sician professes one thing and acts another, he suffers the consequence. The place to meet a brother in professional rivalry is in the arena at the bed side. If we cannot measure swords with him we should yield. such circumstances. gives alms of all he possesses-to be seen of opportunity for the display of honesty or dismen-but he gets his dollar. The physician honesty, truth or falsehood, fidelity or treachis charitable, and at the same time just. If ery, as in consultation in the sick room. The he cannot agree with a brother, the fraternal eyes of the patient or friends, or both, are relation ceases. The question in former times riveted upon the consultant; his every word, was, how shall we let him alone? By passing action, expression of countenance, tone and edicts, like the Pope's Bull against the comet inflection of voice noted, and a meaning given -that was the plan pursued, with the same to each according to the fancy of the patient effect-now we meet as brethren. It we agree or friends, and largely by the intent of the to disagree the patient chooses. If a phy- physician. How easy to confirm the diagnosis and commend the treatment in words; but by the intonation of voice, a shrug of the shoulder or a wink of the eye, condemn the attending physician and his treatment. And I know of no resentment more lasting and imUnder such circumstances it requires nice perishable in the heart of man, and a treachperception and some force of character to ery more deserving the condemnation of all keep intact the golden rule. In consultation, intelligences, than that engendered by such and in conversation about the brethren pro- base hypocrisy as could be perpetrated under fessionally, the words of Holy Writ are peculiarly pertinent, viz., "All men are liars." The The consultant should, as a rule, make a fault is as universal as sin. Since all are careful examination of the case with unnecesguilty and the evil will continue, safeguards sary display, taking as little for granted as should be thrown around its use like many possible, under the circumstances, and arrive other evils that are tolerated, for some of at a diagnosis from what he finds, and from these wrongs are more heinous in their na- the history of the case given by the patient ture than others. If we do not like a brother, or friends, in the presence of the attending there is no statutary law compelling us to. physician. Our dislikes and prejudices may be reciprocated; but we should treat each other honestly. If asked concerning the ability of a competing brother, or in conversation about him, avoid giving an opinion if possible, un- If the case is a serious one, and obscure, it less favorable to him. If something mean is the better plan to arrive at a diagnosis inmust be said, it should come squarely from dependent of the attending physician, except the shoulder out. Insinuations and deroga- to ask him such questions concerning facts tory interrogatories are cowardly. It is sel- clearly coming under his observation. dom necessary to speak of the ability of one's self, but when occasion requires it should be done frankly and without affectation. This self-assertion may smirk of egotism, but it must be acknowledged that the physician is honest, truthful, and has self-confidence three factors entering largely into success. Many times the physician feels humiliated, when his best efforts have failed. If he is diligent he will have a clear conscience, and self-reproach should not be harbored in the mind. A consultation had with a view of confirming the diagnosis of the attendant, in accordance with the history of the case as given by him, is a farce. It is the safer plan after the examination, to hold a private conference before statements are made to the patient or friends. Misunderstandings will be less frequent. If there is an agreement, it is the duty of the consultant to tell the patient of it in words susceptible of but one meaning, and in a healthy tone of voice. If a disagreement, the attending physician had better break the news to him in the presence of the consultant, and then let him choose who will serve him. In either case the lips of both physicians should be sealed to the There is no other place affording such an public or the brethren, as to suggestions made in the consultation as to the treatment of the that it is difficult to persuade the patient they are not present. One patient, I remember, case. It is pleasant to meet a sociable physician. who, while she conceded they were not visible, Sociability and talkativeness are not synony- believed they were present, but microscopic, mous. A physician may be sociable, of few while another imagined she could see them; words, and yet say