteen. Mountain Rose comes in sixteenth- grain round tablets, which are ap- plied with a placer. These tab- lets are said to contain jequirity, calendula, hydrastis, boric acid and slippery elm. MOXIE. This "Moxie," despite the won- derful tale of its discovery, and although so "wholly unknown to botanists," is, we presume to say, a plant otherwise termed avena sa- tiva The great "Nerve Food" is a decoction of oats, made into a syrup and flavored with sassafras and wintergreen. —(Western Druggist). MOTHER SIEGEL'S SYRUP. B Cone, decoction of aloes (1 to 4) 60 min. Borax 1.3 gm. Capsicum, powdered 0.13 gm. Gentian, powdered 2.3 gm. Sassafras oil 0.3 gm. Wintergreen oil 0.12 gm. Rectified spirits 7.5 gm. Fluid extract dandelion. .7.5 gm. Syrup 125 gm. MURRAY'S INFALLIBLE SYS- TEM TONIC, M. I. S. T. Our examination proved it to be: B Aloes 50 gr. Cinnamon, pulv 25 gr. Glycyrrhiza root, pulv 25 gr. Water sufficient Make into a pill mass with a lit- tle water, and divide into 50 parts. Press into gelatine capsules for use. —(New Idea). NERVURA NERVE TONIC. Smile-ax writes to the Drug- gists' Circular that he is informed from a reliable source that Dr. Green's Nervura, so much adver- tised, is comuosed about as fol- lows: B Coca tincture 4 oz. Damiana tincture 4 oz. Calisaya tincture 4 oz. While by no means a "won- derful discovery," still, if made from the best materials, it would afford a handsome profit to the manufacturer. NUMBER THIRTEEN. B Ol. santal alb. opt 2 dr, Tinct. cubebs % oz Spts. lavender comp % oz Spts. nit. dulc y 2 oz Ol. cassia opt 15 min Syr. acacia 2y 2 oz Mix. Dose: A teaspoonful be fore meals. OCULINE OR "THE BRILLIANT EYE." This is a collyrium advertised by a New York firm. It is guaran- teed to cure every description of eye disease, and to impart a beau- tiful and lasting brilliancy to the organ of vision. Examined by Dr. Fr. Hoffman, it has been found to consist of water containing 1 per cent, of boric acid and 5 per cent, of glycerin. — (Pharm. Rundschau). OIL OF JOY. B Alcohol 4 pts. Gum camphor y 2 oz. Oil of sassafras 1 oz. Oil of cedar 1 oz. Tinct. of guaic 1 oz. Tinct. of capsicum 2 oz. Water of ammonia 4 oz. Chloroform 3 oz. OIL OF GLADNESS. B Oil of marjoram... 1 dr. Oil of peppermint 1 dr. Oil of horsemint 1 dr. Ether 2 dr. Tinct. of capsicum... 4 dr. Tinct. of opium 1 dr. Tinct. of red sanders 1 dr. Alcohol, sufficient quantity to make 8 oz. Mix. —(Druggists' Circular). NOSTRUMS 319 ORANGE BLOSSOM. This takes the form of a sup- pository for female disease, each suppository weighing about 31 grains. The New Idea gives the constituents as follows: B Zinc sulphate 1 dr. Alum 15 gr. Cocoa butter 3 dr. White wax % dr. Oil sweet almonds V/ 2 dr. Ext. henbane 1 gr. Make suppositories of above weight. OSGOOD'S CHOLAGOGUE OR CELEBRATED AGUE CURE. B Sulph. quinine 2 dr. Fluid ext. leptandra 2 dr. Saturated tinct. stillingia. .4 oz. Fluid ext. podophy llin 3 dr. Oil of sassafras 10 min. Oil of wintergreen 10 min. New Orleans molasses suf- ficient to make 8 oz. Mix. Dose: One to two tea- spoonfuls. OZONE UTERINE WAFERS. The Boston Journal of Health says that these wafers consist of powdered jequirity in capsules. PAINE' S CELERY COMPOUND. B Celery seed 2 oz. Red cinchona 1 oz. Orange peel x k oz. Coriander seed Y± oz. Lemon peel */i oz. Hydrochloric acid 15 drops Alcohol 5 oz. Glycerine 3 oz. Water 4 oz. Syrup 4 oz. Grind the solids to No. 40 powder, mix the acid and the water, add the glycerine and alcohol, and in the menstruum so prepared macer- ate the power for 24 hours; then percolate, adding enough water and alcohol in the proportion to make 12 fluid ounces. Finally add the syrup and if necessary, filter. Make 32 pints —(Boston Herald). PARSON'S PURGATIVE PILLS. B Aloes 1 gr. Calomel y 2 gr. Powd. colocynth % gr. Gamboge y 2 gr. Soap y 2 gr. Mandrake root y 2 gr. Oil peppermint. y 2 gr. PEEKSKILL'S COUGH SYRUP. B Syrup of tolu 5 oz. Syrup of ipecac 1 oz. Paregoric 4 oz. Syrup of wild cherry 1 oz. ax. —(Medical World). ?ERUNA. B Copaibr 6 dr. CubeJ-^ 2 dr. Calisaya bark, ground 2 oz. Stone root (Collinsonia) ground 2 oz. Corydalis (Turkey Corn) ground 2 oz. Deodorized alcohol 1 pt. Add a.ll the ingredients to the alcohol. Let stand one week. Shake le bottle frequently, and finally strain through several thicknesses of muslin, or filter through filter- ing paper, which may be obtained at any drug store. PALMER'S COSMETIC LOTION. It is said to be a weak (one per cent.) solution of sulpho-carbolate of zinc in glycerine and rose-wa- ter. PATTERSON'S EMULSION OF PUMPKIN .SEEDS. Patterson's Emulsion of Pumpkin Seeds is said to be a good emul- sion for expelling tapeworms. Take two ounces of pumpkin seeds, peel and pound to a paste with sugar, then add by degrees eight fluid ounces of water, the whole to be taken