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to quit all other drinks, but wanted to be sociable some way with the boys, and besides, he liked steam beer.

I gave him the suggestion that wine, whisky and all other liquors would be so sickening to him that he would not want them nor be able to retain them if swallowed! At his next visit he was sorrier than ever regarding all but the beer, and he was regretting he could not drink that with more relish. He said they gave him such awful rotten stuff when he called for beer, but he said that he must drink something.

I then gave him the suggestion that he would not be able to lift a glass of any liquor to his mouth; that his arm would refuse to carry it, and with this final treatment along this line and with his failure to get the glass to his lips he was fully receptive to the moral appeals I made, and he gave up all these habits, but it took me three months to get him away from that class of association and dissipation. I continued treatment for six months altogether, and at the end of that time there was nothing but his name to suggest the youth I took in at the beginning. He had gotten neat in his dress and careful in bathing, polite in manner and a face of a human instead of the awful visage formerly presented. He had become industrious and taken hard work at the iron works. With this result in the most extravagant reprobate I ever had dealings with I would not consider any one, however criminal he might be, without hope and promise of reformation under suggestion properly used. There are several points in this interesting clinic that need our careful attention lest the beginner in such operations would fail. First notice that I could not give him a positive suggestion at first that he would never gamble, drink, smoke or dissipate other but that I had to take up his habits, class at a time; but the particular thing to notice is that even in a deep hypnosis I could not begin with him by a strong and positive suggestion that he would be cured immediately. I knew full well that such a positive suggestion which was so diametrically opposite to his habit (his auto-suggestion) would probably be such a shock to him that he would come

out of the state, or if he did not he at least would never return to my office. I began in the most insidious way by mild insinuation, barely referring to his practices and not referring to them as his, but introducing the idea of his repulsion for it in others.

I profited in his instance by previous experience, in which a parent brought his son to me to be treated, so far as the son supposed, for a physical disorder, but I was requested by the father to treat him also for a moral correction. I gave the suggestion strong and positive and never got the boy back again.

This case needs some consideration at my hands in view of what it will suggest to the reader of limited knowledge in psychology.

To every one, informed or otherwise, it is evident that there is always a spark of good in the human heart. That gentleness and tact can fan this into a flame of righteousness is as plain.

We all need to see both sides of a question, and you are saying if suggestion can build character like that would it not if misused be just as effectual in breaking down a good standard of morals and cause wrong habits in the pure? The reply must be in the affirmative, with some important modification, however. It is inherent in the soul to ever strive to maintain moral and physical integrity and, therefore, when that intelligence is brought uppermost all reforms suggested co-operate with that which is soul's nature and fine reception. However, if a man with a high standard of morals were to place himself subject to day after day for six months hearing suggestions contrary to the high standard, he would come down to the standard suggested. This is demonstrated thousands of times without hypnosis or a trained suggestor, for the best and purest if placed in the environment of unclean kind and remaining there will become like that which is constantly before his eyes or within his hearing. He at least partakes to some extent of the nature of that which is ever before him.

Even though it be true that an operator could, if he had the opportunity for six months to give bad suggestions, destroy

the high standard, how is he going to get that opportunity? Who is going to place himself under the treatment of a pickpocket or any other sort of a criminal. Hypnosis can not be forced upon any man or woman. The deeper states are rare, and only after long development is forgetfulness (amnesia) possible, and so there is that protection to every one that makes the misuse of suggestion in the hypnotic state impracticable and improbable though possible, if any person deliberately selects an evil-minded operator and elects to keep himself under such treatment at his hands for months. The ifs in the case prevent hypnosis from being a partner in crime or even a helpful agent. This article is not self-luminous, but needs the aid of those published in the MEDICAL BRIEF August, September and October, 1904.

2420 Grand Avenue.

Send me the MEDICAL BRIEF for 1905, for which you will find enclosed one dollar. I enjoy the reading of the BRIEF.DAVID M. FINLEY, M. D., Clinton, Ia.

[Written for the MEDICAL BRIEF.] Diagnosis of Disease by Blood Examination-A Clinic.*

BY ROBERT L. WATKINS, M. D., New York.

In these times of advanced medical science, it is scarcely necessary to call your attention to the importance of bloodexamination. Physicians, and patients as well, recognize its efficiency, and have it done not once, but often.

There are two methods: the first, or oldtime way, by dry or stained blood; the second, or newer fashion, the fresh blood examination. The latter is, by far, the more simple, the more practical, and the more important.

A drop of blood is taken from the wrist, placed on a glass slide, over which is put a cover glass, thus, and examined through the microscope while yet living and moving. (We will use a one-seventh objective lens.)

