it as the bismuth chalk, nutmeg and zinc R Sub-nitrate of bismuth......dr. iv Prepared chalk, of each....dr. ij M. Use "Shake" label. S.-One tea- Treatment Wanted. Editor Medical World:-I would like to submit the following case to the readers of the Medical World: Mr. B., age 44, married, German-American, and a farmer, of good habits. About six years ago Mr. B. had diarrhea, which continued several months, but was eventually relieved. Since that time he has, at intervals of a few days, griping pains in bowels, bloating, belching of gas, and may have a few evacuations from bowels, and then all symptoms subside. At intervals of from a few weeks to several months he has attacks of what seems to be cramp colic, coming on, may be, at night, patient awaking with pain in abdomen; pain is spasmodic and in different attacks may be located in different regions of abdomen or may be diffused over entire abdomen. The more severe attacks are accompanied by rise of temperature, which in severe attacks reaches 104 degrees Fahrenheit, in others, maybe, only 100 degrees Fahrenheit. These seizures last from a few hours to two weeks, when the patient recovers his usual health and is able to perform light work. Organs, except as mentioned above, are free from disease. Patient is never constipated and bowels move from one to two times a day; his appetite is good, but nutrition is poor and debility is quite marked. The man has become so embarrassed financially that he is not able to secure proper food. Several physicians have treated the case, but have given only temporary relief. If any of the readers can give me any assistance in the treatment of this case, I hope they will do so through the World. Subscriber. Editor Medical World:-Will some one please give directions for making a good simple syrup, in which the sugar will not crystallize and adhere to the bottle? The druggist and wife say they make a thick Ourselves as Citizens. It is interesting to note that among the issues upon which the recent English elections have been carried are the following: Poor law reform. Care of the industrious poor. Compensation to workingmen for every injury they receive. Improvement of the dwellings of the poor. Aid to workingmen in the purchase of their homes. This may be startling to some conservative minds in this country, yet it cannot fail to be gratifying to those who have studied social problems, to see that labor, the creator of wealth, is at last being granted some recognition. I wonder how much that remarkable book, "Merrie England," has had to do with this result. While we welcome every movement toward giving economic justice to the creators of wealth, yet we think some of the New Zealand plans mentioned last month are preferable to old age pensions. Plans that have for their object the giving of justice to the producer as he goes along, are better than robbing him while he works and pensioning him when he is superannuated. I have recently attended the School of Applied Ethics, held at that historic place, Plymouth, Mass. The economic department was filled this year by the more conservative teachers of political economy, chosen from the leading colleges and universities of this country. But it is my delight to say that in private conversation I found that the most conservative minds there favored such extensions of Government functions as Government Telegraph, Government Savings Banks, and ultimately Government Railroads; and in local matters, municipal water works, gas, electric light and street railroads. This is all that the most advanced reformer could ask at the present time. At the labor conference held there July 13th, a number of prominent leaders were present. It was very harmonious and a number of interesting points were brought cut. An important thing for all classes of reformers to realize is that it is worse than a waste of time to contend concerning names, theories or isms. If all should unite who favor Government Telegraph and Government Savings Banks, regardless of party or other affiliations, there would be no resisting such a host, which would include professors of economics, farmers, mechanics, and all classes interested in the general welfare. Why can't we do this? We are dreadfully behind the rest of the world in social and political progress and these *About a million copies of "Merrie England "have been sold in England in the past year, and it is now having a large sale in this country. Send ten cents to the Humboldt Pub. lishing Company, 64 Fifth Avenue, New York, N. Y., for a copy. It is a marvel of cheapn ss-241 pages. I have received documents showing the operation of the Postal Savings Banks, in Canada. They have been in operation there since 1868, and the deposits at the end of June, 1894, amounted to $25,257,868.14. In a conversation with Ex-Postmaster General Wanamaker a few months ago he roughly estimated that a Postal Savings Bank system in this country would bring $200,000,000. to the Treasury. The figures from Canada abundantly justify this estimate. But the strength to the Treasury is only a part of the good of such a system. Consider the benefit of placing absolute security for savings in the reach of every citizen in every part of the country; many would then save who do not save now; and every depositor would be a steadier and more patriotic citizen. Private monopoly and profit are not the only objections to a private telegraph system. Private control of the means of rapid