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force. A partial withdrawal of the vital force, or a deficiency of the same, is partial death. Tubercle is degenerated tissue -degenerated because of deficiency of vital force. The bacillus is only an incident, but one that may become an active agent for harm when once establisht. Therefore remedies that will destroy the bacillus will benefit the patient, but they will not supply the deficiency of vital force. That must be done by treating the patient, not the disease.

And here is the rub. How can we supply deficient vital force? If it can be done at all, it can be done by making the physical life as perfect as possible. Rest and sleep must be abundant; food of the proper kinds must be abundant; and this includes indicated "reconstructives" which are usually clast as medicines, but they really are foods; the proper digestion of the foods is as important as the selection of foods; air and sunshine are important factors, and a change of climate is frequently required to get pure air of the proper rarity or density, and abundant sunshine; the temperature should not be relaxing, but mild enuf to allow spending much time in the open air; also the moral influences should be agreeable and cheerful. When to all this is added a judicious and skilful use of antiseptics by inhalation and otherwise, with indicated reconstructives and medicaments, all is done that can be done.

But this is the same old story with only the details a little more perfected here and there perhaps as the years come and go, and still the victims die. True, some are saved by the above being faithfully carried out, and the lives of others are prolonged. But many die in spite of everything that can be done. Right here comes in the philosophy that I wish to insist upon. A full charge will carry a cannon ball, say, six miles; then a half charge will carry only three miles. We all know that the members of many tuberculous families die at a certain age, say at thirty. This is usually a class of cases that will die at

about the given age in spite of all efforts to avert death. They are like the cannon ball with only half a charge. They will go along beautifully until the force begins to die out, and then they will go into a decline regardless of all efforts to the contrary, and death comes sure and soon. The supply of vital force, like the propelling force of the cannon ball, has become exhausted, and the end is inevitable; while others, supplied with the normal force, live on, just as the cannon ball propelled by a full charge goes on to the full distance.

We know the importance of the study of heredity; but we also know that families of tuberculous children often come from non-tuberculous parents. Here the problem lies in the hidden and mysterious sources of life. Some apparently healthy couples do not "breed " well together. Either mate, however, might "breed" well with some other mate. Here lies a deep problem. Stock-raisers do not have much trouble in applying this thought in their business, but physicians have not yet "caught on "; and it is impossible to predict when they will.

The thought that I wish to impress is, that tuberculosis is degeneration of tissue, leading to death of tissue, and may lead, by the same process, to death of the individual. This degeneration of tissue is caused by a deficiency of vital force, which may be caused by disease, bad habits, or a "run down condition." Thus tubercular degeneration may follow a badly cured pneumonia. When the tubercular degeneration is thus produced, good hygienics and skilful treatment may arrest the degeneration and restore the patient to health. But when the deficiency of vital force is radical, like the dying force of a cannon ball sent by a deficient charge, prospect for cure is as hopeless as that man should live double his allotted time.

When I first read of the "House of Rest, for Consumptives," in London, I thought "what a noble charity." There are a number of them now in this country, and how fittingly named, 'A consumptive man

or woman is a dying man or woman, and "rest" is fitting for the dying as well as for the dead. Consumption-consuming.

Let hospitals and sanitariums for consumptives continue to be establisht; let hygienics be applied more assiduously; let foods and reconstructives for consumptives continue to be produced and improved; let antiseptics and the appliances for their use multiply; but do not expect that consumption will be exterminated until we know what vital force is, and until we are able to manufacture it at will. The treatment of consumption is far more than bug fighting." The patient is the first consideration; the "bugs" second.

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An Insidious Form of Quackery. Quackery has many forms. A medical man may be learned and skilful, yet he may pursue methods that are quackish in the extreme. Members of a learned profession should be honest, high-minded and modest. The science of medicine has been built up by the devoted, conscientious and unselfish labors of many, many thousands of devotees, many of whom have been martyrs to science, during all the past ages up to the present time. This is a heritage that does not need to be divided-everyone of us is the heir to the entire estate. In the presence of this vast treasure it is fitting that we be modest.

