main unsolved, though every physician knows we are on the eve of grand discoveries in many lines. It is amazing then. to find it stated that this god-like work of prevention of disease, suffering or premature death, "seems rather a hindrance than a help towards turning us out good Christians, or even ladies and gentlemen." The incident shows the utter impossibility of debate with such minds and the certainty that they will continue their dreadful propaganda for they have "fixed ideas" which prevent seeing the facts. The research workers might as well organize to combat what will prove to be a permanent opposition, and plans for perpetual defense might as well be supplemented by plans of counter attack to show the unreliability of each anti-vivisectionist. The overcrowding of the medical profession comes up for discussion every little while, and always will come up, for it is the normal condition in all callings. Economists have repeatedly shown that industries owe their existence to a large unemployed class from whom labor can be obtained at a moment's notice. In the parable, the Master said, "why stand ye here, all the day idle?" There are always more workmen than the work requires and the cry of overcrowding is as old as man and is now heard every year in every trade. In every civilized land we find some doctors in poverty, some lawyers, and some clergymen. It is a condiwhich cannot be remedied and the proposition to reduce the number of medical students is palpably absurd-almost amounts to the suggestion that the sick be compelled to submit to the ministrations of the least efficient. The number of students is being reduced in England on ac Series count of the increasing cost and labor of obtaining a license, but it will not guarantee all the graduates success. Indeed overcrowding is socially desirable, as it increases the struggle for efficiency. In the struggle for existence, success goes to the efficient, not necessarily to those we consider the best. The diminishing incomes of physicians have already been mentioned in these columns, and the causes determined, but that has nothing to do with the utter failure of some,-a matter due solely to the inevitable overcrowding. There is always room at the top, and this fact was dinned into our ears in childhood. Nevertheless the exceptional men are the only ones who get there. Moreover by the ordinary laws of mathematics and biology, it has long been proved that the further from the average the fewer are the specimens, consequently but few men are possessed of that efficiency which is a compound of ability, knowledge and energy. It was dreadful teaching we received in childhood when we were told that every one had an equal chance to reach the top if he would only learn and work hard. The cup of disappointment is very bitter when failure follows. The very ability itself is compounded of intellectual power and a curious "personal magnetism" which impresses the patienta native characteristic which no one can acquire though he may copy fairly well. Consequently there will always be failures, and the overcrowding may be beneficient after all-hard as that sounds. Ignoring the unwritten law is a final development for which we should be pro foundly grateful. The old medieval system presumed that woman was a fool who could be led off by any man who came along, and that she was blameless. A few men have that opinion yet and go around shooting up the community promiscuously when any woman goes wrong. Why in the world they do not shoot her is hard to tell, for as a matter of fact she often lures and the man follows. It seems to most people that such females are not worth fighting over. Modern civilization is freeing women from many of the old restrictions and makes her a responsible agent and she can no longer expect to be saved and her guilty partner slaughtered. Then again, the decision as to who shall die, is in the hands of society and the man who assumes that function must be removed to where he cannot do it againprison or asylum it makes no difference which. One thing is certain, the medical profession must do its share in ending the present carnival of murder in America. One county in Alabama is said to have more murders a year than all the British Islands together, and the rest of "God's country" is almost as bad. The idea of freedom seems to be the right to kill whom we please. If every apprehended murderer is deprived of life or liberty, as in England, the carnival would promptly end. The good work has begun, let it go on. Ignoring the alienists is the punishment meted out as a result of their habit of disagreeing. In two notorious trials recently, the expert witnesses swore to diametrically opposite opinions, and in each case the jurymen are reported to have ignored this testimony and formed their own opinions from the evidence as to facts, as it is their right and duty under such circumstances. In other words, psychiatry, which as a science is now highly developed, can furnish no aid to society in dispensing justice,-a deplorable state of affairs which needs correction in every State of the Union. It is strange that the people themselves do not insist upon a new system, for they must know that no one is safe if it is possible to free every murderer who has money. Society must protect itself and its component units more than it has been doing in the past. Perhaps if all juries will ignore the experts, the reform will come sooner. The indigestion of travelers is a serious matter which demands renewed attention. A common news item is the fact that some prominent man visiting from home, is prostrated by ptomaine poisoning. It is quite evident that there is not sufficient care in preserving the foods in public eating places, here and there, and that the local health authorities are inefficient or repressed by the fear of publicity. It would be well to keep a scrap book of clippings of such cases in order to avoid the places should chance take us that way. Incidentally we might suggest that all eating places be put under daily inspection. Hotel proprietors would do a great stroke of advertising by