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JUST AMONG FRIENDS

A DEPARTMENT OF GOOD MEDICINE AND GOOD CHEER FOR THE WAYFARING DOCTOR Conducted by GEORGE F. BUTLER, A. M., M. D.

AMBER has told us of society-the

frothy, pithless, snobbish, worthless society-that fosters discontent, wrecks happiness, destroys homes, and puts a premium on a glitter that is as whitewash. She has told us of a society in which one enters, only to become but a nonentity so far as worth to humanity is concerned. She has told us of a society that classifies its members by means of Dun's or Bradstreet's reports.

Brains count, indeed-but they must be brains for finance.

Society has been divided into three classes, and one has but to poke his nose into the shopping district to learn of this.

Class one, supposedly the leaders of long purse, the models for the imitators, may be found on Michigan Avenue, where certain stores supply their social standing, in the form of garments that only the long purse can give them.

Class two "shops" on the east side of State Street for ideas, and purchases on the west side, where the department stores supply "nearly as good at half the price."

Class three hovers 'round West Madison and Halsted Streets, where tinsel and plated ware and sweat-shop gowns are doled out by gum-chewing maidens that are paid wages insufficient for room rent, and who are told to trust to luck for provender and clothes.

All the classes are after the same things. Society tickets, in the form of frills and frippery. And if we would learn of the avenues through which the means have come to keep up with the pace set, the squeamish among us would have to use smelling salts, deodorizers and balmacea, while the initiated would retire to the smoking-room to talk it over; for plain tales might be told that would startle by their boldness.

Money is the motive-power of all these stores, for it is upon this that they are fed. Like leaches, they suck at the wages of the great mob, alluring them, as a frog is enticed by a bit of red flannel, into buying-far be

yond their power to buy-the multitudinous objects they are taught to wish for but do not need.

Of peacock inclination, the majority of women (and men, too) judge themselves and their neighbors by the clothes they wear; and so degenerate has the ability to estimate become, that the attractive is the flashy and the imitated are the brilliantly plumed.

To this, then, do the shop-keepers cater, and perverted appetites of the shoppers are fostered by every possible morsel of merchandise that can be produced.

If the state of the purse the income through legitimate channels-limited or cut off the purchasing power, all would be well. Then people would content themselves with their needs and with the luxuries and pleasures they could legitimately afford. But temptation for things just beyond the reach is too great, while, unfortunately, the ease with which the breach may be covered is altogether too great for resistance for the conscience that desire makes so flexible.

Should we go back a few years and live as those who have really given progress to the world, what a revolution there would be! Should we dress in the simple, unostentatious way of those whose thoughts are above the rabble, whose minds are capable of greater things than the discussion of latest fashions and silk linings, what an evolution there would be!

Rid us of "fashions" and "styles," and we shall be rid of idleness and crime, for the mind will be towed into channels where the current of life will run so deeply that there can be no foam on the surface.

Rid us of the temptations to buy the things that our neighbors buy because their neighbors have them, and we shall live more nearly honest lives.

There will be fewer department stores with their crime-provoking wages. There will be small excuse for smoking parlors, opium joints, French restaurants, palm gardens, for all the many other rendezvous for a growing class

of young men and women, there to squander wealth, to idle away precious time in riotous living, to become initiated into immoral ways.

And it seems to me that there is another element among us whose lives might be better lived if there were in them deeper thought for the true and less regard for the superficial.

To go into details a bit for the purpose of illustration, just consider the learned professions.

The clergyman, although generally, as a class, short on practicability, has an eye on the main chance, and in seven cases out of ten holds fondly the hand of his wealthy parishioners, cutting and drying his sermons with greatest caution so that they may not offend the ear of the plutocrat in the front pew. He will preach at 2.10 clip in the little village meeting house, but there is concealed in his breast a secret hope that his sermons will lead him to the great stone church in the city, its large salary, and its social environment.

Custom makes this perfectly proper, and the preacher is not to be condemned or criticized for his ambition to live on Easy Street, with its pink teas and chrysanthemums. He knows, as do we all, that his best work would be done in the frame meeting house or the dingy little settlement in the slums, where he could preach good "stuff" without feeling it a matter of policy prudently to clip it of all its real worth and vigor.

