simply the sequelæ and far-reaching ravages of the contagious affections of early childhood. Banish contagions and infections and we have laid the foundation for strong and healthy lives.

THE MEDICAL "SMART ALECK"

One of the main characteristics of the "Smart Aleck" type of physician is his tendency to boast of his scientific attainments and his up-to-dateness, while he never loses an opportunity to scoff at old doctors, old remedies and old methods. Such a man as this must be seen and heard often and not infrequently he breaks into print. The one we have in mind at this moment hails from Elmira, New York, and he vented his brilliant (?) remarks in a recent number of a journal which is supposed to be mighty in power and great on ethics. This astute medical man quotes a sentence or two from a Summary editorial on pneumonia in which the value of ammonia was pointed out. His only criticism is: "Think of it-an editorial in a medical journal!" He does not in all his wisdom take the pains to tell us what is wrong or wherein it is wrong or what is better. He insinuates and slurs in a destructive manner, but offers nothing constructive or helpful.

The same writer quotes from the same article concerning decubitus and then he offers the smart rejoinder, "In other words, make him bite his pillow!" Think of it, reader, a supposedly powerful medical journal prints such slush as this written by a medical smart Aleck! It is not at all surprising that professional men of this type and calibre find time to "write pieces" whenever they stand a chance of getting them printed.

The gentleman also evidently does not like the injection method of treating nasal polypi recommended by no less an authority than Sajous. Again, however, our friend is more destructive than constructive, for he does not tell the famous Sajous just how he should remove polypi, but sneeringly remarks: "The idea, evidently, being to save wire and make the patient realize the seriousness of his affliction."

This medical S. A. takes a fall out of independent journals, scouts at their "practical" suggestions in general, but offers not a word of helpful, brotherly criticism. The name of this doctor does not matter; he is of too small bore

to be given free publicity. We refer to him only as being representative of a type-the primitive Smart Aleck type. Such men labor under the delusion that they possess a sense of a humor but are seriously mistaken. They are on a par with the youngster who before the feast mutilates his birthday cake with his fist. Some kids, aye and some grown-ups, just have to have their little fling and thus attract attention.

HOW TO BLOW THE NOSE

Is there a right and a wrong way of consummating the gentle art of blowing the nose? Dr. Harrison Griffin, a nose and throat specialist, thinks there is a right and a wrong way and has written an article on the subject. He states that the sufferer from a cold in the head begins to hawk secretion back into the nasopharynx instead of using his handkerchief in the proper manner. An accumulation of unremoved mucus keeps up an irritation and is the main source of winter coughs. Correct handkerchief service, he thinks, would obviate coughs, sore throats, catarrh, etc. Whether the writer's method of blowing the nose will prove illuminating or not, it is given below for what the reader may think it worth.

"To blow the nose properly, it is best to look at it as a double-barrelled shotgun, the nose as the muzzle of the gun, the chest as the air receiver, and the mucus as the bullets and charge.

"A deep inspiration to fill the chest with air, then one finger is placed upon the ala of one nostril to obstruct the passage. With one violent expiration the air from the chest is forced through the open chamber of the nose, and the offending discharge is caught upon the handkerchief. This maneuver is repeated on the opposite side."

Commenting on this method Life and Health remarks: "But is not this the simple old-fashioned way of blowing the nose which our fore-fathers used freely until good society admonished them to use the soft pedal? And is this soft pedal, enforced by good breeding, the cause of our winter colds and sore throats and consumption? I confess I am skeptical, but here is a man who has been specializing in this line for so long that he ought to know. Perhaps, however, other specialists will not agree with him."

WHAT AND WHO IS A CRANK?

The term has until recently been employed rather loosely and to designate almost any unconventional mental or habit peculiarity. At the present time "crank," or its congener "mattoid," is used with a good deal more perspicacity. The man of real genius or overtowering talent usually carries a good many of the earmarks of mattoidism. It is said that Edgar Allen Poe and Walt Whitman exhibited many mattoid tendencies, and a considerable amount of literature more or less eccentric has been produced by mattoids of various types. Philomneste, the Belgian scientist, claims that all men of real genius believe themselves invested with a divine mission. On the

other hand the belief in a divine mission without real talent to back it up constitutes lunacy. And, again, every genius is recognized as either a crank or lunatic until he can get his ideas on a working basis. Egomania is one of the tolerably regular elements of mattoidism. The man who believes himself to be greater than the sphere which he occupies may, by following the wrong course of reasoning, reach the conclusion that some person or class is responsible for his failure to secure the position of honor or distinction to which he feels himself entitled. In many cases his mind works along that line until the attempted removal of those upon whom he places the responsiblity seems to him the log

ical course.

