TWENTY years ago, had anybody asked should get rid of the excess. Lying on the me to name the two principal hypnotics, I should undoubtedly have replied, morphine and chloral. Now I wonder how many years it has really been since I gave either of these as a hypnotic, or even thought of giving them primarily as a means of drowning the excited senses into a drug-oblivion? Sleep is so inevitable that its absence is always indicative of an active cause that prevents it. The indication, therefore, is not so much to induce sleep, as to ascertain why the patient does not sleep. Insomnia is a most valuable symptom, when duly appreciated. It may signify the beginnings of mental aberration, the presence of some form of self-intoxication, or that overtaxing of the brain that surely in time leads to exhaustion and premature failure of mind or body. Insomnia is an effect and a cause of mental derangement; for no human brain can long withstand the effects of the deprivation of the normal period of repose and recuperation. But a busy world demands of us a drug that will compel sleep, and only listens to our warning, after the mischief has been done and it is too late to do more than repair the lesions established. A writer in The Chicago American proffers these suggestions: Sleeplessness being due to an excess of blood in the brain, one left side allows the weight of the body to oppress the heart and so interferes with its action. But if you can, lie on the left side when you retire; the weight quiets the heart and decreases its activity. Then, as you begin to go to sleep, turn to the right side, and the trick is also turned, for you will go to sleep with no further trouble. This certainly is a good way for those with whom it works well. Many times insomnia is due to excessive vascular tension, and this to toxemia. Relieve the tension and favor elimination by taking a small dose of aconitine, and perhaps a dose of saline laxative, and sleep will follow, natural and refreshing, and the toxins will be excreted by the freer supply of blood sent to the eliminant apparatus. But, if the sleep is prevented because the vascular tension is lax, permitting the blood to flow back to the brain and distend its vessels when the patient lies down, we must give a dose of digitalin and restore the needed balance of tension. Sleep will then result, and this will give recuperative force, so that the remedy is curative as well as palliative. I have just had a beautiful illustration of this in treating a man stopping the use of morphine. He did not sleep; and his vascular tension was so low that digitalin was indicated. So he got a dose of itand all that afternoon he was dozing off and getting the most refreshing little naps. These conditions are not exceptionsin truth, they occur so uniformly that I am disposed to place aconitine and digitalin-also the laxative-in my list of hypnotics. How much to give? Just enough to do the work needed. In spite of mishap, let the truth stand that those who travel fast and go far, go by Love's Parcel-Post, concerning which there is no limit to the size of the package. Elbert Hubbard. DOCTOR OR DENTOR? A Doctor of Dental Surgery writes to one of the journals devoted to his specialty, suggesting that his confrères drop the misleading designation of "Doctor," and assume that of "Dentor." The reasons he gives are, that the former title belongs of right to the medical profession, as that of Reverend does to the clergy, and Esquire to the law; that it was an unwarranted assumption for the dentists to take the title, and relinquishing it would signify the complete cutting loose of dentistry from medicine. Neither the suggestion nor the reasons cited appeal to us. The title of Doctor does not pertain exclusively to the medical profession, and never did. Doctor simply implies taught, learned, instructed, or possessed of such qualifications as come by study, in contradistinction from what are gathered from experience. There are, and have been, many kinds of doctors-doctors of law, of divinity, music, and so on, and all these have quite as good claim to the word as we. That which is distinctively our own, of which we enjoy the monopoly, is our title of Doctor of Medicine-medical doctor. Unless we specify the medical part of our degree, we have no distinguishing mark. Should the College of Tonsorial Art see fit to adorn my barber with the insignia of Doctor of Barbering, he can call himself Doctor as lawfully as I. Pharmacy is ask ing for the designation of Doctor of Pharmacy, to which we make earnest protest, for obvious reasons. Between the Doctor of Medicine who prescribes, and theDoctor of Pharmacy who dispenses-and prescribes the public, which has its own affairs to think about, would scarcely distinguish. But the dentist has a better right. He is a doctor, a medical doctor, too, who practises one of the specialties in medicine, and does it well. He has never been charged with encroachments on the field of the doctor of medicine, and has not had to invade, for he has made so much of his own field that he has had no incentive to encroach. Rather he has had to complain of encroachments into his own demain made by the general practician. That the adoption of a distinctive title should signify the complete divorce of dentistry from medicine is another good reason for opposing the movement. It is contrary to the trend of science. The farther we advance along the path of progress in any of the learned professions, the nearer we come together. The dentist can make little improvement on the admirable technic he has developed unless it be by taking cognizance of the rest of the body. Professor Talbot has shown that the malady that so long baffled his dental colleagues, pyorrhea alveolaris, was readily explained by a study of the intestinal conditions, and as readily cured by remedies addressed to the digestive apparatus. Great as was this step in its direct application, it was still more important in indicating the line of advance to the dentist. The dentist must extend his view to the whole body, and study its interrelations to comprehend the disorders of the mouth. He must be a doctor of medicine first and his studies of dentistry must be superadded. As Garretson used to say, a man who is content to spend his life without a thought beyond poking bits of gold into holes in teeth can not