one may expect to gain by carrying the irrigation so far, that it can be set down as a dangerous procedure and should not be allowed.

For suppurative otitis media, mastoiditis, and the dreadful effects produced upon the sense of hearing all speak only too loudly of the necessity of all precautions we can take to prevent infection. At least a care should be taken not to do damage. We have frequently seen cases where infection has extended into parts that would not have been involved had it not been for carelessness of the patient in not heeding the advice of their physician about such cleansing processes. Just now we have under observation a case who has nasal catarrh and has been in the habit of irrigating the nostrils with a fountain syringe and allowing the fluid which is as usual, salt and water, to come out the

sion that may lead to a more serious trouble than we had intended to attempt to heal. Such an abrasion on the Locus Kiselback, for example,, may cause an ulceration that may go on to perforation of the septum.

There may have been an old chronic inflammatory process going on in one of the accessory cavities when the possessor came down with la grippe; then we may expect very severe symptoms indeed.

Another point worthy of consideration is the fact that most cases of so called catarrh can properly be called sinus trouble, the proper treatment of which will relieve catarrh, as is well known. Polypi are outgrowths of sinus troubles.

COMBINATIONS

it from the mouth. She was warned not to persist in such vicious methods, the dangers being explained. Well, the habit was so firmly established that now and then it was indulged in, notwithstanding the advice given, and finally

middle ear inflammation resulted.

The spray that is the most harmless is one with a rubber bulb and that will act as well for oils as liquids. When we take into consideration that the accessory sinuses are but part of the nasal cavity and that an inflammation, serous, muco-purulent, or what not, extends into these sinuses almost invariably, every time the nose is affected, to varying degrees, how important is the treatment then appears. The vicious method of spraying at high pressure, every nose that is presented for treatment, is fast growing out of fashion. The reckless use of compressed air deserves some at tention right here. A blast of any solution aimed at a mucous membrane with ordinary force, will abraid the epithelium, and if continued long enough, or if more force is used, the deeper elements of the membrane suffer an abra

Iowa.

Some time ago Professor Durham wrote that all doctors had their combinations, which is true. While specific medication prefers a single remedy when possible (not always possible) it does not discard simple combinations. These combinations should be of synergistic agents, or of agents whose forces do not antagonize.

If the special pathology of a disease had but a single element, of course there would be no necessity of a combination of remedial forces. If a primal pathologic wrong can be identified, the remedy it demands would be sufficient for a cure; for in removing that, its dependencies dencies would naturally disappear. Under such a resume, the practice of medicine would be simplified. But, unfortunately, that does not obtain in every case. Hence, remedies in combination become imperative in numerous instances.

The flushed face, bright eyes, contracted pupils, and excitation, call for gelsemium-that is true; but associated. with the gelsemium call, is many times

a full, frequent, founding pulse. What for that? Leave it alone to the gelsemium? No; we combine with the gelsemium, veratrum. Suppose (as is sometimes the case) that general muscular aching is present. What then? Would you depend upon the gelsemium and veratrum? Certainly, and we would also add macrotys-combine it, if you please, with the other two. No other indications being present, we would here rest the case. If other indications existed, we would administer the required

gle remedy will meet, the specific man will gladly apply it. Chronic diseases, like acute diseases, are not always met by a single remedy, but by a combination of remedies. Of course, the specific man makes up his combinations similarly to his procedure in acute diseases. He has indications for giving the single remedy, the combination or the compound.

PODOPHYLLIN

Arkansas.

Again, take the second stage of pneumonia as a further illustration. We give a common case many times prototyped here. Let us find a treatment common to this climate. The small, frequent pulse, aconite; adult dose, ten drops to four ounces of water; teaspoonful every one or two hours. But tissue consolidation and pleuritic stitch exist, hence to the aconite mixture is added bryonia, ten drops. But there is abundant expectoration, so to the aconite, bryonia combination is added ipecac, drops ten. In addition to the profuse expectoration a pain extends from shoulder to occiput and to the aconite-bryoniaipecac mixture, sticta, drops fifteen, is added. For other conditions the indicated remedies are prescribed. The case recovers. Which remedy did the work? I answer, each one did its part. Each remedy performed its work in the process of cure-met the conditions of disease against which it fas arrayed. Brother specific medicationist, do you object? If so, raise your hand. Combinations are not discarded by specific practice.

In chronic diseases every doctor of success has his combinations. Of course for any condition of disease that a sin

All physicians of all schools of practice know something of podophyllin, and most all physicians of all schools of practice use it. The early Thomsonian physicians did not use it very much and it was considered a toxic agent by Thomson, but most all physicians of this school of practice use it now as it has been proved to not be a deadly poison or dangerous agent.

