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every one of us must be on his guard against the flaws of character and the mistakes in action that may entail trouble to others as well as to himself. Somewhere in America there is a farmer who must have seen those first tell-tale blisters on the feet of his cow, or calf. Had he used his eyes, millions of dollars would have been saved, thousands of valuable animals preserved from destruction. Thoroughness is the price which must be paid for the preservation of this complex civilization of ours. Carelessness means destruction. Irresponsibility or immorality lends to the evitable debacle.

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LEGISLATIVE MEDDLING.

No one questions the necessity for proper laws to govern the manufacture and sale of medicinal preparations. The National Pure Food and Drugs Act was unquestionably a step in the right direction. Unfortunately, the very success of this measure has encouraged numerous self-appointed reformers to frame all kinds of freak laws affecting the manufacture of medicines and foods. Some of these laws have been passed; more of them have been killed as a result of the strenuous efforts of the considerable number of sensible people who still remain on earth. However, the constant threat of more legislation, especially state legislation, is disturbing to the business interests of this country, not so much because the laws themselves are capable of doing harm as through their lack of uniformity. The manufacturer who is making a product which he expects to be sold in every state in the union, cannot view with equanimity the prospect of having to have a dozen different labels for his product, or being compelled to conform to forty-seven different varieties of rules in putting it on the market.

A well-known pharmaceutical manufacturer has recently sent out the following timely statement, under the title "Whither Are We Drifting." This is so much to the point that we reproduce it herewith:

"Amidst a maze of laws and rulings, with snares and traps set by too sensation loving officials, wander the reputable manufacturers of today, whose products are susceptible to pure food and drug legislation.

"Though they may employ a corps of experts to show them the lawful path, and proceed with the most honest of intentions to follow that path, in this chaos they cannot avoid coming afoul of some statute somewhere. Then on goes a fine, and good will and reputation, priceless assets, go reeling through the columns of the sensational press.

"One state will pass a law that a package shall be labeled in a certain manner. In order to secure uniformity the manufacturer adopts this style for all states. Then he discovers that his style is illegal in another state, and is hailed into court. No wonder that the high cost of living becomes more burdensome because every manufacturer must pass on the cost of producing special packages for each state and the hundred and one other expenses to the ultimate consumer.

"True it is, that food and drug legislation was needed, but not such drastic laws and rulings as we now have. But even these could be borne if only every state had laws which would be uniform with the other states.

"Druggists of America-whither are we drifting? In a few weeks the state legislatures will be meeting, and unless quick action is taken there will be a flood of pure food and drug laws that will play havoc with the trade. Shall we continue to drift, or shall we try to stem the current?"

With this statement we believe that physicians as well as druggists are generally in accord. What we need in America is not more laws, but simpler laws-laws which go direct to the point and are not so elaborate in preparation and so difficult in enforcement as to injure legitimate and proper enterprises. What the business men of this country need at the present time more than anything else perhaps, is the sympathy and co-operation of the Government. Germany's interest in her country's industries is worthy of some emulation in America. Business men are now struggling under great difficulties. It is no time to load upon them still heavier burdens. Our advice to law-makers at the present time, is-"Go slow!"

ORAL AMEBIASIS AND SYSTEMIC
DISEASE.

Last month we called attention editorially to some of the revolutionary work which is now being done in determining the etiology of and finding satisfactory treatment for pyorrhea alveolaris. Inasmuch as this disease is said to be the most common affecting man, with the single exception of dental caries, it is evident that a very great step has been made in banishing human ills if Barrett has really found a remedy which will cure it. At present writing it looks as though he had found the key to the cure.

Another step has been made in a similar direction by Smith, Middleton, and Barrett, who in a late number of the Journal of the American Medical Association announce the discovery of the same organism, the Entamoeba buccalis, in the crypts of enlarged tonsils. While the ameba

was found in only five out of seventeen cases examined, the subsequent demonstration that patients suffering from chronic or subacute arthritis frequently suffer also from amebic tonsilitis (if we may coin that term), and are sometimes relieved or cured of the joint affection by treatment with emetine, after the salicylates and other classic remedies have failed, certainly opens up a fascinating field for laboratory and clinical investigation.

We have long known that both pyorrhea and tonsilitis are connected in some mysterious way with the etiology of arthritis and other systemic diseases the anemias, degenerative visceral diseases, and the digestive disturbances among them. If the "thing" that causes the pyorrhea or tonsilitis is an ameba, then it is a fair inference that destruction of that ameba not only will cure the local disease, but also prevent and (in early stages) cure the more remote ailment.

