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the house this chest accompanied him and was set with impressive caution on the table where it was lookt upon by the family as the repository of the arcanum. Needless to say, this was the doctor's medical case, which, while it did not contain a great variety of remedies, did contain some extremely nauseating ones. It was a veritable purgatory with latent misery and death therein.

Over the door was a sign painted by the kind hearted painter who painted the furniture with green paint. The letters were nearly a foot high, and having done business for a few days for the purpose of not injuring the kind painter's feelings, it was removed and replaced by a more modest sign nailed to the door.

This humble office served for several years, but as patients increast in number, a more pretentious office was taken in a larger building. Since that day the first office, which still stands, has served in turn for a succession of barbers and dressmakers, thus maintaining its prestige, for are not barbers and dressmakers both "cutters?"

The simple furniture of the first office was moved to the second, which comprised two rooms in the second story of a "block." A few more instruments had been added by this time; the case of herbs and drugs had disappeared since a druggist had come to town, and an atmosphere of comfort pervaded the surroundings. A number of books had been added, and one or two medical journals were conspicuously displayed on the table.

A square of carpet made this office more homelike, and a cheap, carpet-covered lounge invited one to rest, but was deceitful inasmuch as there were no springs and a great many slats.

Up to this time board and lodging had been outside. This had some advantages. For example, generous patients would often ask a doctor to dinner or supper. But the lounge suggested to the doctor that he take up his abode in his office, especially since the number of patients was increasing and night calls were frequent.

The next office was on a far more elaborate scale than had yet been attempted. It was in fact a whole house with a dear helpmate to take care of it, a wife who shared joy and sorrow and lent her aid and support in the struggle for success. This house also had a barn in which the doctor took care of his horse. The green table and chairs were banisht to the kitchen,

and an old-fashioned secretary served as a desk and as a medicin and instrument cabinet as well as for a bookcase.

The stock of medicin, however, was diminishing in quantity and prescriptions written in "hog Latin" were often sent to the village druggist. These mystified the people who could not understand the "lingo," and it is to be feared sometimes led to tall guessing on the part of the druggist.

A short time later an opening occurring in a neighboring town, a house was bought and a small wagon load of household goods and chattels was transferred to this new abode. This was an ideal office, for it was so situated, altho a part of the house, that patients gained access to it without passing thru the house. Every physician realizes the convenience of that, for the office-in-the-house plan causes much inconvenience to the family and much wear and tear.

Then came a more decided change; the house was sold to another person, and an office was taken on the field of battle amid the thunder of artillery, the shriek of shell and the rattle of muskets. This office was sometimes in the open air, sometimes in a tent, sometimes in a farmhouse, shot torn and battle riddled.

Sometimes the office was vacated in a hurry without time to collect even personal belongings. As I write, a volume of Gross' Surgery lies open before me with some of its pages torn and bloodstained, just as they were left on the battlefield of Seven Pines, where the book was captured, June 1, 1862, a book which was returned to me some twenty years later by the surgeon who captured it.

This was indeed a sad school of experience in a life of hardship and toil, and it was with sincere thankfulness that practise was again resumed in civil life where the environment, while arduous, was at least peaceful.

A city house was bought in what was then an aristocratic section. As is the custom to-day, there were, a number of physicians who chose this locality for their abiding place, and this street was popularly called Pill Row. Now this was the day when large hospitals did not exist, and these physicians supplemented their medical work by much minor surgical work.

A few years later, a City hospital was instituted and this diverted many patients from the private physician. Business was

also creeping up into Pill Row, and one by one the physicians left for quieter situations.

The next office was in a quiet park, and it took thirty years for the din of traffic to disturb its tranquillity. Then as one family after another moved away it became a site for select lodging houses and a new office became necessary.

As each office was taken a new sign was thought necessary, and it was curious to see how, as the office enlarged in size and became more luxurious, how as success was obtained, the signs diminisht in size and number and were plainer in appearance. Still there was a uniformity, for all these signs were in gilt letters on a black sanded ground, this being considered the correct thing among physicians. Then, signs notified passers-by in all points of the compass, that a doctor's office was within, and at one time box signs were put up on the cross streets, on the lamp posts; but as physicians multiplied there was not room enuf on the lamp posts for the signs, and as the city fathers did not desire to appear partial, those already placed were ordered to be removed.

Then it was thought a good idea to paint the name in black on the ground-glass side-lights or on the fan-light above the door; but as this led to frequent false alarms and the unnecessary routing out of the doctor in the middle of the night by some, belated or hilarious individual who mistook the sign for that of an all night restaurant, this plan was soon discontinued.

One sign, if it can be called such, still remains, but all the others have past away. That one is a modest silver-plated door plate, an early investment that has endured and still announces to inquiring or curious people the name and occupation of the owner whose door it graces.