Very often the mattoid's ideas are altruistic and the ego seems to play a secondary role. Self-aggrandizement may play second fiddle in some great reform movement or propaganda for bettering humanity. It would involve fine points in psychiatry to determine to what extent the paranoid and the manicdepressive elements actuate those whose lives are devoted to the accomplishment of certain undertakings. We find these elements in many reformers, social, political, religious, and so on. As a glaring example it is said that many professional anarchists are pure paranoics.

The crank is usually an agitator, an extremist. He rarely sees his ideas meet with wide adoption and practice. On the other hand the safe and sane majority in their easy-going and smug conservatism seldom voluntarily espouse anything beyond the mediocre until forced into a fight by the extremists. Then

the happy medium measures are brought into action. The crank's ideas would too often, if adopted, prove disastrously destructive, but they may furnish an incentive to the conservative forces to work out a useful constructiveness. After all the crank may serve a useful purpose if he be protected from himself and his visions. And as a philosopher of old said, without vision we perish.

BETTER BABIES

The first week of March was observed quite The general dissemination of knowledge on the generally over the country as "Baby week." care of babies ought to do much toward lessening the 300,000 mortalities which are said to occur among young lives annually. Barring bad heredity it is only natural that all babies should live, provided they have proper care. To a great extent the first three months determine whether a baby is to live and be healthy. Its nutrition is the all-important matter. There is still extant a woeful lot of ignorance on the care and feeding of infants even among people who are otherwise intelligent and well informed. Maternal love and instinct cannot take the place of science, as valuable as these qualities are. It is up to physicians in general practice to instruct the mothers in this matter and to cooperate with them in seeing that simple yet scientific and correct measures are faithfully carried out in the feeding and care of the little lives.

ICHTHYOL IN ERYSIPELAS

Dr. Helen Sexton reports the case of a soldier with a large suppurating wound on the inner side of the arm, in which erysipelas developed, the redness and swelling extending below the elbow. The arm was painted every twelve hours with ichthyol and glycerin equal parts, and covered with oil-silk, and a mixture containing large doses of bichloride of mercury was given. In forty-eight hours the temperature was normal, and all the local symptoms of erysipelas had disappeared; the wound was then dressed with ordinary hypertonic saline solution.-British Medical Journal.

CHIONANTHUS FOR GALL-STONE TROUBLES

BY Wм. M. Gregory, M.D.

The right chionanthus is the best remedy ever discovered for the prevention of attacks of gall-stone colic, which of course means the prevention of the formation of gall-stones.

To secure the prompt and decided results which this remedy should produce, it is absolutely necessary to use the standard, full strength, eclectic preparation, made from the fresh plant. Attacks of hepatic colic, or gallstone trouble, seem to be the especial prerogative of stout, full-blooded, middle aged or elderly ladies, who have a constitutional aversion to free water drinking.

When the bile has become partly evaporated, or inspissated, through a lack of sufficient fluid in the system, a minute epithelial scale from the lining of the gall-bladder may easily form a nucleus for the formation of a cholesterin stone. From the frequency, duration, and severity of these attacks of hepatic colic, it is evident to a close observer that many of them are caused by plugs of inspissated bile, rather than by fully formed and hardened stones.

The green plant chionanthus acts in a very rational and physiological manner in these cases, which is to thin the bile, and promote an increased outflow into the small intestine. I have been using it for several years for this purpose, and I have yet to fail in a single instance to give permanent relief. I have usually used the chionanthus in combination with green plant, or eclectic, chelidonium, bryonia, gelsemium, and veratrum, which are all valuable hepatic, and eliminative remedies. A lady that I had formerly treated, but who now lives at a distance called at my office not long ago. As I had not seen her for

18 months, I asked "Well, how have you been getting along, have you had any trouble?" She answered, "No indeed, I have not, but I have such a lively recollection of those spells of agony I used to have, that I do not like to be without some of your medicine in the house."

