Where are these men to be found? In almost every community, but especially in our great cities, where location is more favorable for the man to get into the drift and float along under the shadow of medical culture, from which he draws the false conclusion, that he is a part of the great progressive army of cultured medical men. A great city is not the seat of general culture, although it must, and always will be, the seat of high medical culture, because of the advantages for medical progress therein to be found. But on the other hand, the most sublime specimens of repose in medical intellectuality are within the same confines. It remains for the medical man in the smaller cities, where true American life prevails, to attain the highest grade of true culture. Here entire self-reliance imparts a mental stability, which rounds out the intellectual integrity necessary for a man to rank among the cultured. Our great cities are the seats of industry, and of commerce, but they never can or will be the seats of culture. By culture is meant the highest attainments in intellectual life which give to man that sovereignty of mind, wherein all wisdom and.all good abide. The physician in the large city is isolated from the cultured class, he has less in common with them, more than in the smaller cities. It is true elite society attains its most perfect evolution where wealth abides, but the most cultivated social coterie is in the smaller cities, and especially the "college towns." One of the most widely travelled and best known women of the French Republic, Madam Blanc, after a year's tour of the United States, during which time she visited all of the great cities, and came in contact with the best people of these cities, said upon her return to France, that the city showing the greatest culture anywhere in America, was Galesburg, Ill., a city of about 15,000 inhabitants-"a college town." When you find such an atmosphere of culture, you will always find the medical man is a part of it. Such a community invites medical culture, and say what you will, there is more of it in proportion to the number of the inhabitants in such a community than you will find in any large city. The medical man in such a community must be a cultured man to hold his own with his neighbors, his friends and his patrons. But aside from this natural demand is the satisfaction of living in such an atmosphere, of being a part of it, it makes the scholar, it makes the physician, and gives dignity and honor to true medical culture. F. P. N. YOUNG men before entering one of the principal medical schools of this country are examined as to their general knowledge. One of the questions given to the candidates for one of these schools last year was: "What are the names of the books of the Bible?" Of one hundred and twenty answers, only five were correct. Among the names of books given were: "Philistines," "Marcus Aurelius" and "Epistle to the Filipinos." -February Ladies' Home Journal. IN THAT sprightly, queer little "periodical of protest," called The Philistine, there appears this month a pitiable, illogical little reply to Mark Twain's The Peculiar recent Cosmopolitan article on the "Christian Science Fad and Delusion." Either the reasoning faculties of Philistine have become badly twisted, or else he is not sincere in what he says. He seems to lean to christian science. In the broad humor of Mark Twain there is clearly more sound sense than in the protesting seriousness of the whole of Philistine's article. Unlike Mark Twain, Philistine is full of mean sarcasm, vindictiveness and scarcely-concealed anger. Philistine says, "It is a well-known fact among all intelligent people, that christian scientists especially taboo eye glasses of every sort and kind." Clearly Philistine knows less about christian scientists than does Mark Twain, whom he impertinently declares has never "associated with" or known them. The writer will be glad to introduce Philistine at any time to some of his friends, christian scientists, who wear glasses. Philistine says he has seen people grievously ill "who were claimed. back into health and usefulness when they renounced all material medicine and gave themselves into the hands of christian science." Very probably ! There is a large class of people, well known to physicians, who swallow a lot of needless medicine, when there is nothing the matter with them. Medi-cine taking, like christian science, may become a fad with some irrational neurotics and ignorant hysterics. But Philistine intends to convey the idea that these people were diseased physically, and by christian science have been made whole again physically. At once we assert, that neither Philistine himself, nor even the quondam patient is competent to decide such a question. Apparent cures are not real cures, any more than relief from pain by a hypodermic injection of morphine is a cure. Only one who knows the nature of the disease, the means employed to modify it, and the nature of that modification, is at all competent to decide whether the patient has been cured or not. Philistine, and christian scientists generally, are presumptuous and egotistical in asserting facts about which they know absolute y nothing, not even the slightest elements. Philistine grieves that Mark Twain does not appreciate more the lofty moral and religious teaching of Mrs. Eddy and her cult, and in