Inasmuch as emetine is so slightly toxic that it can be used with perfect safety and without distress to the patient, there is no reason why the general practitioner, in country as well as city, should not actively enter this promising field. WE VE VE

"PATENTS" AND DOCTORS. Some months ago the lightnings of Dearborn Avenue were aimed at our bald and inoffensive cranium because we presumed to make the statement that the sale and use of "patent" or proprietary medicines was holding its own in this country. We even had the temerity to quote statistics-think of it!

At the risk of suffering a fate even more terrible than that meted out to us in days gone by we shall presume to quote from the address of Mr. Carl J. Balliett, before a meeting of advertising clubs recently held in Detroit, the statement that during the last twelve years "the amount of prepared medicines produced in the United States increased from $100,000,000 to $160,000,000." Mr. Balliett also made the significant statement that "these $160,000,000, if divided among the physicians of the United States would net each doctor $2,000 annually." While Mr. Balliett's arithmetic does not give us confidence in the infallibility of his statements, he certainly has provided us with some food for thought.

The undoubted truth is that the character of the proprietary medicine business in this country is changing. The rank nostrums-the frauds and fakes of other days-are going out and a better class of household remedies is taking their place. These are being sold over the counter by druggists in simply enormous quantities. With

out entering into a discussion of the ethics of the matter we simply tell what we believe to be the truth.

Now why? It is foolish to make sweeping denunciations of the whole class of household medicines. It is equally absurd to try to legislate them all out of existence, en masse. Here they are and the people buy them. There must be some reason, possibly a good one. Isn't it better to go beneath the surface and determine, if we can, just whose the fault may be-if fault there be. The honest truth is that we can use the $2,000 that is supposed to be our share, and want to know how to get it!

In our humble opinion the principal reason why proprietary medicines sell so readily is because the medical profession has made no adequate provision for the treatment of the slight ailments which make up an overwhelming proportion of human ill-health. The fees charged by the doctor are prohibitive to tens and hundreds of thousands of people. The household remedy that promises them relief at small expense appeals to the purse-and judicious advertising and the repeat habit does the rest. That's all there is to it.

When the powers that be-on Dearborn Avenue or elsewhere-devise some simple method of giving people universal medical attention at prices that appeal to depleted purses, the millions now spent for patents will flow, in part at least, into the coffers of the medical profession. For a further exposition of this argument we respectfully refer you to any soap-box socialist orator.

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A TWENTIETH ANNIVERSARY. How many of you know that it was just twenty years ago this month that the first dose of diphtheria antitoxin was brought to Chicago? Thus the first substantial beginning in biologic therapy was made in 1894. True, Koch had already placed his tuberculin on the market (in 1891), and this had been vaunted as a "cure" for tuberculosis. Unfortunately, it fell far short of the claims made for it, and for a time the outlook for remedies of this general class seemed anything but satisfactory. But the brilliant results obtained with antitoxin converted the whole medical world-for a time, at least-to therapeutic optimism.

Since 1894 serum therapy and vaccine therapy have made tremendous strides, not, however, as great as many anticipated twenty years ago. At that time our biologists dreamed of the speedy conquest of all the infectious diseases. Alas! most of them are still unconquered. We seem

as far as ever from the discovery of specifics for tuberculosis or cancer. Yet improved methods of treating tetanus, cholera, typhoid fever, and other serious diseases have been found, and our research men are pressing forward with as ardent a spirit as ever. If we have uncovered comparatively few real "cures" in the last two decades we have at least discovered many new facts, and some tremendously significent principles. One discovery like diphtheria antitoxin is worth a half a century of unceasing effort-and with the tools we now possess there is no reason why we should not solve many a problem of life and death in the next few years. Who can tell what the next twenty years shall bring forth? And how many of us will be here to see?

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"BREED BEFORE YOU DIE." Discussing the possibility of war with France, in his now-celebrated book, General von Bernhardi said: "It would be a war to the knife with France, one which would, if victorious, annihilate once for all the French position as a Great Power. If France, with her falling birth-rate, determines on such a war, it is at the risk of losing her place in the first rank of European nations, and sinking into permanent political subserviance. Those are the stakes."

The encouragement of rapid human reproduction rests upon a purely sordid and immoral basis. The only powerful reason for urging men and women to beget many children is that the nation may be stronger than its neighbors stronger because it has more soldiers. It can then sacrifice more of its people and still survive. There is no intimation that reproduction run riot is going to be better for the people themselves. Indeed, we all know that exactly the opposite is true, for when a family has many mouths to feed and little to feed them with, some one must go hungry. So long as the country has uncultivated land and undeveloped resources sufficient for all, the overflow can be taken care of; but Europe today has no such surplus.

Looking at this matter from the standpoint of the people themselves, this constant effort to breed men for destruction, either in war or in commerce, can have no moral justification. Were war abolished, no one would advocate it.

