V

ERY, very few men are unlucky-they are simply stupid. They didn't think. They only looked at the surface indications, took things for granted, failed to foresee the elements of uncertainty and likelihood, and assumed that all the "luck" would break their way. Then when the inevitable followed they cursed their luck.

Study the reasons for failure. Did you consider the frailty of mankind? When you bought a place you never saw, did you remember to consider that human greed has no limits, and that men will lie a lot to sell at $30 an acre sand flats that they bought at ten cents and you got stung! Maybe the seller was honest-but did you know? The horse was sound and kind, without blemish-but it came in with a lot, and the dealer may not have known that he balked.

The child was on the verge of convulsions and you prescribed the right remedythe child died. The druggist filled the order correctly, but the drugs were old and effete. Your fault? Assuredly. It was your duty to know that the drugs were efficient and that they were given properly. There is no shifting responsibility on the druggist or nurse. In the navy, when a ship enters a harbor, it is in charge of a pilot, who then is captain. But if the ship is lost, the real

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captain stands a court martial, for it is his duty to see that the pilot understands and does his. The great Italian pediatrist, Prof. Laura, said that under certain circumstances the use of the alkaloids was not a matter of choice but of duty.

When a person is writhing in agony, would you wait for the slow and uncertain action of opium, if you had morphine and a hypodermic syringe? When facing a congestive chill, would you administer powdered bark instead of quinine? When examining eyes, would you insert belladonna or atropine? In treating snake bite, would you use nux vomica rather than strychnine?

Since I know your choice in these four instances, I will state that you are four times an alkaloidist.

I, myself, am several more times an alkaloidist. I should take no chances with veratrum when facing eclampsia, for I have the sure veratrine; or, in treating fever with aconite when I have aconitine; or, in sustaining a failing heart with digitalis, for I have digitalin; or, in relieving chordee with gelsemium when I know I can do so with gelseminine. Prof. George F. Butler once gave a whole teaspoonful (!) of the tincture gelsemium to a cat, and it produced no effect. Robinson found that the

hospital heart-patients were getting no benefit from digitalis, until he procured a good quality and increased the doses.

Tests we have instituted showed variability in the strength of tincture of aconite from four pharmacies to range from 16 to 1. If I gave just enough of the weakest to do the work, and the bottle were refilled with the strongest of that series, what would happen? Bad luck? Or criminal carelessness?

Many years ago I ordered for a young mother fluid extract of jaborandi, to increase her supply of milk-and it dried up her breasts completely. I could not imagine such a thing happening to me now, because I should not think of giving jaborandi when pilocarpine was at command. I once used henbane to quiet excitement-used it timorously and ineffectively, for one never knew what the stuff would do. How funny! Now I use hyoscine, of course.

Looking over a book of old prescriptions, I found mention made of cinnabar, orpiment, and other minerals. Queer! People used to apply Seneca oil as a liniment, and a barrelful supplied the market for a year. How many "active principles" have been isolated from that oil, and how many uses have been found for them!

Don't you think we might apply the same analysis to cinchona with its 30 active principles, to opium with 26, chelidonium with 17, sanguinaria with 6?

There are some things that seem too obvious to justify argument.

The galenic is a club; the wood may be rottenwho knows? The alkaloid is a finely tempered steel rapier-unerring in the hand of skill.

SIGNS OF THE TIMES: VIENNA WAKING UP

Dr. Karl Feri, in No. 19 of the Wiener Medizinische Wochenschrift, and Dr. Adolph Kronfeld, the editor of this same journal, both ask the physicians of Vienna to participate in founding a therapeutic society (Gesellschaft fuer die Gesammte Therapie). Their invitation begins with these words: "The great progress in the various disciplines of medicine has done away with the

therapeutic nihilism in all branches of our science."

The proposed society is to serve as a clearing house for the immense and constantly growing number of communications to medical literature on therapeutic problems.

The fact that such a declaration could proceed from Vienna, which not so long ago was the cradle and for many years the hotbed of the most extreme therapeutic nihilism, is significant. It vindicates those who always have insisted upon the value of an active, well-considered, and deliberate therapeutic interference in disease, and who persistently have refused to rest upon their oars and watch nature taking its unaided course after a diagnosis was made.

