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KNOWLEDGE AS A PREVENTION OF DISEASE.

By NEWTON M. COLLINS, M.D.,

Rochester, N. Y.

RANTING that ignorance is the cause of a large percentage

of diseases, are we as a profession doing what we can to enlighten those with whom we come into contact? True it is that we labor early and late to cure disease, but its prevention we too often neglect.

Our State legislature has wisely passed a law requiring physiology and the effects of narcotics to be taught in the public schools a certain length of time each day,—undoubtedly a step in the right direction-but it remains with us or the parents to instruct children concerning sexual relations and abuse, evils of kissing, promiscuous dancing, and habits fatal to the continuance of health, which easily come into being during the formative period of childhood.

After birth a careful examination of the genital organs of the child should be made, malformations if they exist corrected, and the mother and nurse instructed as to the proper care and treatment to be followed in the early years of life. The most common malformations are phimosis and adhesions about the clitoris, which frequently cause serious symptoms and encourage the formation of bad habits if left uncorrected. The mother should be taught to exercise care in the selection of a nurse girl, as unscrupulous girls often resort to titillation and narcotics to quiet restless children.

At just what time to instruct children in the use and abuse of the sexual organs is a mooted question; but it seems to me that such teaching should BEGIN Several years before puberty, before habits are formed which may jeopardize their health and that of generations to come. Many parents, actuated by false modesty or the fear of interfering with the innocence of youth, hesitate to mention the subject to their children, and the poor unfortunates have to learn many a dear lesson by bitter experience, which comes too late to prevent disease and unhappiness. Such parents should become the objects of our instructions as well as the children themselves. The selection of children's companions should be the subject of thought, as older boys and girls often impart evil habits to younger ones and indulge in suggestive conversation in their presence. Parents should supervise their children's reading and eliminate all literature apt to

excite the mind and thus put its impress on the body. What young man would deliberately put himself in the way of passing years of his life in pain and misery, if he were early taught what follows a fast life? Many find out these things, when habits are formed that are almost as hard to give up as life itself; and then hope is lost of ever living the life that is seen and admired in others. Would a man unthinkingly store up suffering for his wife and children if he knew cause and effect early in life? A large percentage of the diseases of women that require operative measures, are caused by transmitted sexual disease, which the husband may think was cured long before marriage. If young women had any idea of the after effects of "sowing wild oats" they would seldom marry men to reform them. What do our marriageable girls know about themselves? At that age more is thought about dress and society, than their future health and happiness, which are often synonymous terms. Do they consider what kind of a life a young man who may be paying them attention has led, or do they think only of his social standing and bank account? If a young man is a hard drinker, a girl may hesitate, but even then promises of reformation are accepted as an earnest and marriage entered into before his power of reformation is tested. In speaking of marriage it is hardly necessary to warn young men, as they, no matter what their past life has been, expect a woman's character to be above reproach.

Kissing has long been known as a potent causes of disease, and few appreciate it as well as physicians who often treat syphilis acquired in this way. Thus children should be taught to present the cheek to those desiring to kiss them.

So much has been written of late on the unsanitary public drinking glass, that it is necessary for me to say but a word in passing. When impossible to avoid its use, it should be placed below the mucous membrane of the lip and thus much of the danger avoided.

The instruments of physicians and dentists may easily convey disease unless well sterilized before use; dentists are especially careless in this respect. When the masses are instructed, they will insist upon having clean instruments used upon them. Many gynæcologists have now abandoned much of their office treatment, especially intra-uterine, because of the danger of treating patients who are not antiseptically prepared.

Abortions and prevention of conception furnish their full share of disease. The former stands next to gonorrhoea in the number of its victims, and it is high time that women are taught the dangers

that are involved; true, death does not commonly follow, but diseased uterus and appendages, requiring removal, often result. In view of the facts mentioned I fear we often neglect the moral responsibility resting upon us, and either from lack of time or indisposition, do not honestly strive to prevent disease as well as cure it.

THEORY OF THE LARGE AND THE SMALL DOSE. By W. BUIST PICKEN,

THE

London, England.

HE question of the rationale of homoeopathy has again come to the front, each revival of it taking us one step nearer to a settlement that is much to be desired. One of the fine points in Dr. Proctor's able paper, "Hahnemann and Darwin," just published, is his bringing to focus of this dark problem. "After a host of theories have been constructed and abandoned," says Dr. Proctor, "there remain two that appear to hold the field, viz., that of wave interference and that of the opposite action of the large and the small dose."

