list of a great university plus a Wall street interlocking directorate.

Whatever the origin of this Institute, the idea certainly is a good one. It is recognition of a fact to which our sanitary optimists persistently have shut their eyes-that the span of life, instead of growing longer, in reality is growing shorter. We know that, as a result of the stress of modern business and the strain of living and making a living in a great city, a very large percentage of our ablest men are cut off in their prime through such diseases as arteriosclerosis, nephritis, and heart disease.

The purpose of the Life-Extension Institute is to do missionary work among these high-tension workers for a consideration, of course. It is bolieved that much disease can be prevented, many lives saved, and many more prolonged, through the recognition of disease in its incipiency. This is to be accomplished by the appointment, in every moderately large community, of official examiners for the Institute, to whom the subscribers will be referred for repeated physical examination. Upon the first aberration from health, the first evidence of disease, these individuals will be referred to physicians for proper treatment.

The plan certainly is an excellent one, providing any considerable number of persons can be prevailed upon to accept the services of the Institute. Unfortunately, men are notoriously blind to the whisperings of disease and rarely can be persuaded to consult a physician and seek aid until the whispering becomes a veritable outcry. We predict that before the Institute becomes a real success it will be compelled to do a large amount of educational work, and educational work, as a rule, does not pay in dollars and cents. Perhaps the insurance companies interested in the promotion of this plan will furnish the funds to insure its continuation. We certainly wish them well.

WE OUGHT TO STUDY DRUGS MORE. We-meaning by "we" the real working medical men are leaving too much to the research branch of the profession, i. e., to our various councils, institutes, and laboratories. Not that we should try to get along without the latter or would subtract one iota from the praise that should be theirs for the splendid work they have been doing. But we have got into the very bad habit of accepting what they say as final.

If someone inquires whether a certain drug has merit or not it is promptly referred to the Council on Pharmacy and Chemistry; the Council, in turn, refers it to some laboratory or institute; and the big man in charge at this point turns it over to some bright young assistant just out of college

who happens to have a penchant for "research". This young man puts the suspected drug through its paces. It is analyzed. Its active principles are carefully estimated. It is tried on a guinea pig-then on a rabbit-then on a dog. The young man nearly always finds out something interesting about the drug, and his report is turned over to his chief for an "O K". He in turn turns it over to the Council, and the Council is very likely, we fear, to add its own indorsement to the report and send out to the world the pronunciamento that the remedy is excellent or worthless (usually the latter) as the case may be.

This method is all right up to a certain point. But it is all wrong when it is used as a substitute, even by inference, for actual extended clinical experience. Take echinacea, for example. Our Eclectic brethren raise a united voice in its praise. Hundreds and perhaps thousands of men are prepared to make the unqualified statement that it is of very great value in certain "septic" statesusing the word septic for lack of a better term. The negation of values to that drug by a bright young laboratory man does not convince them it is worthless. Nor should it convince anyone else. Even modern science is "swopping horses" or hypotheses too often to be accepted as infallible.

What we need is a clinical court that can be depended upon. Personally, I place more faith in the testimony of such men as Solis-Cohen, H. A. Hare, and a few others like them, who are actual practitioners of medicine, than I do in the combined wisdom of the laboratories of the country. When these men are backed by the experience of some thousands of hard-working general practitioners I will support them against all the thunderings of the Council.

A FEW WORDS ABOUT "DIAGNOSTIC ACUMEN".

We have much to say about "diagnostic acument-too much the writer thinks. After all, it is not second sight, or a "gift" like "bonesetting," or even purely a matter of education and sense-training, although the latter are indispensable factors. The two things which are absolutely essential are close observation and the most painstaking thoroughness. average physician is altogether too much inclined to take every case at its face value. He has a certain number of patients to see in the course of the day and hence is not disposed to allow more than the allotted time to each one. The patient tells his story-on sufferance. The doctor feels his pulse, looks at his tongue, takes his temperature, listens to the sounds of the heart and lungs, inquires about the state of

the bowels, writes a prescription-and is gone. Thousands and thousands of visits are made to the sick in which this routine is carried out with humiliating invariability.