In an early day the powdered root of podophyllum peltatum was used, but it was generally roasted before being used, as roasting it destroyed much of its harsh action and did not interfere with its therapeutic action.

After podophyllin was discovered, which is the active resin of podophyllum peltatum, it has been used in most all cases in place of mandrake. There is another active principle in mandrake called podophyllo toxin, but it has not come into general use and likely has no advantages over podophyllin. There is one objection to the use of podophyllin and that is it makes a patient very sick when used alone in doses sufficient to have much effect. It is claimed that this can be overcome by combining it with dioscorein, and no doubt this is true to a great extent. It should be used with horsemint (monarda punctata) in order to see if the horsemint will prevent it from causing a patient from vomiting and becoming nauseated, as horsemint has a reputation of such in

fluence when combined with some drugs. There is a great difference in opinions in regard to the dose of podophyllin and the maximum dose is half a grain, according to most authors. I think podophyllin should, as a rule, be given in larger doses than most supposed, especially in the beginning of acute cases. Most physicians give just enough to make a patient sick, and if a much larger dose were given it would not make the patient any more sick and the results would be better.

In acute cases where the liver is torpid and the bowels constipated and large doses of medicine are required, as is the case in many malarial districts, a single large dose of podophyllin every twenty-four to forty-eight hours, as needed, will do more good and less harm than small doses frequently repeated. When I say a large dose I mean two to four grains or more. I have given eight grains of podophyllin at one dose with real good results and without making a patient much more sick than one grain I will make them.

Large doses of podophyllin will not only purge and cleanse the bowels, but it will act thoroughly as an emetic and thoroughly cleanse the stomach and relax the system almost if not as well as lobelia. It will, in very large doses, abort many acute diseases, as in most all diseases the liver should be thoroughly aroused. If the liver is thoroughly aroused in grand shape and the bowels purged out well the system is then in good shape for the action of other remedies. I know that many will not agree with me in large doses of podophyllin, but that cuts no figure, as we have different opinions; if we did not we would all be eclectics, homeopaths, physiomedicalists, regulars, osteopaths or Christian scientists, etc. The cause of different opinions is the shape of our brain, our teaching, and other influences too numerous to mention.

Podophyllin is a liver remedy of great value in either acute or chronic condi

tions. I consider it of most value in acute or sub-acute conditions, and as a rule I like very large doses, but not always, as there are some cases that require small doses, and small doses are all that is needed. The question of dosage is for the physician to decide in each. particular case. There is one thing about large doses that should be remembered, and that is, some people object to large doses and will not employ a doctor who is in the habit of giving large doses of drastic medicines and make their patients very sick in any and all cases. Good judgment in using large doses should be exercised as well as good judgment in all other things.

In country practice where a physician. has gained a reputation and the people have come to look upon him as almost being in the resurrection business, he can give medicines to his regular customers as he pleases, but in among patients who are used to using many different physicians a man that is not well established must be careful what he gives.

The eclectics used podophyllin as a stimulant to the liver and upper intestines and claim it influences the ductless glands and favors blood-making. indications for it are full face, full oppressed pulse, full tongue and yellowish coating, and dizziness of head.

The

Scudder says: "Specific podophyllin in small doses not sufficient to affect the bowels, is to be preferred to the resin of podophyllum for its general effect upon the glandular structures and may therefore serve a good purpose in syphilis, tuberculosis and rheumatism."

The eclectics use the first decimal trituration of podophyllin in doses of one to ten grains, three times daily, as a stimulant to the process of digestion and nutrition and to arrest chronic diarrhoea and dysentery with profuse mucous discharges. They consider it the best alterative in the materia medica, acting powerfully upon the glandular and mucous membrane.

are pinched, the pulse wiry and small, or when the pulse stroke is sharp.

The first decimal trituration of podophyllin is ten per cent podophyllin and ninety per cent sugar of milk. I have used podophyllin in this triturated form but have never had any good results from it. All the results that I could get would be to cause slight nausea, so I have discarded it.

Dr. Hasty, a well known physician, highly recommended the triturated podophyllin in typhoid fever and said it had direct influence upon the liver, while plain podophyllin was too much of an irritant to have a good influence on the liver.

I do not consider than there is any particular difference in the effect of plain podophyllin and triturated podophyllin when given in equal amounts. When I give calomel I usually put some podophyllin with it.

THE MEDICAL EXPERT By Gordon G. Burdick, M. D., 72 Madison St., Chicago, Ill.

(Continued from Page 397 December Recorder)

ETHICS.

