Prof. Alonza Clark, M.D, of the same school, says, with many other condemnations of the methods of the school: "All of our curative agents are poisons, and, as a consequence, every dose diminishes the vitality."

my medical friends asks, "What is it in English?" Now this is just what I am going to speculate about, and if we can understand what it means in nature, then we know what it is in English, and in very tongue on the face of the earth. If I reply that Dunglison defines it John Mason Good, M D., F.R.S., says: "The science to be a term employed to express that instinctive heal- of medicine is a barbarous jargon, and the effects of our ing power in animal or vegetable, by virtue of which it medicines upon the human system, in the highest decan repair injuries and remove disease. Does my friend gree, uncertain, except, indeed, that they have destroyed understand any better the full signification of the term? more lives than war, famine and pestilence combined." We only know a thing so far as we know all its prop How far these unqualified statements are simply the erties, functions, and modes of acting. There has been result of a misanthropical and cynical mood, or whether a great deal of flippant talk about the power of nature they represent at all the belief of the alleged authors, to cure, and this talk has been indulged in many times, or what might have been their motive for making the doubtless, without stopping to consider what nature is, statements here quoted, is of little interest, excepting or what are her powers. We believe in the power of so far as publicity given such statements purporting to nature to cure, and her power also to kill; all powers come from men in high authority, may prejudice the belong to nature but not always do these forces obey public against the system of practice, which we, as her will. It is only when these forces are disobeying members of the great catholic school of medicine, have or ore diminished, that we should interfere. There is a pinned our faith to, and to the success of which we are class of negative minds who think they must believe devoting our lives. For we, unlike the laity, cannot, if what they are expected to believe; who have an excess we are honest and have faith in ourselves, be long unof veneration or reverence for current opinions of so- duly influenced by the dictum of any one authority, ciety and the age in which they live. They are so ultra since we owe no allegiance but to truth ard fact, and fashionable that they follow the fashions in regard to the consensus of opinion in regard to any matter of their belief. which the body of average medical men are capable of judging, must determine the truth and settle the question for us. Great men are liable to great mistakes. A single individual, or several, may be deceived in regard to a matter of common observation, but the liability to err is reduced to a minimum by the concurrent opinion of thousands of clear-headed, honest, practical medical men. It might seem as little worth while to argue for a moment on the matter in question, as to spend time in proving the man is in error who says, "The sun does not shine!" or "the world is not round!" I have met only one man during my life, whose sanity was unquestioned, a level-headed, practical man attempted to disprove the rotundity of the earth. How many there are who may have some doubts about the matter, I cannot say, but certainly where there is one who believes the earth is flat, and a few more who don't know what to believe about it, there are thousands and tens of thousands who are either convinced that the drug treatment is an unmitigated evil, or are very skeptical in regard to any advantage to be derived from the drug treatment. We form our opinion of anything by its relative or comparative qualities or position, therefore if our ideal conceptions as the power which drugs possessed to cure disease have raised too high our expectations, when we become acquainted with the real limitation of their power, we estimate them as far below their real value. If, then, it were true (which in a certain sense it is) that Prof. John Smith, M.D., of the same school, says: men as they grow older, lose confidence in drugs, it is "All medicines which enter the circulation, poison the because the active imagination of youth had clothed blood in the same manner as do the poisons which pro- them with magic and specific attributes which makes duce the disease, and drugs do not cure disease. Dis-real qualities seem as nothing in comparison. That we ease is always cured by the "Vis Medicatrix Naturæ." lose confidence in drugs in one sense may be true, but And again, "Digitalis has hurried thousands to the as one illusion after another disappears as years roll on, grave." we find alas! there are few things in life in which we

When Symon says, "Thumbs up!" theirs turn up; when he says, "Thumbs down!" down go theirs. They would rather appear to be anything, even a chameleon, than an unfashionable crank. Such persons, and there are many such, will be unduly influenced by expressions of opinion from those occupying high positions, or who are supposed to occupy those positions. The sad ef fects of such unkind thrusts as these, given by persons from whom I will now quote, we see and feel too plainly in the panicful condition of the public mind and the unwarranted suspicion of medicine. Some twenty-five years ago one of the Boston papers attributed to Dr. O. W. Holmes the remark, "That if all the medicines in the world were emptied in the sea it would be infinitely better for mankind and infinitely worse for the fish.” The New York Semi Weekly Tribune of December, 1891, gives publicity to the following:

Professor Alexander H. Stevens, of the New York College of Physicians and Surgeons, says: "The older physicians grow the more skeptical they become of the virtues of medicine, and the more they are disposed to trust the powers of nature, and notwithstanding all our boasted improvements, patients suffer as much as they did forty years ago." And again, "The reason why medicine has advanced so slowly, is because physicians have studied writings of their predecessors instead of nature."

have not lost confidence, at least we have not modified our opinion in regard to. It would be more correct to say that we do not value drugs less, but other things more relatively.

