vasion of different kinds. Besides, there is a peculiar class of cases with which we have a great deal to do. They occur in children of from 5 to 8 years, who are reported as having never been sick, but never well. They are not always listless, and languid, but they are anemic, thin, pale, under-weight, and easily tired. You find no organ diseased, and the blood-count is not pathognomonic. If you leave them alone, and with the consolation that the seventh or the fourteenth year will set matters all right, you leave death or life-long invalidism alone. Many of these children have syphilitic fathers in whom the disease was, or was believed to be, extinct when that child was conceived. In those cases think of syphilis. No arsenic and no iron, no country air or hydrotherapy will do them any good before they have been treated carefully and persistently with mercury. These are the cases in which mercury adds to the number of red blood-cells in a remarkable manner. It has often appeared to me that the absolute belief amongst our predecessors in calomel, which was considered indispensable in all the diseases of infancy and childhood, was in part founded on the frequency of just such cases.

Pertussis is a self-limited disease. Nature will get through with it; but in many cases with the child also. As long as whooping-cough lasts there is danger from hemorrhages, from convulsions, broncho-pneumonia, and perhaps connected with it, from tuberculosis; cases of encephalitis, spastic spinal paralysis, hemiplegia, posthemiplegic chorea, and paralysis of the abducens have been observed. Some of these direct results are liable to occur during the height of the disease. If we shorten the duration of the illness we prevent its opportunities for mischief. One of the first convincing experiences of this kind I had when a young practitioner. An infant with whooping-cough had a severe convulsion with every attack. Three days and nights either I, or a substitute, sat by, chloroform in hand, which had to be administered dozens of times every day. There is no doubt in my mind that by this active treatment I prevented either death or cerebral hemorrhage, with idiocy or epilepsy.

In gonorrhea of the male, or female, what do we prevent by active treatment and great care? Stricture and epididymitis may not count for very much, and aspermia in the male may not be estimated a great misfortune, but there are many here who have seen gonococcal arthritis and polyarthritis, endocarditis, septicopyemia, and death, or at least, ankylosis and long suffering. And the woman who is the victim of a man that was insufficiently treated over the apothecary's counter, or by his medical adviser, and perhaps thought himself freed of his gonococcal tenants! We have all seen from that cause endometritis, salpingitis, peritonitis, parametritis and perimetritis; and if not death, or lifelong invalidism, both of which do happen-at all events, sterility. Most, or all of these, could have been prevented.

Fine principles, when put to the test of daily practical experience, lose sometimes much of their ornamental glitter, and much of their usefulness. We hear the saying, and pass it on, that simplicity is of the greatest value in practice, and that a compound perscription is the damnation of the practitioner. If there be one indication, or one alleged indication, there should be one remedy. Here is an example: In a case of collapse, lowering of the head is a good remedy; compression of peripheral bloodvessels another; hot-water injection into the rectum a third; salt-water infusion, either subcutaneous or intravenous a fourth; the hypodermic use of alcohol, of camphor, of strychnin, of digitalis, of caffein, a fifth, sixth, seventh, eighth and ninth, the internal use of musk a tenth, and many more. If there be any simplicity and one remedy preacher who means to live up to his own notions and teachings, let him decide as to the single one of the indicated remedies he will select. There are only a few things that are quite simple and uncomplicated; one is a corpse, and the other a coffin.

Who is it that made the rule that a prescription must contain one drug only, not two, nor three, though they chemically be ever so compatible, if not the nihilists who preached that there is nothing in medicine but autopsies, and that medicine is a science and not an art; or, perhaps,

it was only exaggerated antagonism to the yard-long theriacs of the Middle Ages. If there is in illness an uncomplicated condition, give an uncomplicated drug; but be sure that the organ to which you direct your remedy is also simple and uncomplicated. Is there such a thing? Let me again take the example of the heart. When we speak of heart-failure, or a debilitated heart, does that not mean something more than the flabbiness or over-extension of an Indian-rubber bag? A heart is composed of muscular, intercellular, fatty, elastic tissues: it supplies all the organs with blood, and is itself thus supplied. Its circulation is pulmonary and nutrient. Its blood-vessels are exposed to the anomalies of all of the rest of the bloodvessels. In its nerve-supply there are sympathetic ganglia and fibres; there is the pneumogastric, there are fibres coming from the medulla, and in the medulla there is the head center of the circulation. Its normal innervation is that of the contracting muscle and of inhibition besides. If this compound body fails in its co-operative action, is it probable that a single drug will restore it in all instances? In some, certainly, for the strengthening of inhibitory power is often sufficient to gradually restore the disturbed equilibrium; but in many cases the circumstances are not so simple. Digitalis acts in many ways; according to Traube the slowing of the heart's contraction is its main effect; but aconite has a similar effect without any muscular influence. Digitalis increases arterial pressure, so does strychnin; digitalis causes diuresis by raising tension in the renal arteries; it has that effect in a lesser degree than strophanthus, which influences the arterioles less markedly. Digitalis also raises the blood-pressure, and thereby improves the nutrition of all the tissues, that of the heart included To its action on the heart, and also of the arteries, is due the rapidity of circulation; when, however, its contracting influence on the small arteries is too intense, that rapidity is stopped. To restore it nitrites are employed.

