tient's life seemed to hang by a thread. Little by little nature's forces recuperated and recovery followed.

To narrate in detail the histories of other of the tabulated cases would be only useless repetition. Symptoms may vary, and even be so obscure in some instances that diagnosis is impossible. Such cases are usually the ones that permit of delay.

Those illustrated by the third case render diagnosis easy by their very gravity and immediate menace to life. Nothing but an internal hemorrhage can account for such an impressively alarming state of

matters.

FETTERED BY A CODE: A BIT OF FICTION THAN WHICH THE TRUTH IS STRANGER.

F

BY CHAS. S. MACK, M.D.,

La Porte, Indiana.

ETTERS—Why, Freeman! Where did you come from? I thought you lived in Denver.

Freeman-So I do, and am on my way there now. Train leaves at 5:30.

This meeting was in the dining-room of the West Side Railway Station in Chicago. I had not seen my friend Fetters since we were hospital internes together, after graduation from the Sydenham Medical College in Philadelphia a dozen years ago. After graduation he settled in Philadelphia, where he has somewhat distinguished himself as a student of bacteriology and a writer upon the subject. He is at present one of the Sydenham faculty. We were very intimate in student days, and during our residence in the hospital. I settled in the West and until this meeting had had no communication with him, excepting that he wrote me a note of bantering criticism, astonishment and reproof when he learned four years ago that I had actually associated myself by practice and by name with homoopathy. The whole tone of his note was such that I made no reply to it. And here we were sitting down to lunch together while waiting to get out of Chicago.

Fetters-Well, this is luck. I've thought of you often, and have wondered how in the world you ever came to take up with homoopathy. Do you practice it only, or are you one of those who claim. to practice "both ways"?

Freeman-What do you mean by practicing both ways?

Fetters—I mean do you sometimes use rational practice, and do you use empiricism; or do you ignore all the modern research and discoveries that don't lead up to homoeopathy, and do you disregard the accumulated experience with practices which seem to do good but have nothing to do with homoeopathy?

Freeman-I have great respect for rational practice and use it frequently. I also have respect for empiricism, and use it when I think I can't do better.

Fetters-Good for you. I'm glad that you're not so taken up with homoeopathy as to lose sight of everything else. I have nothing against homoeopathy-I was brought up on it, and for aught I can see the homœopaths (if they don't tie to homœopathy alone) do as well with their patients as any of us. But what I don't see is what reason you have for calling yourself a homoeopath when you practice rational medicine and empiricism as well as homœopathy. Come, now, can you really give me any good reason for it?

Freeman-Indeed I can-the very best of reasons; and if you are willing to listen, you are just the man I'm looking for, for I am brimful upon that particular subject.

Fetters-That's right. I like enthusiasm, if it is well directed,— and yours is well directed if you can give any earthly reason why a man who practices rational medicine and empiricism as well as homœopathy should call himself a homoeopath. Fire away, and be quick about it, for it's near my train-time.

Freeman-The point is this. The particular cure of which similia is the law outranks, in a sense, any other cure which one can intellligently attempt with drugs-it transcends the possibilities of rational practice and cannot be intelligently attempted in empiricism. Seeing this, and seeing, too, that a

Fetters-Hold on. You are going too fast. What do you mean by saying that the cure of which similia is the law transcends the possibilities of rational practice?

Freeman-I mean precisely what I say. Let me define that particlar cure of which similia is the law: it is "such modification of the quality of vital processes and their effects that, whereas these processes and effects are abnormal, they shall become normal as the immediate result of the medicine used." By immediate in this definition I do not refer to time--I simply mean that there is no drug effect mediate to, or precedent to, the cure. In rational practice one cannot attempt to immediately transform vital processes from abnormal to

normal, for the data to any rational practice must be in themselves knowable, and vital processes are not in themselves knowable. Vital processes can be known only in their effects; so, too, of the dynamic properties of a drug (those properties by reason of which the drug acts immediately upon vital processes) they can be known only in their effects. Now, while we cannot in rational practice attempt the cure I have defined, we can attempt it under guidance of a law of nature (if such there be), stating what relation between the effects of diseased vital processes and the effects of a dynamic drug as a pathogenetic agent indicates that drug as capable of effecting that particular cure. Do you see what I mean?

Fetters-Yes, I think I do. As vital processes are known only in effects, and as the properties by reason of which a drug acts immediately upon vital processes are known only in effects, you would look to a law of nature for a statement of the relation between the effects of disease and the pathogenetic effects of a dynamic drug. capable of immediately transforming from abnormal to normal the vital processes back of the disease effects.