It is important to consider that wherever change may occur in our estimate of any drug or drugs, our confidence in the principles governing the treatment by drugs continues unshaken.

All things are natural inasmuch as they are accomplished by, or are the manifestation of the forces of nature. There is nothing below or above nature but the Supreme. But in speaking of nature we refer more particularly to normal nature, or that which is the result of natural forces acting in obedience to the universal will. Water may run up hill, but when we find it doing so, me know it is natural under the circumstances, but we will find the circumstances to be that it is obey ing not the universal or normal will, but a special or abnormal will, that of the man at the pump or engine. Therefore we say that disease is a natural process since it is the result of natural forces, but these forces directed by a will in conflict with the universal or normal will, therefore abnormal, an insurrection against the central authority or nature.

What is it to cure? I consider this a relative term; one can cure a little or can cure still more, or can cure until the patient is well. The Irishman who presented his bill for "Curing your wife till she died," was correct in his expression. So far as a drug or person by any means does something for the sick, one that makes it easier for nature to throw off the disease, so far he cures, whether the patient lives or dies. The action of medicine is not so uncertain as might at first appear; any drug having a physiological action can be relied upon to produce that action, allowing that the conditions are present under which it is capable of so acting, but nature is very particular, and before giving the drug, if the conditions under which it is capable of acting are not present, we must first produce those conditions. But whether its action will be curative depends much on our individual judgment. Remember, we are dealing with conditions, and not with names for diseases. Certainly a very large class of what we call diseases, possibly the larger number, ore the result of diminished dynamic energy-the force by which nature governs. That force which preserves and constructs becoming feeble, the destructive or negative force prevails, consequently the degenerative chances so often seen. We believe in the power Whether it is better to bear the ills we know or by of nature to preserve, and its power also to destroy, and a presumptious interference to invite those of which we it is our duty to make the best use of the knowledge we know not! Whether it is better to rely on the efforts possess, and by every means control and direct these of nature, unaided by medicine or art, is now the ques- processes. We are relying as implicity on the "Vis tion. Of course, most persons will say a presumptuous Naturæ," even exhibiting in a greater degree our faith interference by medicine or otherwise is not advisable. in nature by active interference in behalf of the sick But it is a question with many whether any interference one, than by waiting and doing nothing. For it is by drugs is wise; whether it is not presumptuous to use drugs at all! The belief prevails, to a considerable extent, that as a man grows old in the practice of medicine, his faith in the value of drugs diminishes in the same ratio, since age must necessarily bring experience, experience wisdom, and wisdom knowledge, that drugs do more harm than good. Professing, therefore, to have that knowledge seems to many a guarantee of wisdom, because a lessening faith in drug treatment is what is expected in this age of experience and wisdom. Drugs are poisons inasmuch as they do not belong in the system, and it is by virtue of their being foreign to the system that they are capable of producing physiological effects acting along those channels and through those organs by and through which they are expelled from the system. But because poison, that they necessarily diminish the vitality, I deny. It is by the active use of any organ or function that its strength is preserved or increased, and even excess or abuse of action within a certain limit, can only lead to some abnormal development of size or strength. These drugs or poisons do not remain in the system, but are soon expelled by some organ or organs, and by the increased functional action of these organs their strength is increased. To be sure the increased action requisite for expelling the poison absorbs some vitality, but vitality is not a fixed quantity, and nature returns the amount expended with good in- The expression "expectant treatment," which means terest. It has been said, "Drugs do not cure disease." no treatment at all, seems to supply a necessity by ex

none the less nature's work because her forces are first transmuted into right thought-natural thought-and then into right action on our part. And moreover, are we not a part of nature?

A doctor stands in the same relation to his patient as a farmer to his farm. We often hear the latter speak of raising a crop, or making a crop. Now, the bestfarmer cannot make a blade of grass, or hill of beans grow. Nature only can do that-but by studying the ways of nature, and observing the conditions under which the best results are obtained, he can do much in assisting. In the same manner a doctor cannot cure a patient, but by observing the conditions which nature requires in order that she may cure, he can do many things to assist. You don't hear a farmer talk about adopting an expectant treatment in conducting his farm or garden, though you will find many farms and gardens that evidently have been treated according to that waitand do-nothing system. Man has no right to expect the best results from the operation of nature's laws while closing against her that avenue through which only she can manifest the highest of all powers, "conscious, intelligent thought and action. That avenue, the stupendous achievement of millions of years of evolutionary work which nature has prepared, that she may reveal herself more fully to the world.