The envelope sent to physicians who inquire concerning his "treatment" contains a letter and a circular. The following is the text of the letter sent to an inquirer, and probably a similar letter is sent to all other inquirers:

Dear Doctor:-Yours of ---- is at hand. Enclosed find the circular letter that explains the nature and uses of my work. With it you can treat rectal diseases and hernia in your office, and you can treat these troubles and catarrh as successfully as the noted men in the great cities. You can thus take on three new lines of work and increase both your practice and income.

"I

But here comes a man who says: know how to treat so and so better than anybody else, and I will tell you how to do it for five dollars!" This thing has been increasing during the last few years, showing that it evidently pays. A few of such announcements have, at different times, insidiously crept into our advertising columns, but now we are on the lookout for them. We here present the literature sent out by perhaps one of the best of this class. Of course we do not give the name nor address of the doctor, but his medical record as given in Polk's Medical Directory, indicates that he is an educated man. His stationery is printed as modestly and properly as could be desired.

The work is now in 43 States, and no fault has ever been found with it. On the other hand I have received a good many very pleasant letters, among which are the following:-"You will be pleased to learn that we have cured two cases of right inguinal hernia, both congenital and there was but one injection in each case. We think a great deal of the treatment." Another has this: "I delayed writing so as to test your work. And I did it on a very bad case of piles and fissures of over 20 years' standing. Thanks to your solution, he is perfectly well. I wish you the best of success which you surely deserve." Another has this: "I am satisfied with the progress I am making, and I see that your work is right." Another says, "Your treatment for catarrh is certainly a success." Another says, "Your treatment helped me to cure rectal ulcers and catarrh in a boy that I had not been able to help before." A surgeon with a sanitarium says, "And I wish further to state that I am very much pleased with the success I am having with your methods of treatment." Another has this: "Considering the value of the points given your charge is small." Another has this: "I would not take $100 for the pile part of the work alone and be deprived of the privilege of using it." Another has this: "Your book of instructions is splendid. I have been a student at several colleges and I have got more good from you than from them all." And another has this: "Thanks for your new edition. I see you are not standing still, but keep growing. Good for you. I wish you success, for you have helped me greatly."

I was offered the "Guarantee Rupture Cure "-headquarters somewhere in Illinois-for $50 and 25 per cent. of receipts afterward. It is needless to say I did not take it, as I know my own work is not surpassed. The price of this rupture cure shows that the price of mine, with two other lines included, is merely nominal.

I now include with my work the formulæ for The Woman's Specific and the Best Treatment for Gonorrhea. These remedies would add to your success in these lines.

I send you the card I do my business on without advertising. A wise and energetic use of cards is all the advertising you need. Fraternally yours, The following is the text of the circular inclosed:

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I have arranged the best and simplest treatment for this disease.

The statement was made in a recent journal that the rectal specialty is the best one in the whole field. The rectal, hernial and catarrhal are the least occupied of any of the specialties. One in six had some kind of rectal disease, one in eight has some kind of rupture, and one in six has catarrh of some kind.

There are but few doctors in this country who pretend to treat rectal diseases without the severe chloroform operations. And as only those who suffer so severely that they must have something done or die will submit to these operations, comparatively few are ever treated and cured by physicians. Everyone who has any rectal trouble would be glad to be cured if he knew the cure could be effected without the knife, cautery or chloroform. A doctor ordered my work after losing a $100 case because he could not cure him without a chloroform operation.

I have the best system of rectal treatment that I know anything about, and I know them all. I know all the injection treatments that have been brought before the profession. While some of these treatments have been useful for some kinds of piles, none of them have been generally useful and satisfactory. The old carbolic injection method is difficult to control, sometimes causes great suffering and is dangerous. When the right medicine is properly used the intra-mural method has no equal for piles. It is always effective and is free from suffering and accidents. I cure all kinds of piles, catarrh, fissures, fistulæ, prolapsus, ulcers and most cases of stricture without chloroform operations. The fees for these cases run all the way from $10 to $200.

