There is frequently a tendency to magnify diagnostic details which, however important in theory, may prove highly prejudicial to the welfare and comfort of the patient when tested by actual experiment.

tidin and phenacetin are chemically identical and of equal quality as sold, the price charged for the latter is five times that of the former.

The Association Journal might have gone a step further and pointed out that phenacetin is only one of several patent-expired products for which, under their old patentnames, exorbitant prices are still charged by their German makers, and which, under their chemical names, are now procurable (of presumably equal quality) for a tithe of the prices of the former. Here is an interesting list:

Real men are developed by difficulty. With such men there is no thought of yielding in the face of danger-only the determination to go forward with courage, and to overcome.

GERMAN GREED AND AMERICAN GOLD

The Journal of the American Medical Association deserves the commendation of the profession for pointing out the extortionate methods of the German manufacturers of the "patent" coaltar chemicals so largely prescribed by American physicians.

In the Association's chemical laboratory a careful examination was made of different samples of phenacetin and of the identical product admitted to the United States Pharmacopeia under the name of acetphenetidin. Phenacetin originally was patented in this country by the Farbenfabriken of Elberfeld Company, which still supplies it. The patent expired years ago, and the Company now has no proprietary interest in the word "phenacetin." At present it sells this substance both as phenacetin and as acetphenetidin, while it is also manufactured and offered for sale by several other concerns, under one or both of these names.

The striking fact revealed by the Association's inquiry was, that, while acetphene

TRADEMARK

Aspirin.

PRICE

NAME

$4.40 lb. 21.00"

Veronal. Heroin. Aristol.

Trional. Duotol. Urotropin.

8.00 oz.

1.55" 1.15 "

1.30 "

Sulphonmethane.

.34"

1.25" 60"

Sulphonethylmethane

.14"

Guaiacol carbonate...

.24"

Hexamethylenamine.. .04"

.16"

The first two in this list are still protected by product patents, though it is more than likely that the celebrated aspirin suit may be reopened and that the patent may later be declared illegal. The prices quoted for these two under the chemical name are those charged in England where there is no product-patent protection.

The remainder of the products listed are no longer protected by patent in the United States; therefore, the prices charged for the fancifully named articles are purely arbitrary ones. Glance through the list, and you will realize something of the enormous. toll being gathered by the German chemical manufacturers from American physicians and their patrons.

The preceding relative scale of prices will apply substantially to many other remedies upon which the patents have expired. For lack of space we do not give a complete list, nor quote prices; but the "method" and "scale" apply in the sale of salipyrin (antipyrin salicylate), europhen (diisocresol iodide), benzosal (guaiacol benzoate), lactophenin (lactyl paraphenetidin), salophen (acetylparamidophenol salicylate), xeroform (bismuth tribromphenolate), and other preparations of a similar nature.

It would be interesting to explain how these German patented-medicine makers, as patents expire, play the whole gamut of molecular interchange, in order to evolve

wonderful "new" products, and thus keep the doctor "coming." But that is another story!

The moral of the Journal's exposure of the long- and well-known German chemical maker's methods is, for the physician to use honest products of recognized merit, as procurable from good American chemical houses. By so doing, they will discourage this "scientific" extortion and encourage our American chemical industry, which needs but the support of American physicians to rival in extent, as it already does in quality of products, its not overscrupulous foreign competitors.

American physicians and their patients are being relieved of millions and millions of dollars by these skilful manipulators of our all-too-lax patent laws-laws which protect the foreigner and squeeze out our own people. And presuming upon the ignorance of American physicians in chemical matters, they manage to keep the flood of American gold still rolling into their pockets long after the "protection" of these laws has ceased to be legally operative.

Isn't it time that you, doctor, "got wise" to these facts? What's the matter with a little more of the sentiment of "America for Americans"?

Ah, Love! Could you and I with Him conspire To grasp this sorry scheme of things entire, Would not we shatter it to bits-and then Remold it nearer to the heart's desire.

-Omar Khayyam.

TREATMENT OF THE HEART IN SYPHILIS

On the basis of his experiences in fifty cases, Dr. Harlow Brooks (Medical Record, February 24, 1912) asserts an almost universal occurrence of serious cardiac lesions in syphilis, which, he claims, begin early in the disease, and which possess, through the later stages, a largely irradicable character. These lesions have no other characteristics than those of myocarditis or aortitis, or a coronary sclerosis, yet when these signs appear and any possibility of syphilitic infection be present, the case should be given the benefit of the doubt, disregarding the age of the probable lesion.

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If really permanent benefit is to be expected in these cases, treatment must be instituted very early, probably early in the secondary stage, and the drugs must be pushed to their full physiologic limit. Curschmann long ago reported good results from iodine in cardiovascular syphilis. Longcope, also Collins and Sachs, called attention to the fact that syphilitic disease of the circulatory organs demands active treatment with mercury pushed just as vigorously as in acute syphilis of the central nervous system. The author believes that salvarsan is no more dangerous in cases of marked cardiovascular disease than in other and seemingly simple cases.