*Special notes and photographs taken for the MEDICAL BRIEF.

In private practice, it is my custom to take a photograph of each specimen, which furnishes a permanent record of the patient's condition on that date. My camera is permanently fixed at the left side of my office desk (Fig. 1), with my electric sterilizer on the right, and the microscope in the center.

This method of examination is open to the general practitioner. He can tell, at a glance, whether there is a normal number (Fig. 2), or a lack (shown plainly in Fig. 4) of red cells, and many of the other pathological conditions.

I will now call to your attention, chiefly, the points which can be observed by look

[graphic][merged small]

ing at the blood, exclusive of subjective symptoms.

This man looks about fifty-six years old. We will take a drop of blood, and, putting it under the microscope, we see that the cells are not strong. As we let this blood stand on the slide, changes take place which are important to observe. While the cells are still moving, their contour is becoming serrated. This occurring in so short a time, indicates lack of nervous energy. Still further, on moving the slide about, crystals are seen floating in the serum among the corpuscles. It is very easy to pronounce the subject as

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rheumatic. When questioned, he says he is sixty years old, and has had rheumatism for thirty years, but what he comes for now is his weak condition; he has

FIG. 2. Normal number of cells. Blurred cells at the bottom were moving. 1/12 obj. x 900.

no ambition. He has been working very hard, mentally. This man has rheumatism, together with his neurasthenic condition, and needs, beside treatment, a vacation. (Fig. 4.)

This is a colored man, who has suffered for six weeks with a swelling in the groin. This examination is to ascertain if it be an abscess. Blood from his wrist does not reveal any excessive white cells, so we will take a drop, from a puncture with the hypodermic needle into the swelling. An examination of this shows, also, no excess of white cells, therefore no pus, and the swelling will abate of itself.

This woman, you will note, walks with a limp. The blood shows the characteristic agglutination or stickiness of the cells, which is invariably present in rheumatism, together with crystals of urates and cystine. This case includes several forms of rheumatism, each of which would be interesting to consider, if time permitted. (Fig. 3.)

Her daughter, who accompanies her, requests a blood examination. She only desires to know if she has inherited rheumatism. The examination shows normal

number of cells, evenly arranged, and of good tone. There is not even a rheumatic tendency. The only abnormal point is the eighty per cent hemoglobin.

This man is fifty-six years of age. He is very thin and anemic. His appearance and his voice would indicate tuberculosis of the lungs. For our purpose, it is sufficient to learn that he has been ill four or five years. A drop of blood is taken, as usual, from the wrist, and it shows that there is no tuberculosis whatever; but it does show that while the proportion of white to red cells is about normal, there is a lack of both, and, also, a lack of hemoglobin. This latter would be perceptible even in a photograph.

The serum is very clear, but not in excess of normal. On questioning, we find the man to be suffering from diabetes.

There are also present a great many spores of syphilis. He denies any such history, and his brother, who is present, claims for him a model life. Nevertheless, on closer investigation, it is acknowledged that such might have occurred some thirty-five years previous.

This young woman, who is apparently twenty-one years old, is brought by her

FIG. 3. The adhesive moving cells are carrying broken crystals and amorphous urates. Fibrin in the serum.

friend, Mrs. B., to see if she has incipient tuberculosis of the lungs.

You will notice, by her face, that she is slightly anemic and emaciated. The blood

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[graphic]
[graphic]

shows that the cells are evenly distributed throughout the field, pretty free from granulated edges, and that there is in the serum no tuberculous matter.

Thus we know, without further evidence, that this is not a consumptive case, which greatly relieves the anxiety of herself and her friend. On questioning her, we find that she has been working very hard in her school, and conclude that she is simply run down, and in need of the vacation which she is about to take.

This reminds me of a case I examined a year ago. Mrs. T. was about to be operated upon for cancer in the large intestine, which included part of the rec

FIG. 4, Shows a field of this blood, where the crenated or weak cells are the most marked.

tum. She had been suffering, off and on, for many years. The symptoms were emaciation, loss of strength, difficult and painful evacuation, with an occasional hemorrhage. The family sent for me to examine the blood. The serum was found to contain a little yeast, together with a sticky, fibrinous material. The cells were very much stuck together, and decreased in numbers. The proportion of white cells to red was about two to three hundred. My diagnosis was catarrh of the bowels, and not cancer. I told her she would live a great many years, and certainly needed no operation. It was a great relief to her family. She is now at

tending to her duties, and is in better health than for many years.

Mr. E. brings his bride of a few months to be examined for premonitory disease. The blood of the young wife reveals a fermentative product, together with an adhesiveness of the blood cells, which indicate a pretubercular condition. It is anemic. There is a goodly quantity of red cells-four million-and the white cells are only slightly in excess of normal. There is a slight indication of septic blood.