consequence he devotes nearly all he has to say to a commendation of christian science as a religion. There Philistine, like all christian scientists, reveals the wabbling condition of his reasoning faculties. The dispute is not with christian science as a religion, or a system of morals, or a simple belief; the dispute with it is solely on the ground of its capability to handle physical changes, known as organic disease, in our physical bodies. An easy way to dodge and escape this hard thrust is of course to deny the physical body, and that is the cowardly way that christian science escapes. All discussion, of course, ceases the moment one or the other side denies the reality of its opponent. That is magnificent strategy, but it is not fair, honest, logical, reasonable, scientific or christian. Science loves to discuss and compare, and Christ hesitated not to reason together with his oppo nents. Philistine caps the climax in his queer, hysterical little protest when he naively asks us to "imagine what the reputation of Jesus would have been had he lived to be eighty, and been pensioned by the estate of Joseph of Arimathea, and then finally died in a home for superannuated ministers ? ' In the name of the Divine Savior, could blasphemy go farther! The Christ, the Son of God, whom the christian scientists so devoutly believe in, falling into "babbling senility," as Philistine clearly intimates Mrs. Eddy is falling into! He says Mrs. Eddy will now be written down in history as a "quasi fakir, and Olio will bracket her with Ann Lee, Francis Schlatter and John Smith of Nauvoo." "Already," he says, "she has lived too long." Perhaps he is right about Mrs. Eddy, but to think it possible that the divine, loving Savior of mankind could ever live too long! Clearly Philistine is one of those who would have cried out, "crucify him, crucify him, both for his own and christianity's sake. He may live too long, and become a burden to his friends and a charge upon the charitable." And that said of Christ! Well may christian science pray to be delivered from the hands of its friends, and well does it begin to appear that it is even less christian than it is scientific. L. H. M. ALL treatment is based on diagnosis. It is, therefore, of the first importance that we recognize consumption before we can hope to effectively direct Home Treatment of treatment. The advantages of an early diagnosis of consumption are obvious. And when we consider that tuberculosis, in its varied forms, is the one disease universally distributed among civilized races; the one disease which directly or indirectly affects civilized man beyond our comprehension, it is imperative that we do all in our power to make an early diagnosis, that thus being forewarned we may become armed to meet its invasion. Tuberculosis may go unrecognized. The beginnings of the disease not infrequently run the whole gamut of disease before the correct diagnosis is made. This should not be, for while we are all liable to err, yet if we practice eternal vigilance in our observations of a case, we should, with the aid of the newer methods of diagnosis arrive at an early decision. To begin, we must go to the first principles, and learn that a patient cannot be afflicted with tuberculosis in any form without first being infected with the bacillus tuberculosis. We all have opportunities enough to become infected, but thank fortune, our tissues present resistance sufficient under normal conditions to prevent the harboring of the parasite. The soil not being suitable the seed does not grow. But let a lessened resistance occur, as for instance, following or accompanying an attack of la grippe, typhoid fever, or other debilitating conditions, and the soil is then cultivated and ready for the seed. Then infection may occur. We must, therefore, in considering diagnosis, consider, first, etiological conditions-diathesis, while we know that comparatively few cases are inherited, yet we know, truly, that a predisposition runs in families, on account of the feeble resistance offered to the invasion of the tubercle bacillus. Next consider that every case of a chronic nature, obscure in origin, should be put under suspicion as being tuberculosis. Enlarged glands, pathological conditions of the lymphoid tissues of the throat, the bronchial glands, also the pleural membrane and the peritoneum should be watched carefully. All digestive disorders should be observed, for many cases of dyspepsia are tubercular cases first shown in this manner. Again, many cases of nervous dyspepsia, and diagnosed neurasthenia, are cases of tuberculosis. The temperature should be observed, especially in cases where we have accelerated pulse, a history of an old pleurisy and a mild bronchial catarrh. A pulmonary hemorrhage ushered in without warning or previous intimation is usually tubercular, and should be so regarded. To clinch the diagnosis, however, in all cases, we need the confirming knowledge of the presence of tubercle bacilli. When found in serum, blood, pus, or the secretion from any gland or mucous membrane, then we are certain of our diagnosis. Again, the positive diagnosis by the use of tuberculin is invaluable in obscure cases. I say positive, because in nine cases out of ten the reaction indicates the presence of tuberculosis. Tuberculin is an invaluable agent in diagnosis, for, as Whittaker well says, "it enables