Now, this is all wrong. Even the simplest case or what seems to be a simple case deserves study, and upon study may be found to present factors which would never be thought possible to the "casual" diagnostician. A case of this kind occurs to the writer now. The patient began to experience trouble with his eyes ten years ago. He went to an oculist, and as nothing much seemed to be the matter, an error of refraction was corrected and he returned to his work. But the eyes continued to give trouble. Again he went to the oculist, who discovered some corneal cloudiness, which seemed to subside under local treatment. Still later there developed slight ulceration of the cornea. Another oculist was consulted, who again gave local treatment and a new pair of spectacles. Then came a period of ill health. Nothing much seemed to be the matter except a general adynamia, some disturbance of the digestive function and rather marked loss of flesh. Several good physicians were consulted, who gave various diagnoses, varying from constipation to neurasthenia. The eye was still giving trouble.

Finally, after ten years, a physician was consulted who thought of making a Wassermannand, lo! the problem was solved! But meantime there were ten years of ill health-and a Ichild which died of "narasmus''.

There should be no "minor ailments". Every case should be considered serious until it is proven to be otherwise, and it is "up to the doctor" to supply the proof. Our instruments of diagnostic precision are multiplying every day, and there are no longer the excuses for making mistakes there once were. We should use such instruments more; indeed, we should use every method at command to determine the exact cause of illness, and, once it is discovered, every therapeutic expedient which gives fair promise of restoring that pearl of greatest price-health.

The doctor has no business to make mistakes. He should be made to feel his responsibility, for some one inevitably "pays".

lieve that in all this pother over medical education we are applying the pressure at the wrong place and in the wrong way. So far as society is concerned it cares not at all how or where a young man gets his training for the practice of our profession-whether at a day school or a night school; at a Class A institution or a Class B college. The one essential thing is that he shall be well qualified. And the only way in

which the state can assure itself of that fact is by supervising his education from the very beginning.

Put the pressure on the man. Make him understand, from the day that he begins his course, that he must make good or get out. Take the power of examination away from the school and place it in the hands of society as a wholethe state. Eliminate special privileges. Eliminate school favoritisms. Eliminate class favoritisms. And demand scholarship. Such a course would stimulate our student body to seek out the special teachers who could help them the most-whether these teachers were connected with great universities or operating private courses of their own. The bright man would be enabled to complete his work more quickly, while the dull man would not blunder along through four years of half success only to fail miserably at the end of his period of Sisyphus' labors.

In these days we are worshipers of forms. We are trying to run everything into molds and turn out men who are all alike, and all in the same time. We need to stimulate a healthy individualism and permit a larger liberty.

Whether the idea appeals to you or not we hope you will read the Brief editorial, which we are reprinting elsewhere, also the extract from President Lowell's fine address at the Conference on Medical Education, which we give likewise in this issue.

EDITORIAL NOTES.

Chronic Intestinal Statis is now dividing the attention of the profession with radium and Abderhalden's tests for pregnancy and cancer. These three topics are all attracting intense interest. "Intestinal stasis", by the way, is our old friend, "intestinal toxemia", under a new name, and we owe the revival of interest in the subject to the remarkable studies and daring surgery of Sir W. Arbuthnot Lane, of London, who has shown that the long array of symptoms ascribable to absorption of poisons from the bowel is fundamentally due to mechanical obstruction of that canal. When there are "kinks" or constricting bands or anything that causes angulation and narrowing

of the gut, then the fecal stream is slowed, masses of decomposing matter accumulate, bacteria multiply, they and their toxins extravasate through the bowel wall at the point of narrowing, and low grade inflammatory action is set up which further intensifies the trouble.

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The Catalogue of Symptoms due to intestinal stasis given by Lane fully rivals that printed in the liver-pill almanack in its palmy days. We are told that this damming back of feces causes severe and repeated headaches, pigmentation of the skin, loss of flesh, nervousness, mucous colitis, hepatic, renal and cardiac disease, chronic coldness and lividity of the extremities, pyorrhea, rheumatoid arthritis, cancer, and a host of other ailments. If such an indictment came from a less able man, we might be inclined to listen to this catalogue with a smile, but Sir William knows what he is talking about and, with his disciples, has supplied a great mass of evidence in support of his position. No one can read the articles of men like Bainbridge and Hayes and remain unconvinced of the truth of much they claim. While they are enthusiasts, and all enthusiasts are inclined to see and do too much, they are giving us real facts to explain a condition which every practitioner has seen time and again, and failed to understand.