In this last office the walls were lined with books that had accumulated almost day by day, a striking contrast to the three or four that had ornamented the cheap green table in the first office. This table had given way to two roll top desks. The chairs were massive, leather covered, stuffed, easy chairs, while an operating chair of the latest style with all the modern improvements was a conspicuous object. An instrument cabinet held a glittering array of keen-edged knives, polisht sounds and probes and hundreds of other articles. A microscope stood ready for use on a special table, while a sink in

closed in an alcove was decorated with chemical apparatus and bottles of reagents. In one corner was a medicin cabinet with enuf medicin in concentrated form to kill or cure an army.

The walls were decorated here and there with framed engravings, while bronzes and articles of virtu adorned the mantle shelf, under which, in cold weather, an open fire sparkled merrily.

On the floor was a heavy Wilton carpet. On the walls was a rich and cheerful paper, while from the tinted and decorated ceiling hung a brilliant chandelier.

With all this luxury, life was no less arduous than in the days of the little white-coated, green-shuttered office in the nearby village, when time hung heavy on the doctor's hands and enforced idleness was irksome.

Toil brought success both professionally and financially, but with it came fatigue and ceaseless care. In the quiet village there was no competition; it was a case of "me or nobody;" in the city it was a constant struggle to maintain, prestige, and words of calumny, even from brother physicians, embittered honeyed praise.

Sometimes at the midnight hour, wearied with his daily toil, books of reference were laid aside for a moment, and gazing into the fire, visions of the early days arose when the struggle was hard, when the fight was strong, and well-earned victory brought a sense of elation. Then the walls dwindled to the little cosy office of the first days. The chandelier dimmed its brilliancy until it glowed only with the feeble flame of the lard-oil lamp, and the open grate gave place to the air-tight stove filled with wood which the doctor took as credit, wood which he sawed and split himself to save money. Then, poor tho he was, he was a lord among the villagers, revered and honored.

Now a knock at the door for a moment starts him, and he thinks to himself: "I must saddle Tom and ride out to Tim's;" but as he comes back to the present he realizes that the past has gone, and that on its ruins he has built a lofty structure pinnacled with success; but that true unalloyed happiness is buried at the base of the structure, along with the simple people who were his first patients and his true friends.

He may meet with grateful patients. but none will ever come to him as did Farmer John in the early days, and with tears in his eyes grasp the hand of the

young doctor and with a trembling voice exclaim: "Doctor, I can never thank you for what you have done; you have saved my daughter's life." What matter if the fees were small, the office small, and the practice small; that made small things grateful and joy bearing. No matter if he is now famed in medicin and holds positions of trust, they will never be quite as important as when he was one of the school committee in that little village. He has prospered beyond his most ambitious wishes, and he is withal truly thankful; but he still reveres the memory of the good old days when he was young and began to fight his way, and above all he reveres the memory of his First Office. Massachusetts. LEON NOEL.

[Next subject by the above writer, "My First Horse." In next issue.-ED.]

A Dream.

An angel had been sent to call the doctor from labor to reward. He had served the people faithfully and well; had gone to see them at all hours of the day and night, in all kinds of weather; had made moderate charges and waited patiently for his pay; had sympathized with them in their afflictions, mourned with them in their sorrows, and rejoiced with them when restored to health. Before leaving for heaven, the doctor askt if he could visit the regions below. Permission being granted, while the angel waited outside, the doctor went in to look around.

Having been gone an unusual length of time, the angel went to look for him, and found the doctor seated fanning himself and watching a lot of people burning in one of the hottest fires in the place, while a look of supreme bliss lighted his face. The angel lookt, and over the door was the sign: "These are the people who did not pay the doctor." The angel toucht him and said, "Come, let us go." With a radiant smile the doctor said, "You go on; this is heaven enuf for me.'

A WORLDITE.

Many subscriptions always expire with our December issue. Notification is inclosed to those to whom this applies. As a rule our subscribers are in the habit of renewing promptly. We trust that this year the exceptions to this rule will be fewer than ever. Also, to avoid the bother of renew. ing every year, our rate of four years for $3 is at your service. More of our patrons have taken advantage of this during the past year than ever before. We expect a flood of four year subscriptions during December, and we hope that yours will be one of them, if your subscription expires with this number. Don't forget WORLD Binder. Very large value for price, 35c, each or three for $1. Awl for punching WORLDS, 5C.,

Dr. Waugh and Iron.-Dont's in Pneumonia. Editor MEDICAL WORLD:-I know of no stronger or more brilliant writer, medical or not, than William F. Waugh, M. D. He is one man who has not lived, and is not living, in vain. But even he, with all his practicality, and common-sense assertiveness, and intrinsic forcefulness, will slip a cog occasionally. He has actually ventured to disagree with me in reference to the therapeutic sphere of iron! Now see me do him up.