in two or three draughts at short intervals. PERRY DAVIS' PAIN KILLER. B Gum myrrh 2% lb. Capsicum 10 oz. Gum opium 8 oz. Gum benzoin 6 oz. Gum guiac 3 oz. Gum camphor 10 oz. Alcohol 5 gal. PHENOL SODIQUE, B Carbolic acid 188 gr. Caustic soda 31 gr. Distilled water 4 oz. PLEIS' FIT POWDERS. B Bromide of potassium 15 gr. Powdered gentian 5 gr. Mix. Make one powder. —(The Drug Mill). PERRY'S COMPOUND SARSA- PARILLA BLOOD PURIFIER. B Turkey-corn root 2 1b. Stillingia root 2 lb. Sarsaparilla root 2 lb. Yellow-dock root 2 lb. Sassafras bark lib. Simple syrup 2 gal. Diluted alcohol 32 pt. Iodide of Potassa 2 1b. Water sufficient Percolate roots and bark with diluted' alcohol, add syrup, then iodide of potassa. Dissolve in wa- ter to make six gallons. Mix. — (Kilner's Modern Pharm). 320 NOSTRUMS PETTIT'S EYE SALVE, The formula for this old and pop- ular remedy is as follows: B Olive oil 4 dr. Spermaceti V/ 2 dr. White wax V2 dr. Melt together, and add gradually, under trituration in a warm mor- tar, to the following in fine pow- der, and thoroughly mix: White precipitate 20 gr. Oxide zinc 30 gr. Acid benzoic 2 gr. Morphine sulph % gr. Oil rosemary Y 2 gr. Finally stir until cool, and pre- serve in a well covered vessel. —(Western Druggist). PIERCE'S "FAVORITE PRE- SCRIPTION. B Savin 150 gr. Cinchona 150 gr. Agaric 75 gr. Cinnamon 75 gr. Water sufficient to make a decoction of 8 oz. To this add: Acacia 150 gr. Sugar 75 gr Tinct. digitalis V 2 dr. Opium V 2 dr. Oil Anise 8 min. Dissolve the gum and sugar in the strained decoction, then add Alcohol, 2 fluid ounces, in which the oil has previously bene dis- solved. — (Hager.) PIERCE'S GOLDEN MEDICAL DISCOVERY. R Fluid extract of cinchona.. 16 oz. Fluid extract of columbo..4 oz. Fluid extract of guaiacum 8 oz. Fluid extract of licorice — 4 oz. Tincture of opium 1 oz. Podophyllin (resinoid) 120 gr. Glycerine 6 pt. Alcohol Sufficient.. Dissolve the podophyllin in the alcohol, and add the rest of the ingredients. Mix them. Dose: —A tablespoonful —(The Drug Mill.) PLATT'S CHLORDDES. Piatt's Chlorides we found to be approximately as follows: B Magnesium chloride iy 2 parts Potassium chloride 1% parts Sodium chloride 1% parts Zinc, chloride 1V 2 parts Aluminum chloride 7M> parts Water, sufficient quantity 100 parts Mix. —(New Idea). POPE'S CURE FOR NEURAL- GIA. B Iodide of potash 4 dr. Extract of conium 1 dr. Comp. tinct. of cinchona — 2 oz. Syrup of sarsaparilla 4 oz. Mix. Teaspoonful three times a day. —(National Druggist). POWELL'S BALM OF ANISE SEED. This patent preparation is mere- ly a modification of "Paragoric Elixir," without the perceptible presence, of camphor, but with the addition of a small quantity of extract of licorice, and the faint- est presence of rhubarb. The medicine is distinctly acid, owing to the presence of benzoic acid, and when water is added it becomes turbid and milky, from anise seed oil being one of the principal constituents. —(New Idea). PROCTOR'S VERMIFUGE. B Santonine 16 gr. Fluid ext. of senna 2 oz. Fluid, ext. of pink-root.... .2 oz. Dose for a child two years old, one teaspoonful night and morning until purging takes place. Used to tpel stomach worms from children. PISO'S CURE FOR CONSUMP- TION. B Tinct. tolu y 2 oz. Fl. ext. lobelia 2 dr. Fl. ext. cannabis indica....2 dr. Chloroform 1 dr Sulph. morphia 4 gr! Tartar emetic 4 gr. Ess. mentha viridis 10 min. Water 8 oz. Sugar 14 oz. Mix the fluid extracts, tincture tolu, chloroform and essence of spearmint, and shake with the sugar in a bottle. Dissolve with the morphine and tartar emetic in hot water, then add the water to the sugar in a bottle. Dose: One teaspoonful. —(New Idea). PRICE'S PILE OINTMENT. B English calomel 1 oz. Powdered opium % oz. Pure carbonate of lead..... .1 lb. Oxide of zinc lib. Olive oil 2 lbs. Fresh lard (without salt).. 2 lbs. Mix by trituration in wedgewood mortar. It was put up in two- ounce gallipots, tied over with a bit of bladder, and was sold read- ily at $1, the principal purchasers being. river and flat-boat men.. NOSTRUMS 321 QUICK STOPS FOR HEAD- ACHES. Besides camphor, it contains a little over 1% grains of cocaine to the bottle; that is about % grain of the alkaloidal salt to the dose. The greenish color is evidently due to some greenish fluid extract, and underneath the camphor there is an odor suggestive of henbane, though we failed to isolate any al- kaloid having devided mydriatic qualities. The cocaine dilated the pupil slightly, but the dilation was attributed to the cocaine itself, which is reported to sometimes have this effect. —(New Idea). RAD WAY'S PILLS. B Aloes 4 parts Jalap 2 parts Ginger 2 parts Myrrh 2 parts Make into a mass with musilage and divide into 2-grain pills, of which about four dozen are put into each box. — (Cooley). RAD WAY'S READY RELIEF. B Soap