Lane is a Surgeon, and it is therefore natural that in dealing with the problem of stasis he should turn naturally to the knife. While he resorts to mild laxatives, like liquid petrolatum, abdominal supports and a restricted diet in the mild cases, and promises relief through these simple expedients alone, in the cases of a more serious type he insists upon surgical intervention. The moderately severe cases are corrected by the removal of the constricting bands or other tissue factors that cause angulation or narrowing of the bowel. But there are very severe forms where even the entire removal of a segment of bowel may be necessary. There certainly is great promise in surgery of this kind, and we advise every physician to keep in touch with it. Study these cases of autotoxemia more closely. You have some of them in your own community-more than you imagine, perhaps. Often they are called "neurasthenia", or, perhaps, if you are more nearly up to date, "enteroptosis".

as the public thinks, and the terror with which people regard these unfortunates is really quite unjustified. "Paris has been startled to know," says our contemporary, "that lepers have flocked there for years and there are now two or three hundred domiciled in that city. Every one of them has contracted the disease in endemic territory, chiefly the tropical colonies, and not one of of them has transmitted the bacilli to anyone else." There are lepers in London, and lepers in New York also, we may add, in Chicago-at least there have been lepers here. Yet the disease does

not spread in these cities. There are even physicians who deny that the disease is contagious at all, believing it to be essentially hereditary. Really, we know very little about it as yet-enough, however, to exercise a finer humanity in our treatment of its victims.

New Light Has Been Thrown on the Etiology of Dementia Praecox from an unexpected source. Applying the Abderhalden test to cases of insanity, Fauser, of Stuttgart, was able to show that dementia praecox is apparently always associated with dystrophy of the sexual glands, i. e., the testicles and ovaries. This conclusion was based upon a study of 84 such cases, the blood serum in all reacting to these tissues when used as fundaments. In this connection, special attention should be called to some experimental work now being carried on by Dr. G. Frank Lydston, who has transplanted testicular tissue into his own body and ovarian tissue into the body of a woman of fifty-nine. He has definitely proven the possibility of doing such transplantation successfully, and believes that it opens possibilities of tremendous significance, among others the likelihood of doing something for persons suffering from this hitherto hopeless form of insanity. For further details. we refer you to his protocol, which we publish on another page.

UR disposition of sex-vice in this country may justifiably be called a "comedy of errors"-with due apology to the illustrious Bard of Avon. I wonder how much longer this matter is going to be taken seriously. One has only to dip into the history of harlotry, and to devote a little time to observing at close range the conditions now actually prevailing, to appreciate how nicely the quotation describes our senseless dallying. Then we see almost nothing but errors of the most ludicrous sort and we cease to wonder why we continue to miss the purpose ostensibly aimed at in the treatment, by society, of the problem of prostitution.

And just what is the prevailing attitude toward sex-vice?

it.

First, we try not to see it.

Second, we try not to recognize it if we do see

Third, we try to avoid dealing with it if we are bound to recognize it.

Fourth, we try not to deal sensibly with it, if we must deal with it.

The situation is similar to this one: A lowbrow, well known to the police, murders a pedestrian as he crosses a dark alley-way. Along happens an officer at the same moment. The officer tries not to see what is going on. Being so close, however, he can hardly help seeing. Then he pretends not to recognize the murderer. Next he decides to refrain from making an arrest. He turns his back and, as he does so, he spies a citizen looking on. Then he changes his mind and in behalf of law and order, makes a dive for the murderer (who has now finished the job by picking the pockets of his victim), but misses him. Finally, the twain scurry away, the one after the other, the officer starting off as though he meant business, but halting just as soon as the chase has taken him out of sight of the citizen on-looker.

That is about as seriously as we engage in tackling the sex-vice.

How shall we account for the peculiar attitude of that officer? Was he afraid of the lowbrow? Was he friendly toward him? Was he a partner in the crime? No-neither! The reason why he did not “get” the man and march him off to jail. as he could have done, is a simple one: That

lowbrow was bedraggled and dirty, and the officer didn't like to touch him, because he had on a new uniform.

Ludicrous, isn't it? And just as ludicrous is the manner in which we are dealing with sex-vice. Why do we try not to see it-nor to recognize it -nor cope with it in a sensible way? This is why because this particular form of vice is related to sex, and anything that relates to sex is nasty.

Yes in the general opinion, syphilis (among the other vice-diseases), is a wicked, vulgar disease, and therefore, not for nice, virtuous folk to deal with, or to discuss, or even to think about.

"Keep silent about it and cover it up" is the order of the day; in view of which we can scarcely expect any sane action to be taken against the terrible diseases that are slowly but certainly besmirching our whole social fabric.

And, if we were to go a step further and inquire what it is that transforms people, who apparently are strong physically and right mentally, into weaklings and dunces, we should find this answer: "Prudery".