Freeman―That's it exactly. I believe that similia similibus curantur is that law of nature. Now you know, as well as I, that those whom you call regular physicians are, as a body, opposing in every way they can the spread of homoeopathy. They would gladly consign it to oblivion, while I believe that the cure of which similia is the law transcends any that can be attempted in rational practice, and, in a sense, outranks any other cure that can be attempted with drugs. In the circumstances I feel called upon to identify myself by name with homoeopathy, so that, whatever my practice in a given case may be, I shall be known first, last and all the time as an adherent to and advocate of homoeopathy. Do you understand now why I call myself a homoeopath, though I practice rational medicine and empiricism as well as homoeopathy?

Fetters-Of course I do: it's perfectly clear, and the thing that's made it clear is your definition of that particular cure of which similia is the law. I never before heard that that cure is different from another, but I see that it is entirely different.

Train-starter-The train is now ready for Marshfield, Pittsburg, Harrisburg, Baltimore, Washington, Philadelphia, New York and Boston. The train stands on track No. 5.

Freeman-Here's your umbrella-don't forget it, and don't forget what I've been telling you.

Fetters-Indeed I shall not. I've enjoyed your talk immensely. That definition lets you out in great shape.

Freeman-I'm glad you like it. I'm going to send you a little

book.*

Fetters-Do.

Freeman-Will you read it?

Fetters-Indeed I will.

Freeman-All right. I'll send it. Good-bye.
Fetters-Good-bye.

Off moved the train.

From the day of the above conversation Fetters has, in the bottom of his heart, believed that the homoeopaths are the best all round men in the medical profession, and that those who call themselves regulars are part of the time shutting their eyes to, and the rest of the time actively antagonizing, that which is best in medicine. At times Fetters has even felt an impulse to identify himself by name with homoeopaths, but he is fettered by an iron-clad code which he could not throw off and retain his position in Suydenham College. Besides, he is a bacteriologist and does not want to practice medicine. He says to himself, "If I were in practice, I'd throw off this miserable code and be free as Freeman is."

GALLSTONES.†

BY J. P. RAND, M.D.,
Worcester, Mass.

OME two years ago my attention was called to the proposition, that gallstones were often the direct result of mechanical pressure from tight lacing.

I had never seen this statement particularly emphasized in any text-book, and yet the more I thought of it, the more I became convinced of its truth. In my own experience I had never met a case of even suspected gallstones in the male. I questioned my professional neighbors and found that many had only met with a very few. This made me suspicious of the statistics of the books, which give the

* Principles of Medicine, by Chas, S. Mack, M.D. Published by the W. T. Keener Company, 96 Washington Street, Chicago.

Read before the Rhode Island Homœopathic Medical Society January 14, 1898.

ratio of males to females as about 2 to 3, and I determined if possible to compile a few statistics for myself.

Accordingly, a few weeks ago, I addressed a brief circular to the physicians of my acquaintance asking for information in regard to this very point, and the result of my investigations form the groundwork for this paper.

I find, however, that my little personal experience does not represent the larger observation of the fifty odd physicians who responded to my request.

The summary of statistics I am able to present is so similar to those already recorded that, apart from the fact of its being new, possesses but little significance.

I confess to a certain degree of disappointment in this result, for it does not seem that my individual observation of gallstones could be so absolutely unique. However, facts are what we want, and if the theories do not correspond, so much the worse for the theories.

Through the kindness of my professional friends I have been able to secure the records of 288 cases of suspected gallstones. Of this number 109 were males and 179 were females, making the proportion of females about 62 per cent.

But the best of diagnosticians sometimes make mistakes; and in order to eliminate all possible sources of error, I asked for further information in regard to the cases where the diagnosis had been actually confirmed by an autopsy or the finding of the suspected This gives evidence from which there is no appeal and it is the only evidence I shall make use of in this paper.

stones.

I find that of 132 cases in which the stones were found there were 38 males and 94 females, making the proportion of females about 71 per cent., which compares closely to the tables in some of the books. None of my correspondents have ever seen a case of gallstones in children of either sex.

Now it would be manifestly absurd, with such figures before us, to claim dress as the sole etiological factor in the production of gallstones, and yet I can but feel that as yet it has not been sufficiently emphasized. I will go even further than this and say, in my opinion, the greater frequency of gallstones in the female can be fairly attributed to it. But opinions are of no consequence; let us turn our attention, right here, to something else.

And first I think we may grant without question that the average man does not constrict his thorax. His clothing is suspended from the shoulders and the action of his respiratory muscles is free. On