with any cutaneous malady; the paucity of recorded cases compared with the vast number of gonorrheal infections renders this the more probable.

Nevertheless, considering the extraordinary virulence and endurance of this venereal parasite, it does seem remarkable that general infections with peripheral manifestations should not be far more frequent than as yet have been suspected. That such cases actually do occur, is shown by one encountered in the writer's personal practice.

A man of middle age had had gonorrhea not less than sixteen years previously, this resulting in chronic infection, as manifested by leucorrhea in the wife and the presence of the cocci in her vaginal secretions. This man applied for relief from a most distressing pruritus, generally worse at night. Examination revealed the presence of a few papules scattered over the body unsymmetrically, some of them pustular. The pus contained no microorganisms other than numerous gonococci.

The pruritus and the infection resisted treatment with the calcium and arsenic sulphides pushed to full saturation and sustained there-this requiring a daily dosage of 50 grains of the former and about 1-8 grain of the arsenic. Both pruritus and infection finally yielded when pilocarpine in full sudoriferous doses was added, and a strong local germicide was applied to the affected skin.

The importance of this case consists in the fact that the organisms were demonstrated in the cutaneous lesions by the microscope.

There are two kinds of fools-those who think they are wiser than they are, and those who think they are less wise than they are.-The Silent Partner.

EDUCATION? WHAT EDUCATION?

Time was when people talked of getting "an education." The curricula of all schools were arranged with the idea that there was one education that embraced everything worth knowing. The Youth The Youth who proudly stepped forth from his alma mater, sheepskin under his arm, felt that he was educated-usually conscious of

knowing it all. Should he decide to devote himself to one of the professions, he passed a few more years at college, and then, surely, he must be superlatively "educated."

Realization is not long in coming, and the young man quickly finds that practically he knows nothing. There is little exaggeration in the caustic remark that he has to begin by forgetting nine-tenths of what he has learned at school. Plunged into the thick of the battle of life he finds the musty lore he has spent years in acquiring has been utilized and gone to form a part of the universal, subconscious stock of the race. Mankind has gone far beyond it and is continually adding new knowledge that has not yet been crystalized in texts.

Education consists in the acquisition of knowledge and the training of the faculties of the mind. Knowledge has developed far beyond the point where any one person may hope to acquire all there is of it. A college course does not render the graduate capable of tackling any and every task that may come to him, but merely gives a foundation upon which he may begin to build his true education. Even in so far as the training of the mental faculties is concerned it is now understood that this applies only to the things in which the training is given. A course in Latin and Greek does not aid the pupil in his other studies, according to present belief. Nevertheless this is not altogether true, for one learns from the study of languages, and from mathematics and logic, correct methods and sound principles that may be applied to other branches.

The acquisition of knowledge, nowadays, does not aim at universality, but at best a selection must be made. What facts are to be gathered? The college course is largely selective. The essential thing to be held in view is that this necessitates a choice of material based on the future life work of the student. The selection must be of such topics as treat of the work he expects to devote himself to later.

This selection must begin during the college course. Whatever may be the student's preference as to a profession, medicine, law, theology, pedagogy, engineering in any of its numerous depart

ments, agriculture, business, the college curriculum offers a choice of topics designed to prepare him specifically for the selected vocation. Even in colleges especially designed for the study of agriculture a number of different selective courses are open for the student's choice. He may specialize in agronomy, forestry, irrigation, pomology, horticulture, agricultural engineering, or in several other departments.

The choice should be made not later than the beginning of the junior year. If the student intends to enter the medical profession he should give especial attention during the junior and senior years to appropriate topics-not with the idea of shortening the period of study in the medical school but to render himself better qualified to comprehend and utilize his instruction there. A groundwork of anatomy, physiology, chemistry, and botany, renders the labors of the medical faculty easier and more effective. How fervently does the teacher long for the day when he may teach what he wishes, to students qualified to comprehend his teachings! An incident of the writer's first course illustrates: Our professor of ophthalmology had occasion to recommend the use of "mitigated" nitrate of silver; but one of the class insisted he had said "medicated" --and many of the class agreed with him!

