ment are the things which interest the practical man. He is always on the lookout for new methods and better ways of accomplishing things. The practical man applies the test of merit every time. If he is a doctor he uses the remedies which give him results, no matter who makes them, or what anybody says about them. He takes the journals which give him information and help him in his practice. He even takes the journals of other pathies than his own, for the practical man is very broad-minded.

The practical man can not be made a fool of by anybody. No political party, union or other form of organization can use him.

Dangers.

It is always necessary to guard against the know-it-all crank, who has an axe to grind. There are a lot of fellows who are always talking about analysis. Do not forget that analysis is yet in its infancy.

The doctor's main concern is to cure his patient. Never lose sight of that fact. When the doctor finds by experience that certain drugs, whether compound or single, meet certain pathological conditions, commonsense says use them without regard to the prejudices of others.

Another important thing is to see that the patient takes precisely what the doctor prescribes. This is a matter of real importance in this day when there is so much sophistication of drugs.

It is nonsense to say that the best medicines are confined to one manufacturer. Each manufacturer excels in a few particular remedies on which he makes his reputation. This is true not only of drugs, but in every department of life. The discriminating man or woman learns where he can obtain the best values and buys accordingly. Wherever the doctor finds a reliable remedy in a particular form, let him use that one and no other. Do not let yourself be prejudiced or led by outside parties. Never use something "just as good." There is no such thing. It is either better or worse, and in this connection it is invariably worse.

Guard against the bigotry of those who want to use you. Take the trouble to think for yourself. Never be indifferent

as to who makes the preparations you use. It is just as important to know your medicines are prepared by a reputable house as to know your coffee or your omelet are made by a qualified cook.

Another thing to guard against is the man who offers us laws to remedy our troubles. There is too much legislation in this country right now. Be on the lookout for the man who wants to use you politically.

Germany is reported to have the highest death rate of any nation. This is generally attributed to the large consumption of beer by the Teutonic race, as all heavy drinkers of this beverage must absorb an injurious amount of salicylic acid-the latter being used in the manufacture of beer to prevent fermentation.

A certain publication, largely read by the old women of both sexes, recently established the awful fact that there is more alcohol in a tablespoonful of many medicines than there is in an equal quantity of beer. The writer of the article referred to does not condescend to consider that beer is not administered by the drop or tablespoonful, but is usually taken by the glassful and sometimes even by the quart.

Food In Health and Sickness. The question of food is an important one, and should be faithfully and conscientiously studied. The doctor is supposed to be able to say what is best to eat, varying according to ailments and constitutional conditions. He is often puzzled by a lack of knowledge as to the component parts of the ready foods on the market and he should, without delay, read up and be ready to say at a moment's notice what is best suited to the conditions, and if he is giving remedies, what would be the least antagonistic to results from such. We all know that the finely bolted flour from which our bread is made the whiter in appearance, the better it sells-must necessarily show that the outer covering of the grains of wheat are eliminated in order to produce

this whiteness, and the cellulose is thus left out.

There are many prepared foods on the market, and the physician should become familiar with their make-up, and thus be able intelligently to commend them, as they are marketable at any time, while others, such as vegetables, are at times out of season, and, of course, at such times they are not good to eat because of forced growth and hot-house production.

[Written for the MEDICAL BRIEF.] Little Things in Treatment of Little Folks.

BY LINCOLN PHILLIPS, M. D., Professor of Pediatrics in the Pulte Medical College, Obstetrician to the Bethesda Hospital, and Consultant to the Protestant Home for the Friendless and Foundlings, Cincinnati, Ohio.

With a tremendously decreased birth rate among the well-to-do classes, and with an increased death rate among the middle classes, due to the overcrowding in our large cities, we may well consider the question of race suicide.

At the present time about twenty-five per cent of all deaths occur in the first year of life, and thirty-five in the first two years. Are these figures not a little alarming? I fear the pathetic little white hearse is making too many trips to the graveyard. No one can question the fact that many of the poor, deserted, unclaimed waifs of the city, burdened by the heritage of sin and disease, are far better off dead than living. At the same time, we must not forget that these are only a small part of the great total.

This is the age of specialists, and I believe that those physicians who have a natural skill in treating infants and children should make a special study of the subject. Still the physician can not do it all, he must have the co-operation of city officials and citizens.

The two leading causes of the large death rate in the cities are (1) unsanitary surroundings and (2) a poor milk and water supply.

The proportion of infants requiring artificial food is steadily increasing, and we are all aware of the fact that that

means more deaths, even under the most favorable circumstances; but when the noise and vitiated air of the densely populated centers, together with the poor water and bad milk, are considered, the prospect is far from encouraging. In the sweltering heat of the summer, the drawn, emaciated little ones make a pathetic picture indeed. The societies that are laboring to furnish a better milk supply and fresh air for the little ones are worthy of support and confidence. Our cities are not as keenly alive to the evils of unsanitary surroundings as they should be; if the profession of medicine had never done anything else than to demonstrate the necessity of pure air and sanitary conditions in the stamping out of disease, it had not lived in vain.

