naturally be dispensed with, leaving to the cell itself the function to obtain its building material directly from the atmosphere.

Eating to Be Made a Moral, Rather Than a Physical Act.-The processes leading up to this high vegetative state are engendered by a careful selection of foods, with quality ever placed above quantity, and end above means, thus gradually turning eating into a moral rather than a sensual act. To eat in response to necessity rather than to the craving of a more or less exaggerated appetite, and by constantly keeping in view the supreme fact that eating never was intended to constitute an end in itself, but a means by which an end may be attained, forms the basis of all sane and truly progressive existence. For appetite is an animal rather than a human quality -the impelling force by which Providence guides its unreasoning creatures of the lower kingdoms along paths of unfailing, because of instinctive safety; while the human individual is equipped with faculties of thought, reason and volition, by which he is enabled to choose for himself and in perfect independence of a craving, which, owing to artificial and abnormal modes of living, is mostly irrational and misleading. As an exponent of self-consciousness it behooves the human being more and more to assume control of his vital processes, and bring his functions to yield ever higher results in the course of a constantly intensified evolution. The control of appetite and eating is not less important in the pursuit of health and progress than the control of breath and motor muscles. It must be within the power of man to gradually assume complete control of every function and faculty of his nature, and wield them in the service of universal progress.

Physical Culture of No Value If Divorced from Usefulness.-But the way to attain this power lies not in any exercise carried on for its own sake. Swinging with dumb-bells, punching the bag, or any howsoever elaborate stretch of muscles, etc., is powerless to accomplish what a useful, purposive exercise in the open air will accomplish. Usefulness, creative work, universal purpose, are the levers of

universal power which yield the greatest and most permanent results.

It is in the midst of nature that life exhibits its greatest results. To mingle with her forces, to coöperate with her efforts and unfold in the direction of her aims and purposes, turns the mere mechanism of action into the dynamics of universal usefulness. Unselfish motive, embodied in vigorous purposive action, is the key by which the individual may open up Nature's sanctuary of health and power. "Not what I have, but what I do, is my kingdom."

611 S. Flower Street.

[Written for the MEDICAL BRIEF.] Asthma.

RY J. H. JERGESEN, M. D.,

Milwaukee, Wis.

[No. II.]

True asthma, or spasmodic asthma as it is also called, is supposed to be of a pure neurotic nature; it comes on, apparently, without any cause and leaves without leaving a clue to its factors.

Asthma caused by a visible or traceable cause is therefore not true asthma. To the form of asthma having a traceable cause belongs emphysematic asthma, bronchial and catarrhal asthma, renal and uterine asthma. Hay asthma must also be considered in class by itself, and so must hysterical asthma. Cardiac asthma, which is, strictly speaking, not asthma, may properly be classed as a mechanical form.

The earliest writers recognized two forms, one which they called ȧcopa (short breathing) and another called on you (short of wind.)

Emphysematous asthma very similar, in some particular, to spasmodic asthma, but very different in many particulars. The symptoms of emphysematous asthma differ chiefly from the spasmodic in that it seldom leaves the patient entirely; it has its permanent pathological cause, dependent on destructive changes in the lungs, and, in cases of long standing, a malformation in the chest-walls. Such destructive changes being progressive, produces as a consequence anatomical deformities in sympathetic organs-such as the heart.

Emphysema exists when the minute anatomy (histology) of the alveoli and air cells of the lungs are permanently changed, and their physiological functions interfered with in such a manner that the whole or part of the lungs are incapacitated from bringing the venous blood in the intralobular capillaries in immediate contact for aeration and oxygenation by the air in the infundibular. As a consequence of this destructive change we have on the slightest provocation an attack of emphysematous asthma. Here, therefore, we have a visible or traceable cause and is therefore not "true asthma," or spasmodic asthma, but emphysematous asth

ma.

Emphysema may be caused by whooping coughs, bronchitis and spasmodic asthma as well.