Then take a look at the physician. The doctor is perhaps as good an example as we can find of the man who does the best he can; of a man living in accordance with his precepts and conscientiously attempting to do good where'er he serves. Assuredly, it profits him to do the best he can, for only in this way can he attain to or establish the reputation for which he is striving-his capital in business. But there is no canting sham or driveling hypocrisy about him. His work does not call for such rot, nor would it profit him. It is his skill, his intellect, his depth that counts.

But even in the ranks of the physician there is the tendency to hobnob with the glitter, and there often is evidenced unconcealed joy and a heavy chestiness when a call comes to attend a member of Mr. Goldbag's family. It gives him what he is pleased to call "prestige," and there is led to his door the host of imitators who employ him because

of this fact. It is creditable sagacity on his part, and in nine cases out of ten he is as conscientious and as earnest in his efforts to save the pauper as he is to save the goldfilled specimens of mankind.

Only when the doctor stoops to toady is he shorn of the virtue of dignity, for he is the confessed cad, who would sacrifice himself for the dollars that might come to him.

What can be said in praise of a clergyman who would cater to the whims of his rich parishioner by conducting elaborate funeral services over the body of a pet poodle? Yet this has been done in New York City by three clergymen, any one of whom would have felt insulted had the poor of the backseats requested like services of them.

And of lawyers? What can be said in praise of them, or of that vast majority of them who stand like hungry whelps, with jaws agape, looking wistfully for a bone to be thrown out for picking? Their true, sublime office is to see that laws are lived up to, that the persecuted are protected, that justice is done. But what a thinning in the ranks there would be were there no pursestrings to be untied! And what a diminution of "injustice" there would be were lawyers relegated to humane work!

Make a misstep on an uneven sidewalk, and fall; clumsily unload yourself from the moving trolley-car and receive a bump for your carelessness. Your conscience tells you to pick yourself up, rub off the dust and go about your business like a man. But a lawyer is at hand, to whisper a word of warning. You must lie still where you fell, must be picked up by a hireling who is "onto his job," must be coached by a trusted physician and the scheming lawyer to be "very ill"; for there's a suit on hand—a job for him, extra fees for the M. D., and a handsome little nugget for yourself!

"What will a man do for money?" Ye gods! He would sell his soul, and with the proceeds buy a tin whistle, or the equivalent, a passport into society, that he might play the ape to those who, though possibly his intellectual inferiors, are placed by himself above himself on a rickety and insecure pedestal.

In the absence of any method for determining quantitatively the resultant action of a drug, how are we to proceed? We must content ourselves with qualitative methods, and with the recognition that the influence which we are employing is on

JUST AMONG FRIENDS

the hither side of that line which separates therapeutic action from toxic action. The chemist in his testings is wont to make use of a reagent that is very sensitive to that particular condition which he desires to maintain during his experiment; and it is thus that by litmus or other color-indicator he determines a required alkalinity or acidity and is able to maintain with precision the one or other state.

Borrowing from the chemist's methods, we shall seek to discover which of the organs or tissues is most sensitive to the influence of a given remedy and can earliest inform us, by the nature of its response, whether the remedy is acting favorably or unfavorably upon it. Such organ will give us the danger-signal and so lead us to reduce or stay administration upon its appearance. This method might be called the indicator method; and, indeed, it is largely employed in medicine, both consciously and unconsciously, although scarcely as consciously, as systematically, and as critically as it should be.

In another way it is possible to make use of the indicator method, but this time it is not the more sensitive, but the more refractory, organ which we shall select. When we employ this variant the organ chosen is of more vital importance, and we are content to ignore more or less the action upon other less vital parts. Upon this latter method the anesthetist relies, and by its means he suppresses fearlessly function after function until life is reduced to a "little flesh and breath," the "ruling part" having long since taken its departure. Here the response of the centers in the vital knot absorbs wholly the administrator's attention; all else he ignores.

Upon the former method many physicians, using the renal system as an indicator, control the administration of digitalis, the dose of which they maintain or push as long as there continues a free secretion of urine. In like manner the action of arsenic is controlled by the symptoms of irritation that are prone to appear in the alimentary tract, conjunctiva, and skin, all of which are sensitive to the drug. Upon this plan, also, it was customary to administer mercury, in the days when this metal was employed in more heroic fashion than now prevails; the doses of the mercury being advanced until

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a specified degree of stomatitis was induced, as measured by the quantity of saliva collected.