a great deal. His look is and I knew another in whom the sensation friendly and expectant, and a glance at him was confined to the back, who believed we saw encourages conversation. He keeps his own them, but would not acknowledge their prescouncil, and is respected for it. It is a charm-ence. ing virtue. We should differentiate, and can, between this form of silence and innate dumbness, with just sense enough to look wise and deceive a credulous public. In other cases there is a tingling sensation, such as flannel underwear produces in persons with sensitive skins; in others a pure, unmixed pruritus-from prurio, I itch. It may The great talker may be very nice, attract- be intermittent or constant, only annoying, or ive and interesting, like the meteor that flashes so intense and grave as to be a source of inthrough the sky lighting up the whole heav- tolerable distress, absorbing all sensations and ens momentarily with its brilliancy, and rival- desires, save one interminable itch and inconing the sun in its noonday splendor. But it trollable desire to scratch. In yet other cases is a flash, and all is over; while the silent man all these symptoms combine or alternate. may be likened to the sun in its orbit, which Through continued irritation and loss of sleep furnishes the light and life to the whole plan- there result various conditions of nervous exetary system. Such was the victorious leader haustion. in the great American conflict; and equal honors may be shared by those who are engaged in the universal conflict with the last enemy-death. Pruritus. BY W. L. SCHENCK, M. D. Read before the East Kansas District Medical We invite brief attention to a disease chief ly manifest by its subjective symptoms, which, however, are not unfrequently sufficiently marked to make life a burden. Pruritus is usually considered a purely functional disease, is without structural change, and is characterized by the single symptom from which it derives its name, but this symptom taxes at times, to the last extremity, the patience, endurance and sanity of the patient, and while scratching yields little of the joy a Scottish king is said to have envied in his subjects who suffered from the "Scotch fiddle," the patient is irresistably impelled to scratch. In some cases the sensation is that of small insects crawling over the body, so marked Pruritus may occur at any age, but is most common in mid-life and old age. When local, its most common seat is at the openings of the mucous coated cavities, especially the vaginal and anal. In the pruritis senilis of elderly persons the trunk and limbs are most frequently involved. When the pruritus is general, the itching rarely invades large areas simultaneously, but one part is scarcely scratched before another imperiously demands attention. The disease is a consequent of various causes, as gastro-intestinal derangement, disease of the genito-urinary tract, disease of the kidneys and liver, especially such as result in failure to eliminate morbid products, gestation, etc. From whatever cause it arises, it has been considered purely functional, and due to reflex irritation, and its gravity is ordinarily in the gravity of its cause. While the disease is not manifested by any eruption, secondary lesions, due to scratching are not uncommon, and may simulate prurigo or eczema. It may be mistaken for pediculosis, but its location, and a careful examination relieves the diagnosis of this error. The only difficulty in diagnosis, and it is sometimes almost insuperable, is to know the cause from which it originates. It may not be difficult to say pregnancy, jaundice or other cause, but why do these produce this peculiar ceived, but at the end of the third month, and annoying symptom, this particular neurosis? Take this case, which I have seen many times in consultation with Dr. Haller : without known cause, aborted. Shortly after, conception again occurred, and was again followed by abortion at about the same period. Mrs., aged 32 years, fair complexion, About the middle of last June she again married 7 years, always in good health until missed her monthly climacterix, and about four and a half years ago, when she com- the middle of October, or when four months plained of indigestion manifested by irregular advanced, her pruritus returned with all the appetite, eructations, pain and tenderness in variations, and with all the intensity known the epigastrium and right hypochondrium, to the disease, tingling, prickling, crawling, the pain never sufficiently acute to indicate itching, now here, now there, now everyhepatic colic, or obstruction of the gall ducts where, a scratch at one point being promptly by concretions, the liver becoming