In our American cities, this very moment, the "comedy of errors" is being enacted. Witness the useless and purposeless onslaught on the open brothel and the segregated district. Apparently, the idea in the aldermanic cranium is this: "We don't want vice heaped up like this-it shows too plainly to outsiders, who may think we are not a moral community. Let us spread it over a large area; then it won't be so noticeable and it won't shock people so".

Or, is it possible that those whom we elect to govern us are so unsophisticated as to believe, sincerely, that the closing of the brothel will abolish prostitution?

Well, anyway, vice is "wiped out", which means, not that it has been abolished, but that it is being scattered. The female inmates of the brothels (where order was enforced and prophylaxis encouraged) now disperse in every direction. Each one now begins to operate on her own account and, free from the restraints imposed by the madame and the district patrolman, she is less scrupulous than ever.

Just as likely as not, this "dispersed" courtesan alights in the midst of respectability. On the street, she pretends to be respectable-when an

officer is in sight, or our good wives and daughters, with whom she now can mix intimately. In secret, she venerealizes and demoralizes those about her. She is less conspicuous, yes, but we must know that the harm she does (in the dark) is greater by far than when she operated in the

open.

It was the great novelist Balzac who said, "The prostitute is an institution if she a necessity". But there is no question about it, for none know better than do his own countrymen.

We who have gray matter enough to consider the matter at all, and who also are not afraid to say what we think, are ready to admit that every normal man is born with a dormant sex-desire which he gratifies in later years-if not in wedlock, then outside of wedlock. That makes the prostitute a necessity or "a necessary evil", if you wish to put it that way, since economic conditions allow only 60 per cent of our males to marry, while convention forces those who do marry to wait long after the sex-desire begins to assert itself.

Now, if you will grant that prostitution is "a necessary evil", then you must also grant that we are obliged either to tolerate it, with restrictions, or to license it, under regulation. Most people are willing to concede to the former; in any event, ready to say that supervision (police and medical) is easier and more effective when vice is segregated than when it is scattered.

Are We a Nation of Prudes?

In this country will be found the greatest collection of prudes in the world. In no other country are there people who can so successfully affect innocence and virtue as here. Yet, while we pretend to be the most moral people, we are really about the most immoral. The morality we possess is all on the surface, and it is mighty thin, at that. Just puncture our surface morality (very easily done), and you will be horrified to see a cesspool of vice and licentiousness such as you never imagined could exist anywhere.

My own residence is in what is considered a first-class neighborhood. Superficially, everything is "according to Hoyle'. The visitor within our gates sees none of the familiar earmarks of vice. He sees no saloons. He sees no gambling rooms. He sees no brothels. Our diversions

seem to be limited to the moving-picture shows, the soda-fountains, and such like. But, as a matter of fact, this neighborhood is steeped in immorality-full of kept women-secret prostitutes-recreant husbands-faithless wives-sexperverts. There is gambling in the homes, participated in by women as well as by men; there

The report of the bureau of social hygiene of New York has just been published. It is a staggering report. It shows that the city is viceridden from top to bottom. Now, vice was supposedly wiped out" of that city several years ago. Verily it is to laugh! The truth comes out now, and we are told New York is worse than ever. In one borough alone are 15,000 prostitutes of the labeled brand. How many unlabled, the Lord only knows. The principal streets abound with girls soliciting-they stop you every few paces. The hotels and cafes are breeding-places of vice. And disorderly brothels are doing business under the guise of tobaccoshops, boarding houses and delicatessen stores. This Dilly-Dallying Must Stop.

No, this dallying of ours is costing us too much. It is time we stop it. It may go against the national grain, but we must soon acknowledge that the prostitute is an institution and that we must deal with her as such. She will be with us till one of two things happens: Till marriage becomes universal and people marry earlier in life than at present; or till a new morality displaces the old, which will condemn sex relationship outside of wedlock.

The very fact that municipalities are disinclined to protect their citizens makes it all the more imperative that the young should be informed how they may protect themselves. "Yet, so curious are the workings of the ordinary mind that vociferous protest is heard against measures designed to prevent the development of disease, after a pure or an impure act. But, if it is allowable to give mercury for the cure of syphilis, once it has declared itself, why should it be wrong to apply a prophylactic ointment immediately after such an act, to prevent disease?'' A certain prude who had read my book said to me recently:

"I think it is wrong to tell people how to escape syphilis. This disease is one of the wages of sin imposed by the Lord upon the wicked, the fear of which constrains the good to be good.”

Then I proceeded to convince him, if possible, that the fear of contracting disease kept very few, if any, normal males from gratifying the sex-desire. Also, I reminded him of the thou