}

plaining what we are doing when we are doing nothing obstruction which could not otherwise be removed, and for our patient. It seems to cover the unavoidable ig- this being accomplished the finer forces of nature can norance of the doctor, or excuse his indolence, and if do the rest. Our crude mechanical and chemical forces, the lazy farmer cared to excuse his shortcomings he directed by intelligence, can as well serve 3 needful äid would long ago have used the same or a similar word; to nature in dealing with a sick person as in cultivating unfortunately there are cases to which only the expect- our farms and gardens. ant treatment is applicable. But I am sorry to say we too often see cases that are suitable for active, intelligent treatment, when nature is allowed to struggle along alone, the doctor making simply a show of doing some thing by giving a placebo. It is true that nature, unaided, will sometimes bring about a slow and imperfect cure, but handicapped as she is, her work is not so well or thoroughly done, and the after-condition of the patient is far from being as favorable as if nature's efforts had been supplemented by efforts on the doctor's part. Because we believe in the "Vis Medicatrix Nature" is no reason why we should stand idly by and neglect to do that which the simplest common sense would suggest, and by doing which we increase the efficacy of nature many fold. Drugs are to the physician what the tools are to the mechanic or artizan, and in dealing with the complex conditions, which we call disease, we select the drug to do one work, and another to do a work quite different. What would be thought of a carpenter should he use a pocket knife to cut a board in the proper length, instead of using a saw? or if he wish to make a smooth, plain surface he should use a hatchet instead of a plane? or if he used a saw, specially adapted to cut at right angle with the grain, for the purpose of cutting the board lengthwise? We should undoubtedly conclude he did not understand that each instrument was special ly adapted to accomplish a certain work, and could do the work better than any other. Let us make an appli cation now to ourselves, and use our drugs within the sphere to which nature has adapted them. It is one thing to say we know a fact, and another to realize the full force of what we say we know; to have assimilated that knowledge so that we feel the full force as a mo tive of action. It is not enough to know a thing is good, but how good? That something is important, but how important? We must discriminate between those matters of minor importance and those of paramount importance; between the principle and auxiliary, otherwise our chief efforts will not be expended where they can do the most effective work for our patients. 'Yes," you will say, "that is what I have always been taught; I know all that." But do we realize the full force of what we say we know? Our actions only will tell.

Much has been said in condemnation of the practice of treating symptoms. Certainly we should try and remove the first cause, when that cause is known and when possible to do so. It has been claimed that many symptoms are simply manifestations of the efforts of nature to cure, and therefore should not be restrained, but we should wait for nature to discontinue her efforts in that direction. Certainly every symptom is natural under the existing circumstances, inasmuch as it is the result of nature acting according to reason or the eter nal necessity of the case. Therefore, since natural, or according to nature, the symptom does not constitute the disease. The disease is that which makes it a necessity so to act. It is the primary disturbing element that caused the forces of nature to vary from their nor mal mode of acting. But although not the disease, and moreover a perfectly natural phenomenon, many symp. toms lead eventually to conditions which constitute disease, therefore the wise physicians will continue to treat symptoms, and by so doing hope to break the long chain of cause and effect. Because we cannot, unfortu nately, go back to the first cause and remove that, it is no reason why we should not arrest any one or all of the resultant causes. Because we cannot now prevent match from being made that lighted the lantern that in turn set fire to the hay, is it any reason why we should not extinguish the fire in the hay and thus save our barn? Undoubtedly some symptoms are the manifes tation of nature's efforts to cure, but it does not follow, therefore, that they do cure or tend to cure. They may be highly detrimental, Nature's forces obstructed in one direction naturally flow towards the point of least resist ance, and from being preservative and constructive they may become destructive. Health consists of a ready and willing obedience to nature's authority of every part of the body, from member to minutest cell. While this loyal state of healthful acquiescence contiuues, nature finds it necessary to exercise but a small part of the power vested in her, and the functions of the whole complex government are carried on without friction and with the smallest possible expenditure of force. This is the "Vis Nature" quite sufficient in times of peaceful obedience. It is different, however, when the forces of dissension and destruction, whether arising in Let us endeavor to realize what we now know, that the body or assailing it from without, threaten to overdisease is not an entity except in some few instances, turn the peaceful government of nature. She at once but is a conflict between the forces of order and the brings to her defense her reserve powers drawn from forces of disorder, and when the scales are evenly bal every available source. She exercises all the power anced a feather's weight may turn them in either direc- vested in her to maintain her authority, and the poten tion, therefore the importance often times of little tial energy in drugs is as much a legitimate resource of things. Let us not despise what seems a matter of nature in overcoming the insurrection in the body, as small consequence. With our drugs, as well as by other the latent energy in gunpowder and dynamite when means at our command, we may remove many a gross used by a government to repel a foreign enemy, or in

