electricity, or drugs, or food fads, or freak exercises can supply the requirements of every disease is going to be sorely mistaken. The exponents of any fad and all those misguided persons who have a cure-all ultimately find out that all the fools are not all fools all the time.

The greatest success in the profession of medicine comes to the honest man who can say that he does not know, when a diagnosis is uncertain, and who can take pleasure in telling his patient their needs, even if he is not able to supply them.

Were some physician to announce that he had discovered a medicine that would make brains, some might laugh, yet if it were advertised sufficiently well, it would find a ready sale. As a matter of fact no medicine can make muscle or nerve or strength any more than it can make make brains. There is a popular superstition that fish is a brain food, yet we do not find many examples of overdevelopment of the cranial contents of those persons living in regions where fish are the most plentiful.

Drugs are necessary and give positive results in certain diseases, and they may be used to stimulate or repress the function of certain organs. The heart, the liver, the intestines, and the stomach all respond to certain well-known drugs. The nerves respond to electricity, and the man skilled in its use can stimulate or paralyze, as he desires; the efficient masseur gets marked results. Yet all of these are but artificial and the occasion for their use is a matter to be deplored.

When they are demanded and prescribed, it means that the individual is lacking in an ability to keep from getting sick, or is deficient in that self-possessed remedy for getting well. The first we speak of as immunity, the second. we consider in terms of resistance. Animals are not customarily the subjects of certain diseases, but nearly all animals can be inoculated and be made ill by germs that are harmless, if the animal is tired out by fatigue or excitement, or weakened by deficient or unsuitable food. As examples of this, white rats, who have a natural immunity to anthrax, readily become infected, and frequently die, if previous to being inocu

lated with the germ, they have been tired out by being placed in a revolving wheel and compelled to run a considerable time. Chickens also are naturally immune to anthrax, but if they are inoculated and then placed in a cold room and left for twenty-four hours, they develop the disease and die as a consequence. Pigeons will contract the disease after a period of starvation, but not if they are given plenty of food. In man, we know that exposure to cold, lack of proper food, overwork and excesses of all kinds make the individual more susceptible to such diseases as pneumonia, erysipelas, typhoid and other fevers.

What Is Bird-Cage Disease?

With this introduction, we can better understand the signs and symptoms of bird-cage disease. First, as to its cause, it is a matter of lack of exercise, oftener overfeeding than lack of proper things to eat, and dependence upon artificial stimulation to make up for habits acquired by personal neglect. The signs of this disease are self-evident to a careful observer who watches the expression or lack of it in the face of the affected person. They are easily tired, nervous, subject to fits of despondency, given to moods, and have dispositions that are irritable if nothing more. Their complexions are pasty, when the patient is not an artist. As to the things they complain about, one word would describe it, "everything." As to what they have been doctored for, the same word would answer, "everything." As to what they have tried to obtain relief, the same word again would tell us, “everything." This being the case, we can study the patient a little closer.

"I

"How are your bowels?" "Constipated." "How much water do you drink?” don't know." "Do you drink your water with your meals or do you drink it between times?" "Most of the fluid is taken at mealtime, of course." "How much are you out of doors?" "All that I can get a chance to be." "How far can you walk without getting tired?" "Not very far, I am too tired before I start." "Do you have any pain?" The answer to this question varies as to the number of doctors

the patient has consulted and the kinds of treatment they have taken. For every doctor usually discovers a new sore spot and a different cause for the disease. It is not unlike the story of the six blind men and the elephant:

It was six men of Indostan,
To learning much inclined,
Who went to see the elephant,
(Though all of them were blind),
That each by observation
Might satisfy his mind.

The first approached the elephant, And, happening to fall

Against his broad and sturdy side, At once began to bawl:

"God bless me! but the elephant Is very like a wall."

The second, feeling of the tusk,
Cried: "Ho! what have we here,

So very round, and smooth, and sharp?

To me 'tis mighty clear,

This wonder of an elephant

Is very like a spear!"

The third approached the animal,
And, happening to take

The squirming trunk within his hands,
Thus boldly up and spake:

"I see," quoth he; "the elephant Is very like a snake!"

The fourth reached out his eager hand, And felt about the knee:

"What most this wond'rous beast is like, Is mighty plain," quoth he; ""Tis clear enough the elephant Is very like a tree!"

The fifth, who chanced to touch the ear,
Said: "E'en the blindest man

Can tell what this resembles most:
This marvel of an elephant

Is very like a fan!"

The sixth no sooner had begun
About the beast to grope,

Than seizing on the swinging tail
That fell within his scope,

"I see," quoth he, "the elephant
Is very like a rope."

And so these men of Indostan

Disputed loud and long,

Each in his own opinion

Exceeding stiff and strong,

Though each was partly in the right,
And all were in the wrong!

It is not always the doctor's fault that different diagnoses are made, because at different times the various weak spots show themselves, and the most hypersensitive place is given the most careful examination. Headaches are common and

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most of our patients are decorated with the evidence of a visit to the oculist.