gradually followed by a demand for a like compliment and irregularly enlarged and the product of at another, the scratching being repeated until the hepatic cells being gradually reabsorbed the arms, body and legs everywhere show the into the circulation, so that at the end of six force of female nails. months there was marked icterus, the skin It is needless to say the changes were rung having the ordinary icterine hue. About this on treatment, general and local. Building up time pruritus made its appearance and became the nervous system with iron, the phosphates, a very troublesome symptom. The patient arsenic and oil, in conjunction with nervines, was greatly emaciated and life became a bur-chologogues and sudorifics, and using topically den. She was seen by quite a number of phy-various applications, the pruritus subsided sicians, some of whom diagnosed with great under the use of the warm bath followed by positiveness, cancer of the liver, though nei- inunctions of cosmoline and ol. pipermenth, ther Dr. H. or myself made quite so unfavor- but not until insanity became a serious comable a diagnosis. During the three years that she was an invalid she received a great variety of treatment, apparently deriving the greatest benefit from hot baths and massage, especially of the hepatic region, with full doses of phosphate of soda internally, though the massage and baths were not instituted until there had been considerable advancement in the case. The pruritus was most marked when there was the greatest amount of bile in the circulation, and the least carried to the alimentary canal, which for some months gave no evi-lieved. dence of its presence, and gradually subsided Though not connected with the disease we as the functions of the liver were restored. are discussing, a peculiar and permanent conDuring the day it was frequently absent and dition followed the jaundice-patches of pigsometimes not present at night, though parox-mentation, or bile-stained deposit beneath the ysms often occurred in day-time and usually skin at the inner canthus of the eyes. at night. This symptom was present, with varying intensity, for about twelve months, the invalidism of the patient lasting for nearly three years, and though the patient has since enjoyed fair health, a corset, or any pressure over the liver always produces discomfort and a sense of fullness in the hypochondrium. plication, partly puerperal and partly consequent upon the exhausted excitability incident to the constant and annoying pruritus, from which it was often impossible to secure sleep except through free doses of chloroform, chloral or whisky. After advising with Drs. Gardner, Haller and Beasly, on the 5th inst. it was decided to induce premature labor by introducing a rubber coil, since when I have not seen the patient, but understand the insanity is not re In such cases it is easy to understand that when the circulation is loaded with effete products, whether from a diseased liver or pregnancy, the skin taxed with extra depurating duty, and the cutaneous nerves irritated by deleterious products, the pruritus may be more than a sympathetic disease. So when the blood is loaded with the waste Soon after her return to health she con- the kidneys fail to eliminate, or when sugar Neligan recommends the following for Mistura ferri composita, is manufactured by abnormal hepatic action, In looking up the literature of pruritus we find it exceedingly scarce and generally unsatisfactory, many authors not distinguishing pruritus from prurigo, a disease manifest not only by formication, crawling, prickling, stinging and itching, but characterized by an eruption in which the pàpulæ are easily discovered by passing the finger over the surface, and in which rubbing often produces wheals as in ursticaria, the eruption usually occurring on the neck, shoulders, back and outer surface of the limbs, and in which local treatment is often more important than constitutional. In pruritus the itching is often confined to the outlet of open cavities, as in the old worm signs at the nostrils and about the anus, at the labia pudendi, due to disorder of the uterus or vagina, at the meatus urinarius, consequent upon irritation of the bladder or urethra, and wherever occurring, is caused chiefly from reflex action and not irritation. When the disease covers large portions of the surface of the body, it may be wholly sympathetic, or in part dependent upon local irritation caused by waste products that have failed of elimination by normal methods; and sometimes perhaps, one of the peculiar ways in which the rheumatic, gouty, or syphilitic diathesis manifests itself. Produced by whatever cause, its diagnosis is all important, and