Referring to the little things in the treatment of little folks, I would say that so far as the physician himself is concerned, tact, keen power of observation and attention to small details are prime requisites of success. The infant's symptoms are objective ones, and how much does the treatment hinge upon the power to observe closely! I believe there are very few physicians, myself included, who are really suited to practice among children. He who has not real love and sympathy for children, who can not enter into their little pleasures and thoughts-can never hope to make a success with them. At a very tender age they can "read us like a book." Tact in handling children is a jewel of brilliant lustre. To observe, examine and do whatever is needed without the little one knowing what is being done is skill of a high class. The general practitioner can scarce take the time that is needed in making this call. Suppose he enters the house when the child is cross or angry. It is crying and nervous; the mother is nervous, and it makes him nervous, and in trying to get at the condition, they all get more nervous. What can be accomplished under such circumstances? Obviously the thing to do, unless the condition is one demanding immediate attention, is to retire to some other part of the house until the ruffles can be straightened out and the waters calmed; then and then only can the picture be obtained. Here patience is indeed a virtue.

It takes twice as long to take the case as it does the adult case. Why? Because the adult can tell his own story, but the infant has to depend upon the story of the nurse or mother and his own little mute signs.

Every detail must be gone into. What is baby eating? When? How much? When does he sleep? How does he sleep? And a thousand and one little things, as to fresh air, habits, etc. Many of these things you must actually see for yourself or the nurse, or even the mother, will mislead or deceive you purposely or not. Stripping the child will oftentimes render a diagnosis easy where before it was hard. Insist, and again insist, upon regularity in method as to feeding, sleeping, bathing, etc. It is surprising what can be accomplished by judicious training. The little folks acquire knowledge by what we teach them and by their own observation. A baby can be taught to go to sleep at a certain hour in its own bed, without breast or bottle and without a light just as well as it can be taught the opposite.

Noise, excitement, irregular hours and habits make sick babies. For the first year of life the great nervous system is developing at a marvelous rate. It is a mine ready to explode on the least provocation. How important then is regu larity and quiet. I have no patience with parents who want to drag a baby from one place to another, let every one handle it, trot it, and excite it. Another point along the same line: We do not do our duty when we neglect to instruct parents in reference to punishment of children, telling the children the policeman will get them, cut off their ears, etc. Many an idiot and nervous wreck is the result of such training.

Raising babies on artificial food in our cities is a fearfully discouraging task. Above all else, here is where attention to detail and little things count-attention not for a day, but weeks and months. The majority of sick, emaciated, rachitic, deformed children, brought to my clinic are the result of poor artificial feeding. As to the little things in diagnosing babies' troubles-what a mine of information we have in the sleep, the cry, the gestures, and the expression. The single sharp, shrill cry in the dead of night

tuberculosis of brain or bone; the suppressed cry-pleurisy; the "quack-of-theduck" cry-post-pharyngeal abscess; the sudden and long-continued cry, with every evidence of pain-ear-ache or colic. And so we might go on indefinitely.

As to the prognosis-"babies get sick quickly and get well quickly"-but we must never lose sight of the fact that with the unstable nervous system little troubles may prove fatal.

As to treatment-Holt has taken good advice from our school when he says: "Never give a dose of medicine to a child without a positive indication. Never give a nauseous dose of medicine when a pleasant one will do. Small doses frequently repeated are better than one large dose and are not so apt to upset the stomach." I feel as he does that children are drugged too much, that better results can be obtained by other means.

To sum up: The children's doctor must be especially fitted by nature, ability and rigorous training. Neglect or carelessness in regard to little things marks the distinction between a mediocre man and an expert.

1004 McMillan Street.

[Written for the MEDICAL BRIEF.] Asclepias.

BY A. B. ERWIN, M. D., Bangor, Ala.

Having just read your editorial on asclepias in October BRIEF, I am pleased with your article. I have used asclepias twenty-five years, in colds and fevers. I cut short those continued fevers, typhomalaria (not typhoid), sponge patient, and give liver medicine, if necessary. When fever is lowest, which generally occurs in the latter part of the night, give quinine in three or four portions, and when last portion of quinine is given then give Dover's powders and asclepias t. i. d. (of crude root), enough to start perspiration; hot as patient can drink and enough to keep up perspiration until evening; repeat next day to keep fever from return. ing. The Dover's assist the tea in perspiration. I have it always on hand, never without it.

grees of intensity which are noticed among patients whose mental condition is in other respects free from disorder. Patients suffering from these states of depression form a fairly numerous class in the out-patients' room of our hos pital. They apply for treatment on account of this depression because they are "so low spirited" that they are unable to follow their ordinary avocation or to take an interest in the daily round of life. This condition seems to affect both sexes equally, and to appear at various ages, and in a large number of cases no apparent cause can be found to account for it. Yet these states of "mental dejection," "despondency," "loss of heart," and the "giving up of hope," are found lying on the very threshold of melancholia, and are the opposite to the state of exaltation and the delirium of grandeur which usually usher in conditions of mania, especially the mania of general paralysis of the insane, megalomania, and the like.