liniment, about 1V 2 oz. Tinct. capsicum, about — V 2 oz. Water of ammonia, about V 2 oz. Alcohol, about % oz. Mix. —(J. J. Pierson, Ph. C). DR. RAD WAY'S RENOVATING RESOLVENT. B Potassium iodide 2.5 grm Concentrated sarsaparilla decoction 15 grm Bitter almond water 10 grm Syrup 30 grm Parrish's simple elixir — 90 grm Distilled water 250 grm Caramel sufficient to color. Mix. — (H. B. Parsons). RAD AM' S MICROBE KILLER. Dr. R. G. Bccles, in the Drug- gists' Circular, gives the following formula for the preparation: B Sulphuric acid (strong) 4 dr. Hydrochloric acid 1 dr. Red wine (about) 1 oz. Well water 1 gal. RANSOM'S HIVE SYRUP AND TOLU. B Fluid ext. squills 2 dr. Fluid ext. senega 2 dr. Soluble essence tolu 2 dr. Tartar emetic * 4 gr. White sugar 4 oz. Water to make 4 oz. It is readily prepared by rubbing the tartar emetic and sugar well together, adding the fluid extract and essence of tolu, and then enough water to make, after short slight heating and straining, four fluid ounces. Each fluid ounce of the syrup contains 1 grain of tar- tar emetic. —(New Idea). REAVE' S EMBROCATION. B Olive oil l 1 ^ oz. Aq. ammonia 1 oz. Goulard's extract of lead..l oz. Oil origanum 2 oz. RECAMIER CREAM. B Rice flour 48 oz. Zinc oxide .60 oz. Glycerine 640 oz. Cocoa butter 48 oz. Lard 48 oz. Mercuric chloride 4 oz. RECAMIER BALM. B Zinc oxide 5 lbs. Glycerine 2 dr. Alcohol 2 oz. Mercuric chloride 4 oz. Distilled water 64 qts. —(Boston Herald). RED STAR COUGH CURE, We purchased a bottle of it and have submitted it to examination, and find that it is a syrup prep- aration of wild cherry bark, with a little tar and slight trace of chloroform or chloric ether, with possibly a little bitter almond add- ed. It is put up in a green panel bottle containing full three fluid ounces. It is a clear reddish-brown syrup A of thick substance, has a very faint acid reaction; but has pronounced bitter-almond flavor, and tarry taste and odor. —(New Idea). REE'S CHOLERA MIXTURE, B Spts. chloroform 12 oz. Spts. lavender, comp 12 oz. Vin. opium 3 oz. Oil of cloves 40 min. REVALENTA ARABICA FOOD. Consists solely of Lentils ground up into a fine powder. —(Stokes, in Hygiene). REX MAGNUS. According to Science, the com- position is roughly indicated by the following' formula: B Boric acid 33^ per ct. Borax 33^ per ct. Chloride of potassium 15 per ct. Water IS per ct 322 NOSTRUMS RIFAN'S STOMACHIC TABLETS. These widely advertised Stom- achic tablets are said to derive their name from the first letter of the name of the ingredient they contain, which spells R-I-P-A-N-S. Each tablet containing the fol- lowing: B Rhubarb powd 2 gr. Ipecac powd 1-20 gr. Peppermint Ys min. Aloes % gr. Nux vomica Vs. gr. Sodium bicarb 5 gr. Dose: One or two tablets after each meal. The above combination offers a splendid tonic-digestant of known power and activity. The chief aim in dyspepsias is, not to perform the act that is lacking, but to stim- ulate the organs to perform this for themselves. Thus, this com- bination tends to stimulate all the secretions of the prima vitae and enable each and every organ con- nected with the digestive and as- similative processes to function- ate. Where digestive ferments— pepsin and pancreatin and their deriatives —are employed, it is with the ex- pectation that they will artificially and mechanically perform the of- fices that belong to the digestive organs, leaving the latter no labor but that of assimilation. The re- sult is a putrefaction process that, theoretically, reduces proteids to an assimilable form. Stomachic Tablets, on the contrary stimulate the organs themselves to normal activity, whereby digestion be- comes a physiological instead of forced and mechanical act, and en- sures, with a reasonable degree of certainty, the desired assimilative function. RICHMOND'S SAMARITAN NERVINE. According to our analysis, this wonderful agent has the following formula: B Potass, bromide 1 oz. Sugar 1 oz. Caramel 20 min. Water 5 oz. Dissolve and add oil cassia 10 min. Mix. —(New Idea). ROCHE'S HERBAL EMBROCA- TION. B Digest asafoetida 2^ parts with Olive oil 60 parts for some hours; decant and mix solution with— Oil caraway 2 parts Oil turpentine 2 parts And add a few drops of oil gaul- theria. —(Western Druggist). ROGERS' ANTI-NEURALGIC PILLS. B Asafoetida 10 gr Ext. valerian 10 gr' Galbanum 10 gr'. Castoreum 10 gr. Mix. Make 10 pills. Dose: Three or four pills a day. —(Country Doctor). ROGER'S EXCELSIOR CORN CURE. B Fluid ext. cannabis indica..l dr. Sulph. morphine 20 gr. Salicylic acid 10 gr. Collodion to make 2 oz. Mix well. Pare the corn down thin, apply till a coat forms; do so twice or more, and you can pick the corn out. —(Dr. Sullivan in Medical World). RUSSIA SALVE. A formula for a preparation said to resemble this preparation is given in the