tions should be made with reference to moral character at the time young men enter school. Once enrolled they should be taught that no man should come to the threshold of this profession and hope for success who is not already really and truly noble.

Young men are instructed that before entering upon the work of their profession, or before specializing, they should dig deep at the foundation branches, anatomy, physiology, etc.

But professors of medical schools, you have not yet reached the chief foundation stone; beneath them all is the solid rock, character, without which no man can ever attain to eminence. To establish this fact you have but to again thumb the pages of history; and you will find that the truly great men of all walks in life, poets, lawyers, statesmen as well as men of our own profession, have been as a rule men whose lives were blameless. These have been and ever will be the torch-bearers of wisdom.

This fact has been so patent that for ages there has been even among the uncultured a well-established conviction that a right course brings success and a wrong course disaster. There is a scientific reason for this aside from its moral phase. No man however depraved who does wrong knowingly but regrets it. It is a source of worry and anxiety to him. This produces nerve depression; like a long bent bow the nerve tissue loses all elasticity, and the function of the organs and glands presided over by the nervous system become impaired; digestion and assimilation are soon involved; the tissues begin to degenerate in consequence.

The delicately constructed brain cells first feel the pinch of hunger and if this condition of affairs continues, are ere long hopelessly deranged. The mind becomes mechanical and dead to ordinary suggestion.

The physician of all men should have his faculties at his ready command, so that when he say, go they will go, or when he says come they will return. Emergencies arise in the practice of medicine which must be met and acted upon promptly, or it is everlastingly too late. The man whose mind is depressed through the cares which vice brings is not equal to these emergencies.

Some medical students seem to think they can debauch all night and come to lectures next day with their outraged nervous system aching from excesses and absorb the same amount of information as their fellows who have been regular in their habits and obeyed all the laws of nature. This is an utter impossibility.

Some doctors carry the same ideas into their profession, but an outraged moral nature rebels against their vile and shameful practices, and they soon find themselves wrecks upon a moral sea.

The human intellect has but a given amount of force, and if this is dissipated in the manner indicated it can not be utilized in the accomplishment of work in the line of duty. Some of the most successful men have been men not originally of great intellects, but men of great character. They have utilized all the nerve force they possess. For ever since the decree went forth that man should live by the sweat of his brow, his success has depended upon his ability to work; his ability to work depends upon his nerve force; his nerve force depends upon the circumspection of his life. The medical student should be taught that success in life is more

than mere money getting; the physician who starts in his profession with wealth as his ideal is a foredoomed failure. If he would succeed he should let growth, expansion of mind and wealth of character, not money getting, be his aim. He should of all men measure up to the full stature of sterling manhood. He should broaden himself and his ideas by taking some interest in other things than those which concern his immediate business. Reading good literary books; a knowledge of affairs which affect the life of the nation; and an active sympathy with every movement directed toward progress and the improvement of mankind, will not only enlarge his calibre intellectually, but will increase materially the satisfaction and enjoyment of life and add many fold to his value to society and the profession. He should devote some of his time and attention to securing better conditions for those less fortunate than himself.

With honesty as his watch-word he should interest himself in politics; attend the primaries; in fact let his influence for good be felt everywhere.

He should remember that he is first of all a man and then a physi cian, and "that making a life is man's first duty."

The one indispensable element of success in these days of close competition as well in the practice of medicine as in other vocations, is character. The man who lacks it will never write his name high upon the scroll of fame. Those who possess it will succeed in spite of difficulties, and go on to victory where others turn back.

Nature has placed in every normal mind a reserve fund of nerve energy which if properly cultivated and cared for, and judiciously drawn upon make the possibilities of man unlimited.

Through the stimulus of proper living he is enabled to take hold of this and appropriate it, and as he does so life takes on a high and noble meaning, and he is fired with a desire to do more than he has ever done before, and to be more than he has ever been in the past.

I again assure you, brethren, that I would not discount the great army of noble physicians who have dedicated their lives to the service of mankind; who have enlisted as honorable soldiers in the warfare against the ravages of disease, and who are doing valiant duty in the line of battle. For them no task is too difficult, no sacrifice is too great. They are devoting their lives to the welfare of their fellowing-beings, and in the discharge of duty would face death without fear and without flinching; these are truly great men.

It is to those who have fallen from this high estate, or who have never reached it that these remarks are directed. And I appeal to you, that instead of presenting the sorry sight of one who is wasting his energy in ruinous habits of dissipation, of vice, and neglect of opportunity, to become masters of yourselves, and in doing so you will feel that glow of satisfaction which is derived from success in overcoming difficulties and be filled with that self-confidence which is necessary to become master of others. In doing this you can not help but recall your past and instinctively to contrast the real greatness and nobility of a true man with the littleness and meanness of a vile man, and thus kindle the fires of manhood within you and to be urged to noble and yet nobler deeds.

T

TREATMENT OF DIARRHEA OF ADULTS.