With its numerous specialties, it would seem natural that the medical course should likewise be largely optional, and that after the two years of anatomy, physiology, chemistry, materia medica, histology, pathology, bacteriology, and the principles of therapeutics, including hygiene, the student might devote himself mainly to the specialty he intended to practise. But at present this is impossible, for the state boards examine on the ancient system, all applicants looking alike to them. So long as this is the case the instruction in the junior and senior years must also be general, and the special studies undertaken by the student are voluntary and casual. He can only devote himself selectively to his chosen specialty when he comes to the post-graduate college.

Here we light upon an astonishing phenomenon the physician attending these

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institutions rarely devotes himself to the things he most needs in his practice at home, but runs about amusing himself. Explain?

The average physician does family practice. His is the most important, the most useful, the most essential, of all the medical specialties. He sees the patient first, recognizes the malady in its earliest stages, has the best chance to treat it effectively. He must know to the uttermost limit of the known or knowable, three things: physiology, pathology, therapeutics.

He must be up and ready with all the numerous non-drug methods and appliances, and if he is a real physician he knows that for nine-tenths of his work drugs form the readiest and best resource. And instead of demanding of the post-graduate college instruction in these departments— he trots off to see somebody extract the Gasserian ganglion, which he never in any possibility could be called upon to do, or to operate for cataract or appendicitis, which he straightway proceeds to do-and botch. Or he investigates the conditions presented in a great city but not in his own community. He may enjoy himself, but he should call it by its true name, a vacation, and not a period spent in a serious attempt to improve himself professionally.

Not a solitary post-graduate school in America has a chair devoted to the principles of therapeutics, or to drug applications.

Finally when you go to post-graduate schools, devote yourself to the things you can use in your work. Try to make of yourself a better doctor.

The tendency of modern therapeutics is towards Webb Wilcox. smaller and more frequently repeated doses.-Reynold

HIGH COST OF LIVING AND "LOST MANHOOD" NOSTRUMS

One phase of the iatrophobiac* type of degeneracy is that which, looking upon medical care as a luxury, dodges payment for it. This parsimony, which Molière ridiculed in "Purgon," buys patent med

*I. e., "doctor-hating." From iatros (Gr.), physician (iaomai, to cure; ios-Lat, virus; Skr., vish-as-poison and also drug; same as pharmakon).

icines to avoid paying physicians' fees, gets "cut rates" on "domestic remedies," patronizes"free dispensaries," and "sponges" prescriptions. One of the moral obliquities of the adolescent sexual nosophobia (morbid fear of disease), as opposed to hypochondria (morbid belief in disease), is this type of parsimony. Such a young man is bled by "lost manhood" nostrums and quacks under the guise of saving physicians' fees. Of course, his parsimony affects the substitutes.

The Chicago Board of Review should not, therefore, have been astonished at the high cost of living cutting into this luxury. Yet, members of the board of review looked up curiously when the announcer lately called out the case of a medicine firm that makes a tablet warranted to rejuvenate, regenerate and exhilarate any man, age or color notwithstanding, satisfaction or money refunded. Up stepped a small, weazened man, emaciated, wrinkled (apparently with worry), and nervous.

"You-you represent this concern?" asked Fred W. Upham, weakly.

"I do," was the answer in a small, uncertain voice; "and I want to protest against this assessment, because our business has been very poor and we have decreased our stock considerably."

"I grant everything you say," decreed Mr. Upham, cutting the assessor's valuation more than half.

Despite the boom given the "lost manhood" charlatanism by the distinguished "chemist," late of the Tweed-governed New York institute of pathology, now the great subsidized university at Baltimore, the sexual nosophobiac is becoming economical in "curing" his "loss of manhood."

Energy will do anything that can be done in this world; and no circumstances, no opportunities, will make a man without it.-Goethe.

