mysteries why this procedure has won so little favor in civil life.

While prophylactic vaccination gives almost complete immunity, its employment should be no excuse for carelessness on the part of the sanitarian. Greater care was never taken in our army than is now in the disposal of excreta and the protection and preservation of food. We know that flies convey the infection; therefore all food should be protected against contact with insects. In military camps all excreta are now burned. Only in our cities do we still permit this dangerous waste to be poured into lakes and streams. The time is not far distant when such a disposal of sewerage will be absolutely prohibited among civilized people. But meanwhile, a fairly efficacious remedy has been found for the treatment of contaminated water in calcium hypochlorite, which in very weak dilution--as low as one part in twenty-five millions- -seems to be effective in destroying the bacilli of the colon group. Many cities are now employing this chemical disinfectant with alleged good results.

These problems of prevention, whether through the control of the carrier, the vaccination of the individual, the improvement in the water and food supplies, or the chemical disinfection of the water, are discussed elsewhere in this number of the Medical Standard, in our Round Table department. This is a problem of vital interest, and as such we trust will be carefully considered by every reader of this journal.

SHALL THE OLD DOCTOR BE DISBARRED? We learn from the newspapers that Dr. W. O. Thompson, president of the Ohio State University, in his address to the graduating class of the medical department of that school, declared that a professional man who has made no progress in his education during the first five years out of college should be disbarred from further practice.

This statement is in line with that made by Dr. John B. Murphy, a year or more ago, that every doctor should be re-examined every five years and if he failed to make good his license taken away.

Suggestions like these sound well in public addresses. They are sensational, and for that reason get into the public prints. It would perhaps be presumptious to suggest that they are made for this very reason; yet we really can not believe that either Doctor Thompson or Doctor Murphy expected to be taken seriously.

Of course there are many men practicing medicine who ought to be doing something else.

Everybody knows that at least every layman. But is is also true that not a few of these professional incompetents could pass a very acceptable theoretical medical examination, often acquitting himself better than his own versatile and successful brother. Tests of this kind are of value in keeping unqualified men out of the profession; but after they are once in it there is no "examination" which so generally shows the practitioner's worthiness or unworthiness as his ability to win the confidence of his patients-in other words, his ability to "get along."

Would it not be an edifying state of things for every doctor to be compelled to "plug up" for a state examination every five years? What a multiplication of "preparatory" schools-of special quizzes--there would be as a result of the change! Men who had time to prepare for these examinations would surely "pass"; while the poor devils who were too busy curing people of summer diarrhea or winter colds, and who might as a consequence be rusty on the latest theories in immunity or with regard to the new triumphs of pathological research, would be very likely to be plucked. Fact is, that a doctor who actually practices his profession and fails to add something to his store of useful knowledge every day will soon be completely out of the running. No examination will be needed to eliminate himthat will be taken care of by the unerring law of the survival of the fittest.

Let us devote any time we may have to spare from our own particular business for the reforming of other people to training the young man who is still aspiring only to be a medicthe man who looks longingly over into our fold but is not yet in. He is our legitimate meat. When he is through his course he can pass examinations which not one in five hundred of us would dare to go up against. Perhaps that is a good reason for keeping him from breaking in; he may prove a dangerous competitor! But who of us will admit that he is a better man than we are?

ANOTHER WHACK AT SALVARSAN.

It never rains but it pours! The enemies of Ehrlich's much-vaunted specific for syphilis have been gaining ground and showing new courage since the Los Angeles catastrophe, and following the attacks on Professor Ehrlich in his own city of Frankfort, where a suit for libel is pending against a newspaper publisher who asserted wholesale deaths from salvarsan poisoning in the city hospital, following the use of "606" on

According to Gaucher the reappearance of the lesions after the giving of salvarsan is not due to reinfection but is really a lighting up of the disease; also, the cures of early cases are not cures at all, but just mistakes of diagnosis; while, the numerous cases of syphilitic meningitis now being reported are not syphilis at all but just arsenical poisoning!

This caustic critique may be only an evidence of Gallic irritation to a Teutonic achievementyet there may be something more in it. It is said that certain Germans have petitioned their government to prohibit the sale or use of this drug. For the present, however, we need take neither side too seriously. Salvarsan has an established place in therapy. Its value is attested by too many men to be denied. Yet it must be used with caution by physicians who understand it. That much we may all wisely admit.