George H. Candler, M. D, Chicago, Ill.

HE ADULT with diarrhea is not, it is true, in as much danger as an infant or the child of very tender years, but he makes as much fuss as though he were upon the verge of instant dissolution; and to tell the truth he feels about that way. There are diarrheas and diarrheas, but the particular variety which interests us at this moment is the diarrhea of summer-cholera nostras, or to use the more popular term, summer flux.

As far as cause is concerned the malady may be due to any one of several things. Usually the fermentation of some food in the intestine starts up the rathological condition, but it may also follow a sudden chill, the ingestion suddenly of large quantities of cold water or ice cream, or may become the most evident and troublesome symptom of general debility caused by overwork and overheating. This latter combination, especially when combined with lack of sleep, irregular meals and unwholesome ones at that when taken at all is perhaps the most potent factor of all.

The dyspeptic form, as it is often termed, comes close on the heels of some loading-up of the stomach with fruits (ripe or unripe), vegetablescucumber soaked in vinegar till thoroughly tanned, for instance. If there is a subacid condition present, diarrhea is more likely to follow than if hyperacidity prevailed. This is due to the better conditions that exist in the intestine for fermentive changes and the irritation caused to the bowel by the process.

At first, the passages contain particles of undigested food, the bowel is full of gas. there is much rumbling and shifting of flatus and the stools leave the patient with some force and extreme frequency. This is the time to check the condition. The first thing necessary is the digestion of the disturbing mass and its subsequent voidance. The stomach may be emptied by emetics, but that will not help the bowel, and that is where the trouble all is. If the disease is not checked early there is a strong probability that an enteritis will follow. As soon as seen the patient should be given either pepsin and pancreatin, or better still for clinical results, caroid or papayotin, with charcoal. In an hour give either magnesium sulphate (the saline laxative won its laurels in such conditions) or castor oil. Rhein if combined with the intestinal antiseptic may follow, or cotoin, or geranin, will serve equally well.

The laxative having worked, a high enema should be given consisting of normal saline solution to which has been added a drachm or so of ext. pinus canadensis. One drachm of glycerite of tannin to two quarts of water is one of the best things I have ever used. No food at all may be taken, but the patient can have barley water, albumin water, beef juice (prepared or home pressed), and he should be kept quiet and perfectly cool without getting chilled. From one hour after the giving of the laxative the exhibition of from five to ten grains of the triple sulphocarbolates (as combined in the intestinal antiseptic W. A.), should occur every two

or three hours. The astringent selected can be given with or alternating with the sulphocarbolates. Pain will yield readily to atropine as a rule, especially if strychnine is given with it. If intractable, however, capsicin and cannabis will stop the trouble. A dose or two of chlorodyne may prove of use in the beginning of the trouble, but if opiates can be avoided it is best to do so. If the bowel is fully emptied and nothing put in it with the exception of the things named above, and if at the same time the intestinal antiseptic and some one of the astringents are exhibited, the summer diarrhea of the adult will end quickly enough to suit even the patient.

If the form of the disease is nervous, proper attention must be given to the system generally. The nervous tone is below par, and here is the field for strychnine, iron and nuclein. The, triple arsenate granule of alkalometry should be given, one several times a day after nutriment has been taken. Passiflora will calm the nerve storm, as will also scutellarin, while dermatol and strychnine will act as a tonic generally and soothe the irritation of the bowel at the same time. This is a very useful combination. Hyperacidity calls for the neutral cordial of the A. A. list, one or two tablets two or three times per diem. As soon as the flux is controlled the patient should be put on an easily digested and nutritious diet. To his stomach nothing should be offered which could in any way prove irritating. The juices of meat, fresh eggs, koumiss or buttermilk, fruits (stewed), predigested and dextrinized milk, and gruel, may be followed by the more easily assimilable cereals and farinaceous foods. The hypophosphates may be given freely, but the writer prefers the triple arsenates with nuclein, adding thereto small doses of zinc phosphide. Free bathing, gentle exercise, attention to the liver and the daily use of saline laxatives, will enable the patient to regain his strength in short order.

PAPERS

READ AT THE SEMI-ANNUAL MEETING, MARCH NINETEENTH, COUNCIL BLUFFS, IA.

DIAGNOSIS OF DIASTOLIC HEART SOUND.

LeRoy Crummer, B. S., M. D., Omaha, Neb.

Associate Professor of Medicine, Creighton Medical College; Physician to St Joseph's Hospital.

N THE differential diagnosis of valvular heart disease the rhythm or phase of the heart's action in which a given phenomenon occurs is of the first importance when we come to check up the results of our previous examination by auscultation. Concerning the occurrences in systole, I will have nothing to say, as a full discussion would consume too much time for the limits of a single paper; but I do want to consider carefully the diastolic events, as it seems to me that considerable confusion exists in most of our minds concerning murmurs and other sounds heard in this interval.