Druggists' Circular: B White pine pitch 2 lbs. Beeswax 1 lb. Temper it with olive oil to the proper consistence. The "pitch" and wax are, of course, to be melted before the "tempering" pro- cess begins. RUSSELL'S BOTANIC KING. ' As Dr. Russell states on the la- bel, of a mixture of powdered ex- tracts of dandelion, mandrake, bu- chu, yellow dock, and peruvian bark, each 10 parts; aloes, 50 parts. —(New Idea). SAGE'S CATARRH REMEDY. R Powdered hydrastis cana- densis 1 oz. Powdered borax 10 gr. Salt 10 gr. Ferro-cyanuret of iron; suffi- cient to color. Mix. The above is the formula of Dr. Sage, and sold by him to Dr. Pierce, of New York, for $300. The formula was given to me by Dr. Sage himself, while on a visit to relatives in Switzerland county, In- diana, two years ago. -(Dr. Hewitt in Medical World.) SAUL'S CATARRH REMEDY. B Comp. tinct. benzoin 2 oz. Tinct. tolu ..» 2 oz. Chloroform 1 dr. Sulphuric ether 1 dr. Aromatic spts. of ammonia 1 oz. Oil of tar 1 dr. Rectified spirits 5 oz. Mix. Use with Cutler's inhaler. —(Dr. Brucker in Medical World). NOSTRUMS 323 SANFORD'S RADICAL CURE FOR CATARRH. Consists, according to an analy- sis made by Prof. A. B. Lyons, of a distilled extract of witch ha- zel, containing- a little alcohol and glycerine, perhaps as much as 5 per cent, of the latter, and be- tween 10 and 15 r>er cent, of the former (no exact determinations attempted), also an important con- stituent — morphine — quantity not estimated. The "solvent" consists mostly of nitre and bicarbonate of soda, with a small quantity of the yellow pow- der, insoluble or sparigly sol- uble in water— probably a vegetable powder. — (New Idea). SCHENCK'S PULMONIC SYRUP. The following formula for Schenck's Pulmonic Syrup was given to me by an old lady sev- eral years ago, who professed to know all about the late Dr. Schenck when he commenced: B Wormwood y 2 oz. Catnip V 2 oz. Tansy V 2 oz. Hyssop Vz oz. Hoarhound V2 oz. Hops % oz. Chamomile V 2 oz. Comfrey V 2 oz. Senega Vz oz. Elecampane y 2 oz. Boil with sufficient water to make, after straining, one quart; then add: Gum arabic iy 2 oz. Liquorice V/ 2 oz. Then one good-sized Indian tur- nip, and finally add: Sugar 3 lb. Brandy y 2 pt. Juice of two lemons. — (H. M. Wilder in Pharmaceu- tical Record). SCOTCH OATS ESSENCE. Recent analysis assert that a certain nostrum, "Scotch Oats Es- sence," widely advertised as a wonderful nerve tonic, containing neither alcohol nor other harmful ingredients, Is, in fact, loaded with 35 per cent, alcohol and with two grains of morphine to each bottle. —(Western Druggist). SEELEY'S PILE OINTMENT. B Sulph. morphia 3 gr. Tannin 48 gr. Pine tar 72 gr White wax 72 gr. Benzoated lard 766 gr. SEVEN BARKS. B Extract of hydrangea 1 lb. Extract of poke root 12 lb. Extrac of Culver's root ..12 lb. Extract of dandelion 12 lb. Extract of lady-slipper 12 1b. Extract of colocynth 12 lb. Extract of bloodroot 6 lb. Extract of blue flag 6 1b. Extract of stone-root 6% lb. Extract of golden seal iy 2 lb. Extract of mandrake 24 lb. Extract of black cohosh ..24 lb. Extract of butternut 48 lbs. Spirits of sea salt 14% lb. Aloes 10 lbs. Borate of sodium 15 lb. Infusion of capsicum 4% lb. Powdered sassafras 111b. Ginger 6 lbs Sugar-house syrup 40 gal. Water, sufficient to make 98 gai Mix. H. Greeley, in National Druggist) SENCKENBERG'S MIGRAINE PASTILLES. B Methozine (antipyrine) .Ay 2 gr. Antifebrin iy 2 gr. Rhubarb % gr. Calamus 1-3 gr. Cinchona x / 2 gr. Mix. — (Pharm. Cent.) SEA-SHORE DIPHTHERIA AND SORE THROAT SPECIFIC. The following formula will make a preparation practically identical with the original: B Sol. of chloride of iron 18 min. Zinc, -chloride 2 gr. Magnesia chloride 2 gr. Sodium chloride 4 gr. Chlorate of potassium 6 gr. Water 2 oz. Mix. —(New Idea). SEVEN SEALS, OR GOLDEN WONDER. B Ether 4 parts Chloroform 6 parts Camphor 4 parts Oil of peppermint 2 parts Tinct. of capsicum 35 parts Alcohol (90 per cent.).... 50 parts These proportions are approxi- mate. This preparation is recom- mended for " cholera-morbus, rheumatism, wart, corns and all diseases." —(National Druggist). SEQ UAH'S OIL. A mixture of two-thirds Turpen- tine and one-third Fish Oil, scent- ed with a few drops of Oil of Cam- phor. —(Stokes, in Hygiene). 