That the indicator method should be used consciously and systematically is clear, but it is no less clear that it must be used with great discrimination, since all organs do not speak with the same authority in the council of members. Thus it would be folly to place upon the same footing a dyspnea or syncope on the one hand, and a conjunctival irritation or a pigmentation of the skin on the other; and we may judiciously overlook a pronounced symptom in an organ of secondary importance in favor of a less obtrusive symptom occurring in an organ of the first rank. Dr. Murray, of Newcastle, counsels wisely, therefore, when he advises that an epileptic refractory to the more usual methods of treatment should run the risk of an argyria, provided that the nervous symptoms bid fair to yield to a course of silver nitrateto exchange a clouding of the mind for a darkening of the skin is surely profitable barter.

Without pursuing this matter further, it is necessary to add that the indicator which has proved reliable in the rule, may not prove so in the particular, and that, while average results must always initiate our therapeutic measures, these will ever have to be controlled or modified by close observation of the individual; also that as a general rule it is not safe, except perhaps in crises, to concentrate attention upon the functions of a single organ, to the exclusion of those more general aspects of the body which must always be paramount. (To be continued.)

CLINICAL CONGRESS OF SURGEONS OF NORTH AMERICA

The third annual session of this great Congress, which was created three years ago, through the energy of Dr. Franklin H. Martin and Surgery, Gynecology and Obstetrics, is to meet in New York City, November 11 to 16. The headquarters are to be at the Waldorf-Astoria.

The clinics this year promise to be exceptionally remarkable in every way, and there is no doubt that every physician interested in surgery will find the whole meeting invaluable to him.

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Laboratory Methods: With Special Reference to the Needs of the General Practitioner. By B. G. R. Williams, M. D., assisted by E. G. C. Williams, M. D. With an introduction by Prof. Victor C. Vaughan. Illustrated with forty-three engravings. St. Louis: The C. V. Mosby Company. 1912.

This guide on clinical-laboratory methods is different in so far as it is intended particularly for general practitoners. It attempts to make good its claim for practicability and efficiency as well as service to the general practitioner by eliminating from the start all unnecessary "frills," keeping down the equipment to the simplest necessities, and suggesting such substitutes of apparatus that may be found in any household-certainly in any hardware store-as may suitably replace more expensive fixtures and apparatus for which instrument-houses charge fancy prices.

The authors take up seriatim all the different examinations a physician may find desirable to make, such as sputum examinations, searching for germs, examination of the gastric juice, examination of the blood, detection of poison, examination of urine, milk, water, feces, etc. Even a simple method of finding the treponema pallida is suggested and a technic for carrying out postmortem examinations is given. The directions for the several methods described are given in simple language and the reviewer is convinced that with the aid of this very useful guide any practitioner who will take the trouble to study the principles of pathology will be enabled to make most of the laboratory examinations that he may require.

It goes without saying that here, as in all other things, practice makes perfect, and at the start many a physician will fail to find what he is searching for; but, with conscientious and persistent effort, Dr. Williams' book will enable him to become an efficient laboratory worker, able to determine many points of value in diagnosis and in treatment which otherwise would either be left unsolved or would entail a considerable expenditure of laboratory fees.

We recommend Dr. Williams' book cordially to our readers, and wish it the success that it richly merits.

AN IMPORTANT VETERINARY WORK OF INTEREST TO PHYSICIANS

The reviewer has recently had occasion to examine at some detail a veterinary work which is being published in the English language and which had originally appeared in German, namely, "The Special Pathology and Therapeutics of Diseases of Domestic Animals," by Professors Hutyra and Marek, both of whom occupy important chairs at the Royal Veterinary College in Budapest.

This work, which was published in two volumes of about 1100 pages each, was accepted very favorably in all German-speaking countries. It soon was translated into Italian and Russian, and has been introduced in most of the important veterinary colleges as a textbook.

For physicians, the principal interest in this work centers in the first volume, which deals with the infectious diseases of domestic animals. It gives at considerable detail the course of investigations and their results in regard to the causation, symptomatology, pathology and treatment of infectious diseases; and, since most of these are transmissible from animals to men, it goes without saying that a careful and detailed discussion of the problems presented by these diseases needs must afford much information to physicians.

In the discussion of the organic diseases, also, the reviewer has found much that was of value and that elucidated some problems which he had pondered over for some time. The work is very complete. The English translation was made by a number of American and English veterinarians and physicians and the work occupied nearly a whole year. The first volume of the work, which is just about to be put on the market, forms a beautiful large-octavo volume, and this will soon be followed by its conpanion volume. It is understood that the price of the set is placed at $15.00.

