erish people, immune to hysteria, the jerks or the madness of crowds. Get among the best of people when, in your own case, you see signs of sanity and convalescence.

"Yes, this obscure road of mine, almost too frowsy to admit the passage of a Ford, much less of an automobile, bends thrice to the left and he who follows it in proper mood will walk through a land where mother used to live and a good many mothers I wit, and he will breathe deeply to take in the fragrance of purity and the sweetness of modesty. Yes, it will come about that if you travel my way and do not closely watch your shadow, you will insensibly turn your back upon the crowd of fanatics on the pike, and, long before sunset, you will come home again and sit down in your own house to think it over.

"I hope that I am charitable. Although I am going back I think well of my good friends who have gone up the pike. They exhort overmuch on one theme, unfit for the contemplation of children, and they write books for the general reader that must necessarily be unclean, and it is as sure as sunrise and sunset that they do all this with the best intentions, but they shock me beyond all power of telling; they discuss private matters in public, and that is the worst sort of indecent exposure; they particularly offend me by shaking the tree of the knowledge of good and evil when there are young and, as yet, unspoiled people present. Charity will not stay my steps. I am going back with the wholesome tingle of shame on my cheeks for that I have come so far. "You are travelling with an earnest company. Let us say that in charity. There are the volunteer instructors who have no capacity for rampant sexuality and who had no knowledge of sexual follies and crimes until a recent date when advised to read a slobbery book or two about what I ought to tell my little boy or what every girl should know. Upon that they took fire, old maids of both sexes, preachers, teachers and all. What a craze it was and is! Housekeepers slighted their work that they might do something for the youth of our tribe; they made speed to the schoolhouse to instruct the children, one sex at a time, in mysterious meetings after school, and the poor little initiates went home sheepishly, filled full of new and definite knowledge of masturbation, normal procreation, the universal call to fornication, the tangoes of the scarlet woman of Babylon and the venereal possibilities of drummers and married men about the age of forty.

even the medical students, the theologs of all degrees of immaturity, the sisters from the Sunday schools, willing for some diversion from the exposition of the parables and miracles, and all willing to be coaxed to take up the new 'work.' Most of these are worthy people but among them are evangelists and others who vociferate because they need the money, like our secretary of state, and boast of their absolute frankness and under pretense of that virtue, use terms that ought to cause their immediate arrest.

"And that's my very strongest reason for going back. I hate filth with a complete hatred. Yes, I remember that I was once compelled to have some dealings with a vault-cleaner. I found him in the profound, almost embalmed among deodorants, his sons assisting on the dizzy verge above. It was the hour for lunch as some reckon time, and the young men had quenched their thirst and had lowered the beer-bucket to the father with a certain remnant of fluid in it. They had also tossed him three pretzels which he caught very adroitly. After we had spoken the prologue, he came to himself and broke out, 'My Gott, Doc, I never sought I should forget my manners so. You must a bin hungry, eh? It's a shame, dat's what it iss, anyway. De suds iss all drunk, aber here is a pretzel yet.' Upon that he tossed me the last twisted tortuosity out of his soiled hand-nightsoiled, in fact and, for manner's sake. I was obliged to catch it and dispose of it in a private place. Fellows and sisters, that's the way they hand out the bread of life in this decade, and I have been wondering when the parents and the doctors of medicine will insist on cleaner hands and better surroundings.

"Good form, alone, ought to deter good people from this hideous botch of giving the children discourses in a field of knowledge where there should prevail a decent reticence until there is manifest the need of reproof and instruction to fit an individual case, but, alas, the passing fashion demands all this as applied to masses of children who, for all that appears to the contrary, are as pure and virginal as snow that falls in the night. The blundering instructor is in a way to arouse in his pupils some inchoate memories that belong to the race. The little creature collates these scraps of freshened intuition with this or that whispered bit of conversation he has heard with his sharp ears. And now he is stuffed full of crude dogma from the instructor; and he, of the rampant childish imagination, touches up all that he has heard until, the very truth, he has, as we often say, 'something to take home with him.' I am deadly sorry that any one, or any mob, should promote

this exploitation of young minds; if it comes in good time for one child in a roomful of thirty, it must inevitably come too early or too late for twenty-nine. It is not extravagant to say that it is not the characteristic act of a gentleman or a thoroughbred woman to tamper with the little Americans in this brutally reckless manner. Good usage, good sense, good physiology and good form cry out against it. In a group of a century of volunteer teachers I can not believe that we can find one that is fit to lay hands upon the delicate mental machinery of the growing child, scarce awakened to the knowledge of sex, nor one competent to meddle with the fine evolution whereby nature slowly, gently and discreetly arouses the individual to the perpetuation of the race. It is a matter for growth, not for human tinkering.