The beginning of genius is the power of desire. Genius is inspiration, desperation, and the culmination of perspiration.-Alfred Montgomery.

ON THE CAUSE AND TREATMENT OF INFANTILE BERIBERI

Accustomed as we are to observe a very much lower mortality among breast-fed children than among those fed artificially, it strikes us as very strange to find (Bulletin of the Manila Medical Society, 1910, November) that, in the Philippines, the mortality among infants is greatest in breast-fed babies. Chamberlain and Vedder, of the Medical Corps, U. S. Army (Bulletin of the Manila Medical Society, 1912, February), have shown that one of the most common diseases of infancy prevalent in the Philippines, called taon, taol or suba, is justly considered to be infantile beriberi.

Assuming, with very good cause, that beriberi and polyneuritis gallinarum are due to the same dietetic deficiency, that is, to the use of highly milled (polished) rice, as a principal article of diet, and having found that the polyneuritis of fowls is cured by the extract of rice polishings, these investigators determined to treat cases of infantile beriberi by administering their extract of rice polishings to sick infants, while permitting them to continue nursing.

Previous to their work, rice polishings had been used in the treatment of infantile beriberi, but the polishings had been ad

ministered to the mother, and lactation had been suspended, the child being fed artificially. The proceeding of the authors, which appears very much more sensible, proved successful in fifteen infants, which they treated with the extract of rice polishings.

Their patients were all breast-fed, and, with one exception, all under the age of three months. The disease was usually ushered in with vomiting, which, after a few days, was followed by great restlessness, sleeplessness, continual whining, and later by dyspnea and increased cardiac action, together with edema of the face and legs. Still later oliguria and aphonia developed in many of the patients.

The authors conclude, from their results, that the extract of rice polishings is a cure for beriberi in the true sense of the word, just as lime juice is a cure for scurvy, and that it acts just as promptly as fruit juices do in infantile scorbutus. Their mode of preparing the extract of rice polishings is given in detail in their paper, to which we refer for particulars.

The scientific interest attaching to the observations of the authors is hardly less than the practical importance, since their work almost surely disposes of the theory that beriberi is a toxemia. It is most irrational to suppose that such an extract of rice polishings could cure a child in a few days while the child was still receiving the toxin which had originally produced the condition. The infection-theory is even less tenable, since so sudden a cure would not be likely to occur in an infectious disease as a result of such treatment. Their results, therefore, are a most conclusive argument in favor of the dietary origin of beriberi.

One can hardly fail to be convinced that beriberi is due to a deficiency of some as yet unknown substance in the food, and that infantile beriberi is produced in those children who receive milk from a mother suffering from such a deficiency. Otherwise how can the remarkable effects of the extract treatment be accounted for?

The authors regard their work with infantile beriberi as the final link in the chain of evidence which has been built up

from experiments on men and animals, and which proves that an improper diet, usually one consisting mainly of highly milled rice, is responsible for the development of beriberi.

"Right now is the time to "get busy" and steal a march on your competitor who is going to wait until "after election." Procrastination is a prolific breeder of "lost opportunities." "All things come to him who waits "-you've heard this before, but don't you believe it! All things come to him who hustles while he waits.-Robert Brown.

FREUD'S THEORY OF NERVOUS DISEASE

Since Beard gave us the classic description of neurasthenia, this malady has been universally accepted and assigned a place in the nosology as a definite form of disease, with well-defined features.

Now comes Freud and seeks to modify our conception of the great majority of the cases heretofore included under this designation, and to these he affixes the term apprehension neurosis. And this condition he attributes to sexual causes, and more especially to unsatisfied desires.

Stripped of technicalities, this condition. of neurasthenia is an arraignment of the present social system, and a plea for natural conditions as represented by those impulses that stir in man or woman as animals and are held in check by social, legal or religious restraints. The young man strongly desires to gratify his sexual promptings, but is restrained by timidity; the man indifferent to his wife is powerfully attracted by some other woman; the girl feels the impulse to seek the embrace of a mate, but is deterred by modesty or by the dread of pregnancy and the consequent exposure; but in all these cases the victim suffers from the balking of nature's impulses, and then this form of neurasthenia follows.

The theory flatly denies that continence. is harmless, it questions the value and wisdom of self-restraint, and remorselessly traces the consequences of violating nature's law, which provides for the perpetuation of the race despite all social and religious artificial restraints and interferences.

While this deduction is not the one dwelt upon by the numerous writers who have been discussing Freud's theory during the past year, it is the one most directly to be drawn from it, and the most momentous in its influence. In this it is in harmony with the conclusions reached by studies in other and allied branches. The reader of Krafft-Ebing's great work arises from its perusal with a new conception of sexual morality. He reads of instances of perversion with an abhorrence so great that he must feel a certain sense of approval of the hopefulness of the victim who speaks of his ability to accomplish ordinary fornication. The man hopes to overcome his appetite for bestiality or sodomy, since, although he is cold and impotent toward his own wife, he has found another woman who excites and satisfies his sexual appetite and needs. Beside the unspeakable vileness of the former, mere illicit intercourse seems venial, even if not commendable, as a natural, wholesome exercise of a vital function in a normal, desirable manner. If, under such a course, the victim reports the subsidence of the unnatural appetites and resumption of healthy conditions, the question comes to the medical adviser whether he shall look on the case with the eye of the physician-scientist or that of the law-abiding, moral, decent citizen.