In this short article I shall deal briefly with the theory last mentioned. Having in another place (Mon. Hom. Rev., November, 1897) lately taken exception to the current terminology of this theory as mischievously unscientific, I need but remind my readers that the only scientifically small dose is the negative dose, as the moderate is the passive, and the large is the positive dose. It is the organism, as constituted and conditioned at the time of our dealing with it, that alone can determine what to it is a large dose or a small one. A dose is "large" when it is positive (self-determinative), and "small" when it is negative (self-effacing). The former represents drugselfishness, the latter drug-altruism. In this truth may be seen the explanation of the fact, regretfully admitted by Dr. Proctor, that the formula of similia, unlike that of contraria, does not appeal to common sense as a natural law. But the ethical law of self-renunciation no more than its drug congener appeals to the natural man as a rational mode of augmenting individual harmony and happiness. They both belong to ultra-individualistic evolutionary states. Homœopathy naturally appears amongst the most enlightened and progressive people simply because of its advanced evolutionary status. It has long been known, as the Golden Rule has long been

known.

Both rules have yet to become generally known, under stood and practiced, and for the same reason. In all kinds of rudimental government the principle of contraria is conspicuous; in proportion as forms of government progress, of necessity the principle of similia emerges. The beautiful freedom which flows from impersonal, harmonious self-government is the ideal state for individuals and societies, in medicine as truly as in religion and politics. But it is forever impossible under systems of contraria, whether of person or populace. The glory of homoeopathy is its embodiment of this great spiritual truth in systematic medicine. Positive drug medication is "of the earth, earthy"; the idea of practical negative medicine is truly "from above."

From this point of view it should now be easy for us to measure the validity of the received theory of the large and the small dose as an explanation of homœopathic therapeutics.

In current phraseology, the large and the small dose are said to have opposite actions. To say that they have opposite effects would

be correct.

In a matter of this kind, great precision of perception and expression is necessary. These so-called opposite drug-actions are . commonly thought of as if they were alike direct drug-actions, which would be to imply that they are both positive drug-actions. For whatever determines action is positive. The real action of the large dose is obvious. Bearing in mind the equivocal character of the popular use of the terms "the large" and "the small" dose, and remembering the scientific equivalents which I have introduced, we shall soon perceive how confusion of thought has given rise to the familiar theory of the large and the small dose.

Being that which on the physiological organism will produce its characteristic effects, and on the pathological organism can exhibit the phenomena of contraria, the large dose is evidently a true cause. Its action is under general laws, is comparatively calculable in terms of its own force, and relatively unconditional. In accurate language, it is positive, and therefore determinative of its own effects on the organism. Its force, moreover, is chemical. And the chemical principle in nature is manifested typically in decomposition, not integration. It rules supreme in the dead organism alone. In this truth, again, is found the physiological explanation of the inevitable failure of a system of positive medicine. If the chemical principle in nature acted typically in composition, then would the law of contraria yield the results in medicine that for centuries have been

sought from it in vain.

what as things are he

The chemist then could achieve in synthesis can accomplish in analysis only.

The passive form of drug-action has its type in food, not medicine. This fact explains why the old school of medicine has so long and tenaciously clung to the belief that its method is rational; it also shows why the failure of this school has been so great. The difficulty of finding the true contrary, and of applying it passively (which unconsciously to the old school is its ideal), is enormous, to mind in the ordinary state. Because by this method symptoms must be construed into pathology and etiology, and as there is no necessary direct expression of one by another, there is here infinite scope for the commission of error, as the whole history of orthodox medicine has shown. Pathological causes and conditions have to be cancelled physiologically, for which drugs are not typically adapted, while symptomatology may mislead more than guide.

The passive and the negative systems of medicine have, however, their superiority over the positive one, as therapeutic or lifepreserving forces, established by their different polar relations to the organism, or life.

The same substance, say phosphorous or lime, may be poison, food, or remedial medicine, according as it functions to life positively, passively, or negatively. The typical positive drug is poison; the passive, food; the negative, medicine.

The small dose of any substance is therefore that which on the physiological (or approximately healthy) organism is incompetent to cause any sensible effect. Its so-called action is not action of the drug, as such, at all. Instead of being direct, a necessary consequence of mere relationship with the organism, the therapeutic action is derivative, as by induction, and specific to only one form of relation. The influence of the drug is not general, but particular, its specific effect absolutely dependent on the fulfilment of a unique condition of relationship to the organism in its abnormal state. This condition of therapeutic action is strictly comparable, as regards correlativity, to the conditioning of generation by union of the masculine and feminine principles of life.

Neither positive nor passive, the homoeopathically small dose has no action properly its own. It does not oppose force with force, the equation of which may be regarded as a problem in physics, nor so balance chemical action and vital reaction that their equation is to the organism a sum of plus in its physiology. The typically small or negative dose acts spiritually, i. e., the converse of materially. It

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