propose that we take a broad view, not simply as homeopaths, for this is no question of therapeutics, but as physicians having at heart the welfare of the whole medical profession as well as the good of humanity.

As we look back through the vista of years, the thing which stands out most prominently is the progress which has been made in the prevention of disease, especially in the last quarter century. No other achievement in medicine equals this; even the brilliant results obtained by modern surgery, splendid though they be, have done less to save human life and lessen suffering and sorrow than preventive medicine. In civilized countries, especially in those most highly civilized, we are steadily and gradually driving out scarlet fever, diphtheria, small pox, typhus fever, typhoid fever, yellow fever, the plague, cholera and consumption. That we have made less progress with measles and whooping cough is due simply to the fact that we have attacked these diseases less vigorously than the more serious ones. Malarial infection we are but recently overcoming, but its source and means of transmission being now better understood, it will certainly diminish as the years pass. We have made less progress in eradicating typhoid than we ought to have done, considering how accurately we know the means by which it spreads, but the failures to prevent it are due more to carelessness and inefficiency than to ignorance, and it will become less frequent. Pneumonia has not decreased either in frequency or severity, but on the contrary has increased and has passed tuberculosis in mortality, and now causes more deaths than any other disease.

I do not need to quote statistics to prove the decrease in these diseases I have enumerated, which belong to the zymotic class, and which are, with the exception of malarial diseases, communicable from one person to another. The personal experience of every physician who has been in practice twelve or fifteen years will confirm the statement. The first point to be made then, as we look back through the vista of years, is that there is actually less sickness. than there used to be. And this is the more surprising and gratifying when we consider that it has taken place in spite of the great influx from country to city, in spite of the enormous tide of foreign immigration which has poured in upon us, both adding to the congestion and overcrowding in city life, which are such a fruitful source of disease. This splendid achievement is the work of the medical profession, and we should glory in this triumph and the greater triumphs which are to come. There are discouragements and failures enough in other directions. No one sees them more clearly than we do, or realizes more fully how powerless we are at

times to save life, so let us take what glory is rightfully ours in this field of conquest.

There is, however, another side to the picture, and it is a side which most of us, I believe, have looked upon in the last few years. As there is less sickness, so there is less business for the doctor to do, and that means that incomes have decreased; and that is where the shoe pinches. Viewing the field from all sides, I am confident that physicians, especially general practitioners, have had less business in recent years than formerly, and even those in well established practice have found it more difficult to make a comfortable living, especially as their children reach an age when the expenses of college and professional education are incurred. This state of affairs is not confined to the homeopaths by any means, but affects the profession as a whole in much the same way, irrespective of locality. Of course there are many exceptions, especially in the large cities where very large incomes are earned by physicians in general practice and by specialists, but I am of the opinion, nevertheless, that the income of the profession as a whole has undergone a shrinkage. But let us be honest and seek to discover all of the causes which are operating to produce this result. Actual decrease in disease, while the largest factor in the case, is by no means wholly responsible for this somewhat disquieting situation-if it were, we should be selfish if we regretted it. It would then be plainly our duty to rejoice that the human race is spared just so much sorrow and suffering. But the falling off in business is partly due to the fact that a number, quite a considerable number, of our patients have deserted us and become Christian Scientists, mental scientists, osteopaths and followers of various other cults. There is no use in complaining of this; but there is a great deal of use in clearly understanding the situation and attempting to command it, so far as lies in our power.

There is another picture to be drawn, different from the one I have just sketched, and it will repay us to study it closely While it is true that the contagious and infectious diseases have decreased, diseases in the main acute and self-limited, there has been a positive increase in other diseases, mainly those of metabolism, of tissue change, of degeneration, and those of the nervous system, chronic in nature, not self-limited, caused by the complexity and stress of modern life, the wear and tear of the struggle for mere existence and the struggle for wealth, caused by lack of food and by too much food and drink, and by climatic influence. These diseases are the various forms of rheumatism, indigestion, heart disease, gout, Bright's disease, cancer, nervous prostration and insanity. From

their cause and nature, their prevention is almost impossible and their cure slow and difficult or thus far beyond our skill.

