mate. Children are the natural result of such a union. All normal individuals have the desire for such a union, for marriage. The man is the responsible head, the breadwinner, while the wife is the administrator, the child-bearer, and the child-educator. The best and the hardest work falls to her lot, the strain of sustenance and of protection to his. An intelligent man does not hastily unite to himself the woman he loves if he is insecure in his ability to give her a reasonably good home. In his estimate of his ability he must count upon the expense of children for many years to come. Nor will a wise woman thoughtlessly tie herself up for life, even to the man she loves, if she can see nothing but stagnant poverty before her. She is self-sustaining and has no need to sell herself to a man for her sustenance, clothing and shelter. Marriage has at last come to be something nearly the union of two equals, as it should be. So much for fewer marriages.

Divorces are more frequent because of the spread of the spirit of individual independence, of the unwillingness of intelligent women to continue an undignified, a profitless, a loathsome, or otherwise unbearably objectionable union for an indefinite period, in other words, possibly to sacrifice her entire life, or its better part, to perpetuate an error. Many more women than men seek and secure divorces. Men are the greater offenders in more ways than one. So much for the greater frequency of divorces.

Lesser fecundity in the marriage state is due to the steadily-increasing standard of living, and the unwillingness to sacrifice all social and other pleasure for the hardship and privation of rearing a family. The bulk of our men are ordinary wage-earners. They are unable to marry and beget children, and at the

same time participate in the limited enjoyments and luxuries to which they have been accustomed. Ambition and hope seduce them to attempt the almost impossible. Their only mode of partial relief if the union is personally agreeable and marriage stipulations have not been seriously violated, is to curtail the number of offspring either by the prevention of conception or the production of abortion. The determined and bitter spirit in which these steps are taken by married couples is a grim index of whither we are drifting. It is the fixed, the unalterable, and growing stern determination not to sacrifice the multitudinous available pleasures of life for a sense of duty to the community. The persons who make the sacrifice are usually those who are ignorant of how to avoid it and those who do so through a conscientious sense of duty. So decided is this determination to avoid what is getting to be so commonly considered a thankless sacrifice, that women grimly go right ahead despite all the danger of chronic invalidism or even death rather than assume the burden of motherhood for a father and a community that will not and cannot give any additional help. So much for prevention of conception and abortion.

The remedy is simple. Avoid the cause. First, by constant watchfulness and suitable legal restrictions, from time to time as needed, limit the "specialprivilege" possibilities of certain classes to unjustly amass great fortunes of the people's wealth, by which they are able to advance to an unreasonably extravagant degree the luxurious standard of living, tempting the class of useful producers to wrong methods in trying to keep up with them. Second, by all methods of precept and example to discourage fashionable ostentatious display in private living, and to encourage a

prudent limitation of expenditure to that which is sufficient for all the reasonable needs of the family. Third, so long as each added child means added poverty for those who precede it, efforts will prevail to prevent its coming. As we said once before editorially in the way of advice to France for the increase of its birth-rate, and which we said at the time would soon fit this and every other civilized land as well, the only way to insure a satisfactory birth-rate is to remove the sacrifice incident to child-bearing and raising. If the State will assume the cost of sustenance of children until they are self-sustaining, we venture the prediction that the birth-rate will rapidly increase. Then those who purposely remain bachelors or childless to selfishly further their own social or financial ambitions will find that they cannot thus escape their proper share of the common burden-that of sustaining a generation to succeed this That government which first adopts this course will be the first to benefit from its advantages.

print herewith a synopsis of the doctor's treatment of small-pox, a printed slip of which he was good enough to send with his letter. This is specific information in terse form that we did not have from the doctor before, and which the large success of his treatment makes it so desirable should be in the hands of practitioners.

Rational Treatment of Small-pox.

The solution of warm or hot water is made with not less than 10 per cent. of pulverized bichloride of mercury in a half gallon of it. half gallon of it. With a large sponge this is to be thoroughly mopped all over the body, neglecting no part of it, twice over before stopping is all the better, and the clothes pulled on while the skin is wet to disinfect them at the same time. Caution the patient to keep the eyelids closed, as the solution is severe enough to inflame the eyes if permitted to get inside of the lids.