Chionanthus is of the greatest value whereever there is retention of bile, unless it be from organic obstruction.

Some years ago I was asked to treat an elderly lady for inflammation of the liver of five years standing, with enormous enlargement of the organ. She also had a very severe case of gastric catarrh, a right-sided hydronephrosis, and prolapse of the rectum and vagina. She had been medicated so long, and so thoroughly with morphine and calomel, that her system would hardly respond to medicine at all. Her degree of gastric debility was such that I had to make malted milk her entire diet for nearly three months. The first hint or pointer that I got was when her sister and attendant, told me that the patient's stools were never of a natural color, sometimes white, sometimes bluish, sometimes gray, but never brown. All the bile, and all the systemic waste that goes to make bile, was being retained in the system. I immediately put her on chionanthus, gelsemium, bryonia and veratrum. I think chelidonium was afterwards added. I did not get any immediate response, but the stools gradually became darker, then perfectly black, and remained of that color for at least a month. Her condition steadily improved, and I think much of our success in getting rid of the acidity of the contents of the stomach, was due to the regular and continued use of 5 grain powders of natural sodium salicylate. All symptoms of congestion and inflammation of the liver disappeared, and what seemed really wonderful to me, all the enlargement of the organ disappeared. I

would have supposed that with a history of enlargement of the liver of five years standing, that the organ would have contained fully organized new tissue. It evidently did not, as the enlargement which was perfectly enormous, passed away entirely. I shall always be sorry that I did not measure the waist line of this patient, as the quacks say "Before Taking and After Taking." It certainly became a good many inches smaller while she was under treatment. The symptoms of right hydronephrosis gradually disappeared as the liver went down. I judged that it had been caused by the pressure of the enormously enlarged liver obstructing the right ureter. The patient has remained generally well since that time. She has had no signs of inflammation or enlargement of the liver. It should always be remembered that these vegetables remedies, like chionanthus, chelidonium, etc., etc., will enable the expert to readily cure any, and all liver troubles that are not of organic origin. Berea, Ohio.

CAUSATION AND CONSIDERATION OF VALVULAR LESIONS OF THE HEART

BY DOUGLASS HAYES, M.D.

It is my opinion that the rapid strides of the Americans as a Race, prevent their attending physicians from giving, for the proper length of time the drugs required, for the elimination of the productive causes, that in time establishes our organic heart lesions.

For instance, very near all of our acute contagious and infectious diseases in an indirect way, if not properly treated—can be productive of organic heart lesions. While it is true, some have a greater bearing along this line than others. Yet, from personal observation, I have seen valvular lesions following very near all of the acute infectious diseases of childhood.

A child ill with scarlet fever, diphtheria, whooping-cough or rheumatism, is never out of danger of heart complications, for weeks after the acute symptoms of the disease have subsided.

When we stop and think of it, looking back over our field of work. We will notice that the congenital cardiac defects are not so very numerous, for as a general thing, only a few of these cases live to maturity. I do not believe

that I would be far wrong, were I to say threefourths of our organic heart lesions originate before puberty, and that seven-tenths result indirectly from microorganism. By their invasion, damage can be, and is done quite often to the heart and its valves, and yet to all outward appearances, no symptoms will have shown, until lost compensation occurs. Many of these cases die, while at their daily occupation, and no thought was given the heart, previous to their death.

I have traced back chronic heart lesions in old people to their childhood, showing where it followed some acute infectious disease at that time. Twenty-five years ago, we treated our patients laboring with acute infectious diseases with but one thought in our mind, that was to get them through with the illness at that time.

The physician of today, should treat with a view of the sequela. If we do this, and medicate thoroughly as we should, we will have far less organic heart lesions to contend with in advanced life.

Mitral Insufficiency, the most common of all our valvular lesions I have seen develop following endocarditis, which in turn, was occasioned by only a short attack of rheumatism.

Rheumatism at its onset, is an acute febrile disease, depending upon specific bacterial intoxication, and without doubt is one of the most productive of all heart lesions.