"How have we inverted the order of nature! Everywhere, from lowliest plant to man at the pinnacle of the mighty show, we find function after function appearing and then, in proper order and in due intensity we begin to perceive the appearance of regulative and inhibitory apparatus, daintily self-regulative through vascular and nervous influences and the juices of organs which we only begin to comprehend. And we psychological butchers fancy that our proficiency is so perfect that we dare run after the tender and reluctant wildings and poison them with our sexual dogmas and ill-timed suggestions. Perhaps there are those in the crowd of sexual enthusiasts going up the pike who should be canonized for the courage which animates them; yet to my later and clearer vision they appear sinners against the laws of infantile physiology, and that's my best reason for going back where I may not see your offenses.

"May the mighty gods help the little fellows and the little women! May Esculapius work his will upon you, with healing for your sorebruised minds!''

AFTER THE OPERATION.

Dr. William J. Robinson, the brilliant editor of the Crític and Guide, has been through an operation for appendicitis, and "lived to tell the tale." His description of the physical and mental agony before and after such an operation is the most vivid one we have ever seen, and the fact that it is written by a physician, who ordinarily takes an objective rather than a subjective view of diseases and suffering, gives it not only added interest, but also great practical value. We regret that we cannot reproduce the entire article. Let us begin with the stage following the disappearance of the anesthetic ac

tion. From this point we will let Dr. Robinson tell his own story:

"Yes, I felt fine. I congratulate myself on the ease with which I got over my trouble. But I was not over it yet. No, not yet. In about three hours I was a different individual. The effect of the morphine had practically passed off, and I awoke with a severe pain in the wound, discomfort from the drainage tube, and what was a real torture, distention of the bowels. And for the next three-four days this distention made my existence hell. It is an indescribable feeling. One must have it to fully appreciate it. So I thought at the time, I didn't care if it was a split infinitive. People with split abdomens do not mind split infinitives. The doctors and my nurses were not at all lazy and did everything within their knowledge and power to help me, but only with slight relief. They tried to console me by telling me that such distention was quite common, quite 'natural'; but I found no consolation in the fact that the patient in the next room had it much worse than I had. And I thought that the surgeons would do very well, if, instead of devising new operations, new techniques, or new instruments, they would devote a few months or a few years as long as necessary to intensive research, how quickly to alleviate, or still better, how to prevent post-operative paralytic intestinal distention. There must be a method-chemical or mechanical-of preventing the formation in or of removing the gas from the intestines. You will not convince me to the contrary.

"The second and third days after the operation were my very worst, for to the intestinal distention there became associated another disagreeable phenomenon: extreme arrythmia. More or less accidentally feeling my pulse on the second day. I noticed that it skipped; six-seven regular beats and then a skip. And having noticed that I could not refrain from feeling my pulse or my heart every few minutes; and gradually the condition became worse: it soon skipped every fifth, third and finally every second beat. And I did not like that. I knew that for centuries back my heredity was a clean one; I knew that my blood had not a trace of any alcoholic or syphilitic taint; that I was not weakened by excesses of any kind-I could not turn out such an amount of work if I were but my heart was always a little finicky, and resented any extra or sudden strain. And apparently the injection of the anesthesia and the shock in general were a little too much for it, and it began to shirk its work and skip beats. And I thought the possibility of my dying was not such a very remote one. And I didn't like that. I disliked it for myself, but still more did

I

I dislike it on account of two pathetic figures— Mrs. Robinson and Victor, who I feared were too helpless to be left alone in this cold, cruel world. felt consoled by the thought that I was leaving them and the other children comfortably provided for, but still I felt it was too soon to leave them. And then occasionally I also felt that perhaps my work was of some use to humanity. And that several thousand people would miss me. I was not very conceited on that point. When one is face to face with death, all conceit falls like a ripped garment from one's shoulders.

"For fifteen nights I suffered terribly: the nights seemed interminably long, and the sleep was fitful and disturbed by dreams and nightmares; on the sixteenth night I had my first normal, refreshing sleep. The various hypnotics that I was given only made conditions worse, and I soon refused to take any. My insomnia was due to a considerable extent to the constant noise outside of the hospital, and to this noise I must devote a special paragraph.