transmission of intelligence is perhaps the greater objection. The abuses are easy and numerous. Newspapers that wish prompt service must not oppose the monopoly. Prices and politics are manipulated against the general welfare. Other countries have seen the importance of making the telegraph a part of the postal service. Why should we stay in the rear of the procession? Doctor, keep these facts before you: 9 per cent. of the population of this country own 71 per cent. of the wealth; we all know that the 9 per cent. of people did not create the 71 per cent. of wealth. On the other hand, 52 per cent. of the population own only 3 per cent. of the wealth; we all know that this 52 per cent, of people have created far more than the 3 per cent. of wealth that they are permitted to own. There is a middle class, far too small, between these extremes, that represents the normal condition of society. Now, the practical question is, what shall we do to lessen these extreme conditions? Perhaps nine tenths of the voters of this country will agree that one step toward this is to stop contributions to the telegraph monc poly-for the Government to either purchase existing telegraph lines at a fair valuation, or to establish lines of its cwn, and conduct the service for the public good. Every natural monopoly that is taken from private control and profit, and conducted at cost, like the postal service, for the public good, is a tep in the right direction. The medical profession is devoted to the betterment of mankind. Our civilization has thus far been from the standpoint of the dol. lar. Let us work toward the standpoint of the man. Let us cut off private profits upon natural monopolies, and put them at cost to the people so that no one gets a profit but every one gets the service. * At least nine-tenths of the voters of this country are agreed that Government Telegraph and Postal Savings Banks are in the direct line of progress. Why can't we have them? Do your best to shape the platform of your party. If you can't do that, examine the platforms of other parties, and when you find what you want, vote for it. We can never get what we want by voting year after year for what we don't want. Examine the question until you have convictions; then on election day have the courage of your convictions. I understand that one of the platforms of Kentucky favors an amendment to the National Constitution permitting an income tax. It should also favor a National graduated inheritance tax. Doctors must serve the masses. Hence our interests are in the direction of economic justice to the masses, and against speculation, manipulation and unnatural profits. The British people keep an expensive luxury, the royal family, all, like queen bees, fed by the workers numerous children, grand children, etc., each drawing an income from the government for his or her support We in this country don't have a royal family. We believe in all "families" supporting themselves by their own exertions. But we have a telegraph monopoly to which we contribute just about as much each year as it takes to support the British royal family, with all its branches, palaces, castles, etc. The British have gotten rid of their telegraph monopoly, and now they have a government telegraph, which is a part of their postal system, and operated not for profit, but at cost for the service of the people. They would not think of going back to the private monopoly plan. We would not think of having a royal family in this country, but we contribute the money just the same, to a family whose name begins with G.can you guess it? We don't contribute it in the form of annuities, as the British people do ; but as dividends on watered stock, exorbitant charges for telegrams, etc. The British royal family stays at home as a rule, and its members spend the money given them in their own country; but our "G." family hob nobs with aristocracy in foreign capitals, sails yacht races with royalty in foreign waters, and has recently established a branch in France; all on the money that we give them mainly through our telegraph service. We would be horrified at the idea of placing our postal system in the hands of private monoply and having to pay about ten cents instead of two for every letter, and have inferior service, and strikes by underpaid postal employees. Yet we complacently do this with our telegraph service—and have you forgotten that extensive telegraph operators' strike not many years ago which crippled all kinds of business so badly! C F. T. Current Medical Thought. The Theory and Practice of Protective The axiom that "the more accurately we know an enemy the more easy it is to overcome him," nowhere more adequately applies than in the prevention and treatment of disease. Since it has been conclusively shown that communicable diseases are caused by specific parasites, which elaborate within the body specific poisons called "toxines," causing the particular symptoms of the disease, it has become possible to study more accurately these causes of disease and devise better means by which the life of the parasites and the action of their toxines might be inhibited or altogether destroyed. The treatment of infectious disease has been greatly advanced, and, although some of these disorders are still in a stage of generalities, far-reaching changes have taken place in others. The system of antiseptic surgery discovered and applied by Lister, and the exact knowledge