Children are far more prone to rheumatism than many would judge. The "growing pains" better known as leg-ache of childhood, is rheumatism. The so called neuralgia of childhood is more than apt to be of rheumatic origin. Now all these cases of rheumatism of children should be properly medicated at the time with a view of in after days, of heart complications following.

It is far better to occasion slight gastric trouble by the continued use of the Salicylates, than to allow them face an organic heart in days to come.

The great trouble with some, is that they neglect this chance. Yet, when an organic lesion is shown, they start an active treatment regardless of how well the compensation may be at the time, why try to correct something that is impossible. There is a time for all things, and so it is in these cases. A heart that may show its valves involved, does not require direct treatment, unless lost compensation

occurs. Keep your digitalis, strophanthus, strychnine, out of them or you will do more damage than good. Assist nature to cleanse through the kidneys and bowels, look well to your dietetics, improve in this way the physical condition of the patient, nature is a better Doctor than yourself at this stage, and doubtless will care for the heart for a long time, if you will look after the other organs. Tracy City, Tenn.

APPENDICITIS

BY JAMES E. FREE, M.D.

Suppose my medical reader, you were acquainted with a youngerly surgeon who liked to operate; and in the pursuit of his profession, he should find a friendless young stenographer, who suddenly complained of a sharp and continuous pain in the right ileac region.

What would you think of this surgeon's determination to operate for appendicitis, on the theory that the sudden onset of pain was sufficient justification?

My own idea would be the surgeon, under the circumstances was nuts on appendicitis. It is not easy to convince old practitioners that any of the surgical diseases fastens itself to a locus in one hour and begins to grow.

This patient was removed from the consultation room, in an automobile, to the hospital and immediately operated upon. In twenty-four hours she was dead. The surgeon had carefully suspended the amputated appendix in a preservative fluid, after its removal from its connection with the thirty feet of garden hose, called the intestinal canal: for the purpose of convincing, let us say, the skeptic, that his opinion was justified. Probably it hurt his professional conscience to see it standing on the shelf in his consultation room, and for that reason he turned it over to the party of the other part.

It is not often such a unique chance is afforded the clinical investigator to study the appendix, by itself. Text-book literature on the appendix is weak when it comes to making an actual picture of the lesion stick to the mental ribs. Some of the pictures look very much as if the appendix, in situ, was built for the purpose of providing a nest for intestinal But here is a clean cut specimen,

worms.

which does not present any indications of circulatory derangements, and which appears to the naked eye as if it should still be abiding in the abdomen of a living girl.

In shape and size it resembles the little finger of a rubber glove. There is a pronounced constriction at the amputated end; just as if circular fibers were present to form a sphincter. The organ is a continuation of the small intestine and must therefore be supplied with longitudinal fibers needed to carry on the function of peristalsis. When this phenomenon has reached the infundibulum of the appendix what does it do? Stop as it does at the anal terminus; or does it turn back and come round, and proceed on down the canal? Peristaltic waves in the unattached end piece must make it wag more or less like a dog's tail. If the impulse jumps off the end into surrounding space it ought to be the simulator of motion sufficient to fool a pregnant woman into the belief that she can feel motion in an abnormal place.

If there should be an accumulation of gas in the small intestine, and peristalsis should be forcing the contents through the opening between the small and large intestine, it could very well happen that gas would distend the appendix and be the means of helping the contents to pass downwards. Without any gaseous contents the appendix might receive a fragment of the contents of the small intestine. Once beyond the appendix orifice this intruder could act as an irritant to the lining membrane of the cavity and be the exciting cause for contraction of the orifice.

Extrusion of the foreign body being impossible, irritation would increase until reflex impulses would cause the individual to understand how a new condition had been somehow created. Increased quantities of blood would be rushed towards the appendix. Hyperemia would pass into congestion and a little later into genuine inflammation. There would then be an increase of secretory activity in this cavity or cyst, which up to this time has been

only a cul-de-sac.

only a cul-de-sac. In a comparatively short time the foreign body would be suspended in a dropsical effusion much like the fetus is in the amnion.

Secretion in normal amounts, in this locality is intended for lubrication; but under the new conditions it would very soon be transformed into dead matter, and the next step will be putrefactive decomposition. Abrasion of the