The Protean Symptoms of Our Patients Examine into the causes for these things, and we know it requires exercise to make muscle, yet how much muscle does the average woman develop in her daily round of housework? She cooks three meals a day and washes the dishes afterward. She makes the beds and does a little sweeping. The household laundry is about the only place where actual muscular effort can be expended, but it is so easy to send the laundry out, and the laundry ladies are given the benefit of this exercise, to their physical and financial betterment. It is hard work to iron, especially in hot weather, and mending is tedious, while sewing is hard on the eyes. Now, to obviate all this, it might be suggested that we burn wood instead of gas, and have our wives cut the wood. Instead of getting water by the tedious process of waiting for it to run out of a faucet, our good wives could draw it from the well, and the deeper the well, the more exercise for the backmuscles and the forearm.

And how does all this affect the bowels? First, the indoor habit was begun when outdoor conveniences became less common. Personal neglect to nature's stimulus is the greatest factor, but two others make the neglect more easy. Lack of exercise affects the muscles of the stomach and the intestines as much as it does those of the arm or leg. Again, the greatest liver stimulation is received during active exercise, when the blood is being sent faster through all the vessels of the body. Bile is the natural cathartic and acts as such, and when the liver stops work, constipation

ensues.

With lack of exercise, there is a tissue relaxation and a fall of the blood pressure. The organs of the abdomen get loosened and we find floating kidneys, dilated and dislocated stomachs, and a general displacement downward of all the abdominal contents. That is one reason why the corset has become a necessity of such importance. Fashion has followed necessity, and a proper-fitting corset is a fre

quent prescription, and the corset is advised for everyday wear, and not for dress parade. By a corset is not meant one of those hourglass contraptions that were an insult to anatomy, physiology and every phase of hygiene, but a support for the lower abdomen. This general looseness is now so common that eighty percent of the women that frequent a doctor's office are affected. Floating kidneys were fashionable in the beginning, because only the careful examiner found one. Nowadays they are more frequent because we look for them, and, of course, since they became common, they are not considered a SOcial badge of distinction.

There is an old saying that

"Early to bed and early to rise
Makes a man healthy, wealthy, and wise."
Nowadays it has been changed to
"Early to bed and early to rise

Is all very well for sick folks and guys.
But it makes a man miss all the fun till he dies
And joins the stiffs that are gone to the skies.
Go to bed when you please and sleep at your ease,
For you'll die just the same with a Latin disease."

We

The kidneys are our greatest excretory organs; they eliminate the poisons that are formed in the body or that are absorbed from the intestine and other surfaces. can't clean out a sewer very well by the dry process, and the fear of water that is a part of some people's constitution makes us uncertain but what they have hydrophobia, even though they never were "dog-bit."

Water is all right in its place, and while there is great truth in a certain whisky advertisement, which says that water has killed more men than have bullets, one should not drink that kind. Too much water taken at mealtime dilutes the gastric fluids so much that they are ineffectual. A certain percentage of acid is necessary for proper digestion, and when this percentage is diminished by dilution, digestion is just that much impaired. Water should be drunk between meals, and an average of half a gallon a day is not too much. A healthy person should get rid of at least eight grains of solid matter for every pound in body-weight every day, and pass this poison through the kidneys. Instead of this, it is rare to find a woman whose

excretions average more than five grains to the pound of her bodily weight.

Developmental Defects Are at the Basis

We can take up the symptoms that are given to us by the average patient and refer distinctly to some developmental defect in the majority of cases. This defect is brought out by our bird-cage existence, for the luxuries and conveniences of civilization have enmeshed us with something more than conventionalities.

Near-vision is not the natural function of the eye, and the necessary use of the eyes for close application in our surroundings and the means of making a livelihood, together with the elimination of the necessity for using the eyes to discover possible enemies at a distance, as in times gone by, have brought out this defect and made optical assistance an almost universal practice.

When we speak of nerves, the physician must insist on a private interview, for that is a most sensitive subject. We have all kinds of people and all kinds of nervesor lack of them. Our manner of living is so self-centered in the ego and the us, that our first act is to develop a degree of selfconsciousness that, like the hair and teeth and nails, just grows on us. We become hypersensitive, more responsive to outside impulses and stimulants, and soon a reaction follows that demands extra stimulation as a necessity. This demand for artificial stimulation is a will-o'-the-wisp that draws our women, especially, into the various fads and fancies of club and freak diversions.

Bird-cage disease is synonomous with neurasthenia, but one of our most prominent diagnosticians says that it is inadvisable to make a diagnosis of neurasthenia in a family unless they have an annual income of ten thousand dollars. This has made necessary the coining of a new term, because nervous prostration and hysterics are not easily borne by the laity. Many physicians make a grave mistake when they size up a patient and state that there is nothing the matter with him. They may speak the truth in so far as these patients have no organic disease, but functional disturbances in our patients are becoming

of far more importance from the diagnostic and therapeutic standpoint than many of the organic or infectious diseases. There are usually two good things to be said of the latter class of patients, however: they either get well or they die. Our neurasthenic patients seldom do either, to our discredit and our disturbance, mental and professional.