Strychnin increases arterial pressure without an inhibitory effect. That is why, when only a moderate amount of inhibition, but competent pressure is required, small,

doses of digitalis should be combined with good doses of strychnin. Inhibition is rather paralyzed by atropin; that is why rather large doses of digitalis are both tolerated and beneficial when combined with atropin. Spartein has little direct action on the heart-muscle and depresses the inhibiting pneumogastric; that is why digitalis, when its muscle effect is demanded, is borne when combined with spartein, in fair doses, for a long time in succession. Such combinations are not only permissible; they are requisite. I give such combinations, say of 4 decig. daily, of digitalis or its equivalent with half the amount of spartein for six weeks with perfect safety without going to see the patient, with no cumulative effect; the latter cannot always be avoided when digitalis is given alone. Though I must be brief, I should not conclude, however, without the remark that the combinations of so-called heart-stimulants may be much more various. Like strychnin, ergot affects the medulla and the spinal-cord centers. Caffein, camphor and ammonia stimulate both the heart and the vasomotor centers; hydrastis both the vasomotor centers and the peripheral vasomotors. Adonis appears to be almost identical with digitalis in its cardiac and arterial effects; strophanthus, with its modified action on the heart and principally on the arteries, finds its associates in convallaria and apocynum.

Fragmentary though these remarks have been, there is but one conclusion to be drawn from them, viz., that it is sounder practice not to rely on a single remedy when the disorder is multiple, and the tissues complicated. To win battles and to render war the reverse of ridiculous, you want the co-operation of brave troops, of well-informed and conscientious. officers, an experienced commissariat, expert engineers, and an effective medical administration; not a single one of them only. In addition, you want to be sure of the condition of your armamentary-be they rifles or drugs. It is true, here as everywhere, that brains come in handy for guidance.

In closing, allow me to thank you for your patience in listening to the many fragmentary remarks I took this opportunity to make. The stand I take in the mid-wife

question from a social and sanitarian point of view will probably be shared by many who will acquaint themselves with the ever-increasing necessities of the crowded millions of a large city or of the forced hermits of the backwoods. Nor will much objection be raised to what I presented in connection with premature senility. I am, however, not quite so certain about the universal approval of my views on therapeutic preventives in the different camps of medicine. Indeed, I am quite aware that many of those to whom we are under great obligations for services rendered to the advancing medical sciences will quickly disagree.

Anatomists, physiologists, chemists, bacteriologists—all these pillars of etiology and diagnosis should, however, suspend judgment. What I said was in the interest of the man, woman, or child not yet on the autopsy-table. The demands of actual practice in hospitals and at the private bedside cannot dispense with the results of the labors of those mentioned; but clinical medicine requires more than the knowledge of morbid changes and their causes; it demands means to prevent, to relieve, or to heal. That is what creates the superiority of clinical medicine over the special branches of study, and its standing as the first of all humanitarian sciences and arts. When this will be fully understood by the hosts of medical students and young practitioners, therapeutics in all its parts, diet, hygiene, and drugs, will receive greater attention.

The latter deserves it more from year to year, with the increasing results of laboratory-research, which adds to accuracy and safety. It is a queer spectacle to notice that the use and abuse of drugs is growing with the actual or pretended indifference of medical men in regard to them. More than $200,000,000 annually are spent on proprietary medicines in this country. The pirates of the single-pill persuasion are ably seconded by the wholesale manufacturers, who supply you not only with their wares, but with the formula of your prescriptions. The contempt in which we are held by some of them is, perhaps, best shown by the way in which they show their conviction of our absolute ignorance. It is only a few days ago that I re