I have bought several systems of hernial treatment for purposes of investigation. The fluid I use gives the best results with the least pain of any that I know anything about. And I am able to give more practical points about where and how to inject the different varieties of hernia than I could find in all that has been said on this subject. There are three essentials about the hernial work. 1st, a fluid must be used that will produce a non-absorbable exudate: 2d, the fluid must be injected into the ring of emergence; 3d, the rupture must be kept back till the exudate becomes firm and strong. That is all there is of the hernial work, no difference what or whose the "system" is. All hernias are curable that can be reduced and retained with a truss-about ninety per cent. Relapses are not more common than after the old hospital operations. A patient will submit to another injection or two when he would not submit to another knife operation. The fees for curing hernia are from $25 to $250, generally $100. Some say now that there is more money in the hernial specialty than in any other. And it is not difficult to learn. The pain is but slight in the rectal and hernial work, and there is no detention from business except a little in unusual cases.

You should be just as successful in the treatment of catarrh as the specialists in the cities. There are two essentials about the catarrhal work: 1st, the removal of neoplasms when present; 2d, the cure of chronic inflammation of the membranes and its causes and results. To accomplish these ends the resources of simple surgery and general and local treatment are brought into use. The elaborate machinery in use for the treatment of catarrh is more useful for advertising purposes than for anything else. The simple, direct and effective means are generally overlookt. The fees for curing catarrh run all the way from $10 to $50.

You cannot push general practice, but you can push these specialties. You can hunt up these cases and tell them what you can do. And every cured case will be an agent for you, so great is the relief and satisfaction.

Many doctors take Post Graduate work for some special knowledge which costs, including loss of time, several hundred dollars. I offer you at home what I believe to be practically better on these branches, than a Post Graduate course in any school. Take it in regard to rectal diseases: here I give a one-man treatment that certainly gives as good results as the hospital treatment with its two or three doctors to perform its operations and its expensive hospital accompaniments. Bear in mind that I also give all the after-instruction and help in the three specialties by correspondence that is desired, thus affording the largest opportunity to make the work satisfactory. There can be no failure in the work unless one is too low in skill and energy to make an intelligent effort to use it.

If you are tired of general practice you can take these specialties, and by a judicious use of cards do office work exclusively. If you hate the night-bell as much as I used to you will appreciate having your nights unbroken.

Doctors have paid for one of these specialties, even

in a crude and bungling form, from $100 to $500. As most doctors will not wish to take up these branches as exclusive specialties, but to improve their general practice, I have decided to put the price within the easy and immediate reach of all. For the small fee of $15 I will give you, in printed pamphlet form, the formula with complete directions for injections, operations, applications and treatment in these specialties, including all needed after-help by correspondence. There are no secrets in the work. On receipt of the work a doctor wrote, "I must admit you have succeeded in condensing into very small compass a very rational working formula for the conditions under consideration." I now include with my work the formula for The Woman's Specific. It is the best combination of remedies for most nonsurgical diseases of women. I also give The Best Treatment for Gonorrhoea. These remedies would add to your success in these lines of practice. The work is copyrighted, so you cannot be deprived of its benefits by publication. The charge I make is intended to cover cost of publication and advertising and give me a fair remuneration for my time and work. Remit by P. O. or express order, bank draft or registered letter. Personal checks will not be accepted.

I should have said that I also give some instruction about the business side of these specialties, so that your work may be more remunerative. Many doctors fall short on the business side. I can make your work not only more successful in curative results, but also more profitable.

The outfit required to do the work of these specialties is simple and inexpensive. You probably have instruments enuf now to to enable you to enter upon the work. You might buy a few instruments as you go along, according to your fancy. The medicines for the formulae can be obtained at any drug store.

There is work enuf along the lines of these specialties in your community to add to your income from $500 to $2,000 per annum. You can just as well do this work and enjoy the reward. Only a little determination and energy are required. My work will be sold to only one man in your place, unless it has a population of over 20,000, and the one who gets it will have the advantage it confers.

If you could place $1 so that in a year or two it would yield $100, you would think it a good investment. It is easily within your power to make $15 put into this work an equally good investment. Your first case in any one of these specialties should more than bring your money back.