A paroxysm of emphysematous asthma might be induced by exertion (walking, climbing stairs, coughing, catching cold, etc.) and it may come on any time and anywhere, under all circumstances, whereby the systemic blood circulation is accelerated, and in consequence the blood current is insufficiently oxygenated, so that carbondioxide is found to excess in the blood irritating the respiratory centers, and a cry for oxygen from every nerve and tissue-cell in the whole economy is impressed on the respiratory centers and dispatched over the pneumogastric nerves to the lungs; they immediately increase their action, though without relieving the condition. The paroxysm, however, although like true asthma in many features, is unlike it in the nervous phenomenæ being absent; (the patient must be protected from cold air); he is able to raise mucous and cough under paroxysm. There is an absence of the large quantity and often voidance of clear and limpid urine;

the paroxysms are of much shorter duration; comes on oftener, and at all times, night or day, and as often as provocation is at hand, while true asthma is purely a nocturnal affair.

Under ausculation vocal fremitus can be heard over all of the upper half of the chest, moist râles and gurgling sounds are constant symptoms, and undue exertion will produce sibilant notes. Percussion elicits hyper-resonant notes at all times. In emphysema expiration is never complete. In collapse the lungs are found to be expanded as much, as would ordinarily be the case, when in health inhalation is complete.

The respiratory function consists as much in the collapse as in expansionemptying the lungs of air, as it does in filling them. Therefore, if the power of normal contraction is lost, and therefore unable to empty itself of its contents, and if the power of expansion is still normal, and forcible inhalation takes place the lungs already being full-the natural consequence must be an over-expansion of the air-cells, and, if continued, a permanent dilatation takes place. The lungs lose their resilient elasticity and hypertrophy is the consequence.

The lungs are divided into lobes, each of which is a lung in miniature, consisting of several infundibulas, with their nerves, arteries, veins and lymphatics. Such an infundibula is normally one-third larger than their areolas opening into them, but, by this permanent expansion they become proportionally much larger. The alveoli themselves next enlarge and their septas wither and lose their elasticity from lack of proper blood supply. The lungs having lost, in that way, their normal elasticity no longer tend to further contract to complete expiration, so that a large volume of residual air remains in the lungs.

The thoracic walls and the diaphragm, instead of being drawn in and upwards by the traction of the recoil of the lungs, simply collapses to their position of rest, and are thenceforth a dead weight to the expiratory muscles, instead of aiding the action of these muscles through their elastic rebound. From that we see, in emphysema, the inspiratory act begins, where in health, calm inspiration should end.

The deformity of the thorax, or the socalled emphysematous chest, is without a doubt caused by the pathological changes of the histology of the lungs. It has been considered congenital or hereditary, but it is so invariably present that pathologists look for it as an undisputable symptom or condition in emphysema. That that condition is caused by the abnormal condition of the lung seems to be agreed to by all modern teachers of etiology, reasoning in this way: Impairment of lung texture will render any dilatation, howsoever induced, more or less permanent, and an enlargement to the chest will result. Thoracic resilience must also, by degrees, be impaired. When, therefore, thoracic recoil does not pass beyond a certain point the chest must assume this as a permanent position; because of the tectural changes in the cartilage induced by non-use, as is natural in all tissues. Is this position first fixed? It is. Does the recoil never pass beyond a certain point? Ossification at that point must take place. Such changes having taken place and we have the deformity commonly called by its name "emphysematous chest."

The chest is rigid, the ribs are straight and seemingly broader, the intercostal spaces are diminished, the chest capacity is much enlarged, it is uncollapsible beyond a certain point.

In a paroxysm of asthma the chest is seemingly enormously distended, the epigastris is drawn high up under the ensiform and ribs, and apparently it does seem as if the uncollapsability of the chest wall were the only cause of the trouble.

Bronchial or catarrhal asthma is another form of asthma which is liable to be confounded with true asthma. As a rule, it is not difficult to differentiate between the two diseases. Catarrhal asthma has its own history of daily coughs, hoarseness and harshness of the voice, the face is bloated, bags under the eyes. He complains of pains in the chest, a fulness and tightness, which is often described as a girdle sensation or a band around the waist, and weight on the sternum, which, in many cases, are very uncomfortable symptoms.