"From the moment I woke from the operation on September 29, to the day I left the hospital on October 17, the noise was Nemesis. It pursued me every hour of the day and night. It seemed as if all the noises of the city were concentrated in front of my room on Fifth Avenue. Milkwagons and trucks, brewery wagons and automobiles, bicycles and motorcycles, baby carriages, children on rollerskates and just loafers, peddlers' carts, organ-grinders and scissors-grinders, all combined in one steady, continuous noise which rendered the day hideous and the night a torture. Very, very often, when I would be just on the point of going off into a peaceful slumber, an auto would whiz by at a rate five times the legal one, the horrible cacophonous auto grunt would shatter my tympana, and then good-bye to sleep for several hours. I had to order the windows tightly closed-I feared I would go insane otherwise. Of course, the air would become stale and stifling, but I had to choose the lesser of the two evils. I do not know how much Mt. Sinai Hospital is worth -one million or ten millions; but whatever it is worth, it is worth fifty per cent less on account of its location. It is a horrible location for a hospital. I have no doubt that the noise has a deleterious, retarding effect on the patients' convalescence. I know it had on mine.

"If anybody thinks I am exaggerating, let him investigate, but investigate under the same conditions. Let a director or a surgeon have his abdomen slashed, and then let him spend a few days and nights in a room facing the street. The inside rooms that do not face the street are less noisy,

but more disagreeable in other ways: dark and gloomy.

"I do not believe that even the street noises are beyond the control of the hospital authorities. I am quite sure that if the hospitals made a united effort to have the city "hospital street" ordinance enforced they would be successful. As it is, it is an absolute dead letter. If they tried they could have even a stronger ordinance passed, especially so now, with the intelligent and broad minded city officials we have been having and are going to have for the next four years. Do it, gentlemen, for to a sick individual, with the nerves at almost snapping tension, every little noise is intensified a hundredfold. An insignificant noise unperceived by a healthy person becomes to a sick person a roaring thander, which shatters ears and brain, and drives to despair.

"To paraphrase Giordano Bruno, there is nothing absolutely good, nothing absolutely evil in this world. It is all a matter of proportion. There are few evils without some good in them. It was evil that I could not sleep, but then I could dream (and later on, read). And what did I not think, and what did I not dream! Thoughts, of course, of the world in general, of its origin and its problematical end, of the why, the wherefore and the whither, of life and death, of design and chance, of palavitalism and neovitalism, of the future of our nation and of other nations, of evolution and revolution, of the ultimate structure of society, of the goodness and nobility of human nature, also of human stupidity and ignorance, of the absurdity and cruelty of our social-economic system; and I thought of something nearer. I thought of the hundreds of patients in this hospital and in other hospitals, and I thought of their sufferings, of the heartaches and hopelessness of some, of the feelings of those who know that when after they get well, they have nowhere to lay their head, but have to go at once hunting a job; I thought of the feelings of the very ill in the charity wards; here I am in a fine room, with a fine view of Central Park, for which I pay one hundred and ten dollars a week, with two nurses constantly at my beck and nod, with many pleasant visitors, with an abundance of fresh flowers daily, with every delicacy that my palate or my caprice may demand, and still I suffer intensely, and feel wretched and miserable, and am burning with impatience to get the thing over. How must the patients in the free wards feel, who. know they are there on sufferance, who have no privacy, who have no bells within their reach, and

are attended at certain hours when the nurse or orderly thinks it is the proper time? Poor people!

"And I thought of the pitiful conditions of the better class of workingmen, the small business man, the struggling professional man, when they get sick. They do not want, they abhor charity. But it is expensive to be sick, if you want to pay for everything. The cost of the operation, fifty dollars a week for a room, and if private nurses are needed seventy-five to one hundred dollars a week-how can a poor, middle class man afford it? A serious illness in the family of a person of small means is a serious calamity, and occasionally makes itself felt for years to

come.

"And I thought further: I personally know of no serious operation performed wantonly, without actual necessity. But suppose the statement made by some that many operations are performed needlessly, for the sake of th fee, for the sake of experience or for the sake of a record, are true. What then? I thought of it with horror. To what low degree of criminal degeneracy must man fall to subject a human being to the ante-operative anxiety, to the shock of the anesthesia, to the post-operative vomiting and retching, to the pain of the wound, to the danger of infection, to the horrible paralytic distension of the bowels, to the nightmarey nights, to the fear of death-and all for some wretched lucre or rotten 'reputation.' I can conceive of no more damnable crime, of no more cowardly act of cruelty than to perform an operation when one is not unmistakably indicated, or at least justified.

"Oh, for a noble band of physicians and surgeons who would consider the case of every patient a really sacred trust, treating it in exactly the same way as they would want to be treated themselves, or as they would treat their mother, father, sister, bride, wife or child.

"This is the only correct criterion. The title of F. A. C. S. is not a sufficient guarantee.

me.