A GREAT EDITORIAL IN A GREAT
NEWSPAPER

One of the most encouraging signs of the times is the interest which the lay press is manifesting in the work of the medical profession. This interest in America dates from the conservation movement inaugurated by Theodore Roosevelt. It was he

who pointed out, if not first at least first with the living power necessary to awaken the souls of men to the importance of the problem, that "this country has grown rich because of the masterly people who inhabit it and the great resources with which Nature has endowed it." (We quote from The Chicago Tribune.) It was he who brought us to understand, as we had somehow failed to understand before, that the future of the nation depends upon the conservation of our resources-resources which embrace not only forest, field and mines, but also strong men and strong women.

The Chicago Tribune in an editorial entitled "Real Progressivism," shows, with a clearness that must convince any thoughtful reader, that there is no question of such vital interest to this nation as the conservation of its manhood. Besides this, the tariff, currency reform, the size of the army and navy, and other topics for campaign discussion, are absolutely insignificant. In caring for our own we have stood still while other nations have advanced. Our commercial rivals in Europe, as The Tribune says, "exert special pains to protect and conserve as their greatest national resource their people."

In Europe the death rate from typhoid fever has been reduced until it is one-third what it is here. Deaths from tuberculosis have been cut in two, while we have not reduced them one-fourth. The Germans and English have evolved methods for the protection of the health of their working people which are far in advance of what we have in this country. The Tribune puts forward, as the really essential part of the progressive movement, "the carrying out of measures, national, state and municipal, for the protection of our greatest assetthe health and efficiency of the people." It puts the thing in a nutshell, when it says:

"Malaria decreases the value of land at least $10.00 an acre.

"Hookworm, by producing inefficiency, influences the price of cotton goods more than the tariff.

"Pellagra is a problem as important as currency reform.

"Consumption is of more consequence than the coinage of silver.

"Pauperism is a practical problem that deserves the most persistent and thorough study."

The progressive program which The Tribune proposes embraces the following propositions:

"That communities should be helped to banish consumption and typhoid fever: "That mothers should be protected during child-bearing;

"That the slaughter of the innocents should cease, as far as it is possible to make it cease;

"That children should be given a chance to grow up in strength;

"That men should be enabled to labor at high efficiency;

"That prevention should replace cure; "That pauperizing of men by charity should give place to a scientifically developed scheme for the care of those who need to be cared for along broad economic lines."

Whether you are a "progressive," a "democrat," or a "republican" you can assuredly endorse this platform. Every man's opinions are his own, and we shall not try to dictate to any man what he shall believe or for whom he shall vote. But we hope that the members of the medical profession will lay aside their differences and for get their jealousies long enough to fight together upon this program for the good of our race and the preservation of our nation.

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local medication is tedious, painful and not very satisfactory. I had been taught to look on the operative methods as the best resort, offering rest for this viscus that might afford relief; but my first experience completely demolished this hope.

The use of definite remedial agents fitted accurately to the disorder of physiologic function presenting has worked here as elsewhere its wonders, and afforded a degree of help not previously attained. I have selected some clinical reports from European sources describing the applications of these remedies made there, illustrating the direct therapeutic method. Note that the use of arbutin was unknown in France when these were published, that remarkable glucoside having been developed since then.

My attention was first directed to arbutin by observing that every plant containing it had been advocated as a remedy for urinary maladies. In these it is enveloped in a prohibitive mass of tannic acid, and only when freed from this could its curative value be determined. Besides, it is one of those slowly acting remedies that follow the processes of nature, and does not commend itself to those who look for the miraculous immediate results of surgery. To those who know its powers and how to use it, arbutin is a boon beyond estimation.

A Portuguese practician, Costa, tells of a man 60 years of age afflicted with retention of urine, necessitating the catheter, and incontinence. He also had dyspepsia, pyrosis, vomiting, anorexia, weak pulse, and urine dark and muddy. He began taking strychnine arsenate, four doses a day; with quassin, bismuth and soda, at meals. In eight days the digestion had become normal, as was also the urine.