These conditions are not limited to our female patients, for occasionally we see a man affected with as severe an attack of nervous irritability and nervous exhaustibility as any of our women patients.

What has been done to these poor unfortunate women, has been more than what has been done for them. They have had their kidneys sewed up, their ovaries removed, uterine fixations, with castration, relaxed outlets sewed up, and all the available orifices stretched to the limit. They have been drenched and douched. They have had their spines stretched and their ribs pushed into place, their atlas and their axis manipulated, and the various forms of electricity have all but electrocuted them.

Get to the Bottom of Things

To get at the bottom of this condition, to treat these poor patients as they needs must be treated, we must consider them as individuals lacking in many things. And these things we must be able to supply or supplant. The functional basis of all symptoms arising is an irritable weakness, and the elimination of the irritation and the development of physical strength furnish an absolute foundation on which we can build many cures.

The diagnosis of these conditions may be hard, but the treatment is infinitely harder, because there are three stages in the case that physicians must meet and surmount.

The first is to eliminate from the patient's mind all disease which she believes herself to be the victim of, or rather the physician must gain the absolute confidence of his patients to such a degree that they will believe him when he tells them their condition is entirely a functional disturbance and that all the supposed diseases which they may have had diagnosed by other physicians and been treated for have no organic basis.

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The second period is an observation period, trying to find out what in the homelife or surroundings there may be that is acting as an irritant or having to do with the progressive development of the neurasthenic state. Unfortunately, in many cases, there is a degree of conjugal dissatisfaction which leads to jealousy and possibly worse features in the home-life. The quicker that this is found out and thrashed out, the better for all concerned.

Weir Mitchell made his great success in the treatment of these patients because of his ability to find out all the causes that led up to the neurasthenic state. And he was able by his personality to convince the patients of their misconceptions and to eliminate their hallucinations. The question of the necessity of an absolute period of rest or an extended visit away from home and of special sanitarium treatment must be applied to the individual cases.

The third, and the hardest, part of the treatment, and that which physicians have neglected in so many cases, is the fact that the major part of the getting-well must be done by the patient himself or herself. Not only must there be a re-education mentally, to eliminate all pathological suggestions, but there must be a re-education of the entire physical body.

Outdoor exercise is all right so far as it goes, but physical development by special prescribed exercises is an absolute necessity. I have frequently taken patients with pronounced neuralgia in the side from a dropped kidney and in from three to six months have had them, by special exercise, pull the kidney back into place and eliminate the pain entirely. The same with back pains and various reflex disturbances. So also with constipation.

But without the helpful cooperation of the patient little or nothing could be promised. We can tell our patients, if they will give us an hour every day and promise us that they will follow our directions and give us from six months to two years' time, they can get perfectly well. Unfortunately for me, I have had a number of my patients stay with me for that length of time, and they have recovered, but what they have done to me in the time

that they have taken up and the nerves that they have worn out and the patience that they have exhausted has almost rendered me a neurasthenic myself.

Perhaps, as a surgeon, it is strange that I should write a paper on a nervous disease but as a surgeon I have seen so much more than the irritable ovary or the dropped kidney that I have learned to give nature a chance.

Each patient that comes to us should be given a complete examination, eliminating not only organic but reflex peripheral disturbances. The spine should be carefully gone over, that we may not overlook a possible source of much diagnostic and etiologic value. Hysterogenetic zones should be mapped out, and relief given by manual therapy or manipulation. And last, but not least, we must take into consideration the factor of the internal secretions, about which we are beginning to know considerable.

As the effects of castration and ovariotomy are almost self-evident to any observant person, so is it my belief that the advent of the fountain-syringe has been a potent factor in the production of many of the nervous complaints of our married women, there being undoubtedly something more obtained from the male than the fertilizing elements.

Unfortunately for the profession, it requires only six weeks, in many postgraduate schools, to make a specialist, and yet at the end of twenty years' study and work the conscientious man has but arrived at a time when he should feel that he is possibly competent as a surgeon. Not but what he may have arrived at a degree of manual dexterity and accomplished in technic sooner, but that his experience may have been sufficient for him to have seen the failures that make us hesitate in our recommendations and guarded in our promises.

selfish masculine rights, regardless of the wife's emotions in the matter. The latter, therefore, is in a constant mental attitude of silent rebellion. She feels defrauded and humiliated. Her real womanly sexuality is dead, because of the forced slavery; and her whole being rebels against an unwritten but accepted law of man's superior privileges and woman's subjection thereto, and her youthful dream of wifehood is buried in a decaying heap of the ashes of love. For these reasons she is not ready for maternity (with her own love-nature misunderstood and defrauded of its rights, how could she be?), and this resultant conception is neither of the will