REVIVAL OF INTRA-VENOUS MEDICATION.

In times past, three considerations have conspired to prevent the general adoption of this method of medication, namely, (1) the risks attending the technique of the method, (2) the untoward effects frequently following the introduction of medicinal substances into the blood stream, and (3) the uncertainty concerning the chemico-physiologic fate of the substances thus introduced. All of these considerations have helped in the past to discredit the intravenous route, until the practice was no doubt very wisely-temporarily abandoned.

It is interesting to note that there now seems to be a disposition among therapeutists to revive the method in the case of certain appropriate kinds of medication, and modified, of course, by modern scientific knowledge and technique. this we are but following the course pursued by

In

modern medical science toward several former theories and practices which were abandoned in the progress of exact medicine as being too risky or too uncertain, or opposed to our new concepts of disease and treatment, but which. with the advent of still further knowledge, have been

revived and utilized in a definite, rational and effective fashion.

Certainly in the present day not one of the considerations cited above is any longer valid against intravenous medication. Asepsis and surgical skill have made of the technique of such infusions matter for a June holiday in the hands of the most unsophisticated practitioner, and have reduced the operative risk to a vanishing point. The science of hematology has made us familiar with the susceptibilities and the capacities of the biood. And a fuller knowledge of physiological chemistry and metabolism enables us to follow, with reasonable accuracy, the life-cycle of almost every known medicinal substance in its course through the viae naturae.

Let us elaborate a little. In the matter of technique, it is a simple procedure to open a superficial vein; and Nature makes an equally simple job of repairing the slight puncture needed to inject a few cubic centimeters of fluid. Modern mechanics has put into our hands an almost perfect syringe with which to make the puncture with the minimum of laceration, and to inject the fluid without the introduction of air. In the present state of our knowledge about asepsis, and our facilities for carrying it out, the most moderate care will preclude the possibility of infection. The whole procedure is easy, quick, all but painless, and free from risk. Certainly, technique can no longer stand in the way of intravenous medication.

As to the effect of the foreign substance in the blood-stream, in the light of modern knowledge this matter is almost as simple, at least in its end-aspects. While the science of hematology has been, and is yet, somewhat of an intricate one, its results, as far as they have gone, are clean-cut enough. While there is still a large field of unexplored ground, yet there is a fairly extensive group of medicinal substances that have been plainly and definitely labeled in regard to their hemolytic properties, and so long as we confine ourselves to this group we run no risk of upsetting the hematic balance.

And finally, in respect of the chemico-physiologic disposition of the drugs which we inject, our knowledge, although equally limited, is equally clean-cut so far as it goes, and enables us to All pick our way with reasonable assurance. of the substances which we are of late proposing to introduce by the intravenous route have been given by mouth from time immemorial, so that the only new question in physiological chemistry that the intravenous method raises is whether, by skipping the digestive tract and the portal sys

tem. these substances lose any good qualities or acquire any evil ones. Our knowledge of this gastro-hepatic circuit assures us that, with the possible exception of certain mild acido-alkaline relations, there is nothing in its chemistry or its physiology to influence drug action one way or the other; and of course no one is going to put hurtful acids directly into the blood. Indeed, so far as this particular consideration is concerned, anything that can be legitimately introduced by the hypodermic method, or by rectal enema, can with equal impunity be given intravenously.

It seems clear, then, that the old objections to intravenous medication no longer hold water. Neither practitioner nor patient need hesitate to employ or to submit to the method on this score. The only real question to consider is whether the intravenous route has any positive advantages over the prima via; and if so, in what instances. We do not advocate-we think no one advocates -the adoption of the intravenous method for all medication that can be given that way. As stated, the revival of the mode is subject to the modification and discrimination of modern science. But, as a general proposition, it may be said that there is always a marked advantage in introducing medication, as directly, as promptly, and as economically as possible to the tissue or organ which it is destined to influence. Hence the medicines to which this mode of administration is most adapted are those which are intended to act directly upon the blood. For them the intravenous route is, par excellence, the mode of administration.

惺惺

EDITORIAL NOTES.

"Excessive Exertion After Fifty."-The following quotation from the Army and Navy Register, relative to the death of a well-known army officer, carries a message and a warning, which doctors may well note, and which it is their duty to pass along to patients who have passed their physical zenith. The Major was apparently in splendid health. "Being a natural athlete and very fond of outdoor exercise, he kept himself in fine physical condition. Every morning early before going to his office he rode ten miles on horseback. In the late afternoons he played golf or tennis, frequently both. Neither he nor anyone else had the remotest idea he had heart disease. There was not the slightest warning.