324 NOSTRUMS SEQUAH'S PRAIRIE FLOWER. Has to the ounce— B Aloes 52% gr. Carbonate of soda 17% gr. Water 362% gr. And a few drops of the Tincture of Capsicum and Myrrh. — (Stokes, in Hygiene). SHILOH'S CONSUMPTION CURE B Muriate of morphine 3 gr. Muriatic acid 3 min. Fl. ext. of henbane 2 dr. PI. ext. of ginger 3 dr. Fl. ext. of wild cherry 3 dr. Diluted alcohol 3 dr. Chloroform 1 dr. Essence peppermint 30 min. Syrup of tar 3 oz. Simple syrup enough to make 8 oz. Mix. —(New Idea). SIROP GIBERT. Is a favorite French anti-syphil- itic remedy, and has the follow- ing composition: B Biniodide of mercury 2 gr. Iodide of potassium 100 gr. Simple syrup 6 oz. Mix. Dose: Two teaspoonfuls given after meals t three times a day. ST. JOHN LONG'S LINIMENT. B Yolks of eggs & Oil of turpentine 24 oz. Acetic acid 16 oz. Water 24 oz. Mix. —(Philadelphia Medical Times). J. L. ST. JOHN'S LINIMENT. According to Eclectic Medical Advocate, this preparation is com- posed of: B Turpentine 7 oz. Sweet oil 3 oz. Tincture arnica 4 oz. Oil origanum 1 oz. Oil hemlock 1 oz. Oil juniper 1 oz. Oil amber 2 oz. Laudanum 2 oz. Spirits ammonia % oz. Camphor % oz. ST. JACOB'S OIL. B Gum camphor 1 oz. Chloral hydrate 1 oz. Chloroform 1 oz. Sulph. ether 1 oz. Tinct. opium % oz. Oil origanum % oz. Oil sassafras % oz. Alcohol % gal. Mix. —(Medical World). SIMMON'S LIVER REGULATOR. B Hepatica 1 oz. Leptandra 1 oz. Serpentaria 1 oz. Senna 1% oz. Mix. Put the ingredients into 2% pints of boiling water. Let stand 19 bours, then strain. Add % pint of good whisky. —(New Remedies). SKINNER'S DANDRUFF MIX- TURE. B Chloral hydrate 1 part Glycerine 4 parts Bay rum 16 parts Mix. —(National Druggist). SMEDLEY'S FEVER POWDERS. B Camphor gum % oz. Gum myrrh % oz. Blood-root 1 oz. Lobelia (seeds, pods, and leaves) 2 oz. All pulverized fine and well mixed. For colds and to break a fever in its first stages, in powders of or- dinary size. For catarrh in the head, use as a snuff. SMITH BROS.' COUGH DROPS. B Average weight of each drop 36.5 gr. Sugar (and glucose in small small quantities) 35.5 gr. Powdered charcoal 80 gr. Licorice in small quantities. And highly flavored with oil of sassafras with a little oil of anise. —(New Idea). STRONG'S ARNICA JELLY. The following formula may be taken as one which will duplicate the proprietary article in all es- sential particulars: B Glycerine 1 oz. Water 1 oz. Starch 120 gr. Fl. ext. arnica 2 dr. Sp. bitter almonds (1 to 8) 2 min. Carbolic acid 8 min. Mix. —(New Idea). STOKE' S EXPECTORANT. B Carbonate ammonia 30 gr. Fluid ext. squills 1 dr. Fluid ext. senega 1 dr. Paregoric 6 dr Syrup of tolu. 12 dr. Water 10 dr, Dissolve the carbonate of ammo- nia in the water and add the re- maining ingredients. Dose: A tea- spoonful. NOSTRUMS 325 STEDMAN'S SOOTHING POW- DERS. B Opium pulv 3 gr. Ipecac 1 gr. Milk sugar 8 gr. Rice flour 12 gr. Mix and divide into eight pow- ders. —(New Idea). STUART'S DYSPEPSIA TAB- LETS. Each tablet contains the follow- ing: B Pepsin 1 gr. Soda bicarb 2 gr. Precip. chalk 3 gr. Jamaica ginger 1 gr. Sugar of milk 11 gr. SWAIM'S VERMIFUGE. B Worm-seed 2 oz. Valerian •> 1% oz. Rhubarb JJ£ oz. Pink-root 1V 2 oz. White agaric 1% oz. Boil in sufficient water to yield 3 quarts of decoction, and add the following oils dissolved in a quart of rectified spirits: Oil of tansy 30 drops Oil of cloves 45 drops S WAYNE'S OINTMENT. Its composition appears to be precipitated sulphur, 2 parts; tal- low, 3 parts; lard, 3 parts. It states on the label that ointment cures tetter, itch. salt-rheum, scald-head, piles, ringworm, pim- ples, blotches, barber's itch, ulcers and eruptions of the skin. —(New Idea). SYRUP OF PIGS. The formula for syrup of figs is as follows: B Senna leaves 14 oz. Coriander seed 6 oz. Figs 24 oz. Tamarind 18 oz. Cassia pulp 18 oz. Prunes 12 oz. Ext. licorice V/ 2 oz. Ess. peppermint V/ 2 oz. Syr. simp 1 gal. The formula omits directions; but probably a water extract should be made of the drugs, so as to measure about four pints, and in this dissolve eight pounds of sugar to make the syrup. —(Druggists' Circular). DR. SYKES'S CATARRH CURE. Mr. D. S. Sager, chemist, Brant- ford. Canada, writes the American Druggist that an analysis of a package of this substance show- ed that it consisted of between 66 and 67 per cent, of chlorate of potassium, with powdered licorice root, and a small amount of brown powder not analyzed. The liquid made by adding the powder to a stated amount of waiter, filtering out the sediment, and then flavor- ing with wintergreen. SYRUP OF STIDLINGIA COM- POUND. This is an old eclectic remedy and may be prepared as follows: B Fl. ext. stillingia comp 1 oz. Fl. ext. corydalis 1 oz. Fl. ext. blue flag . ,%oz. Fl. ext. elder flowers y 2 oz. Fl. ext. prince's pine V 2 oz. Fl. ext. prickly ash berries % oz. Fl. ext. coriander % oz. Sugar 14 oz Water sufficient. Mix the fluid extracts and add water to make 6% fluid ounces. In this dissolve the sugar, using as little heat as possible, and add wa- ter to make one pint. TAMAR IND1EN. B Tamarind pulp 450 parts Powd. sugar 40 parts Powd. sugar of milk 60 parts Glycerine 50 parts Mix and evaporate to the con- sistency of a soft extract, then add— Powd. anise 10 parts Essence lemon 3 parts Tartaric acid 3 parts Mix and divide into 100 boluses and roll in the following mixture: Cream of tartar 5 parts White sugar 35 parts