A paroxysm of catarrhal asthma is, as a rule, ushered in in the form of a common cold, but not as a cold that passes through its initial stages in forty-eight to twentyfour hours; but it passes through all its stages in one to two hours, and I have seen cases of it that passed through all the stages and developed into a severe attack in less than fifteen minutes, caused by drinking a glass of cold water on a warm summer day. It was cured nearly as quickly as it came on by forcing the patient to drink a quart of water at the same temperature as that which caused it.

The first knowledge a patient has of an approaching paroxysm is a dryness of the mucous membranes of the nose. Progressing, there is an uneasiness between the shoulders, the tightness of the girth sensation, and that the otherwise copious expectoration has become scant and his cough, instead of being vigorous and successive, is one long-drawn wheeze, and soon his spell is in full force; but is unlike spasmodic asthma in nearly every aspect. The only thing the two patients have in common is that they are both struggling for breath. In this case the pulse remain full, and often bounding, the skin is hot and suggestive of fever, the face becomes more bloated, increased soreness of the chest. The patient, instead of bending forward, prefers to lean backwards, and have the chin raised. The most prominent difference in the two named diseases is that in true asthma the impediment is to expiration, whereas, in catarrhal asthma the impediment is to inspiration. After a paroxysm is ended, as a rule, there is a profuse expectoration of a thick phlegm, yellow, and often tinged with blood. This seems to indicate that the reverse is the cause to that of true asthma.

In this case it seems that there are at all times an overabundant secretion of the bronchial glands. This, from one cause or another, becomes impeded in the bronchiolas, whereby free access of air to the air-sacs is prevented and a mild form of asphyxia issues, and a struggle for breath is at once in full force.

In true asthma, as we have seen, the reverse is true-a patient may complain

of an uncomfortable dryness of the chest; he often feels the necessity of coughing, but is unable to raise anything and relieve the sensation. When a paroxysm ends there may be a small pellet of mucus expectorated, but beyond that expectoration is scant.

735 Third Street.

[Written for the MEDICAL BRIEF.] The Effect of Vacination on Small-Pox.

BY ANSEL STRICKLAND, M. D., Cumming, Ga.

I have just read and re-read the article on page 677, of August BRIEF, written by Dr. P. S. Ayers, entitled, "The Effect of Vacination on Small-Pox."

Now I will say in the beginning that I did not write the piece on chicken-pox in April BRIEF to get up a discussion through the medical press, nor for notoriety, but for the benefit of the profession at large.

As the Doctor seems to be in doubt as to what his patient had, and asks for information, I will endeavor to make it a little more clear to him.

In the first place, I put down seven points to look after in forming a diagnosis between a case of chicken-pox and a case of small-pox, and if these directions are strictly followed, he can have no doubt. The Doctor says that in all of his cases the period of incubation was fourteen days, dating from the day of desquamation, until those that were exposed came down. Now then, the desquamation in a case of chicken-pox begins on or about the seventh day, that alone would make all of his cases chicken-pox, for seven and fourteen makes twenty-one; now as chicken-pox is conveyed through the breath, then it had to be caught, or could be caught before desquamation began.

To make it plain, A and B sleep together on the night of the first day of August. B starts to his home the next morning. On that day A has what he thinks to be a bad cold, and stays more or less sick for a day or so, and on the 7th he breaks out with what the doctors

call small-pox. Now, if it is small-pox then you go to B's house on the 14th of the month and you will find him sick, but if it is chicken-pox that A has, then on the 21st you will find B sick.

To

Then the Doctor seems to think I put the death rate too high in small-pox. that I will reply that the lowest death rate in cases of small-pox that I find put down by any writer of note, is thirtythree per cent, under the best of treatment. Dr. Eugene Foster, of Augusta, Ga., who was a noted writer on small-pox, and had a lot of it to deal with, said the mortality among infants was ninety per cent; old age, seventy-five per cent, and middle-age, forty per cent.

A few miles east of here, three out of four died, although they had the best of attention; south of here, seven out of eight died with it, and they had the best of attention; that is what I call smallpox. Now we have in this county about fifty cases of chicken-pox a year, with no deaths. I know of a number of cases of chicken-pox in this town now, and we use no quarantine whatever. Those that take hot teas or drink whisky have it badly, and those that take nothing have it lightly.