We insist as we have always insistedthat the making of a diagnosis is only a part of a physician's duties. After the patient is told what ails him he naturally does not rest satisfied, he wants to be relieved of his troubles, he wants prompt, effective treatment to that end.

More power to the physicians of Vienna in their endeavor and in their splendid work! Let therapeutic societies spring up everywhere-real working bodies, I mean, that will go at the subject earnestly and optimistically, giving freely of their experiences and deductions to the profession at large.

In therapeutics, definite and dependable, lies the greatest field of medicine today. Who wants to come to Ravenswood for a three-weeks postgraduate course, and when?

If you are interested, please write me personally!-and now. Our proposed date is early in the fall, the 1st of September approximately.

DR. W. C. Аввотт.

VERONAL POISONING

A writer, in The Bulletin of Pharmacy, tells of a man who took one ounce of veronal and some bromide mixture being found dead the next morning, the veronal bottle empty. The same journal tells of two attempts of suicide, one with arsenic, the other with laudanum. In every instance the druggist dispensed the poisons without a prescription.

The recklessness with which some druggists meddle is shown by the following: A girl who could not speak English well came into the drugstore and pointed to the top of her head. Concluding she wanted a hair tonic, the man of drugs sold her a proprietary of the nature of which he knew nothing. Later it transpired that the girl wanted a nerve tonic, and that she had taken a tablespoonful of the mixture. As the druggist did not know its composition, he was unable to suggest an antidoteand missed another sale.

If there were smiles for sale
At some fair market where
The rich, the poor, the low, the high
Might hurry with their change, to buy,
What crowds would gather there!
Yet there are smiles enough,
And each might have his share,
If every man would do or say
One-just one kind thing each day
To lift some other's care.

-S. E. Kiser.

GOOD OLD TIMES

The plaintive longing for the "good old times" seems to be exclusively an eastern characteristic. One never hears it in Chicago. Possibly this is because this city has no old times. Beginning as a straggling village, sprawling in the mud at the mouth of the river, it has grown to beauty and power through a long hobbledehoy stage. We look upon the East as old so old as to demand of us a bit of reverence, or what comes nearest to that sentiment in the Chicago mind.

So it is with somewhat of a surprise that we read, in the Bulletin of the New York Health Department for March, that municipal sanitation began with that city after the close of the Civil War. As late as 1866 her streets were unpaved or covered with cobblestones, with hardly a pretense of cleaning. Ashes and garbage were dumped in the street.

In Brooklyn, no arrangements existed for removal of garbage, but when things got too bad the new Board of Health undertook the task. Few houses were connected with sewers. Offensive trades-bone boiling, fat rendering-went on without let or hindrance. Cesspools reeked with filth.

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Many cattle were kept in unsanitary stables and fed upon distillery swill. Manure piles mounted high, cesspools overflowed, numerous hogs were kept within the city limits, and the human death-rate in 1865 was 30.3 per 1000.

As late as 1889 the writer found, in Philadelphia, a lodging house with 150 inmates where there was no toilet whatever. And neither was there a law or ordinance by which the owners of houses already built could be compelled to install toilets. Market produce, abattoirs, tenement houses were in a condition properly designated as

"fearful."

Under the rule of the Health Department, matters have so improved that in 1911 the mortality in Greater New York had fallen to 15.2 per 1000. The care of the city's children is one of the brightest pictures in American urban life, especially since the organization of the Division of Child Hygiene, in 1908. Medical inspectors instruct the mothers, nurses visit the homes. Stations for supplying pure milk dot the slums. An effective war is waged against tuberculosis; and the laboratories furnish free antitoxin.

One especial reason for the notable success of the New York health department is its independence and command of means. If it needs money it issues bonds, and gets it.

THE LIMITATIONS OF DIAGNOSIS

The importance attached to diagnosis should not be accorded the dignity of a fetish, with corresponding injury to the patient. Some patients recover without a diagnosis, to the amazement and discomfiture of the attending surgeon. Our zeal in the pursuit of scientific accuracy should never obscure the interests of the individual. The use of potassium iodide, for instance, as a test in pulmonary tuberculosis is possibly dangerous in its tendency to aggravate the disease. The use of tuberculin may be of doubtful advisability because of its attendant danger, while other diagnostic agents may be more or less injurious. We should not forget that diagnosis is not the end of medical practice, but a means.