"The morning of his death he arose in fine spirits, happily anticipating the return of his family for Christmas. With his mounted orderly behind him he rode through the post, stopping in his pleasant way to laugh and joke with various

officers and accepting an informal dinner invitation from the post surgeon and his wife. Five minutes later, when near the corral, he suddenly collapsed as if he had been shot, fell forward on his horse's neck. The autopsy revealed direct sclerosis of the coronary arteries of the heart-athlete's heart. None of the injuries received from the fall were sufficient to have caused death. His faithfulness to exercise killed him."

A Mistake in Sex.-We have just received a letter from Dr. Ellice McDonald, of New York City, in which he says: "While I appreciate the extent and completeness of the abstract and the way in which the essential parts of my article are quoted, I wish to say to you that you have made a mistake in my sex. In these days of feminism and militantism, I regret to say that the nearest I can come to being a woman is to be the father of one, and I wish you would take opportunity to correct this."

Of course, we are glad to correct this We wrote Dr. McDonald that we could only explain our mistake by the resemblance in sound of the words Ellice and Alice. We should have known better, of course. Dr. McDonald is too eminent a figure in the gynecologic field to be the object of errors like this.

Protection Against Typhoid Fever. Of course the ideal method of securing protection is to vaccinate. Last year the ninety thousand men in the United States Army were protected in this way, and of the entire number only three contracted the disease, and of these, two came down within five days after enlistment. Yes, vaccination is sure, safe, and simple. We cannot understand why any one should object to it. But if you have a patient who does protest, and who is likely to be exposed to infection, whether on his summer vacation or at home, let him sterilize his drinking water with chloride of lime. This is the method proposed by Doctor Evans in the Chicago Tribune:

"Take a level teaspoonful of chloride of lime and rub it up, until there are no lumps, in a teacup of water. Dilute this with three cupfuls of water, and keep this stock solution in a stoppered bottle for use. A teaspoonful of this stock solution, added to a two-gallon pail of water and well stirred up, will destroy all typhoid or other dysentery-producing bacilli in ten minutes, and will make the water safe to drink. If this quantity makes the water taste, use a little less, otherwise not. Get the chloride of lime in metallic cases."

Following are a few simple remedies which may well be added to the preceding. Something will be needed for diarrhea, colic, and ordinary abdominal pains. A few chlorodyne tablets will fill the bill, and in case of emergency can be used for any form of pain. It is also well to carry a few laxative pills, the aloin, strychnine and belladonna, or the anticonstipation pills or tablets being most generally useful. For headaches and to control high temperature, provide a acetanilid combination tablets. Tincture of iodine is the best antiseptic-put it in a glassstoppered bottle. Carry some good dusting pow der-borated or salicylated talcum, also a good ointment, like unguentine, for burns or abrasions; and if you are going into a snake country a little permanganate of potash to apply to or inject into the wound. Many other things may be added, but don't make the outfit too bulky.

Public Comfort Stations. We call special attention to a brief article quoted from the Journal of the American Medical Association, which we print elsewhere in this number. It is a study of conditions in New York, as regards provision for the sanitary needs of the individual. The condition is even less satisfactory in Chicago than it is in New York. Here, the individual requiring toilet facilities has no place where he can go except a saloon, hotel, or department store. At night the stores are closed, so that his choice of a place is cut down to the two former. A poorly dressed person is not welcome in good hotels, so that the "poor man's club," the saloon,

principally exercises this public function. Too often it is crowded and unsanitary, and there is always the suspicion that it may be a focus for the spread of venereal disease. When the state and municipality are doing so much for the public welfare how does it happen that this very useful institution, the "public comfort station,” is neglected? Its service might very readily be broadened, so as to provide facilities for baths, resting places for persons slightly ill, and "dispensary' service, for dressing minor wounds and giving relief in minor ailments and emergencies.