A lady wrote to me from a town of about four thousand inhabitants, and said that there was a lot of small-pox in her town and none were dying. I wrote her to not be alarmed, as a single case of small-pox in a town of that size would depopulate it inside of twenty-four hours. In a few days after that I received another letter from her, saying that an expert said it was chicken-pox.

The Doctor further says that inside of thirty days after his patients got well their skin was smooth and no marks left. Now that showed chicken-pox. Then he says it was slightly contagious, some members of the family not having it at all. That pointed to chicken, as smallpox is the king of all contagious skin diseases. What seems to trouble Dr. Ayers most was that some of his patients had a similar eruption some three months before this. While I did not see your cases, yet I would say that they had in November what the older writers called febrile lichen, and in January they had chicken-pox.

Now if the small-pox gets among those patients of yours that had the so-called small-pox, you will see them die like sheep. I want to call your attention to one thing, to-wit: If that eruption you write about is small-pox then why vaccinate at all; for any of them will tell you that they had rather have it than to be vaccinated. If you think that was small-pox, then you should at once quit blowing your vaccination horn.

I want to call the profession's attention to one thing: If the doctors do not stop this calling of chicken-pox small-pox then vaccination will soon be a thing of the past. You will get the people to thinking there is no danger in having the small-pox, and you can not get them to be vaccinated at any price. Chicken-pox is to small-pox what a mosquito is to an elephant. If the Doctor wants to visit a patient that has small-pox I would advise him to get a clothespin and put on his nose, that you may not smell the most sickening of all odors, and a rubber stopper in each ear that you may not hear the groans, and a handkerchief over your eyes that you may not see the fright that no pen can describe. You may think that I am putting this down rather magnified, but you go and see a case of small-pox and see if you don't think I am correct.

If chicken-pox is small-pox then I say away with your vaccinations, for your remedy is far worse than the disease.

[Written for the MEDICAL BRIEF.] A Plea For Liberality.

BY B. B. USSHER, M. D., Dedham, Mass.

The enlightenment that is brightening the dark places of the earth and ever illuminating the pathway of the belated churches, has seemingly failed to flood the profession which has needed it most, and the practitioners of medicine, as a whole, are moving slowly and painfully in a black procession that indicates the presence of the ball and chain of narrowness and bigotry, which hinders progress and reveals its presence by the clank of its links. What business have we to imitate the churches in their sectarianism?

Is it not our part as scientists and apostles of helpfulness to sweep away the barriers that make us a laughing stock? What right has the allopath to label himself or be known other than as a physician? Has the homeopath stuck so closely to his creed that today he can boast of loyalty in his practice to "similia similibus curantur and the attenuated triturations and dilutions which were once the war cry of his 'pathy? Does the eclectic find it necessary to shout the Thompsonian shiboleth of "heat is life and cold is death," in order to proclaim that his medical sect is the only only? Does the educated hydropath, the competent osteopath, find it necessary to shout "Eureka" over his medical wares?

Shame on us, gentlemen of the medical profession, that we are not content to stand before the world as all-round men, wise enough to use any remedy that promises relief for human suffering. Shame on us for our unnecessary multiplication of medical colleges wasting our substance which, better spent, would mean higher education. Shame, thrice shame upon us that in these "United" States we are so divided medically that a reputable graduate of a reputable college becomes a criminal if he pursues his legitimate profession beyond the jurisdiction of his own state board. We have enough to bear without the gibes of the public over our divisions and ignorance of what is valuable in all schools. Let us be capable physicians, no more no less, and being that, bearing the credentials furnished by an accredited school of medicine, let reciprocity be the watchword of state boards, and the college diploma and home state board certificate be all that is necessary for the medical member to practice his profession anywhere under the flag of the American nation. The state board knows its own colleges, and its certificate should be a guarantee of fitness and a sufficient protection for the public. To be pathists is to be at the tail of the professions of science, and in this country there should only be licensed graduates, whose liberty to practice in any State of the Union should be one of the evidences of our departure from those antiquated notions that violate our dignity as educated gentlemen.