of the bacterial disease which devour the toxins in the body and leave little or none for the stronger germs to feed upon. They get rid of the toxins and the person is then called safe or "immune." It has recently been proven in this country and in Europe that the condition. of the body controls the question of safety from disease. In communities where typhoid-water has been drunk by a large number of people, it was found that those whose food was plain and wholesome, escaped the malady altogether; while those who ate a low grade of food were the victims. Experiments have clearly shown that not only the quality of the food had much to do with the safety from disease, but also that the quality and quantity of the air that was inhaled determined the condition in many cases.

The whole science of advanced medical practice of to-day may be summed up in the following statements:

1. Persons whose bodies are free from an excess of toxins may be exposed to infection without danger; it is impossible for them to get sick.

2. The same persons, by change of food, air and habits, may invite an excess of toxins into the body and thus become the victims of disease.

3. The same persons, by allowing different vitiating influences to give rise to different varieties of toxins, may become liable to catch different diseases. This fact is perfectly established, and proves that the toxins in the body give rise to its maladies.

4. Some toxins invite germs of disease; others do not. Many forms of sickness are due to toxins for which there are no known germs; although such germs may exist.

5.

There is no sickness that is not due to toxins in the blood and tissues. Finally, all toxins arise in the body from the food taken in the body that is not made up into pure blood and tissue.

There is no questioning the fact that the great subject of Prophylaxis is considered in a too greatly restricted sense by our profession. From very careful observation by the writer and others it is treated very indifferently by a great many doctors. The so-called rank and file seem to feel that they have discharged their full obligation to their patients when they have prescribed the medicine and given a few general (and often indefinite) directions regarding food etc. In view of the above statements the writer has felt it his conscientious duty to more thoroughly investigate and grasp as completely as possible this matter so as to correctly and courageously and directly inform any and all persons calling for his advice. What a common thing it is to have a patient suffering from any of the great variety of ail

ments so familiar to the general practitioner, and to be able at once to trace the trouble to any of the usual indiscretions. There is no reason why our subject should be limited to the consideration of infectious diseases so-called, for as a matter of fact, how many diseases are there that can not be directly or indirectly traced to infection, either from within or without the body?

The infective nature of Small-pox, Scarlet Fever, etc., together with Tuberculosis and Syphilis are very well known and as a rule careful prophylactic measures are used. It is a very well recognized fact that the subject of Prophylaxis has attained such a degree of proficiency that the almost complete extinction of certain communicable diseases has exerted and is exerting an altogether remarkableeffect upon the health of the individual, and of the community; that the eminently successful efforts of public hygiene to provide a pure and plentiful supply of water, adequate air-space, safe and inoffensive removal of sewage and refuse, and a better control of our food and drinks is producing a meritorious effect that is quite pleasing. It is often true that the medical adviser is called only to divert complications and death where disease has already appeared; as a rule he is seldom consulted as to the manner in which disease itself may be prevented from crossing the threshold. The human economy has been repeatedly approached with the result of an ever-increasing knowledge from the medical, surgical, pathological and psychological aspects, but it has had but a limited period of time and thought given it from the view-point of the prevention of deterioration and disease. For instance, take the subject of drinks and foods. Begin with water. Much that might be taken by a robust person, or one who is not an invalid. cannot be taken ad libitum by one who seeks absolute health. Ice water is never dangerous when taken in small sips; but is quite harmful when swallowed rapidly. First, it lowers the action of the heart, and weakens the bodily vitality. Second, it contracts the stomach and forces food out before it is digested. Third, a large quantity destroys the tone of the nervous system of the stomach and more or less of the adjacent viscera.

Hard water causes intestinal troubles with infants and brings on old age and limy deposits with adults. And further, it often contains various chemical poisons that lead to impoverished blood and organic disease. Well water is seldom safe in either country or town. Mineral waters are practically never safe, for they are charged with carbonic acid gas, and you all know what a subtle and virulent poison it is, causing great depression and sinking of the vital forces. For the above reason all soda waters, beer, champagnes and like drinks

must be avoided by all those who wish to have good health. The beer drank so extensively now is very destructive to the kidneys, containing, as has been shown, so many poisons. Fully one hundred and twenty have been found by analysis. The amount of tannin in tea disturbs digestion and induces vesical weakness. Ice tea especially is. a barbarism in spite of its popularity in the "good old summer time." It is very debilitating, leaving the stomach and lungs a prey to disease, and as the winter season comes on the subjects become easy victims of catarrhs, pneumonia, la grippe, etc. Hot biscuits, fresh bread, doughnuts, pie crust and many cakes, owing to the union of fat and starch, and incomplete cooking, play havoc with the digestive system. And so on with many foods improper in themselves or improperly prepared or served.

The above brief reference to foods is also seen in the indiscretions in wearing apparel, apparently popular, as they are so frequently seen, where the ladies, especially in evening costumes, are so lightly, and slightly, and tightly, and nightly attired for the ball-room and theatre.

It is one of the functions of this branch of medicine to ascertain as early as may be in the existence of the individual, and with the aid of the life history of his immediate progenitors what is the predisposition of that individual towards any given "pathological reaction;" and having ascertained such tendency to prevent its operation.