do even that very well. As pharmacy is a step toward the degree of doctor of medicine, so dentistry should be. a step beyond it. In all the departments of human endeavor the value of a scientific education is becoming evident. The farmer used to enjoy unlimited merriment over the "theoretic cuss" who learned farming in school, from books. Nowadays the knowledge A TRIP TO ANOTHER WORLD that enables one to gather five hundred bushels of potatoes from an acre that no longer produced one hundred, is beginning to be appreciated even by the old-fashioned husbandman. The science that tells what crops a farm is good for and how to make it bear more with less exhausting methods may be theoretic, but it is assuredly also practical. The methods that enable one to realize a net profit of $5000 from five acres, instead of $2500 from 640 acres, are surely practical enough to win the approval of the man whose knowledge consisted in maxims anent planting "in the full of the moon." The dentist who has not a knowledge of general medicine may be a good mechanician, but he is not an educated, and consequently capable, dentist. He may get along with easy cases, but if his practice is large he must sooner or later get into trouble, through his ignorance. The worst of it is that this ignorance prevents his seeing the trouble approaching in time to forestall it. There is another side to this question that has never received the attention it merits: The dentist's studies should be placed at the disposal of the general practician, to aid him in his own work. While the teeth are affected by the conditions of the rest of the body, the latter must also be influenced by the affections of the teeth. The ophthalmologists have taught us much of the influence of ocular maladies over the other vital functions. Woakes pointed out the connection of ethmoid disorders with headaches. Specialists and general practicians refer cases back and forth continually. Inestimable knowledge has come to the present writer while sitting in the operating rooms of a chiropodist-lessons were there learned that not one of the very many physicians with whom he has come in communion had learned. The dentist is, in spite of himself, a specialist in medicine; and as such he has the same need of the rest of the profession it has of him. But to return to the subject-our dental friend forgets that the "titles of address" are not arbitrarily chosen to designate the members of a profession, but are derived from academic degrees. The word "doc 977 tor" has an honorable scholastic history, of which every one who bears it should be proud; and it has been used so long as a distinguishing appellation for professional men, and men of learning, that it would be difficult to replace it even in the case of those dental "doctors," who, after all, are, or should be, specialists in our common art. We hope no dental college will ever try to degrade the profession of dentistry by providing a cheap title which suggests that dentistry in on the level with blacksmithing or plumbing. Many a physician can indorse with a full heart the advice of The Willows Magazine: "Keep the patient's relatives out in the fresh air as much as possible.' A TRIP TO ANOTHER WORLD You are a little tired. A bit discouraged. Things persist in going wrong. Everything and everybody. The country goes to the dogs. Each political party is more corrupt and wrong-headed than the others. The hero you would like to elevate to a pedestal has a smudge on his face. Depravity grows as sentiment decays. Patriotism is lost in graft, honor in levity. The drunkard you have worked over so long, throwing your heart into the task of his reclamation, making untold personal sacrifices for him, goes back to his booze without the shadow of an excuse-except that he wants to do so. Life seems scarcely worth while. Like Cassandra you see the coming evils, but nobody listens to your warnings. Now wouldn't you like to close your eyes a moment and awake in Mars-see about you scenes unfamiliar, vegetation unknown, creations undreamed of, and yet with enough of the known to link yourself to them and enable you to comprehend and appreciate them? What a relief and an uplift the new and different things and thoughts bring to you. You can not voyage to Mars yet, but something of the same relief and uplift come when you leave the world of the Ordinary, and plunge into Dr. William Colby Cooper's "The Primitive Fundamental." It is so far from State Street! His philosophy reaches the roots of evil, and lo, they are the roots of life! What is is-and is because it has to be. The bad is the negative pole to the positive good. Men neglect your advice because they, too, must know for themselves, draw their own conclusions from their own experiences. No matter how wise we seem to ourselves we must never forget the limitless ocean of Truth that surrounds and pervades us, of which we get but shadowy glimpses now and then. Our neighbor's apparent faults spring from sources beyond our ken, and to him they are not faults, even though they would be such to us. Ten centuries from today the problems that beset us now will have lost their significance. Cooper is a most attractive and charming personality. The interviews we have had with him stand out in our memory as oases in the life desert. He likes to follow a writer who drives him to the dictionary, and he himself indulges in words and phrases that stir a man's memory and his thinking faculties. He is optimistic: "There is an absolute philosophy revealing its certainty in that daze which marks the distal limit of human perspicacity, but which holds in its promiseful depths an anticipation of the absolute." He is logical: "Matter is indestructible. It follows in inevitable corollary that matter is uncreatable." He is tolerant: "Good is simply less bad; bad is less good. The jumble results from intrinsic truth's resentment of a false assumption, and is an ineluctable confirmation of the identity of right and wrong." He is surely not orthodox: "The anthropocentric notion grew out of that auxesis which is the direct product of a belief in creation." His thought has a clarity that renders it comprehensible to the most limited intelligence: "Evolution is merely natural law's immanent assertiveness in coincidence with the instant-constant stress of cosmic momentum." His sight pierces