Most of those who have discussed this matter take the ground that the two are synonymous, and that continence is possible, harmless, and as a rule beneficial. This is flatly denied by Freud and his followers, as shown by this quotation from Tannenbaum's paper in American Medicine for December, 1911, page 643: "The onanist must cease masturbating and, if his sexual appetite demands it, resort to a puella publica, with proper instructions." And, again: "The young gentleman engaged to a respectable young lady who must not conceive of sin should be taught the dangers of frustrated excitement and should be advised rather to associate with a puella publica."

Judged by the experience of many years in the practice of our art, we should say that the cases and conditions described by

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Freud are not numerous or the rule, but rather exceptions; and that neurasthenics are not always the victims of sexual repression or abnormalities. Nevertheless a close and intimate inquiry will develop the existence of this element many times when it has not been suspected by physician or even by the patient. We have known many instances of sexual restraint that have not developed any evil, but, rather, great good, physical as well as moral, in the individual; and we are very far from admitting that such restraint is always or even often prejudicial to the health. If it is so in exceptional cases, these are not numerous enough to justify any change in our present social arrangements, which are better suited to the general conditions of man than any other that have been proposed. Indiscriminate license is abhorrent, and impossible in our civilization.

As to the consequences of transgressing nature's laws and impulses, we are in accord with Freud to a certain extent, and in opposition to some of his followers in some respects. We believe that there is no method by which the natural, healthy exercise of the sexual function can be interfered with, and harm not result. All forms of partial and unnatural intercourse, designed to prevent conception, are injurious.

There is no harmless method of preventing conception-and we hope none will ever be discovered. Whatever evils may follow the advent of more children than people think they can afford, they are as nothing to the interests of the race that are sacrificed by prevention.

Freud has opened up a matter of extreme interest and importance. He has developed Baird's ideas and assigned a group of neurasthenias correctly to sexual causes, but that these comprise the majority we do not believe. His psychoanalysis of dreams is a sidetrack of alluring interest, but we can not enter into that phase at present. Meanwhile Freud has thrown a bombshell into the camp of the Philistines, and we may expect furious denunciation, then, as that subsides, some really sensible. discussion of his propositions may follow.

Is it true? Is Woman the ultimate cause of that ceaseless drive that impels man to incessant, never-ending, never-completed exertion?

Let us take a look at the windows along State Street: robes, linens, silks, lingerie, hats, plumes, jewels, bric-a-brac, parlor furniture, summer furniture, confectionery, shoes, hose, laces, embroideries, rugs, toilet articles, perfumery, hair goods, and-well! well! here in the twentieth window we discover some ties, shirts, and a few other articles for masculine use!! Must be an accident!

Judging by the offerings of our merchants, man labors to supply woman her home, its fittings, her personal adornment and amusement. Nineteen-twentieths of man's work is for women. But for her, how many men would care to live in a palace, keep up a yacht, a private car, or any one of those other luxuries of a multimillionair's life?

The wants of a man are relatively few-food, shelter, rest, clothes, and the latter superfluous except when needed for warmth-were it not for woman. As the struggle for existence and supremacy in

creases in intensity, the number of men who revert, as nearly as modern conditions permit, to the savage and become tramps, likewise grows greater. The freedom, irresponsibility, idleness satisfy the atavistic tendencies of the man to whom the solution of life's problem comes in the ready phrase, "What's the use"! There is material for a sermon, a book, a life-study in that brief

sentence.

Woman creates the home. Where she is, is home, be it a palace or a hut, the gilded cage of the princess or the attic of the poetaster, the cave of the troglodyte or the leafy bower of the Suabian. Where She is, is the goal toward which the Man's steps turn when wearied with the search for food. The Home established, it is the instinct of both to adorn it, to fill it with things useful or otherwise desirable. The instinct for the woman to adorn herself is innate, and the man shares it, because her personal appearance is a matter of pride to him-her owner-and reflects credit upon him.

On these primal instincts rests the modern social system, and from them springs every exertion that has raised man from the level of the Australian savage.

We men live and work for Woman; and, glory be! she's worth it.

It was an essentially oriental conception that the obligation to work was inflicted as a condign punishment. We have learned to recognize in Work one of man's chiefest blessings. Necessity is a stern but beneficent master. It drives; and happy is the man who is driven, because he gets on. It drives him to get education; and he is no longer a savage. It drives him to get food; and Agriculture is created. It drives him to dislike the ugly; and Art is born. It drives him to seek companionship; and the Family is formed. Altruism arises; and men learn to look upon themselves as members of a Community. The horde settles; and States emerge from the chaos. Necessity drives him to acquire Property; and Law is developed. The sharp pangs of disease drive him to the study of hygiene; and Right Living begins. The fear of Death drives him to study and avoid its causes.