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EDITORIAL NOTES.

Red-Cross Christmas Seals.-Have you secured a supply? Remember that all the money derived from the sale of these seals will be used to carry on the great fight against tuberculosis. They can be procured at stores, news-stands, banks

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The Schick Test for Immunity to Diphtheria. -Elsewhere in this number we are reproducing an editorial from the Boston Medical and Surgical Journal which gives some interesting information regarding the Schick test, which is now being used successfully by the New York Board of Health to determine whether or not persons exposed to diphtheria possess natural immunity. If they are naturally immune, then it is folly to give them the usual prophylactic injections of antitoxin. That this is important is made clear by the discovery that about half the children between five and fifteen are immune to the disease. The Schick test gives the information desired; and it is simple, easily made, free from injury or distress to the patient, and apparently it can be relied upon. Every physician should be familiar with it.

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Successful Treatment of Bichloride Poisoning. -Some months ago, Dr. Thos. A. Carter of Chicago read a paper before the Chicago Medical Society, in which he proposed as an antidote for poisoning with bichloride tablets the use of sodium phosphite. This was shown to be a chemical antidote for the mercury salts. A clinical trial in a number of cases convinced Doctor Carter that the remedy was an effective one. not all his patients recovered, the majority of them did, including some cases in which the condition seemed so desperate as to offer little hope. We have learned that Doctor Carter has had further experience with this treatment, and that his results have generally been very satisfactory indeed. If the sodium phosphite will do what is claimed for it, it should be available in every drugstore for emergency use. Certainly anything which promises to save the lives of individuals who have swallowed this deadly poison, should be where it can be used immediately whenever such necessity arises.

With the Coming of Spring.-The war is terrible. Yet it promises to become more terrible, for, added to the losses of life, the suffering of the wounded, distress to troops caused by exposure to cold, and the starvation of the homeless and jobless, we shall soon have to consider methods of fighting the great plagues. If these are to come at all they will probably make their ad

vent next spring. Already cholera has appeared Already cholera has appeared in Galicia, Turkey, Russia, and the Balkans. When the snow melts, and the rivers carry the accumulations of the camps down toward the sea the cholera vibrio will almost certainly make its appearance in every part of the continent. That the European nations realize the danger is apparent, since we already hear that troops in eastern Europe are receiving prophylactic cholera vaccination. That this may be effective is shown by the results obtained in the Greek army during the Balkan war. While some cases of cholera appeared in this army, the number attacked was small indeed as compared with the number of Bulgarian soldiers who suffered. But think of the task involved in vaccinating all Europe against cholera-for the women and children must be protected as well as the soldiers. Truly the burden laid upon the world by this war is a titanic one.

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Alcohol and Its Evil Influence.-One of the most significant features of the meeting of the Alienists and Neurologists of the United States in Chicago in July last, was the passage of a series of resolutions in which alcoholism was described as a cause of a large proportion of the cases of insanity. As the Long Island Medical Journal says, "While physicians may be divided in their estimate of the degree of toxic power exerted by alcohol, they are as one in condemning its habitual use, and should be ready to subscribe to the proposition that at best its use does little good except as an occasional stimulant, and that the economic waste resulting from the purchase of alcoholic beverages should at least be kept within bounds by restrictive legislation."

It is no longer the fashion to defend the use of alcohol. At the last election, four states, Arizona, Colorado, Oregon and Washington, passed over into the prohibition column, and Virginia voted for prohibition only two or three months ago. Russia, which has been considered one of the most degraded countries in the world, from the standpoint of the use of alsohol, has at last definitely prohibited the sale of spirits. While the Czar's ukase was a war measure, there is much likelihood that it may be made permanent. Only the other day, in the British House of Commons the question was raised as to the desirability of prohibiting the sale of alcoholic drinks in Great Britain during the war.

These "straws" show the direction in which the wind is blowing. The world is beginning to realize that there is little to be said in favor of the use of alcoholic beverages as compared to its disadvantages and dangers. This certainly is another evidence of the moral awakening of the