Lorenzana details a case of chronic cystitis with hematuria in a priest aged 60, the patient being profoundly prostrated, with temperature subnormal, frequent painful calls to urinate, and chills, the malady having lasted two years. The use of the catheter had been compulsory for three months. Treatment was as follows: strychnine, hyoscyamine, benzoic acid, one dosimetric granule each every two hours; quinine hydroferrocyanide, two, and sodium benzoate,

one granule every three hours; quassin, three granules before meals; podophyllin, three granules each evening. A saline laxative each morning. Improvement followed for ten days; then retention was relieved by cicutine and hyoscyamine, one granule each every quarter to half hour. By the end of a month he was able to resume his duties.

Baillif's case was that of an old soldier, aged 65, hemorrhoidal, with a history of two nephritides. Since the last attack he had difficulty in emptying his bladderfrequent calls to urinate, increasing, and blood appearing in the urine. When paralysis of the body of the bladder follows spasms of the neck, it is necessary to employ simultaneously strychnine, hyoscyamine and digitalin.

Lacoste described four cases of cantharidal cystitis. The first followed the use of a blister. Pneumonia followed, to which the patient succumbed. The second was that of a man of 60, who had had pneumonia, treated by fly-blisters. Cystitis followed, but the physician had now heard of the new method, and administered hyoscyamine, one dosimetric granule every quarter hour. In two hours the urine was discharged without the catheter, and sleep followed. The third was a man aged 30; similar in cause. The bladder resumed its expulsive power after fourteen doses of hyoscyamine, two every fifteen minutes. The fourth was a boy of 7, with cystitis following a blister for pleurisy, allowed to remain in place for eight hours. Hyoscyamine subdued the pain and irritability of the bladder and quieted the spasm of the sphincter, while tending to restore the contractility of the detrusor.

In cantharidism Becler urges the use of hyoscyamine for the accidents attending the use of cantharides. For the violent vesical pains he gives a granule of hyoscyamine every quarter hour. It is rare that more than eight or ten are required for adults, three or four for children under five years.

Van Inweghe tells of a boy, aged 5 years, suffering for three years with dysuria, strangury and ischuria at times. The case seemed thus: The child was infiltrated, probably there was default of the renal

secretion, the urine scanty, charged with salts, these irritating the ureters and the bladder and provoking ischuria. There resulted a cystalgia, with painful contraction or straining of the neck and paresis of the body of the bladder: Surely a want of antagonism.

These three indications should be met by digitalin, strychnine and hyoscyamine, and nothing would be risked by pushing them to effect. These remedies were ordered, a granule of each every half hour. During the night the child urinated freely and in the morning was playing on his bed, free from tenesmus and pain. He had taken twelve dosimetric doses of each, and eight more doses were given during the next two days. Besides, he was given quinine hydroferrocyanide, four doses a day, this being in the low malarial land of Holland. Probably the malady had not advanced beyond the dynamic stage.

If you want to "do something for humanity," do something for those who are doing their own work creditably, paying their own bills honestly, and not howling about their ills or their wrongs. The old and the unfortunate should have our sympathy and our aid, but the best help we can give the shiftless is to compel them to work with their own hands, and to bear their own burdens.

ARTERIAL DISEASE AND ITS TREATMENT

Much carelessness is manifested by authors in describing affections of the coats of arteries. French, writing in The Lancet, describes the three commoner affections as follows:

1. Atheroma affects the tunica intima, in spots, as abscess followed sometimes by ulcer, sometimes by calcification; occurring mostly in the aorta, the first parts of its main branches, the coronary and cerebral arteries.

2. Endarteritis obliterans affects the medium-sized cerebral and spinal arteries, following syphilis, as a concentric proliferation of the whole intima, lessening the lumen and the supply of blood. Senile calcification is a deposit of lime salts in the muscular coats of the medium-sized arteries, like the radial, causing rigidity, but neither obstruction nor high vascular pressure.