to the center of things: "So far as we, in the helplessness of our ignorance, can see, nature as a whole has in it no element of justice or mercy." But faith triumphs after all: "The long stem of evolution, whose joints are chiliads of heartless tragedy, bursts at last into the great white blossom of altruistic beauty and sweetness." Cooper's philosophy is pagan in dogma, Christian in sentiment, good wholesome matter for one's rainy days. Place it on your table book-rack, with his "Preventive Medicine," "Immortality," and "Tethered Truants," for delectation when you are tired through and through. But Cooper is something more than a mere philosopher-he is a doctor, a real one too. He has contributed to the literature of the clinician a case that stands as an exemplar; one of those instances of ready wit and immediate action by which a life was saved from apparently inevitable death; which goes to illustrate the difference between the real doctor and the pretender. The tale has already been told in CLINICAL MEDICINE, and by Cooper himself, but it is well worth repetition: On the street, one of Cooper's wealthiest patrons rushed up to him crying that he had just taken by mistake a huge draught of tincture of aconite. Cooper happened to have in his mouth a chew of tobacco. Telling the man to open his mouth he spat the tobacco into it-and ran for his life. He never would have reached his office had not the man been delayed by the instant and repeated necessity of vomiting. While the patient was breaking down the door Cooper got out the back way and left town, to return only when friends had convinced the man that in no other way could his life have been saved. Even so I feel suspicious that for many a day thereafter they never met without the man's hands itching to get at Cooper, and the latter's legs feeling an automatic tendency to carry their owner far thence. OUR RELATIONS TO THE PUBLIC The relations of the medical profession to the public are beginning to attract more attention. In The Bulletin of the Harris County (Texas) Medical Society (a very creditable publication), Dr. John T. Moore contributes a discussion of this topic. His paper is quiet, conservative, and sensible. He limits his suggestions to some of the minor grievances, such as calls unnecessarily demanded during the hours of rest, inadequate pay for services, and so forth. But the important point he touches upon is the interest the community has in the doctor's betterment. It is the people to whom the movement for higher medical education should appeal; yet so little is this comprehended, even by the higherlegislators, that we have the spectacle of a United States senator rising in that august assembly and declaiming against the Owen Bill as an attempt to monopolize medical practice by one of a number of medical sects. GONORRHEAL DERMATOSES Dr. Moore speaks well of the public's interest in having competent, well-prepared physicians; and of affording these the means of keeping up with the advance by attendance on postgraduate work. This, he rightly asserts, should be made possible by subscription of funds by the people, just as the pastor is enabled to take (and give?) a vacation, and enliven his sermons by the experiences of travel. was To exemplify the benefits accruing to the public, Dr. Moore speaks of the doctor's efforts at preventive medicine. But here he approaches the verge of a precipice. Who pays the doctor for preventing disease? How is he to live if disease is prevented? Every doctor we have known possessed of a stomach that demanded a dose of pabulum, q. s., t. i. d. Most doctors have wives and children. Every last wife needs a new hat and a summer outfit; every last kiddy wears out shoes-gee! how fast! How under the firmament is the doctor to pay his way when he is paid only for attending the sick and there is no sickness? When you have answered this query satisfactorily, you may go on and demonstrate why the proposed changes in our relations with the public, as suggested in recent editorials, are absurd, preposterous, unethic, and impossible. GONORRHEAL DERMATOSES The Military Surgeon for June presents an interesting paper by Past Assistant Surgeon Pugh, U. S. N., detailing a number 979 of cases of cutaneous affections occurring during the progress of acute gonorrhea, and which he attributes to that malady. The evidence, however, by no means is conclusive. That any dermic affection should occasionally accompany an acute infection of this sort is possible, but not specially significant; that there is a direct connection, etiologically, between the two, is a matter that demands proof. Mere inference will not do. Dr. Pugh speaks of the cutaneous manifestations of gonorrhea as of three formsdiffuse scarlatiniform, or rubellous, multiform erythema, and purpuric. Of the eight cases described, three were of the first variety, three of the second, one of the third, and one showed both erythema and purpura. Another displayed macules or papules in addition to a scarlet eruption. Conditions of this nature often are ascribed to copaiba, but in the cases recorded there was no obvious connection of the sort, while in some the eruptions preceded treatment and even the appearance of the urethritis. Three theories have been propounded to account for these dermatoses, namely, that of their reflex character from the urethra to the skin, that of a toxemia from virus absorption, and that of a bacteremia, the gonococci themselves entering the blood. The first of the theories named is another of those assumptions, so many of which have been accepted in medicine as true, without being asked for credentials. Casper and Lewin accept it, and the latter ascribes the outbreak to the passage of an urethral instrument, especially in the later stages of the attack. It is quite conceivable that this procedure may occasion a lesion by which the cocci find entrance to the blood. Senator and Kaminer favor the toxemia theory, while later writers lean to that of bacteriemia. Probably each is right, in some cases, but the ease with which these organisms penetrate the tissues renders it probably that bacteriemia is the rule. A fourth explanation is, that the eruptions, when not due to copaiba, are merely coincidental. There is no particular reason why a person affected with acute gonorrhea should not be at the same time attacked |