The basic proposition in Dr. Waugh's argument inheres in the question: "Does the removal of a cause necessarily remove its effects and restore the situation to what it was before the cause was put into operation!" Certainly not, doctor; only a miracle would do that, and a miracle is an impossibility. This causeand-effect question is festooned with a very dizzy tangle of subtleties-a fact that is old to Dr. Waugh. The truth is, every cause pays itself out in a series of causes and effects.

To illustrate: A number of workmen will complete a house and depart. The workmen were the mechanical cause, and the placement of material, the mechanical effect. The initial cause is gone, but its effect is said to persist. This, however, cannot be true (in the every-day sense of the phrase, cause and effect), for the moment the last touch is put upon the house, it as a totality, becomes a cause. Now unless there is no diference between cause and effect, the house cannot be simultaneously a cause and effect. The house, in entirety, is a cause, the effect of which is all that makes up the concept of a house; i. e., the effect of a house is houseness. This houseness, in turn, becomes a cause, and because cause and effect are different, the house is ablated. Houseness is a sprangling cause whose sprangling effects consist of relationships, each of which will of course be dissipated in the causeness of its effectness, and there you are.

In the ultimate, effect is but projected cause whose intrinsicness undergoes a succession of translations, owing to environmental pressures. After all then, effect is cause and cause is effect, and neither is exactly either in consequence of translatory incidences and contingencies. It was necessary to make this phase of the

included free with $1 order. You should begin keeping your question clear before proceeding to the

WORLDS in Binder at first of year; as each number comes, put it in the Binder, and then you will always have your copies together in their regular order, and when the year closes, your volume is already bound and ready to be placed in your library. Then begin the next year with a new Binder.

discussion of its other features.

I will be pardoned, I trust, if I now get down onto a more practical plane.

The

vaporization of the Doctor's cider-barrel illustration is incidental to the foregoing cause-and-effect exposition. But lest it shall have escaped the reader's attention, I will make the matter even more plain. The Doctor asks: "If a cider barrel has lost its contents by leakage, will mending the leak fill the barrel again?" I am forced to confess that it will not. But if the cider were an element of the barrel, and the barrel were an animal, I should have to answer yes. As it stands, we have nothing to do with the cider. It is normal and needs no physician. It is the barrel that is ailing, its disease being a hole. We stop the hole and the barrel is cured. See? This is a fair, if homely illustration of the modus operandi in the cure of disease. Cure is prevention-the prevention of a disease's further progress. To cure a disease is to bring it to an end. Nature will do the rest if given a chance. No medicin is needed after the disease is gone, and convalescence h set in. You see there is a sense in which one can be not well, and still have no disease. That state is represented in convalescence. Shall we give a convalescing patient medicin? and if so, why? What would we direct our medicin against, there being no disease for it to impinge upon? I know that a vast number of doctors give medicin all thru convalescence, but not one of them can give a sane reason for it. If it is only possible that medicating a diseased person may be right, what will justify medicating an undiseased person? There are tedious convalescences, but as convalescence is not a disease, shall we treat it with drugs? Will you try to cure the sequelae of measles or scarlatina, or the scar left by a burn? Many diseases leave invisible scars. These scars are all of them equally ineradicable. How many doctors are, even now, in this blazing edge of the twentieth century, medically piddling with scars?

Altho, under a strained method of reasoning cause and effect may be made to appear identical, the evidences of practical life contradict such a conclusion. Cause and effect are at once distinct, and inseparable. Otherwise, to treat an effect would be to treat its cause. I do not believe that the profound perspicacity of Doctor Waugh can be brought into an affirmative relationship with the proposition that cause and effect may exist independently of each other. The position is inexorably and irrecusably self-stultifying. An effect is not an effect, unless its

existence ceases simultaneously with the abolition of its cause. A person has a malarial intermittent fever. We will say, for the nonce, that the plasmodium is the cause. Quinin is the enemy of this plasmodium. We give it. It destroys the cause, and that instant which witnesses the destruction of the plasmodiums, witnesses the destruction of their effect-the intermittent. I know how fixt and stubborn is the habit among physicians, to theoretically prolong the existence of an effect beyond that of its cause. It has done immeasurable harm by constraining them to treat at an imaginary effect. It is bad enuf to attempt to treat a real effect. No medicin will repair the damage a disease may have wrought. This truth should be burned into the consciousness of every practising physician. If it is satisfactory to you to look upon the damage as an effect, why do so; but this will only strengthen the reason why you should not treat it.