The disorder (for it can not in this incipient form be called a disease) is characterized by a feeling of unhappiness; all natural feeling of buoyancy of spirits, and the healthy, hopeful looking onward, are damped, while the power of fighting against the weight of despondency is diminished. The appearance of the patient is in keeping with the mental state; the expression of the face is that of unhappiness and uncertainty, and the attitude of the body is that of listlessness and want of energy, thus showing a flaccid condition generally as distinguishing it from the well-known condition of flexion so typical of the pronounced melancholic. Another striking difference between this state of depression and melancholia proper is that in melancholia there is a characteristic tendency to tears. The melancholic is "full of tears," either loud weeping and wailing, or a steadily constant lachrymose condition that remains and persists during the waking state, excepting, of course, certain cases of melancholia with stupor.

Again, these patients, before strangers, and even in the presence of those more intimately associated with the affairs of their daily life will not show this substratum of depression and unhappiness--it is carefully masked. The patient will

say: "I can not understand this peculiar feeling, yet it exists, and I suffer intensely; but it is no use mentioning it to those around me, for they can not appreciate it. When I have communicated my miserable feelings to my friends, the only comfort I get is 'Oh, you must pull yourself together and throw it off.'" And so our patient goes on and suffers. The conditions of civilization have, however, throughout his life taught him to control his features and to avoid giving way to his emotions, in order that the expression of his face may not be an index to his feelings, or, as Shakespeare so aptly puts it, when Macbeth gives way to the intensity of emotion, and Lady Macbeth warns him: "Your face, my thane, is like a book where men may read strange matters." Thus it happens that the feelings of depression are hidden from his friends and associates. This, however, can only be for a time. No man can for long be unhappy, whatever may be the cause, without it affecting his general health. For soon the evidences of malnutrition appear, and the disordered functions tell their own tale in the lack-lustre eye and the altered complexion of the skin, while the coated tongue and the dry, cracked lips, plainly tell of the failing appetite and the envolvement of the gastro-intestinal tract in the general condition of physical deterioration. By degrees the depression, which at first was intermittent (but which under the influence of change of scene and cheerful surroundings could for a time be kept out of consciousness), gradually becomes more or less continuous, and invades a period which should be devoted to rest, so that sleep becomes fitful, unrefreshing, and disturbed, the general health becomes more and more undermined, and there is a loss of the usual energy and capacity for work.

It often happens, on inquiring into the history of these cases, we find that either one or the other of the parents has been nervous or subject to attacks of "lowness," and that the patient himself has suffered from these attacks more or less all his life, but that this one has been of longer duration and greater intensity, and has not given way to simple remedies as formerly. Again, these cases of mental depression are frequently found among

the members of families who are neurotic, sensitive, highly-strung, emotional, uncertain, unstable-always at the top or bottom of the circle, rarely at rest "on the center."

Obviously, the danger in these cases is for the attacks of depression to recur and persist until they gradually and almost imperceptibly sail over the line of disorder and drift slowly away into the depths of melancholia. Melancholia is an insidious disease. It does not burst out into violent manifestations, and by vigorous physical display proclaim the mental storm raging within, as in a case of acute mania. Melancholia is of slow growth. It begins as depression, unnoticed and unrecognized (as in the cases we are now considering), and when the disease is developed the friends will tell us they have noticed a gradual change coming on for a long time-maybe months-before we are consulted.

In these cases of depression we have as a disorder the earlier symptoms of what may develop into disease. Fortunately, the patient retains the power to act, and by coming for advice give us proof that the substratum of depression is a shallow one, and the prognosis is, as a rule, favorable.

As illustrating the class of cases under consideration, the following brief notes are interesting: The case is that of a gentleman seventy-three years of age, of independent means, and possessed of everything calculated to make him happy. For years he has suffered from attacks of mental depression. Between them he is remarkably cheerful, eats well, drinks well, and for his age, is a brisk and energetic man, who will walk his six or eight miles a day with ease. The first time he consulted me-some four years ago-he walked into my consulting room, erect and firm on his legs, and certainly, from his facial expression, depression was the last thought to enter my mind with regard to him, yet he unfolded to me a plain and finely descriptive account of his mental distress. He said he felt so miserable at times he did not know what to do, that he was afraid he might become paralyzed, or that his mind might give way. His physical condition was excellent, and with the dynamometer his right