This then is the situation to-day; a remarkable decrease in one class of disease, the contagious, the preventable, and a lesser increase in another class, broadly those of degeneration. Knowing the past, understanding the present, we can to some extent forecast the future. We can safely predict that the contagious diseases will become less and less frequent; that they will become absolutely extinct is not probable, at least not until ignorance, poverty and vice have first been banished from the face of the earth. That the professional income from the treatment of contagious diseases will grow smaller year by year is certain. The powers and duties of health boards and health officers will be enlarged and extended and more intelligently exercised, there will be more rigid isolation and thorough disinfection in contagious diseases, there will be more careful and thorough inspection of school children and buildings, of all places of public assembly, of all public conveyances by land and water; the water and milk supplies will be more strictly guarded, the disposal of sewage will become harmless and the pollution of streams prevented. This means that there must be a larger number of health officers of one kind or another to perform the extended duties of twentieth century sanitation, and they must be men of a high order of ability. And this brings me to a point which I wish to make the compensation to which the profession is entitled for the loss of income brought about by its efforts to banish disease. The health officials, to whose skill and fidelity is entrusted the safety of the community, should give their whole time to their public duties and not engage in practice at all. And they should be paid such liberal salaries, and their terms of office should be so secure, that the services of the ablest men in the profession could be obtained. This would make for the benefit of the community and the profession alike. The community would secure the best possible service, unaffected by personal motive, and the profession would reap advantage, because certain of its members would be sure of ample income, while the others would not have to compete in practice with officials drawing salaries. This ideal condition may not easily be attained, but it is worth striving for, and as sanitary and medical legislation is almost wholly obtained by the efforts of physicians, those of the profession who are active in shaping legislation should know in advance what they ultimately hope to secure, and year by year get as much as possible. It may perhaps be urged that while the large cities could afford to pay for the whole time of an adequate medical force, the smaller cities and towns, and especially the

country communities, could not do so. I believe, however, that it would in the end be an economy for any city, however small, to be under the watchful care of a trained sanitarian, who had no other duty than to protect it from disease, and that a number of contiguous villages could, with advantage to themselves, unite in employing such a man.

With the growth of the custom I am advocating a new specialty would develop, that of the medical sanitarian (which already exists to some extent), and with the certainty of steady employment at adequate remuneration, many of the ablest men entering the profession would train themselves to become experts in this department.

The next point I wish to emphasize is that since some diseases are decreasing and disappearing, while others are increasing, which have hitherto proved either incurable or very difficult to cure, our efforts should now be more strenuously directed to the discovery and perfection of means of curing these diseases, thus regaining business which we have lost, and at the same time relieving suffering humanity, which is ever the aim of our profession. The question is how can this be done? The answer is not a simple one, but we can at least lay down the lines on which we should proceed. For us who believe in the efficiency of the homeopathic principles, the first duty is to develop to the utmost, separate and scientifically, the methods for which we stand. How this should be done I will not attempt to indicate here. But however perfect our methods of employing drugs may become, we shall nevertheless find that we must call to our aid other means of fighting diseases. Some of these have been long and favorably known and used by the profession, others are newer and but little employed by physicians, but have been exploited by persons either absolutely untrained in medical science, or by others with a sorely deficient medical education. The time has come for the medical profession itself to investigate thoroughly and impartially these methods of healing, to make use of whatever good there is in them, and to put that portion upon a rational, scientific basis. Then shall the profession come into its own, and the signs are not wanting that it has already begun to take possession of that which rightfully belongs to it.

The means, other than drugs, of combating disease which I have in mind are: climatology, hydro-therapy, photo-therapy, mental or suggestive therapeutics, dietetics, electro-therapy, mechanical vibration, physical culture, thermo-therapy.

It may cause pain to some of us to have to admit that similia similibus curentur is not all-sufficient; yet I believe that we may be more faithful than ever to this most valuable principle if, while

developing it to its utmost limits, we at the same time define as closely as possible what those limits are. My own therapeutic belief I can put in a few words, if I may be allowed to quote from a paper I read recently in Boston:

"The day is passed, if ever it existed, when the physician's therapeutic armamentarium consisted only of an accurate knowledge of the homeopathic materia medica; but the day has not yet dawned, and never will dawn, when his armamentarium will be complete without that knowledge."

ELECTRICITY IN

E

NERVOUS SYSTEM.*

BY W. B. CARPENTER, M.D.

Columbus, O.

LECTROTHERAPY is just now going through the searching fire of criticism and investigation that is necessary to determine the true sphere and scope of this agent in the relief of human ail

ments.

It will readily be admitted that it is not and cannot be a panacea; it can never do the impossible; it is, however, one of a long list of agents that is at times specially indicated to assist in relieving or curing abnormal conditions. All will admit that electricity has no specific action, as it itself is but a form of motion; but through its exciting or inhibiting function, it can so modify the existing physiological properties that diseased conditions may give way to those of health.

If by organic diseases of the nervous system we refer to those acute traumatic, inflammatory, or other abnormal states of the nerve structure itself that are so frequently met with in general practice, I hardly think it will be disputed that electricity may be and is really a valuable agent in treatment. Like any other agent to be used for the purpose of the relief of human suffering, I submit that it should be proved in the proper way in the healthy organism. This is constantly being done by many persons, and should greatly aid clinical experience in securing remarkable results in many such diseases.

On the other hand, if by organic nervous diseases, we mean those chronic changes invovling anatomic lesion, we have a very different

* Read before the National Society of Electro-therapeutists.