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A New Pellagra Hypothesis. Of making hypotheses with regard to the etiology of pellagra, there is no end. We have had the spoiled-corn hypothesis and the simulium hypothesis, the rancid-oil hypothesis, the direct infection hypothesis, and the auto-toxemia hypothesis, and only a bibliographer can tell how many more. None of them seemed to fully satisfy the profession. The latest one, however, proposed by Goldberger, of the Public Health Service, is so simple that it has much to commend it to the attention of the profession. In recent numbers of Public Health Reports, he expresses the opinion that the disease is due to malnutrition, and that deficiency of proteins is the primary cause. He came to this opinion after a careful study of the cases of pellagra occurring in insane asylums and other charitable institutions in the south. He uncovered the interesting fact, that while hundreds of cases of the disease have appeared among the inmates of these institutions, there is not a single report of an employe being attacked. The inference is that some difference in environment must be responsible for the difference in the existence of the disease. That difference he demonstrates to his satisfaction to be in the character of the food. The insane are poorly fed and poorly nourished. It is difficult to persuade them to eat such protein foods as meat, eggs, milk, and the like. Considerable evidence is submitted in support of his position, and it seems to rest upon quite a strong foundation. If he is right, then the treatment of pellagra, at least during its early stages, is a very simple thing. All that will be necessary will be to reduce the proportionate amount of carbohy drates, including the corn products, sirup, molasses and cereals generally, while increasing the proportion of fresh meat, eggs, milk, and the legumes.

We have heard the statement made that pellagrins who have been sent north for care and study, and placed under improved hygienic and dietetic conditions, have confounded and astounded their keepers by recovering promptly. Perhaps the reason is that given by Doctor Goldberger. At any rate, he has presented a hypothesis which is so simple that it can be tried out anywhere.

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THE DOCTOR'S DEVELOPMENT.

By GEORE F. BUTLER, M. D., Chicago, Illinois.

IF THERE be a history of the growth and development of any of the "learned" professions, any chapter more curious and vividly interesting than that of the medical professions in the United States, it would be hard to designate its conditions, and place, and time. The story of the general practitioner in America is a story of arduous effort, often under almost desperate conditions, and one, from the beginning, having in it the elements of adventure, sometimes of romance and not infrequently of danger. It is the personal history of strong and earnest men following one after another in paths first most difficult to perceive and, later, to pursue to the best advantage with the best results, but never abandoned until they broadened into the highways open today.

The career of the doctor in the early days of Jamestown or the Plymouth Colony may be imagined somewhat easily. He followed the same course, diagnosed, in a general way, the same diseases, and prescribed the same medicines that he did in England. Possibly an occasional pilgrim or early Virginian had more of his blood let than really was good for him. But the doctor was as the other colonists: he endured the same hardships and lived the same life with the same degree of fortitude as did they. The time had not yet come when he must go out and encounter vicissitudes to which the ordinary man was not subjected. The Indians were not his trusting patients.

After a while, however, there came a mighty change, and the pioneer doctor had his birth. His was a new and grimly demanding heritage, and he who would accept it must be a full man. He He appeared as he was needed. It was in the blood. The settlers were widely scattered; paths there were none or poor ones at best, but everywhere to those who were in need of him the new and the original manner of the doctor somehow found his way. He appeared always with the pioneers as they forced their hewing way through the forests and over the mountains and westward, until they had overrun the Mississippi Valley. Very learned in his profession he may not at all times have been, all the advantages of life had not been his; but many of life's mysteries he had learned,

he was an earnest student of the means at hand, while most rarely he possessed such knowledge, including that acquired from schools and books, as could give him rank with any town practitioner of his time. But, first of all, he was a man of hardihood.

Even the generation of today remembers well the backwoods doctor, him of the saddlebags. Ten, twenty, thirty miles he would come through the wood roads or by rougher ways, if need be, in answer to his almost always urgent calls; for the settler did not summon a doctor on account of any trivial ailment. Night and day as well as the varied pathways were very much alike to him, as he saw his duty; and he saw it rigorously, for the settlers necessarily leaned on each other strongly. To tramp in the forest through the snow of winter, to hear, perhaps, the wild cry of a panther lurking in the woods besides him or an adventure much more serious to be treed by some wandering and all too hungry pack of wolves, these were some of the experiences of the early doctor. And it is not recorded that he ever put them down in his bill! He accepted the situation, appreciating more thoroughly the time when, eventually, what were at least apologies for roads became more general and he could travel on horseback, provided, of course, that he could afford a horse. The burden of the saddlebags, when one had to carry his medicines with him, was in itself a thing to be considered. And, a man on horseback had a dignity.

And what calls were his! The term "general practitioner" was weak as applied to this doctor of our pioneer days. Jackson might have broken his leg by a fall from the roof when shingling his log barn; Mrs. Mason, Spartan wife of Spartan pioneer though she might be, could possibly endure no longer the agony of an ulcerated tooth; or the malaria-smitten family of the Raffertys might be out of fever-medicine. "General practitioner!" The old-time doctor counted such a title but a prefix. Surgeon, dentist, and apothecary was he, as well. That to his duties was not always added the supervision of every increase to the population was attributable only to the fact that the exigencies of the times had developed in almost very neighborhood some warlock dame who presided at such function and who was credited by the children already in existence with the

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