Sugar of milk 35 parts Tragacanth 2 parts Tartaric acid 2 parts Powd. red sandal 25 parts Dry and put up in tin foil. —(American Druggist). TARRANT'S SELTZER APER- IENT. The Assistant State Geologist of Arkansas offers this hypothetical combination for this well known article, which we quote as re- ported by J. J. Beidelman to Meyer Bros., druggists: B Bi-carbonateof soda 28.25 per ct. Rochelle salts 26.04 per ct. Potassium, soda tartar. Tartaric acid free ..30.95 per ct. Sulphate magnesia 12.89 per ct. Magnesia 28 per ct Silica 01 per ct. Chloride of sodium.. .17 per ct. Total 9S.60per ct. Loss probably Tartaric acid 1.40 per ct. 326 NOSTRUMS THIELMAN'S CHOLERA MIX- TURE. B Oil peppermint 4 dr. Chloroform 4 dr. Fl. ext. ipecac 3^ dr. Fl. ext. valerian l x /4 oz. Tinct opium, deod 1% oz. Ether 2 oz. Alcohol 6 oz. Shery wine sufficient to mix 16 oz. Mix. —(Western Druggist). THORN'S COUGH MIXTURE. B Hive syrup 2 oz. Paregoric 1 oz. Sweet spts. nitre 1 oz. Mix. Dose for an adult: One tea- spoonful every two or three hours. "THAT LINIMENT." B Oil of turpentine 1 oz. Oil of spike 1 oz. Oil of origanum 1 oz. Barbadoes tar 2 dr. Spirits of camphor V 2 dr. THOMPSON'S EYE-WATER. B Zinc, sulphate 20 gr. Copper, sulphate 5 gr. Tinct. saffron 2 dr. Tinct'. camphor 1 dr. Rose-water 8 oz. Dist. water — 8 oz. Mix and filter. —(New Remedies). THOMAS' ELECTRIC OIL. B Gum camphor 4 'dr. Oil gaultheria 4 dr. Oil origanum 4 dr. Chloroform 1 oz. Tinct. opium 1 oz. Oil sassafras 1 oz. Oil hemlock 1 oz. Oil turpentine 1 oz. Balsam fir 1 oz. Tinct. guaiacum 1 oz. Tinct. catechu 1 oz. Alcohol 4 pt. Alkanet sufficient to color. Mix. —(Medical World). TIP TOP. B Calomel 60 gr. Tinct. iodine 1 oz. Oil sassafras 1 dr. Kerosene oil 3 oz. Mix. Shake well before using. This preparation is "tip top" in some skin diseases, and does not belie its name. With a few drops of carbolic acid added, it will ar- rest or stop a spider or any other poisonous insect bite from assum- ing the erysipelatous or gangre- nous form that we frequently see in course of the practice of medi- cine. —(Dr. Sturdivant in Medical Sum- mary. TOWNSEND'S PILLS. Have been in considerable use among physicians of our acquaint- ance. The formula is the following: B Mass hydrarg 20 gr. Gamboge 20 gr. Ext. aloes 20 gr. Zingiber pulv 20 gr. Oil peppermint 3 drops Mix. Divide into 16 pills. —(American Druggist). TOLU, ROCK AND RYE. B Good whisky 1 gal. Rock candy 4 lb. Balsam tolu 2 oz. Put the whole into a two-gallon jug. Set in a warm place and agitate several times a day until the candy is dissolved. Then strain through muslin. TOBIAS VENETIAN LINIMENT. B Spirits of ammonia 5 parts Tinct. of capsicum 5 parts Camphor 2 parts Alcohol 34 parts Water 10 parts Mix. — (Hager). TRAFTON'S BALM OF LIFE. B Iodide of potassium 80 parts Fl. ext. of opium 20 parts Fl. ext. of senega 50 parts Fl. ext. of squills 120 parts Alcohol 240 parts Water enough to make, by measure 1920 parts Filter. —(New Idea). TRIUMPH CORN PLASTERS. We would suggest the following formula as a satisfactory one for making a good plaster to replace the secret article. Make an ad- hesive plaster by melting equal parts of resin and balsam of fir together; while warm spread on linen, and when cold cut into cir- cular discs, about the size of a nickel, and in the center of each place a quantity, about the size of a half pea, of the following mix- ture: B Resin 3 parts Balsam of fir 2V 2 parts Salicylic acid 5 parts Melt the resins together, then stir in the salicyclic acid. ' —(New Idea). TRASK'S MAGNETIC OINT- MENT. B Lard 1 oz. Raisins 1 oz. Fine cut tobacco 1 oz. Simmer well together. Then strain, and press out all from the drugs. "This is a splendid rem- edy in all skin diseases, as salt rheum, tetter, etc." — (Kilner). NOSTRUMS 327 TROPIC FRUIT LAXATIVE. The following is offered as being a very fair duplicate of the ar- ticle: B Jalap, powdered 5 parts Senna, powdered 5 parts Sugar 5 parts Tamarind pulp (E, I.).. 30 parts Make into lozenges weighing 45 grains each, and coat with choco- late and sugar, and wrap in tin foil. —(Adam Sonrath). VIA VI TREATMENT. This treatment has been exten- sively advertised and sold through agents. The treatment consists of a suppository and cerate, the lat- ter to be applied externally over the womb and ovaries. The sup- positories are to be inserted each night at the mouth of the womb. They are dispensed in two-grain gelatin capsules, filled with cocoa butter, in which jequirity is be- lieved to be incorporated. The cerate is sold in oval tin boxes and contains a cheap oily sub- stance, which becomes rancid in a few weeks and looks like a mix- ture of tallow, lard, boric acid and coloring matter. The cerate was, no doubt, devised for the value which may be derived from the massage treatment while it was being applied. WALKER'S VEGETABLE. VINE- GAR BITTERS. RAloes Socotrin 2 dr. Guaiaci Resinae 4 dr. Sassafras Mucil 1 oz. Aceti 2 dr. Aquae q. s. Coque, et ft. dococtum, add 19 ounces deinde cola, et addantur — Sodii Sulphatis 1 oz. Acaciae .' 