With the peroxide of hydrogen spray the eyes, nose, lips, mouth, throat, and ears to dislodge the germs in those cavi

Small-pox.

In a letter from Dr. T. C. Osborn, of Cleburne, Texas, in reference to our editorial upon this subject in the June Medical Council, he expresses his disbelief in sufficient climatic differences in small-pox to make his treatment effective in the South while not so in the North, and thinks it more likely that the seeming difference to which we called attention was due to the failure to properly carry out his treatment where it seems not to have been successful, to which we are obliged to reply that we do not know whether or not he is right, but sincerely trust, for the good of humanity, that he is. The point we made was, that elimination being more active in warmer climates, and climate unquestionably greatly modifying many diseases, it is likely, or at least possible, that smallpox may be so modified by climatic conditions as to be susceptible to a certain line of treatment in one climate though not so in another. We are pleased to

hyposulphite of soda in half a glass of water once a day, to disinfect the stomach and bowels and to act as a safe and gentle aperient medicine. When this course is well administered, the patient is thoroughly immunized and cannot any longer convey the contagion to any one else; and if the solution is well sprinkled on the bed and covering, and the rooms and seats treated in the same way, there will be no necessity to burn things, as is the general custom. permit a toddy once a day and let them eat whatever they wish.

I

Now, if all suspects are treated in the same way, they cannot possibly take the disease, and may as well go about their ordinary business. It is best that the patient remain up and about. Confinement adds to the fever and encourages the violent itching of the disease. But after the solution is used, there is no longer either itching or cdor, and no pockmarks may be expected.

Respectfully,

T. C. OSBORN, M. D.

Original Articles.

The following articles have been written exclusively to the editor and readers of this journal. Other journals republishing any of these articles will, as a matter of professional courtesy, kindly give credit as follows:-Medical Council, Philadelphia.

A Plea for More Attention to Laboratory Technique as an Aid to Clinical Diagnosis by the General Practitioner.

By T. F. BEVERIDGE, M. D.
Muscatine, Iowa.

While we do not claim that the microscope should be relied upon wholly in making a diagnosis, yet in these modern times the one engaged in the healing art who is satisfied to sit down and formulate a diagnosis, or try to, by the history and objective symptoms alone in each and every case, and not avail himself of the various instruments and methods of precision, is rapidly becoming classed as falling behind the lighthouse.

The extremist in bacteriology and laboratory methods might say that no diagnosis can be made, or pathological condition established, without being verified in the laboratory by finding the particular microbe or toxine causing it. This is as erroneous as the ignoring of all laboratory methods.

Our profession, always conservative, has progressed and is progressing along safe lines, each new diagnostic method, like the various new therapeutic agents and methods advanced, finally falling into its proper place, and being utilized in its own field of practical usefulness, the separating of the wheat from the chaff being the end result of cultivated judgment and ripened experience. The general practitioner cannot do and become expert in the application of all the various diagnostic methods of all the different specialties. In other words, he cannot be his own bacteriologist and chemist wholly, for this is a department by itself. But there are some things he can do with advantage to himself and patient. All patients are not able financially to send to the laboratory for an

examination to verify an opinion, and the physician does not feel disposed to bear the expense, and yet his reputation is at stake, as is also the interest of the patient.

Every physician or surgeon should therefore be prepared to make an examination for tubercle bacilli in sputum, pus, etc. This disease, unfortunately very prevalent, manifests itself in so many different ways and at all ages, and the almost only salvation the patient has being in an early diagnosis, that neglect in this respect on the part of the physician becomes almost criminal. It requires no great amount of skill to make a diagnosis when it is too late for the patient to derive any benefit. Credit is due the man who makes the diagnosis in the very beginning, and gives his patient a chance for his life. True, there may be cases where a tubercular condition in its incipiency may be suspected from the family history, symptoms, etc., and where no pathological tissue or fluid could be obtained in which to find the bacillus, and this sort of a diagnosis be fairly trustworthy, yet this detracts not in the least from the utility of the microscope.