internal dissension to compel obedience to rightful authority. These are the "Vis Medicatrix Naturæ." The science of medicine will appear a barbarous jargon only so far as we fail to comprehend its principles and the grand truth, that we ourselves are a part of nature and that inhering in the developed human mind there. is a power which is destined to disclose all truth and bring order out of chaos.

With reverent spirit, though with honest pride,
That thou art part of nature here abide
Midway betwee the two extremes

Of those who think they're more and those to whom it seems
That they are less than nature.

Here thou may'st hope to happily escape

Some of the sad errors that we sometimes make
When fired by pride, puffed up by self-conceit,

And unsuspicious that we are part of nature,

We make ourselves officious,

Dictate to nature and oppose her will,

Incite her forces to rebellion, and, instead of curing, kill.

We then are like an abscess, boil or wart,

An inflamed spot, excrescence of some sort,
The very things we claim to cure,

And caricatures of nature sure.

No more to be commended, one deficient

In self appreciation, who thinks he's nothing, nature's all suffi cient,

For such a one is just as good as any palsied limb or part

His nerves insensate he feels not the quickening impulse of great
nature's heart,

His sluggish brain refuses to transmute
The thoughts of nature and to action suit.

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Tin-Poisoning. Dr. W. A. Campbell (Therapeutic Gazette) reports six cases of gastro-intestinal disorder occurring in one family in a period of twelve days, one being fatal. The character of the alvine dejections suggested that the trouble was dysenteric. In vestigation showed that the source of poisoning was the eating of tomatoes which had been preserved in cans which formerly contained peaches. These cans, having been ineffectually sealed with wax, had been re-heated and re sealed. A chemical examination of the contents of a can revealed a comparatively large amount of tin and a small amount of lead. He concludes:

1. Stannous salts are poisonous to the human system, being similar in their action to the other mineral poisons -lead, zinc, arsenic, antimony.

Our Drinking Water and Continued
Fevers.

Although the citizens of St. Louis have been cautioned repeatedly to either boil or filter their drinking water, the water supply of St. Louis being objectionable in a sanitary sense, it appears that a great many have not taken the hint. At least in our experience we find that especially the poorer and ignorant classes are drinking water which has not undergone either process and as a consequence we have an increasing number of continued fevers in the city. Some of them are indubitably typhoid, others the so-called simple continued fevers and some remittent malarial fevers. In every case which has come under our observation no precaution had been taken in regard to sterilizing the drinking water and, judging from the experience last fall, when Health Officer Francis was able to trace

2. The salts of tin are anthelmintic as well as the nearly all cases of typhoid to the water supply powdered product.

from North St. Louis, we are convinced that in the vast

3. Toxic doses of the salts produce symptoms similar majority of cases the fevers are due to our drinking

to those from ptomaines.

water. Considering that our hydrant water has been

4. Canned-food products may contain stannous salts found to contain an amount of organic matter which is in poisonous quantities.

more than sufficient for the growth of disease germs, 5. The danger from this source is increased from ex and, moreover, that the bacillus of typhoid fever has posure to the air; hence, all fruits should be emptied been found in it, we hold that it is the duty of every from tin cans as soon as opened. The treatment pursued physician in St. Louis to caution his patients in regard in these several cases was entirely symptomatic-astrin- to the water they drink in order to avoid an epidemic of gent, demulcent, anodyne, or stimulant, as the symp- the same or a larger extent than that of last year. toms indicated. The diet was milk. The writer has charge at the present time of between

In this case the first attack of fever was in all proba bability due to a malarial infection, the second one was typhoid fever.