"There came the day when the dressing was to be removed. And were I to live to be a hundred years old I shall never forget the excruciating, indescribably agonizing pain, which the tearing out of the gauze from the wound caused I never thought that such pain could exist. It was worse than cutting with a knife, probably worse than the application of a red hot iron. It seemed as if every nerve in my body was laid bare and was torn and pulled apart. It was cruel, brutal, barbarous. I do not believe that anybody has a right to inflict such pain on any human being-(or animal for that

matter), or that the infliction of such pain is necessary. And when one thinks that such pain is inflicted a thousand times every day, one will see that the aggregate is quite appalling. I wonder if a surgeon who had that pleasant operation performed on himself, or who had a near relative faint from the shock of the procedure, is continuing the same way, or has adopted some different method. If there is no way of preventing the dressing from drying and sticking to the raw flesh, then the patient should be mildly anesthetized—a little nitrous oxide would be considered a great blessing. I speak for those who cannot speak for themselves, or do not speak because they think this pain is an unavoidable evil. I do not think that any atrocious pain is unavoidable. If there is no way to avoid it, then let us start finding out a way.

"I wonder if in speaking of my case, my doctors would say that I made an 'uneventful recovery'? Undoubtedly. Well, if this is an uneventful recovery, then what is one ""with events" like? When I read in the future of a patient's making an uneventful recovery, I will have my own opinion. Of course, a deathly depression and sickness all over, a drum-like distension of the bowels, a coating of the tongue and mouth which makes the most delicate food taste like absorbent cotton dipped in kerosene, a weakness which makes you as helpless as a one-day old puppy run over by an automobile, sleepless nights, converted into long nightmares, in which you are set upon and choked and dragged by gaunt death and you try to cry for help and cannot all these things are not 'events.' They are natural concomitants of an operation. And, therefore, the patient is reported as having made an uneventful recovery. 'Uneventful,' indeed."

THE MEDICAL TREATMENT OF HEM

ORRHAGE.

Just how great is the power of medicine to control internal hemorrhage? This is a question which seems hard to answer. With the rising tide of surgery there has been a lessening of faith in drugs to arrest the loss of blood following breaking of the continuity of a vessel. Where that vessel can be reached directly no one ever thinks of giving drugs. The hemorrhage is controlled by the ligature, by compression, by styptics perhaps (though these have rather gone out of fashion), and by elevation of the bleeding part, if this is possible. The patient must, of course, be kept absolutely still. Also, if the loss of blood is considerable, resort may be had to intravenous, subcutaneous or rectal injections of salt solution, or to transfusion of blood from an obliging donor.

However, when the blood comes from a point which cannot be reached, then other measures must be adopted. Under such conditions the surgeon generally confesses himself helpless and has viewed with a more or less skeptical air the efforts of the physician. Certain things, however, it is acknowledged can be done and must be done. Rest of the part and rest of the patient are admitted to be imperative. The administration of morphine for hemoptysis rests for its rationale mainly upon its power to quiet the patient, relieve his agitation, and keep him still. It does not lower blood pressure; indeed, it may slightly raise the blood pressure. Some form of derivation that is, the withdrawal of blood from the congested part through various expedients-is usually resorted to. This may be accomplished (1) by posture; (2) by applications of heat to the extremities; (3) by applications of cold over the congested area.

Are there medicinal remedies which aid in withdrawing the blood from the bleeding area? Some practitioners believe that there are, using for this purpose remedies which (1) reduce the general blood pressure, and (2) flush the skin

capillaries. If blood pressure is high, for instance, the use of remedies, like aconite, may be indicated-not, however, when the flow is excessive and the patient is rapidly being exsanginiated. To flush the skin atropine is a favorite remedy, and its use seems justified, both on theoretic and clinical grounds. Many physicians report excellent results from its use. However, the objection sometimes raised to its employment is its tendency to increase blood pressure.

Ergot was formerly much used in cases of hemorrhage of all kinds, but at present its application is generally restricted to uterine hemorrhage, and specifically to that following delivery and abortion. In hemorrhage from the lungs, for instance, it is no longer recommended, since it undoubtedly increases blood pressure and, therefore may do actual harm rather than good. Nevertheless, it is still referred to with commendation in some of the older text-books.

The internal use of styptic drugs for the relief of internal hemorrhages has practically been abandoned. These drugs have a useful local action, and may be of advantage in hemorrhages from the alimentary canal, but even in these cases they are of rather doubtful value.

One of the most striking of recent developments is the discovery by the French clinician, Flandin, that hypodermic injections of emetine hydrochloride have a marked and sometimes marvelous efficacy in cutting short hemoptysis. He was led to try this drug, first because he had used it with success in dysentery, and, second, because he recalled the well-known advocacy of ipecac as an anti-hemorrhagic by the old French clinician, Trousseau. The ipecac treatment has long since gone out of fashion, but that there is something to it the results obtained by Flandin and other French practitioners seems to testify. The drug has also been used in hemorrhages from various other sources, and the results have been encouraging, though not invariably satisfactory. Thus, another excellent remedy, the value of which depended exclusively upon clinical obser