In conclusion permit me to reiterate the fact that disease is not "a thing" but the resultant of many factors, the working together of which alone constitutes disease; and one of the best uses to which the public can put medical science is to seek its aid towards preventing the co-operation of the several factors involved. Pure food properly prepared; pure water, pure air, the cultivation of an aggressive good nature, and a life of varied activity will constitute a prophylactic beyond compare, and as easily attained as it is invaluable.

ON THE NECESSITY OF MAKING EXAMINATIONS OF THE ANUS, RECTUM AND SIGMOID MORE FREQUENTLY.

By George B. Moreland, M. D., Pittsburg, Pa.

In view of the fact that so many people are afflicted with anal, rectal, and sigmoid disease, it seems singular that so many of those thus afflicted should go untreated, or if treated, that treatments should be given on the subjective symptoms alone. Why is it that examinations of these parts are not oftener made? The prevalent idea that

such investigations are always accompanied by disagreeable features has no doubt had an influence in deterring physicians from making examinations. A series of examinations made will show the fallacy of this thought. Fear on the patient's part that examination means. great pain has caused them to decline to submit to examination. Gentleness and the use of proper instruments for diagnoses-some form of the tubular specula-will dissipate this fear.

The lack of appreciation of the great influence irritation and disease in these parts has on distant parts of the body has tended more than any other reason to lessen investigation.

If all the symptoms elicited by diseased conditions of the anus, the rectum, or the sigmoid were localized-and by diseased conditions are meant any changes from the normal-and were of such a character that their cause would be invariably discovered, there ought not to be any necessity for writing on this subject.

Yet so many cases with distinctly localized symptoms are neglected, and treated, if treated at all. in such a half-hearted and apologetic way, without examination, that it is necessary to emphasize the idea that all cases with local symptoms should be examined.

If such cases are neglected, it is little wonder that those presenting obscure symptoms, frequently with no apparent relation to the actual cause of the disturbance, should receive no attention.

It is hard to conceive, in the light of our present knowledge of the results of pelvic irritation or disease, of any physician neglecting to make examinations of women who come to him presenting symptoms that may be caused by such conditions. While, of course, such cases are at times neglected, and even when examinations are made, no cause for the symptoms found, through inability perhaps to connect the symptoms presented with the slight changes from the normal that are present, or from lack of knowledge of what the normal consists of, yet there are none practicing medicine to-day who do not realize to a more or less extent the relationship that exists between irritation or disease of the female sexual apparatus and the production of disturbances remote from the seat of trouble.

The anus. the rectum, and the sigmoid are supplied by nerves having a similar origin to those supplying the other pelvic organs and the sexual apparatus, or by branches of the same nerve.

As an instance, take the pudic nerve, composed of nearly all the third sacral and branches of the second and fourth sacral, which forms a large part of the nerve supply to the penis and clitoris. Branches from this nerve supply the bladder and rectum, hence the great disturbance that arises in the pelvis-in the bladder, the rectum

and the genital organs, in any one or all of these-when one of these organs is damaged. If irritation of these nerve endings in the penis and the clitoris cause reflex disturbances, it is equally true that irritation of these nerves in the anus or rectum may cause similar symptoms. Experience teaches that this theory is a fact.

I have in mind a case where a gentleman suffered for over thirty years with frequent periodic headaches of a severe neuralgic type, whose headaches disappeared immediately following an operation for the removal of hemorrhoids, to the surprise and delight not only of the patient but to the astonishment of the surgeon, who had not anticipated any such result. This gentleman was so struck with the evident relationship between rectal irritation and disturbances elsewhere, that he recently came to me for examination in order to discover if there existed any reason in the rectum to account for some gastric symptoms that resisted all other forms of treatment.

More cases could be related to demonstrate that rectal irritation causes such symptoms, but one will be sufficient to emphasize the necessity of physicians familiarizing themselves with the disturbances evolved from such causes.

No one can diagnose accurately diseases of the rectum, anus, or sigmoid, on the subjective symptoms alone and the more one familiarizes himself with these organs, the more and more he comes to realize the necessity of ocular, digital and instrumental examinations in attempting to make a correct diagnosis.

The entire field from the anus to the sigmoid, or even the descending colon, is open to ocular inspection by means of the electrical lighted proctoscope and sigmoidoscope, unless some unusual condition intervenes, and in most cases these instruments can be used without pain and without the use of a general anaesthetic. There is no longer need of blind guessing, when with the aid of the instruments at our command we can both feel and see. All cases presenting local symptoms should be examined before treatment is instituted. While it is possible to treat satisfactorily some cases without an examination, it is not so in the majority of them.

I have in mind a case of fissure, a perirectal abscess, a stricture and a rectal polypus, all of which cases were treated for hemorrhoids, without an examination, in any one of which a correct diagnosis would have been made by any one who examined by digital and ocular

means.

Cases presenting such symptoms as indigestion, flatulence, loss of appetite irregularity of the bowels, vague aching pains about the pelvic or sacral region; pains in the legs, especially in the left; a sense