This is an age of push in all lines of business. If you want to rise above the ground floor in the profession you must go into or take on some kind of special work. You must reduce your competition by being able to do some lines of practice better than your competitors do. And there is no money in anything but special lines of practice.

I am helping doctors in the smaller cities and villages do what a few doctors in the largest cities are doing. You may be just as successful in these specialties as they are.

If you are in a small place and have the laudable ambition of moving to a larger place, you need this work to give you a good, quick start. It will pay you well where you are, no difference how small the place, but you ought to become familiar with it before moving so that you can use it to the best advantage at the start in a new location. If you have recently changed location this work will be specially useful in helping you to get into practice.

If you are just entering upon your professional life you need this work. It will help you to treat these neglected cases as easily and successfully as your ordinary cases. You will thus take on a larger practice at the beginning.

If on account of advancing age you want to retire from general practice, take this work and do office work exclusively. I knew an old physician to do better at hernia alone than he had done at general practice.

The statements in this letter may be relied upon. The work is what it purports to be. No word of dissatisfaction has ever been exprest to me about it, and many good letters have been written to me in its favor. I will answer any inquiries, but as the work is right, you would just as well make your order at once as many do.

I have room for only two testimonials. I do not give the addresses of signers because I do not wish to impose an inundation of correspondence upon them. But I will give their addresses by letter to any one who wants them. Fraternally,

The above is very cleverly and skilfully worded, and perhaps many unwary are caught. Yes, and perhaps some who are too

lazy or too stupid to look into the vast treasure of accumulated medical knowledge which is their heritage find the above offered information worth the price-to them. Knowledge is usually worth what it costs, but how foolish a man is who pays $15 for knowledge that he already has (or ought to have) in his library! Medical literature is now cheaper and better than ever before. It is the means of preserving and of distributing to the individual members of the profession the vast heritage that is their own. Medical books and medical periodicals each cover a distinctive and very useful field. Spend $15 judiciously for medical books and magazines and you will get many times more than is offered in the above copied circulars.

The leading spirits of our profession are constantly striving to discover new and better means of curing their patients, and when one suceeeds in making a decided improvement or discovery does he "put it under a bushel" and advertise it at so much a peep? Not much. He is proud to give it to his brethren as speedily and completely as possible. He will present it to the next meeting of the largest medical society of which he is a member, or he will offer it to the medical magazine of largest circulation. That is the spirit that has built up the healing art.

Our customary reply to those who wish to advertise secrets for sale is, "Give what you know freely to your medical brethren thru the columns of THE MEDICAL WORLD. Don't be afraid of being too generous. You owe a debt to the profession greater than you can ever hope to repay. This applies to us all. Or, publish what you know in a book; and if you will sell it at a reasonable price, we will be pleased to advertise it in our columns.”

We should all discourage by every honorable means possible this insidious and growing form of quackery. It is ungrateful, to say the least. We should all freely give to the profession what little we can for the much that we have received. THE MEDICAL WORLD stands for this principle,

as its constant aim is to give as wide currency among the members of the profession as possible to all that is best and latest in the healing art, from whatever

source.

The following is another example of the quackery referred to above. It may be of interest in this connection:

The Letter.

THE MEDICAL WORLD:- -What would your terms be for inserting the following advertisement, three months, commencing with the June number.

I have made a valuable discovery and know of no better way for to bring it before the medical profession than by advertising in your valuable journal. Hoping to hear from you in due time, your terms, etc., I remain yours truly,

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M. D.

The Advertisement.

Doctor.-Increase your income by regulating the menstrual periods in women by the use of the method. On receipt of $2.00 I will send you an individual right to use this method, with Satisfaction formula and specific directions. guaranteed where instructions are carried out. Address, Dr. My Reply.

Yours of May 22d just at hand. Have you not received your entire medical education from the medical profession? Then do you not owe to the profession what little you can do to advance it? I would suggest that you do your duty by publishing your "valuable discovery" to the medical profession thru THE MEDICAL WORLD or some other recognized medical medium.