us to distinguish the disease at the start, before the development of sepsis and other complications which go to make up the composite picture we call phthisis." The test is of especial value just at the time when it is most needed; that is, when we can hope to direct treatment with a view of being able to overcome the disease. We all remember the able work done by the State Veterinarians of Illinois, and the tests made among the herds of the State institutions, with a view of eradicating tuberculosis. The results justified the expense, and encourage us to use this agent in diagnosis in cases occurring in our practice. Now, granting the diagnosis has been made, in incipient cases, what is to be the treatment, when it is impossible for the patient to take advantage of a more suitable climate? Unquestionably, the treatment of tuberculosis is one of nutrition, we must nourish the patient, and to this end his hygienic surroundings must be arranged for this. He must go into training and improve his resistance, build up his body, and prepare to fight a good fight. Osler, in a paper before the Medical and Chirurgical Faculty of Maryland (Maryland Med. Jour.) said in speaking of Home Treatment of Consump-. tion, "Of the measures by which the general nutrition of the body may be encouraged and improved, the first and most important is fresh air." He insists upon fresh air, and gives the following directions to his patients, to insure that they get it: "Take the almanac and count the hours of sunshine. In winter cut off two hours in the morning and an hour in the evening, and for the rest of the day the patient is to be out of doors. If there is no possible arrangement for life out of doors, the patient is to be in a room with southern exposure with the windows wide open. The bed is to be moved into the sunshine. If there is a balcony or a veranda with a good outlook towards the south, it should be arranged for the patient; if not, a sheltered protection can be put up in the yard at a very moderate cost, on a well padded lounge, covered with a couple of thick blankets, well wrapped up, the patient sits or reclines all day, coming in only to attend to the want of nature. Only on blustering, stormy or very rainy days is the patient to remain in the house. No degree of cold is a contraindication. This continuous open air life, at rest, is the most powerful influence we have against the fever of tuberculosis. It may take a month; it may take two or three months before the temperature reaches normal, but it has been one of the many valuable lessons we have learned from Tradeau, that in the fever of consumption the patient should not only be out of doors, but at rest, taking no exercise. The bedroom should be ventilated, and the patient gradually accustomed to sleep with the window open." Knopf in his recent valuable book, "Prophylaxis and Treatment of Pulmonary Tuberculosis," enlarges upon this advice, and conclusively shows the value of open air treatment, as pursued in sanataria especially designed for such cases. In addition to open air, we must insist upon good food, which is Osler's second measure of importance. Over-feeding is the rule, but methods vary with the patient, likewise the food. Ely, of Rochester, and also Osler, commend eggs as a suitable diet. Ely uses raw eggs, and prescribes them by the dozen. Osler begins with one raw egg, three times a day, increasing gradually until as many as two dozen a day have been prescribed. They are broken into an egg cup, sprinkled with salt and pepper, and swallowed without breaking the yolk. I like the malt foods with cod liver oil, hypophosphites and creosote. I have used maltine with creosote lately with success, giving it with increasing doses, until large doses are taken, every four hours. I frequently employ the liquid peptonoids (Arlington Chemical Co.) as a vehicle for creosote, and recently in the case of a child a year old-a victim of broncho-pneumonia form of tuberculosis, I gave as much as fifteen drops of beechwood creosote in the peptonoids every four hours, and it was retained nicely. I believe in using creosote in full doses I use butter, cream and cocoa-butter locally to give additional fat. To con trol the cough I have lately prescribed heroin with success, but we must be careful in its use for it is deceptive. F. P. N. AT A recent meeting of the Fortnightly Press Company, it was unanimously voted to change the dates of publication of this magazine from the 1st and Change of 15th to the 10th and 25th of each month. We believe the best interests of both editor and reader will be subserved by this change; the subscriber receives his journal at a time when his mind is not preoccupied with his "accounts," and he has more leisure to devote to the study of current literature; the editors, for the same or similar reasons, hope to show improvement in the products of their pens. Subscribers not receiving their magazines promptly on dates mentioned, will confer a favor on us by reporting omissions or delays to this office. THE DECATUR (ILL.) MEDICAL SOCIETY is one of the flourishing active Societies of the State. It has recently been re-organized and has set a pace which will make it a useful organization in its locality, at the last meeting, January 25th, in Decatur, diphtheria was the subject for discussion, and our next number will contain a synopsis of the proceedings. |