Is There a Conspiracy Against the Small College?-Dean Henry C. Tinkham, of the Medical School of the University of Vermont, answers this question with an uncompromising "Yes!" In a public address he made the following remarks, which ought to be pondered over by those interested in medical liberty:

"I am very much inclined to believe that there is a conspiracy, and I say it advisedly after much thought that there is a conspiracy on the part of several organizations and on the part of schools, to put the smaller medical schools out of business. It stands to reason that if the smaller colleges close, the students will have to go to Columbia, Yale, New York colleges or elsewhere. Dartmouth has gone through this same experience, and the octopus has practically experience, and squeezed out the existence of the Hanover Medical School in the past two years. I believe that this organization, the fundamental principle of which is the Carnegie Foundation, is trying to put the University of Vermont out of business. When they release stories to the Sunday papers of New York, and, as I have learned, Springfield and other cities, and furnish them with identical texts and identical cuts, there must be something behind it. When they sent out the cuts of the University of Vermont, they sent a picture of the old medical building, now used as a lodging house, and the worst building connected with the University. They felt they ought to have two buildings and they choose the next smallest, a good one and a new one, but small-the agricultural building. I should like to know what noble mind-spirit must have inspired somebody to send out these cuts when we have such good buildings as you know there are on the campus." VE VE VE

If the babies have diarrhea, try giving them the Bulgarian bacillus in tablet form. These are perfectly harmless and very effective, and make complete stopping of milk diet unnecessary in most cases.

F

OR JESUS, the Jew, I have the profoundest respect, particularly for the virile manhood displayed in his denunciation of hypocrisy, lying, Pharasaical self-righteousness, and deceit. Of the psychosexual perversions, by which religious traditions, under the guise of "the teachings of the Holy Bible," are today being expressed, with its disastrous influence upon human life, happiness, sanity and the home, and into which our American youth are being systematically trained, I will speak at the close of this series.

That the church too often does not deserve the respect of truthloving, honest, and fairminded people the overwhelming majority of physicians frankly acknowledge. That many physicians have lacked the manhood to shake off the debasing influence of theological hypocrisy, I know from my own personal experience. So long as they can participate in the spoils that come from allying themselves with the vested in terests, they are willing to co-operate with any kind of scheme by which the people are exploited, regardless of human life, happiness and sanity.

One of these "church doctors" said to me in confidence: "You are right. You have the line of professional work that is bound to predominate in the future of the practice of medicine. Science, human welfare, and practical therapeutic results attest the worth of the evolutionary principles that you so steadfastly defend, but I can make a living better by passive acquiescence to the church, since I am too old to train my patrons to conform to the new regime."

A thousand times would I prefer to shoulder a pick and shovel and laboriously toil for my daily bread rather than be false to the highest dictates of conscience, honor, professional duty and citizenship.

Fifty years ago, our American government decided that slavery must go; that to exploit human life and liberty was wrong. At the point of our bayonets and amidst the shell and shot and roar of musket and cannon, we gave freedom to a down-trodden race.

Some of us were brought up among these un

fortunate children of fate, and learned to look with compassion upon them in their efforts to adapt themselves to the new order, as the result of the Emancipation Proclamation. We accepted the decree of government after a fierce and bitter conflict, since slave traffic had the consent and protection of the laws of our country.

We now face a reversed situation. Slavery in another form, more despotic and tyrannous is holding millions of our fellow citizens, men, women and children, in its grasp; the many are exploited by the few; church and capital are exercising a despotic tyranny over our free educational institutions by taking advantage of those whose lack of educational qualifications forbid them the power to extricate themselves.

In the words of the immortal Helen Kellar, whose life has been wounded and whose spirit has been deprived the pleasure of gazing upon our beautiful world of flowers, fruit and sunshine, "Let us banish from our schools dead histories, dead languages, dead philosophies. Let us learn about the things that are near to usthat concern our daily life; the cause of slums and social disease, sex hygiene and other truths in which lie the safety of our bodies and minds. Philanthropy is good; everything that ameliorates hard conditions helps; but the thing that really counts is light."

Unborn children at the middle and at the end of the twentieth century are calling us to manhood. Shall we refuse to answer their call?

The great need of the world today is men and women who will give the starving children of this age bread, instead of feeding them on stones; those who will speak out and tell the truth as the more enlightened people see it, so that the coming generations can be qualified to live useful, efficient, healthful lives; those who will not be intimidated by the obstacles set in our path of progress by the traditions of barbarism and ignorance, which is still exercising such a life-stifling influence upon our present civilization.

With all of the light that has been thrown upon heredity and eugenics by recent scientific investigators, one is surprised to note, when he refers to his own actual observations, how small