Scar on forehead much less noticeable and fading rapidly. Suture line along sides and end of nose very faint, bridge of nose symmetrical, although rather thick, right nostril slightly drawn upward. Prior to this case the writer's experience with constructive surgery had been a generous number of perineal and corvical repairs, with a fair number of harelip cases, deformed ears and minor facial blemishes. As luck would have it, one plastic case brought another, so that we were able to begin a series more or less by well-chosen plastic operations. Successful results, however, demand unconditionally some experience in plastic work, a mechanic's eye, flawless aseptic technic, a perfected anesthesia method, and dependable, conscientious postoperative nursing and care. Informal Chat on Therapeutics. BY GEORGE F. BUTLER, A. M. M. D. Professor and Head of Department of Therapeutics and Professor of Preventive and Clinical Medicine, Chicago College of Medicine and Surgery. (Medical Department of Valparaiso University, etc.) T HE AUTHOR, while modestly designating his article an "informal chat" and indeed it is, so far as the simplicity of its language and style is concerned really delves pretty deeply into the elementals of therapeusis. He shows how modern therapeutics, if it is to hold its own with modern medical science in other directions, must be intelligently grounded on laws and principles, for which we must go down to the very elements of cellular construction and pharmacodynamics. Touching the germ theory, the author expresses his opinion that many microbic diseases could be prevented and cured by an intelligent application of drug therapy just as surely and efficiently as by a therapy directed toward the germs themselves. He points out some of the popular fallacies of a misunderstood doctrine of heredity, maintains that the "soil" is hereditary, but not the "seed," and declares his belief that in tuberculosis and other infectious diseases better and safer results are to be obtained, as he quaintly expresses it, "by rendering the soil barren than by sprinkling Paris green on the backs of the bugs." The whole article is in Dr. Butler's usual sane, sensible, witty style, and contains lots of food for intelligent thought on the subject of therapeutics. The mind hungers for principles. "Give me truths" is the cry of our profession today. It is a satisfaction to have lived in a generation when medical science achieved its greatest victories, when it proved the law which alike controls the birth, growth, decadence and death of a monad or a planetary system-that law suspected, guessed at, but never comprehended until recently, when it became known that when an organ or a part of any living entity hesitated in its work that moment the destroying forces attacked it and did not rest from their labors day or night until they had taken it to pieces, reduced it to its simplest elements, and restored them to the common depository for use. The workmen in this process were once called decomposition and decay. We know them better now as the living laborers, the unbuilders of nature. These by countless millions are the enemies with which medical and surgical science has to contend. To obstruct their work, arrest their mysterious reproduction and clear them out of the human body is the herculean task committed to our profession. The best minds of our profession have devoted their lives to the tracing of possibly a single symptom once called disease back to the law of its origin. The diagnosis of disease in its most secret recesses-antiseptic surgery, pathology and bacteriology-are some of the fruits of these men's labors. Every year the cause of science has been pressing onward. The advance in our profession has been marked by more triumphs and greater victories than in any other department of human endeavor. Yet in the scientific application of remedies to disease the progress has not been so great. Object of Drug Therapy. We give drugs in disease for two purposes: (1) To restore health directly by removing the sum of the conditions which constitute disease. Here we act empirically with no definite knowledge often, indeed, with little idea of the action of our drugs, but on the ground that in our hands or in those of others they have restored health in like cases. (2) To influence one or more of the several tissues and organs which are in an abnormal state, so as to restore them to or towards the normal; with the hope that if we succeed in our purpose recovery will take place. This purpose we effect by means of the influence which the chemical properties of drugs exert on the structure and functions of the several tissues and organs. Minute information, therefore, of the nature of the drugs and their action is essential for their proper employment. Nature of Drugs. Drugs were formerly looked upon as simple substances having amongst other attributes the power of curing diseaseindeed, the popular idea concerning them has not advanced beyond this view; but physicians now refer their influence to the textural and functional changes they are capable of effecting in definite portions of the body by virtue of their total composition, or that of certain chemical substances they contain. Not only do the elements of which a drug is constituted affect its action, but the way in which these elements are grouped and combined is of importance. The effect which several of the elements exert in their compounds have been traced by Brunton, Ringer, Harnack, Binz and others. It has been shown that chlorine and bromine, potash, lime and many other metals always tend to act on certain tissues in a definite