is not an unusual school experience, and for some inexplicable reason, family doctors persist in signing these diabolical certificates. Doctors cannot be too careful. Certificates given under such circumstances do injury to the child and cause just but uncomplimentary comment upon the doctor from both parent and teacher, and often from the child, for all know they are given carelessly or unconscientiously. I have witnessed tearful exhibitions between parent and teacher when a mother has insisted that breathing and bending exercises were ruining her daughter's health, and that she had spoken to her doctor about it and he agreed with her. At the same time I have known that the girl was attending night dancing parties, dancing until out of breath, sitting in drafty places, and returning home late. Foolish mother, unfortunate daughter for having such a foolish mother, and both mother and daughter unfortunate in having such a fool-ish doctor!

It is clear the above methods do not satisfactorily solve the problem. Where then may the public turn to find relief? Naturally to the medical profession. The physician is supposed to be prepared to answer all questions and give any information regarding health and disease. He should be, can be, and must be prepared. A few physicians have made themselves proficient, but most of us are densely ignorant of the facts which pertain to the preservation of health. The fault is not wholly ours. We have devoted our time and energies to the sick and let the well care for themselves. Our medical schools have not until very recently given these subjects much prominence, and our literature is limited. Soon there will be less reason for complaint, for universities are now teaching more thoroughly these subjects and introducing experimental stations; cities are erecting laboratories, and individuals donating funds for carrying on this work. In the meantime, however, we should not fail to appreciate the public's position and our duty.

Some universities have compulsory gymnasium training during the first two years of their course. The Y. M. C. A. and clubs have introduced physical culture to advantage. State boards of health are publishing bulletins-Michigan has what it calls a teachers' bulletin. The Board of Health of this state has done what it can with the meager funds at its command. Local

boards of health are endeavoring to accomplish the desired results. All of these are most commendable, and the outcome cannot but be beneficial. They, however, are not sufficiently far reaching to meet the demand. After universities have established chairs, medical schools introduced departments, boards of health eradicated political mismanagement and elected competent specialists, and public schools introduced laboratories and trained teachers, still there will be left for the intelligent, conscientious, untiring, and faithful doctor a field larger than all else collectively. After our municipaities, universities, colleges, clubs, societies, and public schools have reached their utmost limit, to the doctor will fall the greater part of the work, and upon him must be placed the burden of responsibility. He and he alone can reach the families, to him will the people listen and through him the masses be made to realize the weightiness of this work.

Sickness is important from the economic standpoint. Not only does it undermine the constitution and produce suffering, starvation and death, but it is economic waste-waste to the individual and family and corporation, to city and state and nation, and to the commerce and industry of the world. Of equal positive vastness and importance is the economic value of health. Health means wealth and happiness. Preserving health is taking a stitch in time-it is an ounce of prevention. It should be our chief thought. Not sufficient is it for us to cure or even to remove causes of sickness. We must go back of that. We must make man invulnerably healthy.

The all important point is that the physician himself must know what is required. With him rests failure or success. The farmer analyzes the soil, the horticulturist tests the ground, the florist examines the dirt, they tell and understand methods for keeping it healthy. They are taught this in school and college. Not so with the physician. He makes no study of the well-he is taught little of this in school. There is no standard of health. In all this there must be a revolution. The normal man must be known, not alone by the specialist, but by every physician. When the physician understands the causes of health he is prepared to impart knowledge and success will crown his efforts; but if unprepared, only failure can be expected. Never more appropriate than now was the adage, “Physician heal thyself.”

UNCERTAIN THERAPEUTICS.*

By J. M. BLAINE, M.D.,

Denver, Colorado.

How often have we heard the leading men in our profession boast of the rapid progress that has been made in Medical and Surgical science during recent years. No retiring president of a medical society has considered his essay complete, unless he has made reference to the giant strides that have been made in recent years.

We are disposed to boast that the closing years of the Nineteenth century were record-breakers, when compared with the centuries that preceded them.

I do not doubt that the last twenty-five years of the past century saw more advances in surgery and some lines of medicine than the other eighteen hundred and seventy-five years since the Christian era, all combined.

While this is true of surgery and certain lines of medicine, there are other lines in which we have not only not progressed, but have actually retrogressed. I refer to Therapeutics, and in the few minutes allowed for the reading of this paper I will attempt to call your attention to a few of the more common retrograde movements that have been forced on my notice during the past years in which other lines were progressing.