arranging their kitchens as show places, so that visitors might be impressed by the cleanliness and care of the foods. People now know much more. of pure foods than they did a few years ago and are getting so "finicky" as to getting sick, that they may avoid hotels whose kitchens are in some unspeakable dark dungeon, or where flies are fed more. industriously than the guests. There can be no doubt that pneumonia has been known since earliest times. The writings of the ancient physicians from Hippocrates down bear witness to the fact that this disease is as old as civilization itself. Among the laity, it has likewise long been a recognized affliction, and as the dreaded "lung fever," it has been looked upon since time immemorial as one of mankind's most fearful curses. Lack of space forbids any lengthy discussion of the history of pneumonia, although it would well pay anyone to delve into the bygone literature of the subject and study the interesting evolution of opinion concerning pathology and treat ment. According to Musser and Norris, the relation between the clinical manifestation of pneumonia and consolidation of the lungs was first pointed out by Morgagni; while Baillie first described the process as “hepatization." Subsequent studies of great importance were made by Laennec, Cruveilhier and Rokitansky. The actual diagnosis of pneumonia by determining its physical signs was first described by Auenbrugger and Laennec, while to Rokitansky belongs the credit of first differentiating between lobar and lobular types. Occurrence: Pneumonia is world-wide in its occurrence. The people of some countries seem rather less prone to the ravages of this disease-notably those near the equator-but none escape it entirely. Emigration seems to rob individuals of any immunity they may have established in their native climes, and in the country of their adoption they often become much more susceptible. This opens up a most interesting line of thought concerning bacterial virulence and there can be little doubt that the pneumococcus is an organism particularly subject to environal modification. This fact taken into consideration with the great variability of human susceptibility makes it extremely difficult to establish any fixed data as to the occurrence of pneumonia. The factors of the equation presented by bacterial virulence and human susceptibility are so subject to modification that the most we can do is to study percentages and realize that such figures at best give us but approximate truths. All available statistics point to the fact that pneumonia is increasing. Especially does this seem to be so in certain localities, as for instance in Chicago. During the last forty years the mortality from pneumonia has increased from 4.4 to 19.95 per 10,000 inhabitants. The last U. S. Census shows that pneumonia next to tuberculosis is responsible for a larger number of deaths each year than any other disease. While the mortality of tuberculosis seems to be decreasing, pneumonia goes steadily onward, and probably the day is not far distant when pneumonia will head the list of causes of death. There are not a few physicians who question the foregoing and attribute the increase of pneumonia deaths to errors of diagnosis, but there are abundant reasons for believing that the diagnosis of pulmonary diseases and the registration of deaths are far more accurate to-day than formerly. The increase in pneumonia deaths may rightly be considered, therefore, as a reliable index of the spread of this disease that Osler aptly terms the "Captain of the Men of Death." Age. 0 to 5 years. 5 to 10 years. 10 to 20 years. 50 to 60 years. 60 to 70 years. Over 70 , 1910 , Vol. V. 20 to 30 years. 30 to 40 years. 40 to 50 years. 20 to 30 years. 30 to 40 years. 40 to 50 years. 50 to 60 years. 60 to 70 years. Over 70 As a matter of statistical interest the following tables have been selected from the latest edition of Osler's System of Medicine, (1909). THE OCCURRENCE BY MONTHS. The records collected by Wells of 685,566 fatal cases show: Month. January Age. 0 to 5 years. 5 to 10 years. 10 to 20 years. PNEUMONIA IN ITS RELATION TO OCCUPA February March April May June July August September October November December PNEUMONIA IN ITS RELATION TO AGE. Among 32,681 cases: Professional Clerical and official Age. Cases. Per cent. Mercantile and trading. Personal service, police and mili 10 to 20 years. 20 to 30 years. 8,041 24.6 Laboring and servant 11.8 11.7 30 to 40 years. 40 to 50 years. 3,987 12.2 industries 9.8 10.2 50 to 60 years. 60 to 70 years. 1,754 5.4 other outdoor 10.7 13.8 The age was not stated.. , Vol. V. , 1910 One thing is certain and that is that few. diseases are of greater importance to the general practitioner than pneumonia. The unexpected character of its attack, its insidious onset, its rapid placing of a patient, no matter how stalwart, in a state of gravest peril, and the uncertainty of the prognosis until the crisis is well passed, all serve to make pneumonia a disease of the most serious possible character. Such a scourge. that robs us gluttonly of our young and old, weak and strong, rich and poor needs our best thought and study. Mankind cannot remain supine much longer and allow this fearful disease to go on taking annually its unwarranted toll. It was with the earnest belief that every bit of thought given to the question of pneumonia has a potential if not an active value, and may sometime lead, when least expected, to the ultimate solution of this great medical problem, that this symposium was arranged. Such an array of opinions and ideasand from the sources represented—cannot fail to prove of incalculable value to the general practitioner. It is the last word on pneumonia-and if, aside from the facts and ideas it outlines for practical use, it serves ever so little to stimulate further investigation of this at present blot on the medical escutcheon, the time and effort expended in its compilation will be well repaid. Vomiting of Pregnancy is frequently easily controlled by administering one. minim of tincture of iodine in an ounce of water, repeated every two hours. |