AMONG THE BOOKS

The reviewer takes pleasure in recommending this work cordially. It should have a far greater vogue than merely among veterinarians. Physicians will find much in it that not only is interesting, but important and valuable, and they can not go wrong by subscribing for this work. It can be obtained through our book department.

MEDICAL CLASSICS

In his paper on some German publications (CLINICAL MEDICINE, November, 1911) THE REVIEWER mentioned a series of medical classics published by Johann Ambrosius Barth, of Leipzig, under the editorial supervision of Professor Karl Sudhoff. Mr. Barth had the kindness to transmit the following booklets, in addition to those already announced; viz:

William Harvey: Die Bewegung des Herzens und des Blutes. (1628.) Price Mk 3.20.

Joh. Christ. Reil: Von der Lebenskraft. (1795.) Price Mk. 2.80.

H. von Helmholtz: Beschreibung eines Augenspiegels. (1851.) Price Mk. 1.20. Thomas Sydenham: Abhandlung über die Gicht. (1681.) Price Mk. 1.80.

Edward Jenner: Untersuchung über die Ursachen und Wirkungen der Kuhpocken. (1798.) Price Mk. 1.20.

Albrecht von Gräfe: Heilwert der Iridektomie bei Glaukom. (1857-62.) Price Mk. 2.00.

Razes: Ueber die Pocken und die Masern. (About 900 A. D.) Price Mk. 1.20.

Charles Bell: Idee Einer Neuen Hirnanatomie. (1811.) Price Mk. 1.50. This little treatise of Bell's, which is indeed a classic, is published here in both languages, English and German.

Adolf Kussmaul: Ueber die Behandlung der Magenerweiterung Mittels der Magenpumpe. (1869.) Price Mk. 2.00.

Leopold Auenbrugger: Neue Erfindung Verborgene Brustkrankheiten zu Entdecken. (1761.) Price Mk. 1.50. This is the first account of the examination of the chestorgans by percussion.

X. Bichat: Physiologische Untersuchungen über den Tod. (1800.) Price Mk. 3.20. Joseph Lister: Erste Veröffentlichungen über Antiseptische Wundbehandlung. (186769.) Price Mk. 3.60.

Ign. Phil. Semmelweis: Aetiologie, Begriff und Prophylaxis des Kindbettfiebers. (1861.) Price Mk. 3.60. Semmelweis was the first to insist upon the infectious nature

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of puerperal fever. He was hooted "out of court" by his jealous colleagues and lost his mind.

Robert Koch: Die Aetiologie und die Bekämpfung der Tuberkulose. (1887-89.) Price Mk. 2.00. This is one of the most important contributions to literature that have ever been published. Its reproduction by Mr. Barth was a highly commendable undertaking.

Thomas Addison: Die Erkrankungen der Nebennieren und Ihre Folgen. (1855.) Price Mk. 1.50.

It will be seen from the titles that in Germany there exists a lively interest for medical history. Not only German contributions, but also those of French and English writers have met with deserved appreciation in this series of classics. Of course American and English physicians will prefer to read English articles in the original, but the collection contains much that is of interest to physicians the world over.

Of great interest are, finally, the following: Sanitätsrat Dr. Jessner's Dermatologische Vorträge für Praktiker. Wuerzburg: Curt Kabitzsch.

Hautveränderungen bei Erkrankungen der Atmungsorgane. Heft 22, 1911. Price Mk. 0.90.

Die Praktische Bedeutung des Salvarsan für die Syphilistherapie. Heft 23, 1911. Price Mk. 1.80.

Hautveränderungen bei Erkrankungen der Leber. Heft 24. 1912. Price Mk. 0.60.

These little pamphlets afford much valuable information to the general practitioner on skin lesions due to other diseases, and on other affections of the skin.

MURPHY'S "SURGICAL CLINICS"

The Surgical Clinics of John B. Murphy, M. D., at Mercy Hospital, Chicago. Published bimonthly by W. B. Saunders Company, Philadelphia. Volume I, Nos. 3 and 4. June and August, 1912. Price per year, paper, $8.00; bound, $12.00.

"THE SEX PERIL"

The Sex Peril. A letter from a physician to his son in college. Seventh edition. New York: The American Medical Publishing Company. 1912. Price 25 cents.

American Medicine has published a little pamphlet bearing the above title, which purports to be a letter from a physician to his son in college and discusses in a dignified

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