treatment, to be successful, must be directed to the real source of the evil, and must cover a much wider scope than can be reached in a paper upon pruritus. Succi conii, fl. Ziij. Al. ziijss. fl. 3ss. Sig. A tablespoonful every sixth hour. With a Dover powder at bedtime, in which instead of the sulph-potass., it would be well to use the bromide. Where there is torpidity of the liver, and lack of tone in the digestive organs, he recommends the following: R Ext. nucis vomicæ, Pulvris myrrhæ, grs. iij. grs. vj. grs. xxiv. grs. xviij. Misce et divide in pilulas viginti quatuor. S. One to be taken three times daily. When there is great nervous exhaustion, arsenic, cod-liver oil and the phosphates, conjoined with a nervous sedative may be tried. When there is habitual constipation a saline, followed by a combination of quinine, strychnia and belladonna, or by syr. of cascara sagrada will be beneficial When diarrhoea, ascertain and remove its cause, and give small doses of calomel and bismuth, and give as a corrector and absorbent, as carbo ligni half an hour after meals. Regulate the diet in all cases. Avoid stimulants and irritants, and commend nutritious and easily assimilated foods. When the liver or kidneys are at fault remember that, aside from reflex action, a circulation loaded with bile, urea and uric acid, may cause pruritis. Ascertain the cause and character of menstrual disarrangements, and prescribe accordingly. When pregnancy is a cause, discover, if possible, why it produces so uncomfortable a symptom. It will probably be found conseSeek the cause, and if possible remove it by quent upon undue pressure upon the liver or such measures as are indicated. While there can be no effect without a cause, in some cases kidneys. In local treatment the whole pharmacopoeia has been exhausted, often in vain, because the cause is remote. of pruritus, it is difficult to discover any sufficient reason for its presence. When there is derangement of the menstrual function, and an anæmic condition, the preparations of iron are beneficial, and this applies to all cases associated with general debility, but all chaly-ing the rectum with hot water, plain or medibeates should be given in conjunction with cated, often gives relief. sedatives. In pruritus ani see that ascarides are removed, and that the rectum is healthy. Wash Applications of carbolic acid, grs. xv., gly M. Macerate, filter and add an equal part of glycerine. In pruritus vulva, wash out the vagina with very warm water, either pure or medicated with some alkali, as carb. potass. j.,. water 3viij., with carbolic acid 3jss. to a pint of water, or a one to 3000 solution of bichloride, or hypo-sulph. soda 3 j. to 3j. of water, or with boracic acid, 3j. to 3j. Afterward anoint with oleate of cocaine, rub the itching surface with chrystalized menthol, dust with sub-nitrate of bismuth, use free inunction of linseed oil, applied between the vulva on absorbent cotton or R., sodæ boratis ss., morph. sulph. grs. xv., glycerini 3j., aquæ rosæ vel aquæ menth. qs. ad viij., and apply in the same way. 66 3jv. Acidi hydrocyanici dil., Aquæ dist. ad. qs. Dr. Armand Routh says: Whether the pruritus is due to pediculi, ascarades, or irritM. S. Saturate a piece of absorbent cotable urethral caruncle, an endocervical poly- ton, and apply between the vulvæ. When pus, early cancer of the cervix, distension of the pruritus is general, relief may be found Bartholinis' ducts or glands, the leucorrhoea of from the use of hot baths, plain or medicated vaginitis, endo-cervitis or metritis, the irritat- with alkalies, carbolic acid, hypo-sulph. soda, si, ing discharges of advanced carcinoma uteri, or from inunctions of coco butter, linseed oil, or to a gouty or diabetic diathesis, peppermint a bacon rind, and from peppermint washes water excels all other agents, cocaine inclus- and mucillaginous washes and cataplasms. ive, in affording relief, while remedies are But in all local treatment we must always being used to remove the cause. If no cracks bear in mind that we are only treating or sores are present, bathing the parts with a symptom. solution of five drops of oil of menth., one drachm of borax, and one pint of hot water, will relieve the itching. If there is eczema or rawness from scratching, iodoform, grs. v., ol. olivæ 3j. aa is more useful." Dr. Shoemaker recommends the following: R. Ung. hydrarg. nitratis, ziijss. Hydrarg. oxidi rubri, R. Acidi Carbolici, grs.xx. A DETECTIVE of large experience says that men who have committed crime, are usually discovered by their association with women who are known as toughs. AN Irish doctor lately sent in his bill to a ziv. M. Ft. Ung. lady as follows: "To curing your husband |