manner, unless their influence be neu tralized by other elements with which they are in combination. It has been shown also that small groups of elements may play a similar part in more complex compounds, that the action of NH2 and NO2, for ex ample, can be as distinctly traced in the compounds in which they occur as that of chlorine or potassium or calcium. A compound containing that group NH2 stimulates the medulla; a drug containing the group NO2 acts on the vessels and dilates them. On the other hand, in many of the organic compounds we are quite unable to trace the effects of the several elements; and it is rather the manner of grouping of the elements which seems to confer on the compounds their pharmacological and other properties. Two compounds may contain exactly the same elements and the same number of atoms of each, yet if these atoms be differently arranged, the compounds may differ entirely in pharmacological and other properties. Methyl nitrate and nitromethane have the same formula, but the oxygen and nitiogen atoms in the two substances are joined together in a different way. The result is they act quite differently; the nitrate dilates the, vessels. Nitro-methane has no such action. Medicines are such by virtue of their reactions on living elements, and they come into being because of just such reactions. They simply are what they are; because it is a fact that neither your body nor the body of any living organized being, plant or animal, is a unit as it seems to be. Many think their own bodies one and continuous. They an understand nothing about principles of medical action while holding this idea. Our bodies are composed of hundreds of millions of little creatures, each one separate and distinct from yours, while their total constitutes you. We are simply built up of masses, each body being a host of living bodies. Far down in the scale of being our brooks and ponds reveal a form of life of a single unit or cell. A little higher up and we find many compacted in one, much as the coral insects unite their forces to form vast islands. Cellular Construction. Between unicellular and poly cellular forms, every degree of combination does or has existed. Examined under the microscope, human muscular tissue proves to be but a polycellular mass. Nerve structure, similarly treated proves to be the same. The white corpuscles of our blood are the freed units analagous to the unicellular creatures of brooks and ponds. Watched by the microscopist they are discovered to have a separate distinct life from yours. From them, as bricks, the building called your body has been erected. They can eat, sleep, be anesthetized with ether, awake, drink, excrete and do all you do that indicates life, except possibly to think. They have been actually caught in the act of killing and eating the red corpuscles so that there is every indication that cannibalism goes on in our arteries. As I have said already the lowest form of animal life on our planet exists as a single cell. We call it Amoeba. The grouping of these simplest forms make the successive steps of progress. Amoeba-like bodies build all plants and animals up, even to man. The more complex the organism in which they are found the less their individual powers of adaptation to varying conditions become. High up in the scale, division of labor among them has gone on to such an extent that they are forced to depend upon their aggregation for continuity of life. At the bottom of the scale every cell is sort of "Jack of all trades," performing every function in a sort of a way. At the top each has assumed a distinct power or function of its own, which it does well. We have nerve cells, bone cells, cartilage cells, connective tissue cells and others. These have become perfected in a certain kind of work and depend upon their fellows to do all other necessary duties for them. They are like the perfectly organized army with a general in command. Orders are issued by this general, and each subordinate knows his share of the duty in obeying orders. From the frontal cerebral region of the brain emanate the conscious commands that go through nerve ganglia and muscles to come forth as voluntary action. Why are you able to walk? Nerve cells and muscular cells are irritable. Muscle cells are able to contract. What we may call for convenience sake a telephonic message starts in the brain, passes through the white thread-like wires called nerves and reaches the muscle cells. You say "contract." They receive the message and obey. If you say "relax," they obey as promptly. This contractile power of muscle, however, does not reside in your will. Cut away the limb from the body and if you stick a pin in it, you will discover that it is still able to contract and relax, although quite free from your body. A heart removed from a body will continue to beat. On stopping, the prick of a pin will stir it to action again. Every part of your body has this independent life from you, and every part is differently affected by different drugs and in different doses. The properties of drugs used as medicines are due to their specific power of producing certain modes of stimulation or depression in these aggregates of cells. The therapeutic studies of the future, in my opinion, will determine. how certain cells react to certain drugs, and show how combinations of cells give their complex resultants. Old and New Pharmacology. The old anatomists dealt with the organs and described the relationships of the bones and muscles of the lungs and liver, without troubling themselves about their composition. The anatomy of the cell itself is now receiving attention, |