We have now arrived at a place in our story where we must investigate this subject, that makes cowards of men who will willingly face death upon the battlefield, or be found in the front ranks of a fatal epidemic.

What is this terrible curse that has hung like a blight over the professions of law, theology and medicine, binding its votaries with chains, robbing them of their initiative, and making them cipher in our active civilization.

Whence comes it? What does it mean? How is it tangible to its human. victim?

When the world was young, having passed through its preparation for the

man. He, in his weakness, needed constant divine supervision in order that he, in his foolishness, should not destroy the plan of the Creator.

The spirits of law, theology and medicine were sent to be his companions and guide him on the long march of the human race to perfection and the millennium.

Law, to protect the widow and orphan, to secure to man the right to his person and property, to protect him from injustice and to secure for him his just dues..

Theology, to have control of his moral welfare and development, to guide his steps along paths of righteousness, and to secure his eternal reward after death.

Medicine, to attend the physical ills of mankind, to help widow and orphan, to succor the sick and needy, to ease the pains of the wounded, and council the dying.

In this spirit of the Divine, we find no shadow of the "Thing"; it breathes a spirit of eternal helpfulness and love.

Why then this fear of the medical man? A fear of the terrible unknown? To understand this we must go back to the middle ages, when the thought of man was shaped by the triumphant church; when this institution presumed to think for all individuals, and was in a position to enforce its commands. It was here that the professions had grafted upon their divine callings "The Thing" this black, shadowy, unknown fear that has made cowards of the profession from that time.

This malevolent bat is seldom seen or heard, but few professional men ever fail to "feel"-they are conscious of its presence and stand in awe of its power.

If we listen patiently to the "echoes" received while in the presence of the "Thing," we have no difficulty in hearing the "echo of the inquisition," the shrieks of agony, the sound of chains,

the thumb-screw, and the rack and the other unspeakable tortures that gave birth to this monstrosity-"The Thing" -who was sired by fanaticism and damned by suffering and death.

Since this time the psychic force of man has been tormented by this nameless disemboweled thought, until men who would walk fearlessly up to the the cannon's mouth or into the deadliest epidemic, become a craven before the known presence of "The Thing."

Is the time not ripe when we can tear from our mental makeup, this terrible nightmare that we received from the age of torture and death?

In this age of thought and reason, is it not possible for us to remove this hereditary legacy of mind, and apply to our professional life the original divine. thought of our work?

Why should we torture a brother with the thumb-screw and rack by a look or word because he had dared to break the chains of the slave, and has attempted to use common sense and honesty in his relations to the public?

Why should the medical man not become what he was divinely appointed to be an angel of mercy to each community in which he has his being. Why is he not the greatest factor in the greatest sociologic work now going on? Why does he fear to take his true place in our civilization? Why don't we hear his voice in our legislative halls looking after the physical salvation of the people? Why don't we hear his voice raised to protest against working conditions that make invalids and cause death in the community?

Why don't we hear him appear before the law-making bodies to protest against unsanitary conditions that are maintained in this world of greed? What makes the community regard him with suspicion or good natured contempt?

Is it possible that he has no good points? That he doesn't think? Or is he the worst understood individual in the whole country?

He has always held aloof from the people of his community; he has never been understood; his friends and neighbors have observed that he does little petty things to his competitors. He has felt compelled to refuse all public recognition, and why? Simply because he has felt under the shadow of "The Thing." It isn't ethical, and no further argument is necessary.

Now it will probably be a good idea to observe what our official body has to say on this subject. How much of the original divine thought is retained, and how much of the inquisition, and this is supplied under the printed form called the "Principles of Medical Ethics of the American Medical Association."

PRINCIPLES OF MEDICAL
ETHICS.

CHAPTER I.

THE DUTIES OF PHYSICIANS TO THEIR

PATIENTS.

Sec. 1.-Physicians should not only be ever ready to obey the calls of the sick and the injured, but should be mindful of the high character of their mission and of the responsibilities they must incur in the discharge of momentous duties. In their ministrations they should never forget that the comfort, the health and the lives of those entrusted to their care depend on skill, attention and fidelity. In deportment they should unite tenderness, cheerfulness and firmness, and thus inspire all sufferers with gratitude, respect and confidence. These observations are the more sacred because, generally, the only tribunal to adjudge penalties for unkindness, carelessness or neglect is their own conscience.

Sec. 2.-Every patient committed to the charge of a physician should be treated with attention and humanity, and reasonable indulgence should be granted to the caprices of the sick. Secrecy and delicacy should be strictly observed; and the familiar and confidential intercourse to which physicians are admitted, in their professional visits,