Another practical use of the microscope is in gonorrhea. First as to making a diagnosis between specific and nonspecific urethritis. A case in point: A young man presented himself with a violent acute urethritis; copious yellowish discharge. Upon examination I thought he had gonorrhea, and so told him. He protested, saying he had had absolutely no occasion to contract gonorrhea away from home. Said he had a mild attack of gonorrhea several years before, but had for a long time considered himself cured. I procured specimen of pus, examined it, and could find no gonococci. Submitted it to an expert and he could not find gonococci in it, but pus-cells in abundance. The patient said his wife was in poor health, having had a miscarriage some six or eight weeks previously. weeks previously. I prescribed for him in the usual way and in less than a week his discharge had entirely ceased, and he was as well as though he had never had

a urethritis. He then asked me to see his wife. I found a young woman with profuse rather purulent leucorrhea due to discharging pyosalpinx. A typical case, with all the symptoms that go with it. There was uo history of gonorrhea in the woman. Thus we had a satisfactory explanation of the urethritis in the husband.

Secondly, with reference to gonorrhea and marriage; while it is as yet a disputed question as to whether a person once infected with gonorrhea is ever absolutely cured, but that there are some gonococci lying latent embedded deeply in his urinary tract ready to show fight should occasion demand, yet in practice the concensus of opinion, I believe, now is that a large percentage of the cases, if submitted to proper treatment and advice faithfully carried out, a later marriage does not necessarily result in infection to the innocent party. Every person having been infected with gonorrhea, and intending marriage, should have this event postponed until a reasonable time, say at least six months after all discharge has ceased and no cocci are found. No doubt the physician, when consulted by a young man or woman in this condition and intending marriage, is doing an act of charity if he states frankly to his patient that he will see to it that this program is carried out, and in case of refusal to comply he will notify the other party interested.

The use of the microscope in the diagnosis of diphtheria is important, especially in mixed and changing communities as in cities of any consequence. If a piece of membrane is secured the diagnosis can be made immediately, or with the modern simplified methods, by

culture from the throat exudate in a few

hours. There is no fad about this. Practical men who treat largely the diseases of children tell me that it has become so reliable and trustworthy that every sore throat in children should be so examined. Here, again, it is not in the case where the physician is called late, and a blind man could tell by his stick that it was diphtheria; but, in the very beginning, the suspicious, doubtful case.

The physician's responsibility in this disease, like many others, is greater the earlier he is called.

The practical value of the microscope in the early diagnosis of kidney lesions is long since established.

Then there is the great field for diagnosis by blood analysis, only yet in its infancy. Practical clinicians of the foremost rank are availing themselves more and more of the advantages of blood analysis.

The corpuscle-count in the anemias; the Widal reaction for typhoid fever; the plasmodium malaria, etc. Recent experiments also would tend to show that there is some value attached to the leucocyte-count in grave abdominal diseases—as appendicitis, peritonitis with pus, etc. pus, etc. In acute appendicitis a high and rapidly-rising leucocytosis has been found to accompany a gangrenous condition or abscess, even though other symptoms might mask this. And vice versa, where the objective symptoms were marked, but accompanied by a low or normal leucocyte-count the condition. found upon operation did not really justify operative interference.

Perhaps these data have not been sufficiently verified to be trustworthy, yet it shows there is a great deal of work being done along this line which would indicate that practical results will follow.

The microscope, however, is not the only pebble on the beach. A number of chemic reactions of the secretions and

excretions are of importance, and the list is slowly growing.

Besides the well-known albumen and sugar tests, that for indican indicating pus, the diazo reaction as a negative test in typhoid-fever diagnosis, and the qualitative tests for the various salts of the urine in special conditions, might be mentioned.

Then the Roent; en X-ray as an aid to diagnosis in its special field, though small, is valuable.

To summarize: I believe every physician should be somewhat familiar with these various methods of laboratory diagnosis, for, by his knowledge and