we now possess of the propagation and spread of cholera and typhoid fever by means of water, milk, and other articles of food, are cases in point. Scientific medicine, in contradistinction to empirical medicine, has acted on the more rational axiom that "he who cures may be the cleverer, but he who prevents disease is the safer physician," and has gradually unraveled the complex problems of the nature and cause of disease, and in many instances devised means of preventing communicable disease. In all civilized countries and among all civilized peoples the protective power of vaccination against smallpox has been amply confirmed and established. Two points are particularly worth considering: (a) Is vaccinia or cowpox a modified or attenuated form of human variola? or (b) is it a separate and specifically different disease? ogists and sanitarians agree with the origWith regard to the first point, most patholinal proposition enunciated by Jennernamely, that vaccinia or cowpox is a mild form of smallpox in the cow, and just as an individual who has passed through one attack of smallpox is furnished with resistance and immunity against a second attack, so also an individual who has been successfully vaccinated has practically passed through a mild attack of localized variola, and is, therefore, protected against a second attack. In some other infectious diseasesscarlet fever, measles, and whooping cough -one attack, however mild, furnishes, as a rule, immunity against a second attack. This is acquired immunity, as distinct and different from natural immunity as, for instance, the natural immunity of most young children against typhoid fever or cholera, and of any adult persons against measles. With regard to the second point, many pathologists, while recognizing the protective power of vaccinia against smallpox, do not admit that cowpox is an attenuated form of the human smallpox, but that it is a specifically different disease. This belief is based chiefly on the many failures which experimentalists have incurred in trying to produce cowpox in the cow by inoculation of this animal with human smallpox. However, there have been many positive results. In a few instances there has been produced in the cow, by inoculation of matter derived from the vesicles of human smallpox, typical cowpox which, on transmission to the human subject produced vaccinia and not variola, and on further transmission from human being to human being, continued to produce vaccinia in all its typical charac ters. The argument which maintains that vaccinia is of a specially different nature from human variola is faulty for two reasons. First, as a matter of actual experience, vaccination is now and then followed not simply by the production of a vaccine vesicle at the seat of insertion, but there appear other additional vesicles even of the character of a general eruption; this, though of rare occurrence, is, nevertheless, a strong argument for its derivation from variola. Secondly, the "breeding true" of vaccinia in the human subject, through however many transmissions, and the failure of a reversion into variola are completely paralleled by what takes place in a disease occurring in the sheep, and is in all respects, homologous to variola- namely, varicla ovina or sheeppox. Protective inoculation is used against this disease with large success in the south of France, Austria, and Germany. The lymph is "nursed" by local insertion through a succession of sheep, always producing a large local vesicle with mild constitutional symptoms. Such local inoculations have been practiced over and over again, and, as a general rule, only at the place of insertion does a vesicle become formed; there is no general eruption, and, therefore, no reversion to the original type. It is clear from this that lymph derived orig inally from a vesicle of true variola of the sheep "bred true"-i.e., produced on transmission from sheep to sheep only local protective vesicles. If, however, this lymph is injected into the vascular system of a sheep, true variola may be the result. From this it follows that the argument, because lymph derived from the cow and transmitted through human beings does not ultimately revert to variola, but produces a local vesicle only, in no way justifies the conclusion that the two diseases-variola and vaccinia-are specifically different. The conclusion to be drawn from this is that Jenner's original contention is established. Satisfactory results in protective inoculations on the same lines as those pursued by Pasteur in anthrax and fowl cholera, have been obtained in several-swine fever, swine erysipelas, etc.-but not in all infectious diseases. Unfortunately, in all infectious diseases one attack does not protect, although a first attack furnishes, for a time at least, a certain resistance; such is the case in diphtheria. In cases of acquired resistance or acquired immunity, a condition is produced by the first attack by which the body is rendered unfit for second attack. This sometimes happens after a mild first attack, but in other instances this only furnishes a slight resistance, and in still others no resistance. In these two latter cases the resistance can be increased by repetition of the mild attack and by using the second time a somewhat stronger virus, and producing a somewhat stronger effect, but still only a passing one; and after many repetitions in these cases the resistance thus acquired can gradually