thirty and forty cases of continued fevers at the Alexian by forty-eight grains of quinine in twenty-four hours, Brothers Hospital some of them being distinctly typhoid then the temperature varied under the same treatment and but few of the others react upon large doses of between 104° and 105°-no morning remissions-for quinine and are classed as remittent malaria and simple six days. Quinine was discontinued and phenacetine and continued fevers. Whether the last named fever is salol of each two and a half grains every two hours and simply an abortive form of typhoid or a fever sui generis sponge bath ordered. Gradual decline of temperature with is still a disputed question and one that can only be morning remissions. After the sixth day of the second conclusively settled by bacteriological examination of a attack of fever characteristic signs of typhoid, roseola, large series of cases, and since it requires a great deal subsultus tendinum, diarrhea, pea soup stools, and tym. of time to demonstrate with certainty the typhoid bacil- panites developed. The administration of antipyretics lus on account of its great similarity to the bacillus coli, was only continued for three days, the decline of temsuch an examination can only be made by a bacteriolo perature continuing until the twenty-first day after gist who can devote almost his entire time to this work. which it remained normal. It is to be hoped that in the future, and we have no doubt that this will be the case, every hospital and clinic will have a bacteriologist for similar purposes. In the simple continued fever, which, as already stated, With regard to the propriety, at the present time, of is classed by some as abortive typhoid, we find in our classifying all continued fevers that are not of malarial experience an absence more or less of the symptoms origin as typhoid, as is done, we think, by most authors, which characterize typhoid fever. There is no tender. we hold that as far as treatment is concerned, this is a ness in the ileo-cecal region, no tympanites, no diarrhea wise thing to do, for until bacteriological examination (as a rule), no roseola, not the characteristic tongue, no has differentiated the various continued fevers we must bronchial cough, no subsultus tendinum, no epistaxis, always bear in mind that the continued fever, not show. there may or may not be headache, no delirium. In ing any of the characteristics of typhoid, may after all some of the cases there is not even a feeling of malaise, be such and according to Atkinson, of Baltimore, "most excepting perhaps a loss of appetite. The cases last of the new continued fevers that have from time to from two to six or more weeks and in some alarmingly time been written about are sooner or later relegated to high temperatures 106.5° F. have been observed. the class of typhoid fever. Typho malarial fever has They show little or no reaction upon the administration been definitely determined to be typhoid.(?)In countries of quinine. As to the presence of the malaria plasmod where malarial fevers do not prevail we hear of mounium no conclusive researches have so far been made. tain fevers, mucous fevers, gastric fevers, nervous In several of our own cases the result of the oxamina fevers, etc., but sooner or later they have all become tion has been negative. classed as typhoid fever." But correctly so? This question cannot be definitely settled until, possibly, bacteriology will determine other causes of continued fevers. According to Atkinson typhoid fever is the great, the almost universal continued fever, yet, from analogy we would judge that continued fevers also oc cur in consequence of other causes than the typhoid bacillus.

That cases of typhoid fever with an exitus lethalis may occur, which intra vitam were not diagnosed as such by good diagnosticians because characteristic signs of typhoid were absent, has been demonstrated at the City Hospital last fall, when the section of several cases in which a high continued fever, without diarrhea and tympanites or any signs pointing to a bowel affection, was present, showed plainly the characteristic lesions of typhoid fever. The atypical course which a great many indubitable cases of typhoid fever took in last fall's epidemic was striking. Long continued high fever 105° F., from the beginning, lasting in some cases two weeks, then the development of the characteristic fever curve of typhoid with other signs of the disease. This must remind one forcibly of a mixed infection. The cases we have had occasion to observe within the last three or four weeks are of a similar nature and one of these has been of particular interest. A young man, æt. twenty-four years, complains of headache, backache, general malaise, loss of appetite, morning temperature 102.5° F. Therap.: forty-eight grains of quinine in twenty-four hours for one day, patient claimed to be well since for five days, was seen by the writer on the third day after his attack, when he had no fever, on the sixth day he again complained and then had a temperature of 105° F., which was the first day reduced to 103°

Dr. G. Baumgarten, of St. Louis, during the last 15 years has paid particular attention to a continued fever occurring in St. Louis and vicinity, and has read a paper upon this subject before the Society of American Phy. sicians, in which he takes the standpoint that the fever he describes is, clinically at least, distinct from typhoid.

Our own experience leads us to believe that such a fever does exist, although the absolute proof is wanting. Ehrlich's test cannot settle the controversy and we have to look towards bacteriology to solve the question.

The study of the continued fevers that do not present any characteristic symptoms of typhoid, will furnish a fruitful field for bacteriological research and we would urge those that have the opportunity and sufficient time to devote themselves to the subject. To return to the starting point of this editorial we once more wish to emphasize that the citizens of St. Louis should be urged to boil, (in filtering we have to rely upon the quality of