2 dr. Spt. Anisi, 10 p. c 2 dr. Alcoholis 1 oz. Mix. Dose: Two teaspoonfuls. — (Eberbach). WASHBURNE'S SALICYLIC A. A preparation bearing a close re- semblance to Salicyclica may be made by the following simple pre- scription: B Salicylate of soda 4 dr. Make 24 powders. —(Druggists' Circular). Simple syrup sufficient to make 1 pt. Mix. One dessertspoonful three or four times daily. —(Dr. Crider, in Medical World). WARNER'S SAFE CURE. In Germany each maker of pa- tents must furnish the government with the formula for the patent he makes. This is the one fur- nished by Warner for "Safe, Kid- ney, and Liver Cure:" B Ext. of lycopus Virg. (the herb) 308 gr. Ext. of hepatica (the herb) 232 gr. Ext. of gaultheria iy 2 gr. Potassium nitrate 39 gr. Alcohol (90 deg.) 2% oz. Glycerine 10 dr. Water sufficient to make 1 pt. —(Formulary and Druggists' Mag- azine). WATT'S ANTI-RHEUMATIC PILLS. Said to be as follows: B Powd. aloes 4 dr. Powd. gamboge 4 dr. Powd. hellebore 2 dr! Powd. guaic y 2 dr. Calomel y 2 dr. Precip. sulphide of anti- mony 15 gr. Oil of cloves y 2 dr. Soap 1 dr. Spirits of camphor — sufficient Mix. Make into five-grain pills. WAYNE'S DIURETIC ELIXIR. B Potass, acetate 3 oz. Fl. ext. buchu 3 oz. Fl. ext. juniper iy 2 oz. WEIDEMEYER'S CATARRH CURE. We examined in 1880 and found it to be composed almost entirely of bicarbonate of soda, costing less than one-tenth of one cent for the contents of a box, which retails for $1.50. —(New Idea). WHEELOCK'S COUGH MIXTURE B Sulph. ether 3 dr. Tinct. hyoscyamus 1 oz. Syr. wild cherry 1 oz. Syr. tolu 1 oz. Water to make 4 oz. Mix. — (Pharmaceutical Era). WHITE'S ELIXIR. The following is the formula of "White's Elixir," a nostrum ex- tensively sold throughout Vermont for lung complaints: B Antimonii et potassii tart 32 gr. Tinct. opii 2 dr. Tinct. camphorae 2 dr. Tinct. anisi 2 dr. Alcoholis dil 3 oz. Syrupi simplicis 10 oz. Aquae to make 1 pt. Mix. —(Dr. Ladue in Medical World). 328 NOSTRUMS WILLIAMS' PINK PILLS FOR PALE PEOPLE. B Sulphate of iron 240 gr. Carbonate .of potassium.. 140 gr. Sugar 48 gr. Tragacanth 16 gr. Strychnine V/ 2 gr. Arsenic 1V 2 gr. Glycerine 10 mm. Water q. s. To make mass mix and divide into 90 pills and coat with pink sugar. WILSON'S LIGHTNING LINI- MENT. B Oil of cedar 3 oz. Oil of sassafras 3 oz. Tinct. of opium 3 oz. Tincc. of guaiac ..3 oz. Tinct. of capsicum .. ...3 oz. Aqua ammonia — . . .4 oz. Spirit of camphor.. 4 oz. Spirit of turpentine 4 oz. Chloroform 3 oz. Alcohol 1 gal. Mix. —(Druggists' Circular). WINSLOW'S SOOTHING SYRUP. B Morphia sulph V 2 gr. Sodii carbon 1 gr. Simp, syrup 1V 2 oz. Aqua y 2 oz. Spirit foeniculi 1 dr. Mix. —(New Idea). WOLCOTT'S PAIN PAINT. I have made an article closely 're- sembling this, and answering the same purpose, by taking: B Oil of peppermint 1 to 2 dr. Dried mint leaves, finely pulv. 1 to 2 dr. Moisten the leaves with the Oil, enclose in lead wrappers (to pre- vent evaporation), leave enclosed a few days, then dissolve in four ounces of alcohol; add 12 ounces of water, shake and filter. —(Dr. Crull, in Medical World). WOOLFORD'S SANITARY LOTION. A preparation which is substan- tially the same in every respect may be made from the following formula: • B Sodium hydrate 3 dr. Sulphur 5 dr. Water to make 1 pt. Dissolve the sodium hydrate in 4 or 5 ounces of water and add sul- phur, and boil until the prepar- ation assumes a reddish-brown color, which will require probably 15 or 20 minutes. It may now be diluted to one Dint and sulphur- eted hydrogen passed through it for a few minutes, and then fil- tered. —(New Idea). WISTAR'S BALSAM OF WILD CHERRY. The following formula makes a preparation which is substantially the same as the proprietary ar- ..ticle: B Fl. fixt. wild cherry 1 oz. Fl. ext. ipecac 2 dr. Fl. ext. squills 2 dr. Tinct. opium 1 dr. Tartar emetic 2 gr. Sugar house syrup 3 oz. Alcohol 6 dr. Sp. anise (1 in 8) 20 min. Tinct. cudbear comp. (N. F.) 2 dr. Water sufficient to make..8oz. Mix. —(New Idea). WITCH-HAZEL OINTMENT. B Tinct. hamamelis 12 dr. Lanoleum 6 dr. Petrolatum 16 oz. Mix. Lanoleum is here used in place of the copyrighted term lanolin. —(Medical Standard). YELLOW FAMILY DROPS. B Opium 2 oz. Sapo venet lib Croci opt 2% oz. Sp. rosemarini 2 lb. Mix. Digest for a week and add— Ol. rosmarini 2 oz. Ol. origani 2 oz. Camphor 2 oz. Mix well. For spirit rosmarini, take— Rosmarini 3 oz. Alcohol, sufficient to make 2 lb. The above, with the Augsburg Essence of Life and Green Won- der Oil, are famous old formulae used for a century and longer in Pennsylvania. They came to me by chance in a curious old book of prescriptions, which belonged to one of the Fahnestock family. The Yellow Family Drops are still used to break up colds, and are an ef- cient remedy. —(Prof. Waugh, in Medical World). INDEX. 