be increased to a high degree. It has always been shown, both for animals and for man, that the immunity produced by artificial inoculation of attenuated culture, or acquired in the natural manner by a first attack of the disease, is due to the presence in the blood of chemical substances produced in the course of the first attack; these substances are capable of neutralizing the activity of the specific microbes. Moreover, it was found by Behring that the injection of blood serum of an immunized animal was capable of protecting an otherwise susceptible animal and of furnishing it with immunity, so that infection with the microbes of the particular disease was prevented. The degree of this protective or immunizing power of the blood of an immunized animal stands in direct proportion to the degree of immunity or resistance which that animal has acquired by the previous injection or by the previous attack. That in diphtheria the blood of an immunized animal possesses an immunizing or protective property in other animals has been fully proved; but, at the same time, it must be added that the protection thus produced is only of comparatively short duration. In the experiments in which the immunizing and protective action of the blood serum of an animal artificially immunized against diphtheria or tetanus respectively was ascertained another important fact was elucidated by Behring, and afterward confirmed by a large number of workers, viz., that the serum not only possessed protective potency when injected into an otherwise susceptible animal, but that if injected into an animal in which the disease had already made its appearance, the disease could be cut short and the animal would recover. The serum, therefore, acted as a curative agent. Such serum has been applied in diphtheria by Behring and Roux, and in tetanus by Tizzoni and Centanni, with striking success in the human subject; and the published accounts of the cases so treated in Germany, Austria, France, Italy and England place it beyond doubt that in a large percentage of cases the disease (diphtheria) was cut short, and even in severe cases recovery achieved. A question of great scientific interest is the manner in which the serum of animals immunized against diphtheria or tetanus acquired its protective and curative potency. Looked at from a theoretical point of view, this double action might be due to either of two things: (a) The serum might contain one substance which had both these actions, or (b) it might contain two different substances, one for each separate action. The whole subject is only at the commencement of being understood, but this much is already certain, that the work has been productive of good results and is likely to be productive of greater results in the field of protective as well as curative practice.-E. Klein in The Lancet. Recent Developments in Surgery. Mr. Pearce Gould, in his oration at the recent Conversazione of the Medical Society of London, gives some striking deducticns in regard to the recent improvements in surgical theory and practice. We quote from his remarks, as given by the correspondent of the Medical Record: 1. The removal of the formerly admitted anatomical restrictions upon surgical operations, sometimes spoken of as the extension of surgery into new regions. Up to a very recent day surgeons have only removed bone, and carefuly abstained from mterierence with the brain. Trephining is now only an incident in an operation directed to treatment of the membranes of the brain. So our immediate predecessors operated timidly, if at all, upon the posterior part of the vertebral column. Of the surgery of the thorax the same holds true. Now, not only the pleura, but the lung itself is freely operated upon, and the chief bar to further pulmonary surgery is the difficulty of precise diagnosis and localization of lung diseases. The pericardium is aspirated or drained without hesitation, and the suggestion has been made not only to tap the heart itself, but to treat wounds of its muscular substance by careful suture. The mediastinum, too, is now within the pale of legitimate surgery. of legitimate surgery. No single organ in the great cavity of the abdomen is now held to be beyond the reach of the surgeon's knife. The removal of huge abdominal tumors is a commonplace event, and surgical methods extend to all the abdominal viscera. Until quite recently surgeons recognized that many organs and parts of the body lay beyond the limits of legitimate surgical interference, and admitted it to be no reproach to their art to refuse to interfere with the peritoneum, the kidney, the lung, or the brain. A surgical operation was thought to be its very nature lethal; certain tissues and organs were held to be of such anatomical delicacy that to submit them to operation was to court disaster. To-day we know that simple, well-executed surgical procedures are not in themselves pathogenic, and that every tissue and organ of the body is the seat of a power of repair more than equal to the demand surgery makes. With this knowledge the anatomical barrier in the progress of surgery vanished, and from an anatomical standpoint the only bar to the feasibility of an operation is its mechanical impossibility. But a surgeon is not free to incise anywhere and to excise anything. The very removal of anatomical restrictions upon the activity of surgeons has brought into relief the physiological restraints upon their art. The |