I have great reverence for the force and dignity of Niemeyer, and the strong straight-outness of Gross; but have not they--so far as therapeutics is concerned been, in the main, prayerfully shelved? What up-to-date physician is controlled by their therapeutic dicta? What landslides of rugged eloquence have occurred in behalf of salivation and extreme venesection, but there is nothing left of them but a rhetorical memory. The whole world is moving forward, and medicin is catching its share of the grand impulse.

As to iron. I do not know how many different medicinal preparations of it there are, but there are hundreds of them. Now, unless iron is a panacea (under slight modifications), what is the excuse for more than one preparation of it? How many have figured out why the tincture of the chlorid of iron is the best? It is best because its chemical associate is a positive and comprehensive medicin. So it is with all iron preparations; their merits are measured by the merits of the non-ferruginous elements of the preparation. The iron serves as merely a damaging chemical back-stop, and as an eternal reminder of chemical versatility and therapeutic preterism and conservatism. If this is not true, then the limits of iron's therapeutic sphere are coincident with the limits of pathology, for there is no malady in which it has not been enthusiastically used by men with high foreheads. The same is exactly true of mercury, which.

however has therapeutic value, and a very considerable curative range. With all the devilment the latter has been made to do, I believe the former has been made to do more. Mercury, being medicinal, enters into combinations with therapeutic helpfulness. Not so, iron. It can do nothing but add its one lone medicinal element to a preparation-astringency. Dr. Gross's great mind-without our modern helps caught a glimpse of the truth. He saw that the chalybeate element of the tincture of the muriate of iron, cut a very small, if any but a harmful, figure in the preparation.

According to my experience (and I have had thirty-five years of it), iron is strongly contraindicated in all cases not requiring an astringent. I have used great quantities of it, and have, with most conscientious studiousness, watcht its action. For the last ten years I have made a special study of it. I have used it many times in anthrax, and many scores of times in erysipelas. I have used it hundreds of times in anemia. I solemnly declare that I have never seen one instance in which it did any good not dependent upon its one medicinal qualityastringency. I have treated many iron cases (such by common agreement) with iron preparations minus the iron, and always got better results than I did in corresponding cases in which the complete iron preparations were used. Has Dr. Waugh tried these experiments? I am sure he has not, for, being a brainy and broad and fair man if he had done so he would have been driven away from his idol, even as I have been. I have not the slightest doubt that Dr. Waugh and I agree perfectly in regard to the action of quinin in periodic malaria, mercury in primary syphilis, and iodid of potassium or that combined with mercury, in tertiary syphilis. Why do we disagree in regard to the merit of iron in anemia, anthrax, erysipelas, amenorrhea, etc., etc., etc.?

Dr. Baskerville asks for comments upon his, and another man's treatment of a case of pneumonia. Both treatments were unphilosophic, harsh and medieval to the last degree. Don't get angry, Doctor, for I love you just the same, if you do miscue a little on pneumonia. Quinin has no logical place in pneumonia. It is barely conceivable that pathological movements might create a temporary opportunity for Dover's powder. Strychnia is inadaptable to any acute condition, especially where

there is fever. You want to husband the patient's vitality-a blister is scarcely less devitalizing than is bleeding. Remember this, too; anything placed upon the chest is no nearer the lungs, in a therapeutic sense, than it would be if placed upon the nates. There is an empty space between the chest walls and the lungs. Counterirritation is practicable only where there is a continuty of tissue. The mush jacket is an immitigable abomination. It largely increases the patient's susceptibility to chill, with its dangers. It forces the patient to lift, with his respiratory muscles, from 14,000 to 30,000 pounds every twentyfour hours! Besides, poultices are proper in surface inflammations alone. Save your poultices for boils and such; they will at least pleasingly entertain the patient. Amm. carb. is much affected in pneumonia by a class, but if it is any more to the patient than a whip is to a tired horse, I don't know what it is. Under rational treatment, not more than 5 per cent. of pneumonia cases-taking them as they come-should die. As I have two or three times given in THE WORLD what I consider a rational treatment of this disease, I will not repeat it here. However I will append a few dont's with reference to pneumonia.

Don't bleed. Unless it is a fact that the average person in health has too much blood, it cannot be a fact that a sick person has too much. The blood (whatever its character) is the life. To extract it is to extract that much life.

Don't blister. To blister is to at once deplete, and to set up a great source of nervous irritation. Besides, if these objections did not exist, what do you expect to accomplish by blistering, seeing that the lungs are inaccessible to counter-irritation? Don't use a mush jacket.

Don't use an antipyretic, no difference how high the temperature may get. Remember that fever is only an effect, and that to treat an effect is to lose precious time, and reduce the patient's chances of recovery. Drug antipyresis is toxic devitalization.

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