329 INDEX. PAGE. Acetanilid in Nostrums 30 Advertising- 7 Albadermine Treatment 268 ALCOHOL and Drug Habit Spe- cialist 97 Alcoholism Treatment for 101 Dr Gray's Treatment for 141 Dr. Keeley ' s Treatment 138 Drug Addiction Treatment 109 Gradual Reduction Method.... 110 Immediate Withdrawal Meth- od 117 Intermediate Withdrawal Meth- Method 115 Mattison's Treatment 126 Radical Reduction Method — 116 Rapid Reduction Method 114 Triumph Cure for Alcoholism and the Drug Habits 127 Anaesthetine 211 Anaestheto Obtundent 212 Antikamnia 300 Antikol 301 Antinervin 301 Anti-Fat 19 Arophene 213 Barr's Anaesthetic 213 BALNEOTHERAPEUTIC Spe- cialist 37 Baths 37 Acid Bath 42 Alkaline Bath 42 Artificial Sulphur Bath 44 Betz Bath 46 Cold Bath 40 Creasote Bath 42 Electric Bath 49 Electric Light Bath 48 Hot Air and Vapor 45 Mercury Bath 42 Mud and Sand Bath 43 Shower Bath 50 Sulpho-Lava Bath 44 BEAUTY Specialist 263 Bust Development 275 Qbmedone Lotion 270 Delight of the Harem 271 Ecchymosis 272 Eunk's Cream of Roses 271 Finger Nail Polish 272 Galega 277 Glycerine Cream 269 Lac Virgins 271 La Diaphane 270 Melvina Cream and Lotion. .. .269 New Rejuvenating Treatment 273 PAGE. Plaster Treatment 265 Steaming Treatment 264 Bromidia 299 Brown's Dentifrice 215 Calder's Dentine 215 Cascarets 19 CANCER Specialist 59 Bougard's Paste 73 Caustic Remedies 68 Cerny and Trunecek's Treat- ment 73 Come's Paste 73 Colloma 65 Davisson's Cancer Remedy 74 Encephaloma 62 Epithelioma 63 Esmarck' s Paste 77 Fell's Paste 75 Fuschius Paste 77 Guy' s Arcanum 77 Hebra's Paste 77 Howard's Cancer Clay 76 Hue's Treatment 74 Internal Treatment 68 Kline's Paste 75 Landolfi's Paste 72 Lassar's Paste 78 Lutterloh's Paste 78 Melanoma 66 Ozone Plaster 76 Sarcoma 60 Scirrhus 61 Sherman's Paste 78 Wheeler's Paste 74 Chavette's Goiter Cure 251 Charcot's Clinic 218 Churchell's Prescription 291 Corrassa Compound 292 Cost of Nostrums 296 DENTAL Specialist 191 Cocaine 192 Dentrifrices 213 Den's Anti-Poena 211 Dental Surprise 212 Dickson's Anaesthetic 212 Dorsenia 212 Hypodermic Syringe 202 How to Operate 205 Obtundent Formula 200 Enuresis IS Epiplepsy 17 Ethical Specialist 29 Eye Remedies 19 Exodyne 301 Febrinol 301 Fragrant Sozodont Powder L'i4 .30 INDEX. PAGE. FEATURAL Specialist 228 Birth-marks 241 Baggv Skin 244 Bulbous Nose 236 Convex Nose 256 Deformities of the Nose 229 Concave Nose 233 Electrolysis 246 Electricity 240 Encorchment Treatment 237 Gun Powder Marks 243 Neoplasine 231 Moles 241 Protruding Ears 236 Receding Chin 234 Smallpox Pits 239 Superfluous Hair 245 Tattoo Marks 243 Unsightly Scars 244 Warts 241 Wrinkles 244 GENITOURINARY Specialist... 156 Gonorrhoea and Gleet 161 Impotency 161 Nocturnal Emissions 160 Prostate Gland 157 Spermatorrhoea 159 Spermatorrhoea Ring 160 Stricture 162 Syphilis 163 GOITER Specialist 250 Gold Cure 97 GYNAECOLOGICAL Specialist 165 Diseases of "Women .'..165 Combined Treatment for 177 Extra-Uterine Treatment 167 Intra-Uterine Treatment 172 Impotency 188 Internal Treatment 177 Sterility 186 HAIR Specialists 252 Alopecia 253 Alopecia (Advanced) 258 Allen's Hair Restorer 262 Bordet's Hair Tonic 262 Evan's Vacuum Cap 258 Hair Dyes 259 Hair Bleaches and Growers 261 Hall's Hygenic Treatment 286 Hartley's South American Cure 290 PAGE. HERNIA Specialist 143 Application of Trusses 144 Excelsior Hernia Fluid 146 Field's Fluid 154 Fidelity Fluid 155 Heaton's Fluid 153 Hypodermic Treatment 146 Ideal Hernia Cure 153 Langdon' s Operation 149 Method of Injecting 146 Olstrum's Operation 152 Paraffine Injections for 153 Provost's Fluid 154 Saunder's Fluid 154 Testing the Cure 145 Walling's Fluid 155 HYPNOTIC Specialist 216 Hypnotism 216 As a Therapeutic Agent 223 Awakening from 222 History of Hypnotism 216 Methods of Inducing 218 Simple Suggestion 224 Things that Prevent 222 ITINERANT Specialist 9 Jessop's Anaesthetic 212 Local Advertising Specialist.. 11 Mail Order Specialist 13 Massage 51 Mineral Waters 56 Mesmerism 216 NOSTRUMS are arranged in alpha- betical order from pages 303 to 328 This offers a more ready in- dex than listing them here. Nostrum Specialist 2S9 Nostrums, Cost of 302 Office Specialist 31 Osteopathy 51 Painless Dentistry 191 Painless, Bloodless and Suture- less Surgery 247 Pasteur's Treatment for Hydro- phobia 278 Physical Culture 54 Secret Prescription Writing 288 Specialist 7 Special Disease Specialist 12 Stammering Specialist 282 Tape- Worm Specialist 2S Viava 327 Sf P 1 19C5 iMLT y^-3 *9 'jfjjBt r? FjSHi! ^^^Knfl QKw^B tg&*r& f^TTufff^^^fi SItEs! sX SPSi 5SJ5t! 9BS|Sfl ^v^SSn P^^^itA (■P^>yK«W ij^^^jBE B^l^ i53