Our pharmaceutical houses deserve great credit for the manner in which they have furnished us with pure preparations from standard drugs, and in some instances with more palatable combinations, but the physician who depends on a pharmaceutical house to furnish him with his Materia Medica will sooner or later find that he has been chasing the will-o'-the-wisp and experimenting at the expense of his patient, for the profit of the aforesaid manufacturer.

The medical profession stands with open-mouthed wonder while reading testimonials from ministers and congressmen, who have felt the rejuvenating effects of the alcohol contained in Peruna and Paine's Celery Compound, but what can we say of the doctors who lend their names (for a consideration) to the manufacturers of a secret preparation, the formula of which is not

* Read before the Colorado State Medical Society, Pueblo, June 24-26, 1902.

given, the name of which does not indicate its component parts or its therapy, and the action of which is as uncertain as either.

I have frequently been called in consultation in dermatological cases where the physician has been using a certain readymade ointment, the formula of which is known only to the manufacturer, and the action of which is known to no one.

By looking up the literature furnished at regular intervals, I find, according to the doctors who make a business of certifying to everything that comes out, that it is a sure cure for every eruption from tinea favus to pruritus ani, every disorganized condition of the skin from schlerema neonatorum to elephantiasis. What kind of results can one expect if he does not study the pathological condition and know the action of the drugs prescribed?

On one occasion I was asked to have a gentleman in consultation on a case of dermatitis exfoliativa, and he suggested fumigating the patient with burning wool and then anointing him with a secret preparation-the name of which, if reversed, would spell lotion.

I saw a prescription recently for an ointment which contained eight different ingredients, and another for a hair tonic which contained sixteen. In the latter prescription the last ingredient was aquae rosae, q. s. ft., one pint, and when the druggist mixed the first fifteen ingredients, there was no room in the bottle for the rose-water, and the question arose, was the prescription properly filled? The matter was finally compromised by putting in one drop of rose-water. The question still remained -as to whether there were fifteen separate indications which the physician hoped to meet, or was he shooting at random, hoping that one of the drugs might hit the case?

The story of the physician who kept a bottle of “all sorts" for patients whose disease could not be diagnosticated, was probably founded on fact.

Another instance of uncertain therapeutics, or the unscientific application of remedies, is the so-called "therapeutic test" in cases of suspected syphilis. This test, although mentioned in our text books, is worth about one cent on the dollar on a dull market. I had intended enumerating all the diseases for which mercury was recommended in our text books on Materia Medica, but the list is too long.

It is said by Keys, that there is no pathological lesion of the skin that syphilis will not imitate, and as there are many skin diseases in which mercury is useful, it becomes patent to every right-thinking man that the therapeutic test is anything but scientific.

The physician who trusts to the therapeutic test to make his diagnosis in suspicious eruptions not only casts a blight on many fair names and wrecks many matrimonial ships, but in the language of the immortal Dogberry, "he writes himself an ass."

The man who cannot diagnose syphilis, with its many signs and land-marks, had better call professional assistance, or leave the case alone. When he seeks aid from drugs to make his diagnosis, he reminds me of that oft-told tale of the embryonic son of Hippocrates who threw the child into "fits" so as to bring it within the range of his therapeutic armamentarium.

Since the discovery of the gonococcus neisser, the mad rush has been to find a germicide that will cause its destruction. Remedies that will accomplish this object in the laboratory have been tried clinically and in many cases with a total disregard as to their action on the inflamed urethral mucous membrane. The injection of a germicide that is not at the same time a soothing astringent is unscientific and in many instances will increase the area of inflammation and widen the field of operation for the gonoccus.

Treating gonorrhoea with a strong germicide is equivalent to forcibly ejecting a skunk from a drawing room. It is better in either case to use peaceful methods than physical strength.

In order to thoroughly cover this subject, I might and probably should, go over the entire field of medicine, but I deem it sufficient to limit my remarks to the work with which I am familiar and to the instances which have fallen under my observation.

I hope I have made my meaning plain.

I have attempted to bring out but two points:

First-Human life and health are too sacred to be lightly handled, and no physician is ever justified in prescribing for a disease unless he understands its pathology, or has exhausted all possible means of studying it; and