On questioning her, I find that the young lady has a cold sore on her upper lip, and an ulceration over two or three upper teeth. This latter she has had for the past year and a half-canker sores, she calls them; but it is pyorrhea alveolaris.

The young husband shows unmistakable evidence of rheumatism, though not pronounced, with amorphous urates in the

[graphic]

serum.

The vitality of the red discs is good, because the contour is round and distinct. But beside these slight rheumatic traces there are syphilitic spores in abundance.

As he comes simply for his wife's examination, we will defer questions until a private interview can be had. We can probably prevent a further infection in the other half of the family.

Here is a specimen just received through the mail. I unwrap it, and take the glass slide from the case. The letter accompanying it says the patient from whom the blood was drawn had syphilis several years ago, and that he is now suffering from a cough of two years' standing, which is thought to be of a tuberculous character.

In examining for syphilis, the onetwelfth objective lens must be used. I, therefore, turn the nose piece of the microscope around, and examine the speci

men.

The sender of this communication will certainly be very much pleased to learn my diagnosis-no syphilis.

Gentlemen, it costs just four cents to send this specimen to any part of the United States, so that California can be at once in touch with New York.

After all, the first and most important point in medical practice is the diagnosis. When a person becomes ill, the first question he asks is, "What is the matter?" The first thing that the puzzled physician asks is, "How am I going to find out?"

We assert that the quickest, surest, and often the only means, of diagnosis, is by a fresh blood examination, the infallibility of which relieves one from "a deep-dyed doubt of a dubious diagnosis."

Besides, a blood examination may prevent an illness, and "an ounce of prevention is worth a pound of cure."

20 West Twenty-Fourth Street.

Please find enclosed one dollar to pay for the BRIEF for 1905. The BRIEF is a welcome visitor to my office. When it fails to come, I feel like I had missed a month's chat with the medical staff. Long live the BRIEF.-F. KIRKPATRICK, M. D., Riddle, Ore.

[Written for the MEDICAL BRIEF.] Appendicitis (So-Called) and Its Treatment.

BY J. W. C. WEST, M. D., Gill, Ark.

This novel complaint, of late years, has opened up a new avenue for much thought

and a great deal more should be given it than has been by the general practitioner. For several years I have given this disease (appendicitis, so-called) much profound consideration, coupled with several well developed cases for close observation and practical demonstration by medical treatment, and that successfully, etc. Now, I would not have my professional brethren believe and understand me to be absolutely against surgical interference; but go slow, with a more serious consideration in diagnosis-for one-half or two-thirds of so-called cases of appendicitis will recover from well directed medicinal applications, as I hope to prove by a few well defined cases, with treatment for same.

Case 1.-Mrs. L., age fifty-five, mother of several grown children, was taken ill with rigor, followed by fever, with pain over appendix and entire abdominal tumefaction, with constipation. Was

treated by Dr. H. one week-diagnosed appendicitis; operation suggested; countyseat surgeon called, confirming diagnosis, and operation proposed. Family objecting, the case was dismissed and turned over to the family. At this period I was called in. The case looked hopeless, as two weeks had elapsed, and unconsciousness had been added to the above symptoms. I now began treatment by sponging the entire abdominal walls with warm water, flannels wrung out of same and thoroughly saturated with castor oil and applied, covered with folded towel to retain heat, which was followed by thorough evacuation of intestines with a partial return of consciousness. At this juncture I gave bromidia, to control pain and jactitation; tr. aconite and spr. nitre dulc. to conquer fever; gave salines per mouth now until I obtained a complete cleansing of the intestines from all offending fecal matter, which I deem a prime factor in a major part of those diseases named or styled appendicitis nowadays. This case was dismissed in four days-well.

Case 2.-Mrs. L., age thirty-five years. This subject had been sick for several weeks, under the care of two physicians, with symptoms like unto case first, except she retained consciousness throughout her entire illness. Case not improving, physicians were dismissed. The case fell into my hands. I placed her on same treatment as first case, with like results, in eight days-well.

Case 3.-Mr. H., age twenty-five years. Had been under treatment for one week by Dr. McM. Had three other doctors of good standing who confirmed the diagnosis appendicitis. All recommended operation, refusing to give any other treatment, and left the case. Patient then fell into my hands. Put him on same treatment as case numbers one and two, with entire recovery within one week afterward.

Now, these cases had no relapses, as they were under my supervision for one year after treatment.

Enclosed you will find check for two dollars for the MEDICAL BRIEF for two years. The BRIEF is certainly a brilliant journal.-G. P. KINGSLEY, M. D., Madison, Wis.

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