Very truly,

C. F. TAYLOR. This man is a graduate of the Hospital College of Medicine, Louisville, Ky., 1890, but I suppose that worthy institution is helpless concerning the conduct of its alumni. Upon this point the following may be of interest. An alumnus of another

worthy institution is advertising in the newspapers in the most flagrant and quackish manner. I sent a copy of the paper containing the advertisement to the college, and wrote inquiring if there was no way of revoking the diploma of one guilty of such conduct. I have just received the following reply.

Dr. C. F. Taylor, Editor MEDICAL WORLD, 1520 Chestnut Street, Phila My Dear Doctor:-Replying to your favor of the 12th inst., I am sorry to say that there seems to be no way in which the College can do any thing to check the abuse of which you speak.

notice in the advertisement that he does not claim to be a graduate of this institution, but nevertheless, we are extremely sorry that any of our Alumni should so transgress upon the ethics of the code and the profession. Yours very sincerely,

Dean of the Medical Faculty.

Later: A later letter from the first above mentioned emphasizes the fact that he helps his patrons by correspondence, invites them to write him whenever in trouble, etc. I state this in this connection in order to be entirely fair. I would suggest, however, that he publish his alleged "treatments" in the medical prints, in the regular way, either in the medical magazines, or in a book to be sold at a reasonable price. Then offer to receive students at regular and reasonable prices, just like any other teacher of medicine, if any students wish to seek him; or offer correspondence assistance at a reasonable rate, to any purchasers of his book who feel the need of further aid from him. But claiming a secret or mysteriously superior treatment, for sale at an exorbitant price, is quackery pure and simple.

It may be true that the teachers in our medical colleges do not sufficiently appreciate the needs of the general practitioner when he is at home in his own field of practice, far away from hospitals and many helpful accessories. Particularly should the teachers in post graduate courses teach their practitioner students how to accomplish the best results with the aids in reach in their fields of practice at home, rather than make vain-glorious displays of rare and difficult surgery which a general practitioner could not attempt at home.

My Dear Doctor:-Please excuse my delay in attending to this matter, having nearly completed my four score years, as the comic song has it, "I'm not as young as I us't to was,' and so, perhaps, less prompt. Inclosed find P. O. M. Order for one dollar; thanks for continuing to send WORLD. I prize highly your Monthly Talks, and pray you to continue them until the voting cattle of our country shall be transformed into intelligent, upright men-men knowing what constitutes a true civilization

Very respectfully and hopefully, Elkhart, Ind. F. A. BENHAM, M. D.

A busy doctor doesn't want to be bothered to send a dollar for THE WORLD every year. For this reason we establisht the rate of four years for $3. This is a saving of both time and money to our busy patrons. We have received a greater number of four-year subscriptions this year than ever before.

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Therapeutic Philosophy.
No. 4.

Editor MEDICAL WORLD:-I was talking of iron. It is past doubt that iron possesses perturbing qualities, and is therefore medicinal. I do not know that pure metallic iron has been much tested as a medicine, but since it is not a food, it would call into extraordinary activity some neural capital with its dependencies. The simplest ferric compound-the oxid-would disturb some different center, for it is a different drug, and this rule would follow all the ferruginous preparations. Now, it being true that the medicinal sphere of iron is not known, and being true that an unindicated drug, if given, does unmixt harm, it is plain that the use of iron is, nolens volens, malpractice. It is a mitigating circumstance that in one case out of ten thousand, perhaps, the associated element in an iron preparation is indicated. iron is almost never given with special say one case in ten thousand, because reference to its chemical associate. It is about always given under the tissue-feeding impulsion.

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nal of March 30, Dr. Austin, who has exIn the Boston Medical and Surgical Jourperimented exhaustively with reference to the relations of iron to blood, concludes that" organic iron, of which hematin and hemoglobin are representatives, furnishes the most easily absorbable and the most valuable of all iron preparations." Even "the albuminates and peptonates of iron are absorbable, but to a limited extent." It is notable that "iron is being constantly eliminated, both in the urine and feces, even during fasting." No wonder Dr. Austin's conclusions have been widely copied, because for hundreds of years a preparation of iron which should be the most absorbable has been a major desider

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